Tony – Page 38 – Rolling Doughnut

Delicate Decision: Post 4 of 4

On Monday the Los Angeles Times offered a typical analysis of infant male circumcision. There are many points to address from this story, so I’ve broken them up into multiple posts. (Posts 1, 2, and 3.)

Point four:

FOR nearly all of Nada Mouallem’s pregnancy, she and her husband, Tony, had a running argument. She wanted to have their son circumcised. He didn’t. “Many days, I’d go off and research all the pros. He’d go and research all the cons. Then we’d get together at night and fight,” she says.
…

For the Mouallems, family tradition and religion were not factors. “We kept those separate and focused only on the scientific reasons,” says Tony Mouallem, who was against circumcising his son because he didn’t think it was necessary. Plus, he’s not circumcised. “You have to work a little harder to keep it clean, but that’s not a big deal.”

His wife, Nada, however, worried about the responsibility of keeping her newborn’s penis clean. She thought circumcision would help reduce the risk of infection and disease. “I wasn’t keen on my baby having a surgical procedure, but then I thought, why not if we can offer him more protection?”

In the end, Tony sided with his wife. Their son was born Feb. 10, and was circumcised the next day. Tony held him during the procedure. “There was no bleeding and he didn’t even cry,” he says. “I’m still not convinced it was medically necessary, but I didn’t want to burden my wife with the worry of cleaning it. And maybe it will be easier for him in the locker room.”

Choosing surgery over responsibility is the abdication of an obligation when having children. No one states that an intact penis can’t be kept clean. Even ignoring the absurdity that it’s more difficult to clean in his early years when his foreskin adheres to his glans and shouldn’t be retracted, keeping your children clean and eventually teaching them to care for themselves is parenting. Anything else is the selfish subjugation of the child’s needs to the parents’ whims. In this case, that whim is further discredited because the father presumably understands how to keep an intact penis clean.

Post Script: This most fits the “typical” analysis. These “balanced” articles always contain a couple who can’t decide. And the couple always chooses “yes”.

More analysis of this article and the CDC’s obtuse approach can be found here and here at Male Circumcision and HIV.

Delicate Decision: Post 3 of 4

Point three:

Robert and Cara Moffat of Los Angeles, who are expecting their first child, a boy, in May, had no trouble deciding, and plan to have their son circumcised. Robert, who is 30 and circumcised, said, “I grew up with it, and my wife has a preference for it, so that’s what we’ll do. We’re doing what the family is comfortable doing.”

His father is happy being circumcised, so the boy will be happy with it. This is an unverifiable assumption at birth. His mother prefers having sex with circumcised partners. This is irrelevant because I presume she does not intend to have sex with her son. So it leaves the conclusion that his future sex partner(s), who they apparently know will be female, will prefer that he be circumcised. This is an unverifiable assumption at birth. Finally, “what the family is comfortable doing” is hardly a principle of ethics, liberty, or science.

Also note that the parents have said nothing about (potential) medical benefits in forcing this on their son. Yet, they’re allegedly qualified to decide that their son will want this. And legally we’re all supposed to think this is reasonable.

As parents and task forces sort through the variables surrounding this intimate decision, [Dr. Andrew] Freedman offers parents in turmoil this comforting advice: “Rest assured. No matter what decision parents make for their son, most men think whatever they have is just fine.”

There are four potential realities for an adult male when he is finally legally protected to make his own genital decisions the way females are protected from birth. He can be intact and happy. He can be circumcised and happy. He can be intact and unhappy. He can be circumcised and unhappy. In the first scenario, he could do something but he wouldn’t. In the second, he can’t do anything but he doesn’t care. In the third, he can do something and he will choose either the perceived benefits of circumcision he seeks or not facing the drawbacks from adult circumcision. In the fourth, he can do nothing and society rejects his opinion as an individual.

In the first two scenarios, we conclude that the child validates the parents’ decision. We mistake an unrelated outcome for causation. In the third scenario, whatever we conclude, we’ve achieved the minimum standard of liberty that the male retains his right to choose (or reject) medically unnecessary procedures. In the fourth scenario, we either deny its validity or babble on about the rights of the parents. This generally involves some hand-wringing about parents making lots of tough choices while actively missing that none of the other choices involve removing parts of his anatomy. (You didn’t forget that parental rights are greater when speaking of sons, did you?)

