Effective HIV prevention does not involve distorting facts.

I saw this Richard Holbrooke essay on HIV when it appeared a few weeks ago. Nothing in it warranted¹ specific comment from a circumcision perspective that hasn’t been said repeatedly. This is all he offered:

A viable prevention strategy would encompass education and counseling, free condoms, female empowerment, more male circumcision, and abstinence.

Implement four of those five suggestions and number four becomes irrelevant. Or, if you’re in an intelligent mood, replace more male circumcision with more personal responsibility. Life has consequences, even with circumcision. (At the very least, insert voluntary adult between more and male.)

Today, thanks to Daniel Halperin and his essay in today’s Washington Post, I must reference Mr. Holbrooke. Halperin opens with praise for Holbrooke’s stance that we need to reduce the number of new infections before we can suggest any progress. Fair enough, with quibbles, but it’s stunning how quickly Halperin will abandon the logic he demonstrates here:

The most rigorous study yet conducted, a randomized trial from Zimbabwe published last month in the journal AIDS, found an increased rate of HIV after people underwent testing and counseling compared with those who did not, though the increase was not quite statistically significant. The London-based researchers noted that some other studies similarly have found “disinhibition,” or a worsening of behavior, among people who learned they were not infected. While it might seem intuitive that knowing one’s HIV status and, ideally, receiving good counseling would lead to behavior change and reduced risk, the real-world evidence for this conventional wisdom is still unclear, especially for the large majority who test negative.

With what other strategy might disinhibition be a problem?

As Holbrooke noted, circumcision has indisputably been proven to prevent HIV. It reduces the risk of male infection during intercourse by at least 60 percent and, unlike a condom, cannot be forgotten during a moment of passion. Nearly all of 15 studies conducted throughout Africa found that most uncircumcised [sic] men would want the service if it were affordable and safe, and even more women prefer it for their partners and children.

Holbrooke did not state in his essay that circumcision prevents HIV. If he had he’d be spreading untruths, but he chose not to, speaking of ways to reduce the transmission. To be fair, I suspect prevent is a fill-in as a less awkward way for Halperin to say reduced risk. This distinction is important, though, because prevent has stronger implications. Only abstinence prevents sexually-transmitted HIV. Because there are lives involved, this topic deserves more care with words.

It appears – not indisputably, when looking at all data – that (voluntary adult) male circumcision reduces the risk of female-to-male² transmission by up to 60 percent³, not at least. Why the distortion, if not to promote a preferred solution?

Returning to the potential problem of disinhibition in HIV, the real-world consequences of our actions should never be dismissed as a factor the way they are in the circumcision debate. But circumcision advocates already dismiss that in their rush to portray adult males as too irresponsible, so better to address Halperin’s statement in his own context. A condom can be forgotten. True. But it can also be intentionally abandoned because (voluntary adult) male circumcision “prevents” HIV. (See how important words can be in this topic?) Could that possibly lead to disinhibition? Does Halperin believe that circumcised men can engage in unprotected sex and not become HIV infected if they skip a condom only once?

Time to revisit Halperin’s next sentence and put the emphasis where it should be:

Nearly all of 15 studies conducted throughout Africa found that most uncircumcised [sic] men would want the service…

Which studies contradict the belief that men want circumcision? Of those men who do not want it, is it reasonable to assume that some of the infants now being circumcised would not want it?

Remind me again how only people who believe that males (and females) should be protected from medically unnecessary surgery are passionate – in the frothy, derogatory sense – about circumcision. Lying and selective omission of data are the actions of a passionate circumcision advocate.

¹ Also from the Holbrooke essay:

… Anthony Fauci, the famed director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, has stated the case in dramatic terms. Speaking in July at an international conference, Fauci said: “For every one person that you put in therapy, six new people get infected. So we’re losing that game.” He went on to say, “Clearly, prevention must be addressed in a very forceful way.”

Draw from that what you will, but the evidence suggests what kind of force too many people prefer to “prevent” HIV.

² Notice how Halperin wrote “male infection”, not “female-to-male infection”. The latter is correct, as no study has shown that (voluntary adult) male circumcision reduces male-to-male infection. He’s speaking of Africa, where heterosexual transmission appears to be the primary route of infection, but public health advocates like Halperin are rather quick to justify routine infant circumcision for potential benefits it has not been demonstrated to potentially offer. Unfortunately, male-to-male is the primary transmission method in the United States, not female-to-male. But promoting circumcision conforms to our cultural obsession, so it allegedly passes such semantic omissions.

