Preventive vs. Primitive

Provided without initial comment:

Dr. David Watson has already begun thinking about his pitch for a new vaccine to block the sexually transmitted virus that causes cervical cancer.

“What I will probably do is point out that last year alone, more people died of cervical cancer, which was pretty much directly produced by Human Papillomavirus, than were killed in 9/11,” said Watson, president of Pediatrics West, a private practice with offices in Concord, Westwood, and Groton. “People appreciate those sorts of comparisons.”

Parents will soon start hearing similar pitches from their children’s doctors, supplementing a television and magazine ad campaign already begun by Merck & Co., the manufacturer of the vaccine, which is expected to receive federal approval next week. [ed. note: approved today by the FDA]

A vaccine that prevents HPV? That’s great news, right? Only if you’re interested in fact-driven medicine; too many seem motivated by fear of the unknown or the inevitable. Or worse, they’re stuck in outdated, irrational thinking.

THE ARTICLE regarding a virus to prevent the Human Papillomavirus (“A fresh shot,” Health/Science, May 29) is well taken, but it is unfortunate that it did not mention the value of circumcision as a preventive measure.

Medical literature describes the higher incidence of cervical cancer in wives of uncircumcised [sic] males and the higher incidence of cancer of the penis in those males.

Africa is now in a frenzy with masses of men trying to be circumcised to reduce the incidence of HIV. Uncircumcised [sic] males tend to accumulate bacteria and virus unless there is meticulous hygiene.


The only reference to circumcision the article should’ve made is that the argument pushed by Dr. Heifetz is now irrelevant. Modern science is winning, but Dr. Heifetz would prefer that we continue slicing foreskins to prevent something that can now be prevented with higher efficacy in the people affected by the disease. Also, the issue of personal responsibility arises again, as HPV is a sexually-transmitted disease.

Is Dr. Heifetz suggesting that circumcision voids any need for safe sex [i.e., condoms and monogamy]? The doctors discussing the HPV vaccine aren’t making such claims, only that a vaccine is reasonable given the prevalence of HPV in our (predominantly circumcised) society. Dr. Heifetz can only rely on the same, tired excuses for circumcising non-consenting infant males, without seeing the obvious connection that less invasive solutions exist for every bogeyman he props up.

I’ll remember that the next time someone suggests that I’m a crazy person for thinking routine infant circumcision is bullshit.

Maybe we’re really Second World

Here’s a news item making waves today:

In its latest report, the WHO said that women who had female genital mutilation were 70 percent more likely to have potentially fatal hemorrhage after childbirth than those who did not undertake this procedure. “We have, for the first time, evidence that deliveries among women who have been subject to female genital mutilation are significantly more likely to be complicated and dangerous,” said Joy Phumaphi, WHO assistant director-general for family.

It’s a sad commentary on the target audience when the WHO has to demonstrate evidence that female genital mutilation is harmful to make its point that it should be stopped. Relying on the obvious logic against the practice as a human rights violation should be enough. Of course, if modern societies can’t comprehend that this next statement should be universal rather than gender-specific, consider me lacking in surprise.

“By medicalising it, we will be endorsing this practice, this violation of a child’s body and a basic human right of an individual and I think that’s the worst thing we can possibly do,” Joy Phumaphi argued. “It is even worse than turning a blind eye, because you are legitimizing violation of a basic human right and violence against an innocent victim.”

Some in modern society will find that the truth can be scary when finally confronted.

Is critical thinking required in science?

I wonder what conclusions we should draw from this:

Experts don’t know precisely why HIV infection rates are slowing.

One reason suggested in The Lancet commentary is that conditions elsewhere in the world don’t match those of southern Africa, where a epidemiological perfect storm made the region the center of the world’s AIDS crisis.

The factors driving the region’s “hyper-epidemic” included a large population of migrant workers and low levels of male circumcision, a procedure that experts now believe helps reduce HIV transmission. Sexual mores also played a major role: African men tend to have more long-term, concurrent sexual relationships than do men elsewhere, and they rarely use condoms in those relationships.

Men in southern Africa rarely use condoms, but I’m sure low levels of male circumcision are the reason there’s a hyper-epidemic. We should also ignore conditions don’t match elsewhere in the world. The conclusions from southern Africa’s facts are still applicable everywhere.

Rates of new infection remain relatively low in West Africa, possibly, researchers say, because of the practice of male circumcision among many Muslim communities and local tribes.

Once again, the conclusion is obvious. It has to be circumcision. It’s not possible that cultural mores about sex would have anything to do with it.