Dr. Freedman’s opinion tells every man in scenario four his parents’ opinions about his penis matter more than his own. Anyone who argues this refuses to reconcile the complete lack of medical need with any notion of ethics and individual rights. Just because science can (allegedly and potentially) achieve an outcome does not mean it should try to achieve that outcome. That is a slippery slope unbounded by any consistent rule or principle.

More analysis of this article and the CDC’s obtuse approach can be found here and here at Male Circumcision and HIV.

Delicate Decision: Post 2 of 4

Point two:

In the first year of life, 1 in 100 uncircumcised [sic] boys will develop a urinary tract infection. Only 1 in 1,000 circumcised boys will. “While that’s a tenfold reduction, you have to keep in mind that the risk was only 1% to begin with,” says Dr. Andrew Freedman, pediatric urologist at Cedars-Sinai Medical Center. Proper hygiene can prevent most infections.

When considering potential benefits, context matters more than an isolated statistic. For example:

The downside of letting the child make the decision later is that adult circumcision is more expensive, painful and extensive. During an infant circumcision, practitioners numb the site with local anesthesia, then attach a bell-shaped clamp to the foreskin and excise the skin over the clamp. The clamp helps prevent bleeding. In adults, the procedure involves two incisions, above and below the glans (tip of the penis), stitches and a longer recovery. The cost is about 10 times that of a newborn procedure.

Let’s ignore the rights of the individual for the moment. I don’t, but the hypothetical does, so I’ll stick with it. The cost is about 10 times that of a newborn procedure. So what? As a fact on its own, it means nothing. How likely is it that an intact male will need circumcision in his lifetime? If it’s less than 10%, and it is, then a basic cost-benefit analysis shows that we will spend less overall by circumcising only those males who medically require circumcision. The “ten times more expensive” meme is worthless upon minimal inspection.

Dr. Freedman seems to understand this:

“The HIV data is the most compelling to date that circumcision can help prevent the transmission of the virus in male-female sex,” Freedman says. “While this is important to sub-Saharan Africa, the question is how many infant boys need to be circumcised in the United States to prevent one case of HIV transmission 25 years from now? Factoring in even the rare complication that can occur with circumcision may render this study insignificant.”

No kidding. Aside from not being able to predict who (or if) circumcision will help prevent HIV, we can also not predict who will suffer a complication. I seriously doubt the few children who suffer a significant mutilation of the penis care that most circumcisions are “successful”. Nor do I suspect the few boys who die from circumcision care about the general outcome. Of course, this should matter now, even before reducing a child to his (unknown) place in the statistical herd.

But he might not get it:

If parents do opt for the procedure, Freedman advises that they do it when the baby is a newborn, have someone trained and experienced perform the procedure, and use pain control. “The older a child gets, the less benefit there is, and the greater the risk,” he says. “I would ask parents of an older child to strongly reconsider if the only reason they’re doing this is cosmetic.”

The parents of a newborn who choose circumcision for cosmetic reasons? Those are somehow okay? Again, the individual – the patient – matters. When he is healthy, every other outside opinion is meaningless to the consideration of his body.

More analysis of this article and the CDC’s obtuse approach can be found here and here at Male Circumcision and HIV.

Delicate Decision: Post 1 of 4

Point one:

Dr. Peter Kilmarx, chief of epidemiology in the CDC’s division of HIV/AIDS prevention, says the CDC is looking at how the findings apply here. “The early opinion from the consultants — and not the position of the CDC, which involves a peer review process and public comment — is that, given all the previous data on circumcision plus the recent HIV African studies, the medical benefits of male infant circumcision outweigh the risks and that any financial burden barring parents from making this decision should be lifted,” he said.

Nationalizing health care will no more end routine infant male circumcision in America than the elimination of Medicaid funding has ended it in the states where Medicaid no longer pays for the unnecessary procedure. There is a political constituency that strongly supports imposing this on children. Until the universal principle that each individual owns his or her body is codified into law for males the way the Female Genital Mutilation Act now protects female minors, medically unnecessary circumcision will continue. And the state will pay for it when parents can’t (or won’t). Any protection of the individual based on entrenching an existing, or establishing a new, collective will fail.