³ The reduction in risk appears to be up to 60 percent when studies on long-term transmission risk are ended early. There is a lag between infection and testing positive. This period is also the most infectious for HIV transmission. Halperin acknowledges this. Might this matter, especially in light of disinhibition?

Something happens to a man when he puts on a necktie.

From Chris Pirillo:

When Starbucks introduced for-pay Wi-Fi in 2002, it seemed like a great deal. But five years later, the model appears old and stale and ready for a complete overhaul.

According to my friend Mike Elgan at ComputerWorld.com, Starbucks will begin providing their customers with free Wi-Fi within the next year. This is an excellent development. I believe we shouldn’t have to pay for wireless access points, and I bet you don’t, either.

Who pays for the router (infrastructure) and ongoing connection (overhead)?

Delving into relevant specifics, how many people go into Starbucks looking for coffee, a sofa, and a wireless connection? How many people go in to Starbucks looking for a cup of coffee and a fast exit? Given that the cost of the initial investment and ongoing internet connection is not free¹, why should the latter subsidize the former?

If you want a service, pay for it. If you can find someone willing to provide it with the cost included in the primary product of the business, offer that establishment your business. But do not expect another group to pay for something it doesn’t value because you find the fringe benefit so neat-o that you refuse to pay for it.

For fun, change the subject from WiFi in coffee shops to any illegitimate product/service offered by the government, at full taxpayer expense, for a niche group of taxpayers (or non-taxpayers).

Title reference here.

¹ These will be minor on a per customer basis, and I’ll generously assume each Starbucks franchise would not reach its bandwidth capacity. That does not change the analysis. Also, include security to prevent customers from unintentionally (or intentionally) exposing Starbucks to civil and criminal liability.

I’m worth mass redistribution. Or maybe it’s just my vote.

I’m a few days late on this, thanks to being wrapped up in fantasy football, but John Edwards cares about me.

Democratic presidential hopeful John Edwards said on Sunday that his universal health care proposal would require that Americans go to the doctor for preventive care.

“It requires that everybody be covered. It requires that everybody get preventive care,” he told a crowd sitting in lawn chairs in front of the Cedar County Courthouse. “If you are going to be in the system, you can’t choose not to go to the doctor for 20 years. You have to go in and be checked and make sure that you are OK.”

“The whole idea is a continuum of care, basically from birth to death,” he said.

If I’m going to be in the system… How quaint. Do I have a choice? If and when I choose not to be part of the system, do I get to keep that part of my taxes devoted to covering me, as well as the portion that is my charitable “gift” to everyone else in this scheme?

Obviously he wouldn’t emphasize the womb-to-tomb feature bug if the answer to any of my questions was yes. Also obvious is the basic fact that, being unable to understand that government is the problem in health care, his proposal relies on reducing everyone to a lower level rather than working on (effective) ways to enable the unintentionally uninsured minority to mitigate their financial risk. Note, of course, that Edwards – and every other health care nanny currently running for president – misses this true issue in his quest for womb-to-tomb government services. That won’t earn my vote.

More thoughts at A Stitch in Haste and Cato @ Liberty


I wouldn’t expect anyone else to have mentioned it, but a side issue from Edwards’ proposal involves routine infant male circumcision. As I’ve written, a liberal, progressive argument for universal health care and/or coverage is that the government will cease paying for unnecessary male circumcision. This will not stop.

Governments already fund unnecessary circumcisions today, when resources are limited. There is no significant push among politicians to redirect those funds into medically necessary expenditures (or taxpayer pockets). They do not care about the necessity of any particular intervention, or even health care in general. Universal health care is simply a means to create a new, dependent constituent group. If that constituency wants infant male circumcision, politicians will cover it. (I’d make an argument that bureaucrats will make the decisions, but doctors make the same mistake in an effort to please their constituents constituents’ parents.)

Politicians believe there is always another group to demonize and tax to fund whatever gift needs to be made to voters for their votes. I am unwilling to hope that any government run by these fools will miraculously reverse its stupidity. Such short-sighted adherence to self-interest is inherent in government whenever it’s controlled by those interested in the exercise of power. Neither rights nor logic plays any part.