Finally, something for the children

Following up on this post from December, here’s a minor victory out of Canada:

Circumcisions will no longer be performed on newborn boys at St. Boniface Hospital in Winnipeg, hospital officials announced Friday.

The move comes in response to the investigation into the case of a boy who was mistakenly circumcised at the hospital last November.

There’s a reason this victory for common sense requires a qualifier.

Since receiving the review, the chief medical officer at St. Boniface has decided not to reinstate the program, which was suspended after the incident.

Dr. Bruce Roe, the hospital’s chief medical officer, said it was “more appropriate” for circumcisions to take place in outpatient clinics after the family has been released from the hospital.

It’s more appropriate for circumcisions to take place for medically-necessary reasons only. If that requires an outpatient clinic or a hospital, so be it. Is it any more inappropriate to carry out a circumcision on a newborn (male) whose parents have consented than it is to carry it out on a newborn (male) whose parents have not consented? As we implement the law today, the answer is “yes”. But when we stop ignoring the elephant in the room, we understand that the answer is clearly “no”. Regardless of the reason given by the child’s parents, he has not given his consent to the cosmetic surgery. That should be enough to stop the hideous practice of routine infant circumcision.

This decision is a victory for the rights of infant males in Canada, but for too many children born at St. Boniface, it will be only a temporary reprieve. That makes it minor.

How one flaw destroys medical logic

In answering a reader’s letter asking how to persuade a friend not to circumcise her soon-to-be-born son, an obstetrician/gynecologist, Dr Sharmaine Mitchell, responds with a well-reasoned explanation of why the procedure is not necessary. Refute the potential benefits with the obvious argument that there are less invasive responses to medical problems, with an additional nod to individual responsibility. I can’t complain, except for this crushing statement backing every circumcision supporter’s favorite crutch:

The procedure is not vital to the child’s immediate well-being at birth and ultimately parents should decide what they think is in the best interest of the child.

Why is medical science so afraid? Whether it’s fear of all the harm than can occur from infection or disease, fear that no longer circumcising would amount to admitting past mistakes, or a more nefarious fear that parents will suddenly reject the all-powerful doctor for their own critical thinking, the answer is absurd. We don’t allow any other surgery just because the parents want it, unless it involves infant male genitalia. I can’t fathom a way in which so many people can come to the collective conclusion that the two parts of the doctor’s statement are anything other than incompatible. I simply can’t.

If that reader’s friend reads Dr. Mitchell’s response, everything will be ignored except the second half of that sentence. That is why I try to understand such willful ignorance. Perhaps one day I’ll learn how to effectively refute it.

I Can’t Wait to Read the Hate Mail – Part 2

I addressed the religious aspect of circumcision in February, so I’m not going to retread on that here. That post stands on its own and applies to any religion that would circumcise for religious reasons. But this ignorant quote from a worthless article needs its own response to address the question of faith and how it relates to circumcision. My response isn’t meant to specifically apply to Judaism because the question is more universal than any one religion.

The procedure is a “cornerstone” of the Jewish faith, said Dr. Samuel Kunin, a retired urologist who said he has performed more than 9,000 circumcisions.

“I can’t think of any greater act of faith than to circumcise your son,” said Kunin, of Los Angeles. The act symbolizes a thread of Jewish continuity over thousands of years, linking back to Abraham, he said.

Sacrificing the flesh of a newborn child male is not an act of faith because the child has not agreed to the sacrifice. Even a coward can have his child son cut. Circumcising a child boy is an act of obedience by the parents. Circumcision as an act of faith would require a male choosing to have himself circumcised.

Just as Judaism reformed to no longer adhere to biblical laws requiring animal sacrifice and the stoning of adulterous women, a Jew NOT circumcising a child son implies a belief that, although sacred religious text commands it, God is compatible with modern civilization. Essentially, the parents rely on a belief that God will understand. That is an act of faith. It is that faith that allows the rate of circumcisions within religious communities to decline around the world. It is that faith which can lead to ending religious infant circumcision.

Tales of the Weird, with a bit of insight

This story about three men arrested for allegedly performing castrations without a medical license is disturbing enough, needing no extra analysis. However, this quote from Charlotte, N.C. District Attorney Michael Bonfoey jumped out at me. Consider:

“Assuming that the victims consented to this _ and we don’t know that for sure yet _ that doesn’t make it a defense,” Bonfoey said. “We can’t have people who are not medical doctors lopping off limbs and other body parts.”