Here’s a half-point in which I doubt Kilmarx understands the missing half:

“The procedure is so ancient, and steeped in cultures, I’m not surprised that the rate of adult circumcision in civilized countries doesn’t track with medical evidence,” Kilmarx says. “But as scientists, we don’t solely rely on what other countries do as a guideline.”

But as Americans, we don’t (mustn’t) solely rely on what science tells us as a guideline. Ethics matters. The rights of the individual matter, particularly the healthy individual. There is a hierarchy for decision-making concerning surgery on children. Kilmarx, among many, does not start at the beginning (i.e. medical need). That leads to mistakes, as clearly shown by the million-plus unnecessary infant circumcisions performed every year in America.

More analysis of this article and the CDC’s obtuse approach can be found here and here at Circumcision and HIV.

Biographical suggests reliance on history.

Warning: Although it’s semantically incorrect that revealing facts presented in a television show based on a biography of a historical figure as large as John Adams counts as a spoiler, this entry discusses how those facts are presented. If you wish to watch HBO’s John Adams and judge its merits for yourself before reading my impressions of the show, stop reading now. End warning.

I eagerly anticipated John Adams when I first saw an ad for the miniseries. It’s good, except it’s not. It’s compelling entertainment, as much of what HBO produces seems to be. But as history, it’s becoming quite clear that it’s at best a CliffsNotes version of John Adams’ life, and then only if sections of the CliffsNotes version were lost or cropped. Why?

The series leads the viewer to believe all sorts of strange interpretations of events that happen to be at best inaccurate. Events have been smushed together, with little things like periodic visits home being omitted. This may give dramatic tension to the filmed version of John Adams’ reunion with, separately, his wife and his children, but it has the inconvenience of being false. While I understand that turning a book into a film requires edits, alteration is not editing. The miniseries is poorer for it. As a result, my enthusiasm for the remaining three episodes is waning.

Worse, the end of episode four, “Reunion”, angered me. I can’t find my copy of David McCullough’s John Adams because we’ve temporarily piled our books into a closet as we remodel, so I can’t verify whether or not this appears in the source text for the miniseries. However, Mr. McCullough consulted on the script, so I doubt he wasn’t given a chance to comment on episode four’s conclusion, which involved the inauguration of George Washington. To be more precise, it involves John Adams’ reaction to George Washington’s inauguration, but it presents Washington’s oath of office to demonstrate the point.

The episode depicts George Washington reciting the oath in a quiet reserved tone to suggest the humble nature of a great man. After “…defend the Constitution of the United States,” Washington bellows “so help me God.” Are we really to believe that George Washington said this? What does Article II, Section 1, Clause 8 of the Constitution say about this?

I do solemnly swear (or affirm) that I will faithfully execute the Office of President of the United States, and will to the best of my Ability, preserve, protect and defend the Constitution of the United States.

Is it realistic to believe that any of the founders, having spent more than a decade to realize the fruition of a new republic based on limiting the power of government over the people, would deviate from a rule so basic as the oath of office as proscribed in the Constitution? I know our politicians violate the Constitution every day, but is anyone so morally defective that they’d blatantly do so in 1789, in this specific manner? (Yes, I’m aware that the First Amendment was not yet ratified in 1789.) If he was as smart as he must’ve been, would he overlook the absurdity of ignoring the Constitution while swearing to uphold it? And if Washington did add “so help me God,” would he essentially mumble the oath, only to loudly proclaim faith in God at the new nation’s birth? That’s inconsistent on multiple interpretations.

Personally, I lean to Kip’s view that the original appearance of this “fact” precludes any conclusion other than willful deceit. For a more cautious view, read Jonathan Rowe’s analysis.

Unfortunately, America’s founding fathers are misrepresented to push the Christian nation myth. They all believed in a single god, so clearly they wanted us to include God in everything the United States government does. We’re to ignore the controversy from not including a Bill of Rights in the original Constitution presented to the States, as well as the rather quick ratification of the First Amendment after the birth of the new Constitution. It’s ridiculous, but people want to believe it. And nonsense like this episode of John Adams encourages it. For example:

I hope this show can let some people remember that this country was founded by a bunch of men who were extremely religious [sic]

Even if that were true in the way that the writer believes, so what? Some of our founding fathers owned slaves. Are we to conclude that we should own slaves as a result? Or are we to conclude that imperfect men created a system of government capable of filtering human deficiencies from the exercise of power better than any other structure yet created? The text of the Constitution is sufficiently clear on this topic to know that the specific religious views of the founders are interesting but rather irrelevant to how we should operate today.

Writing Pet Peeves

I don’t have time to write any substantive issues this weekend. Instead I’ll just point to this brief explanation to a writing faux pas I’m encountering often enough lately to annoy me.

Although “try and” is common in colloquial speech and will usually pass unremarked there, in writing try to remember to use “try to” instead of “try and.”

Now, about those people who could care less…

When theory meets principle and walks by without notice.

I’ve written before that I don’t much care for Mike Gravel’s politics. I’m not changing my mind now that he seeks the Libertarian Party nomination for president. I don’t have faith in the Libertarian Party and who seeks its nomination, but Gravel isn’t a libertarian. (Not to be confused with a Libertarian. Small-l libertarian standards are principled; big-l Libertarian standards don’t appear quite so principled.) Kip makes this point very well today at A Stitch in Haste, as well as in the comments section to today’s earlier post on libertarianism. So I’ll leave that specific news free from further comment.

Instead, I want to point to point out a common, mistaken critique of libertarians that demonstrates the critic has not sought out an understanding of libertarianism before rejecting it. From The New Skeptic (via The Liberty Papers):

Libertarians have a serious image problem, and people like Gravel and Ron Paul have not helped. Besides that, the Randians (oh no a word I just made up!) are in that “big tent” and stink the whole thing up. People who are serious but realistic about small government and civil liberties want nothing to do with the kooks. It’s one thing to say, for instance, that the Commerce Clause is a strict limit on congressional power; it’s another to formulate a reasonable interpretation of that provision while dealing with and changing the system currently in place. Getting rid of the FDA overnight = kooky; not just kooky, but intellectually immature. Criticism is not the final step in political theory, and if libertarians cannot construct a viable ideological system from the rubble of rejected ideas, then they offer nothing worth overhauling our government for.

I’m by no means the reasonable first source for information on the foundational political theory of libertarianism. I’m too new for that, although I consider my grasp sufficiently robust for most discussions. Still, I’m sure there are countless examples around The Internets similar to what I wrote this morning:

But libertarians are generally smart enough to realize that we aren’t qualified to design a government program. (No one is, libertarian or not.) The prediction guides the desire not to plan. There are government plans, of course, unless one moves beyond a minarchist approach into anarcho-capitalism. And they will most likely not work as planned. We are smart but we are not the next Nostradamus. We remember that our first objective is the maximization of individual liberty. Thus, we seek to limit government to the barest necessity, to wreck as little as possible.

Small-l libertarians criticize government programs not because the aims are somehow lacking in nobility or necessity. The aims are often objectively worthwhile on some scale of measurement. Considering the FDA, no one wants dangerous drugs floating around in the marketplace. Snake-oil masquerading as a cure for cancer is a poor outcome. But the means of government are very often inferior at their best and destructive at their worst. Small-l libertarians understand this.

That does not mean libertarians don’t, won’t or can’t design private solutions, or at the very least advocate for private solutions to objectively identifiable problems. The New Skeptic criticizes libertarians for not having a practical roadmap for dismantling a government program overnight, yet does not provide an example of a libertarian impractically suggesting such an approach. I don’t doubt they exist, but it’s reasonable to expect an example.

To the specific criticism, of course dismantling government bureaucracy overnight is not realistic. But the government has created the situation where this cannot be done. It has destroyed the private market’s incentive to solve the problem independently because it has the power of law and the force of guns to require its solution. The lack of alternatives to government might not be attributable to unwillingness or indifference. Government monopoly is a significant disincentive to to private innovation.