Mr. Bonfoey is so close to the correct answer on the concept of consent and the removal of “other body parts”. Yet, somehow, I suspect he’s so far away from the truth in understanding how people can (legally) run afoul of medical ethics.

Put that on the posters and see how it sells

Updating last week’s post about South Dakota’s new abortion bill, Governor Mike Rounds signed the bill. There’s little surprise there, and nothing really commenting further about regarding the specific topic. Instead, I’d like to highlight a quote from Gov. Rounds:

“In the history of the world, the true test of a civilization is how well people treat the most vulnerable and most helpless in their society. The sponsors and supporters of this bill believe that abortion is wrong because unborn children are the most vulnerable and most helpless persons in our society. I agree with them,” Rounds said in the statement.

That’s a great sentiment, but why do so many Americans only support strict interpretations on that theme? Can anyone imagine a day in which Gov. Rounds would issue a statement like this?

“In the history of the world, the true test of a civilization is how well people treat the most vulnerable and most helpless in their society. The sponsors and supporters of this bill believe that routine infant circumcision is wrong because children are the most vulnerable and most helpless persons in our society. I agree with them,” Rounds said in the statement.

It shouldn’t be such an intellectual leap.

Or Not To Think?

Like most other circumcision news stories I let fade away without comment, Emily Bazelon’s follow-up article that I analyzed yesterday shouldn’t be worth discussing further. However, the accompanying podcast interview with Ms. Bazelon is worth disecting because it holds the proof that she incorrectly equates adult and infant circumcision, as well as offering conclusive parental recommendations unsupported by her inconclusive study. The interview begins by reiterating the basic point of Ms. Bazelon’s concluding article (I’ve transcribed the audio excerpts):

Andy Bowers: What were the results? Is it better to have sex if you’re circumcised or uncircumcised?

Emily Bazelon: Well, I think that actually there’s no answer to the question. That was what all my research yielded.

Again, I expected that outcome because no two men are the same. I also suspect that there’s bias on both sides of the spectrum to reporting a conclusion that matches a preconceived conclusion going into the process. That wouldn’t necessarily apply to those males circumcised as infants, because they’re more likely to be conditioned by society’s views. In the United States, that means circumcision gets a favorable review, without much thought. Ms. Bazelon addressed adult circumcision, I expect those offering an opinion to be biased by individual experience. And that’s ultimately what I’m driving at with challenging routine infant circumcision. Pushing the decision to the individual affected is the reasonable approach.

Next, this exchange is interesting because it reveals how this practice continues without much thought.

A.B. What about the ones who missed having a fore.sp… *garbles the word foreskin*
E.B. Can you believe you’re saying these words? *Says something as Mr. Bowers speaks*
A.B. I love this, this is what’s so great about podcasting, is that I can, I can talk about this, no censorship, no FCC.
E.B. Even when I was writing it, I was like “Oh, my God” *laughter*

Infant circumcision involves surgically amputating a portion of a male’s genitalia. How can anyone pretend that we’re dealing with this topic thoroughly and objectively if we can’t even mention the word foreskin (or glans, penis, and shaft) without be shocked by the sound of the word? That’s a poor indication that parents’ are making the decision for the right reason. Forget the censorship aspect mentioned, because that was a throwaway comment reasonable within the context of the moment. What are the odds that parents afraid of these words will seek as much information as possible when discussing circumcision with a doctor? I’m assuming they discuss it beyond instinctively signing the consent form, of course, which is a gigantic assumption.

Finally, the interview ends with this:

A.B.: Well, any final thoughts for Valentine’s Day on whether circumcision late in life is a good idea?

Pardon the interruption, but I want to highlight this before the answer. Mr. Bowers kept his question focused on the topic of Ms. Bazelon work, which was adult circumcision. Hence, the phrase “late in life”. It’s an important point.

E.B.: Well, I think that if you’re worrying about whether to circumcise your baby, and it’s something you want to do, for whatever reason, you shouldn’t worry that you’re depriving the baby of some pinnacle of the sexual experience. The baby will be fine. And on the other hand, if you don’t want to circumcise your baby, you shouldn’t worry too much that that’s going to be a big problem later in life, unless you think that baby might be at serious risk of AIDS, in which case you might want to reconsider. But generally my feeling is that sex is a really good and happy thing and people enjoy it in many different states.