Free of government intrusion, solutions evolve rather than spontaneously appear. Humans fail and humans learn. From that repetitive process comes a refined solution. But the argument here dismisses libertarianism because its advocates allegedly claim they are capable of performing the equivalent of taking a particle of carbon and giving a human without the many evolutionary steps in between. That’s a test designed to make libertarianism fail.

The shorter version is that humans can be flawed, hence the libertarian distrust of placing too much power in a concentrated group of humans. But the flaws of an advocate do not indict the principles he advocates.

Quote of the Day: Yesterday Edition

Megan McCardle sums up the libertarianism approach to governing:

“It won’t work” is the easiest prediction to get right; almost nothing does. The thought process that tells you something probably won’t work is not always a good way to figure out what will, even if you were right for the right reasons, as I agree lots of people were. That’s why libertarians have a great track record at predicting which government programs will fail (almost all of them) and a lousy track record at designing ones that do work.

But libertarians are generally smart enough to realize that we aren’t qualified to design a government program. (No one is, libertarian or not.) The prediction guides the desire not to plan. There are government plans, of course, unless one moves beyond a minarchist approach into anarcho-capitalism. And they will most likely not work as planned. We are smart but we are not the next Nostradamus. We remember that our first objective is the maximization of individual liberty. Thus, we seek to limit government to the barest necessity, to wreck as little as possible.

Ignore the government mandate that created a duopoly. Scream MONOPOLY!

I haven’t posted on Monday’s long-anticipated decision from the Justice Department on the proposed Sirius-XM merger because I didn’t have much to add to the announcement. (It’s also not the final hurdle, so over-analysis, to say nothing of celebration, would be premature.) But Steven Pearlstein’s column is worth dissecting.

The latest example of a government bailout of a troubled industry has nothing to do with Bear Stearns. It is, instead, the Justice Department’s decision to give the green light to the merger of the satellite radio companies XM and Sirius.

It’s already clear that his position will be staked on rhetoric rather than principles. While it’s good to know that from the beginning, it’s bad economics. The goal of Pearlstein’s idea of competition is not to discover winners and ~~losers~~ other winners, but to pick the correct winners and losers. As he makes clear, that means consumers must win and businesses must lose.

For the past several years, these two companies have been competing so hard for talent, distribution channels and customers that neither has been able to turn a profit, and probably wouldn’t have for years. Consumers have been the big winners, with great programming at affordable prices.

Any cursory look at financial results demonstrates that consumers aren’t winning in a vacuum. At least with respect to Sirius, its cash flow is improving. This matters to a growing company more than bottom-line profitability. But why should we expect such an acknowledgment from a business columnist?

All that is about to change now that the Bush administration has concluded that we’ll all be better off if these heretofore fierce rivals are allowed to stop competing and concentrate instead on reducing costs, paring down their combined offerings and finally delivering profit to their shareholders.

This reveals the problem in Pearlstein’s analysis. In setting up the satellite auction that led to the creation of Sirius and XM, the government decided that exactly two competitors was the best approach. It depended on an assumption that two could compete effectively. It ruled out the possibility for a third (or fourth or fifth or …) to compete, possibly encouraging a different development of the market. It ignored the idea that human involvement might take it in a different direction than the ideal world envisioned by the sages at the FCC. And now that reality has messed with the centralized planning, the only response is to knew what it was doing, facts be damned. That’s not convincing.

More importantly, what new innovations in the business will arrive if the combined companies don’t need to waste resources on two ’80s channels, two popular country channels, or two channels carrying C-Span? I trust competition with other competing forms of entertainment to drive the outcome because I don’t pretend to know what is best.

Pearlstein disagrees, going so far as to analogize a combined Sirius-XM to a combined Coke-Pepsi. Yet, I don’t drink either, so I’m fairly certain humans don’t need them to live. Perhaps the availability of alternatives to non-necessities puts pressure on those evil, profit-maximizing corporations. Instead, Pearlstein deems it reasonable to argue that consumers should have ideal conditions for any and all requests. Anything that helps the corporation must, by definition, harm the consumer. It must be regulated, if not stopped.

He uses interesting logic to get there:

… You would particularly want … vigilance in the case of a government-sanctioned duopoly, which is how the Federal Communications Commission viewed XM and Sirius when it granted only two licenses for satellite radio.