On what evidence is she basing her conclusion that parents who make the decision aren’t depriving their babies sons of “some pinnacle of the sexual experience”? Every man she included in her story was circumcised as an adult, making it an intellectual leap to offer broad advice with no evidence. She couldn’t draw a definitive conclusion about adult circumcision, other than it was important why the man was circumcised as an adult. Yet, there’s a proclamation that parents who decide to have their sons circumcised shouldn’t worry, because the baby will be fine. I repeat: how does she know? It’s significant and it’s one reason why any potential harm from infant circumcision is dismissed.

Do not forget that Ms. Bazelon never addressed whether or not parents have the right to make a surgical decision, for whatever reason, because she’s drawing every conclusion from men who chose circumcision for themselves. It’s not acceptable for parents to alter their child’s son’s genitalia because it’s something they want to do.

As unproven as the first statement was, the second statement is just absurd. An intact penis will not harm the boy when he becomes a man. It should be obvious, but it’s not. Stating as much is admirable. But how is a parent supposed to reasonably know that the baby boy might be at serious risk of AIDS? What? I don’t get it. It takes a pretty prescient individual to know fifteen or more years in advance that the boy will engage in unprotected sex with many random people who also engage in unprotected sex. Again, what? That is beyond ridiculous.

It’s also worth mentioning that the studies involving circumcision as a preventive measure against HIV do not state that circumcision is 100% effective, only that it potentially reduces the risk of infection. The authors, although they fail to broadcast this point as widely, still recommend that circumcised men practice safe sex. Any marketing of circumcision as anything other than an additional measure to stop the spread of HIV. Of course, it’s also worth noting that the studies were conducted in Africa on adult men. The effect may be the same or better when infants are circumcised instead of waiting until adulthood, but to draw that conclusion from the data is irresponsible.

But so is conflating an inconclusive, unscientific study on men circumcised as adults with males circumcised as infants without their consent and without medical indication.

Self-ownership begins at birth

Sunday’s New York Times Magazine included a piece by Jeffrey Rosen considering the question of whether or not ritual circumcision constitutes religious expression. He begins:

Americans pride themselves on their commitment to freedom of religion, but how much religious freedom is too much religious freedom?

Fortunately, I can answer this without reading any further into the article. Religious freedom ends where another’s body begins. In the topic Mr. Rosen is addressing, that means at the tip of an infant male’s penis. This concept should be obvious by now, since it’s clear that ritual (and non-ritual) circumcisions are not done for health reasons. Why bother going further than that in the debate, since removing healthy tissue from a child without his consent would be classified as assault in any other circumstance?

Mr. Rosen continues beyond what is necessary to answer his question, so I will do the same.

Within the right to freedom of religion is also the right to freedom from religion. It’s reasonable to accept that parents may teach their child specific religious views, and raise him or her accordingly. We can’t police thought, and the Constitution indirectly prohibits such a course. But, just as reasonable is the assumption that the child may reject his or her parents’ religious philosophy. While a childhood spent studying a religious text he or she may eventually abandon could be considered wasted, the time spent surely contributes to the child’s understanding of the world. Not in any specific religious context, for that has been and will continue to be debated as long as humans exist. Instead, the child learns by dissecting information, forming an opinion, and thinking independently. This may not be optimal for the child, but he or she can accept or reject everything. Ultimately, despite his or her parents’ best intentions, the child controls his or her mind and thoughts. No amount of forced religion can overcome that if the child so chooses.

Altering a child’s anatomy without clear medical indication can never meet such a standard of freedom. A male child circumcised for religious purposes can’t consent to the decision. His physical body is forever altered, and potentially diminished, by circumcision. If he accepts the imposed faith when he becomes capable of deciding for himself, the presumption may be that the circumcision caused no conflict. If the adult male feels as such, that’s wonderful for him. The point of separating ritual infant circumcision from any notion of parental religious freedom is not to challenge the happiness of those who’ve been circumcised for that purpose. Its goal must be to protect the self-ownership rights of the child to decide for himself if he wishes to alter his physical body. The child who later determines that his preferred religion requires no such action, or indeed commands that he remain intact, will face the ramifications of an inappropriate decision made by another.

Ritual (and non-ritual) infant circumcision necessarily violates a boy’s right to an intact body. The parents’ right to religious freedom may not trump the boy’s right. By extension, that he also retains his right to be free from religion implies that no procedure with invasive, permanent results can be condoned by a free society, absent any legitimate physical indication. He has a right to freedom from harm, regardless of how noble his parents’ intention may be. Any religious practice contrary to that is unacceptable. Ritual circumcision does not indict any religion that continues to practice it, but as every robust, honest religion has done with other facets of its teachings incompatible with modern liberty, the practice must stop.