This irrational faith in the wisdom of government planning is matched only by his absurdity in arguing that Sirius and XM might develop substitutes for each other if forced to compete.

It makes no allowance for the possibility that, if you force the two companies to compete, XM might come up with a morning host who is funnier and more outrageous than Howard Stern. Or Sirius, lacking a Major League Baseball offering, might take a chance on World Cup soccer or college lacrosse and tap into a whole new audience that nobody knew existed. The prospects for that kind of innovation will be greatly reduced after XM and Sirius merge and the combined company focuses on protecting its existing hit channels rather than creating new ones to displace them.

As if college lacrosse will compete with Major League Baseball. Pearlstein looks at the possibilities (allegedly) eliminated from a merger while ignoring the tangible benefits customers already receive. He also dismisses the notion that the possibility that customers will leave if the channel lineup bores them won’t be an incentive to innovate. He ignores that “free” radio is already following the exact path he fears satellite radio will take and ignores the innovations that satellite radio has given and can continue to give as a combined company. (Uncensored Howard Stern counts as an improvement, as does national access to sports broadcasts.) But why worry about details when this story can just be twisted into another screed concluding that the Bush Administration wants to screw the proletariat at every opportunity?

The FCC should immediately match the Department of Justice’s decision and let the merger proceed.

(Disclosure: I’m a Sirius shareholder and customer. I’ve been an XM shareholder and customer in the past. I also desperately want XM’s Major League Baseball with Sirius’ Howard Stern. Economics and free market competition are still the reasons I support the merger.)

Science requires evidence that faith can’t provide.

This British article on circumcision demonstrates several typical lapses in critical thinking. These lapses are usually based in a refusal to consider that actions against children are subject to ethical concerns. That fits these examples. First:

One part of the country that is moving quickly in this direction is Walsall, where the local hospital now offers a weekend male-circumcision clinic. “We have a large Muslim community here,” says Dr Sam Ramaiah, director of public health for Walsall Primary Care Trust, “and we wanted to provide local children with a service that is safe and secure. The procedure takes place in hospital with local anaesthetic and is done by a trained surgeon. The advantage is that there is care available in case of complications and, if necessary, the child can stay in.”

The possibility of complications demands that circumcision be medically indicated based on need when the patient can’t consent. It may be more civilized to offer this service so that children may have their genitals cut in a “safe” environment, but it is not civilized. And it’s not equal; the same concession is not made to parents for cutting the genitals of their female children. Ethics – morality – requires more than good intentions and a clean operating room.

“If there was any hint that there was a physical or psychological problem it would have been suspended centuries ago, something that has happened to other practices in Judaism. And indeed things have changed already. Nowadays we will use only mohelim [people who perform ritual Jewish circumcision] who are doctors. We always use anaesthetic cream. If there is anything that indicates that we should delay the circumcision we will delay it,” [Rabbi Jonathan Romain] says.

The ethical demand from a lack of medical necessity indicates that we should delay the circumcision, so clearly Rabbi Romain is mistaken. But he mistakenly does not accept that fact, so I’ll move to his specific point.

“We’re modern, so we would not continue doing something harmful. We are incapable of it because we are modern. Someone, somewhere, would’ve stopped this if it was bad.” This idea is a typical fallacy that relies on an arrogance founded in the rejection of self-examination. It rejects the science of medicine as an ongoing quest, preferring instead an unstated belief that we know all we may know. Unfortunately, it also relies on knowing only what we want to know.

How long did medical science accept blood-letting as a cure? Have we mostly abandoned the practice now in favor of new understanding? Should men and women of science ceased progress by assuming that progress had reached its pinnacle?

Being a doctor requires ethics, but even in the absence of ethics, science provides the answers to the objective questions. Removing the foreskin is an objective change in the genitals. Cutting is objective harm. (Rabbi Romain proves this, since anesthetic cream would be unnecessary if cutting wasn’t objective harm.) When there is no medical indication for doing cutting, all that remains is the subjective evaluation of the benefits versus the costs of genital cutting. The doctor (and parents) are not qualified under any circumstance to conclude in favor of cutting when the child’s genitals are healthy. All arguments regarding benefits are irrelevant.