Now add the context of a politician like Edwards who wants to mandate that you and I will undergo preventive care. Is it really a long leap to assume that such a stupid person could read the splashy headlines about male circumcision and HIV and ignore the context of voluntary and adult, as well as the truth that condoms remain far more effective at reducing the risk of HIV? Almost everyone in our culture has ignored these last three points in the two years since the first preliminary results were announced, so the answer is a clear “no”.

Politicians will continue to make the erroneous, incomplete argument that the cost-benefit analysis of infant male circumcision is a one-sided consideration, with benefits the only deciding factor. They rarely even recognize potential before the word benefit. If there’s a potential benefit to chase, they will assume that means one less disease to pay for out of the collective in the future. That is incomplete and morally defective, since it ignores the risks, the complications, and the rights interest of the child in making this subjective, medically unnecessary decision. That politicians, parents, and doctors make this error every day proves the fallacy of trusting in the economics of universal health care to rectify an ethical failing.

Should government miraculously reverse itself and stop funding infant circumcision, I still argue that this is largely irrelevant. Many parents will just pay for it themselves. I’ve read too many blog entries of parents fretting over the hundreds of dollars it will cost, yet, considering genital cutting either an “investment” in their son or a “necessary” expenditure so that the boy will be normal common, they proceed anyway, out of their own pockets. To be fair, there will be a long-term reduction, as fence-sitters will decide unnecessary surgery isn’t worth the money, but there will still be many boys facing the knife who should be protected. I’m not okay with that.

Anyway, who will make the argument that politicians embrace the individual rights of their children and refrain from removing healthy body parts from their own sons? I’ll theorize that at least one candidate running for president with a universal health care platform has ignored the violation of his¹ son’s rights and circumcised the boy, to say nothing of the members of the theoretical decision-making apparatus should a universal health care scheme be implemented.

¹ This ignores Sen. Clinton because I assume she did not have her daughter’s genitals cut. However, she should be included in any consideration of politicians and bureaucrats willing to perpetuate the violation of the genitals of male children.

Modesty does not explain this.

Forget the circumcision angle of this link because it’s not (directly) relevant to my point here. The commenter, Jake, is very pro-infant circumcision, and has co-authored at least one scientific (should that be in quotes?) paper challenging an argument against infant circumcision. I have no proof that Jake is JH Waskett, although I am familiar enough with Mr. Waskett’s blog commenting style to know that the linked comment fits my experience with his work. I’m certain Jake and JH Waskett are the same person.

My question is this: if Jake is JH Waskett and footnotes that article in his blog comment, does he have an ethical obligation to disclose that he is the co-author of a footnoted article in his comment? He included the footnote and did not disclose the connection. Thoughts?

Republicans support the heterosexual troops.

This point didn’t fit in my first post on yesterday’s House vote, but it’s worth making:

Rep. Duncan Hunter, R-Calif., said passage would threaten the safety of the troops rather than protect them because the measure would arbitrarily leave units at home that had specialized skills needed in the war.

Arbitrarily? Is it arbitrary to oust gay service members from the military without any misconduct on their part? What if they have “specialized skills needed in the war”? Like Arabic language skills, for example. If we can’t translate gathered intelligence because it’s in Arabic and the persons who can tell us what it says are at home, does that threaten the safety of the troops? Should I expect Rep. Hunter to sponsor legislation to repeal Don’t Ask/Don’t Tell? If not, why is marginalizing gay and lesbian service members more important than protecting the troops?

Who told him how atheists think?

When I commented that Michael Gerson is full of wrong ideas, I didn’t expect him to so quickly be the gift that keeps giving, this time with a ramble about questions unanswerable by atheists. I am not an atheist, so Mr. Gerson’s nonsense isn’t directed at people like me. Many of his assumptions are, because the questions answered by belief in Mr. Gerson’s god rely on irrationality. For example:

But there is a problem. Human nature, in other circumstances, is also clearly constructed for cruel exploitation, uncontrollable rage, icy selfishness and a range of other less desirable traits.

So the dilemma is this: How do we choose between good and bad instincts? Theism, for several millennia, has given one answer: We should cultivate the better angels of our nature because the God we love and respect requires it. While many of us fall tragically short, the ideal remains.

How do we choose? This is a trick question, right? How about we use our subjective reasoning to decide what we value most. I could be cruel to someone weaker than me. The opportunity presents itself and it’s in human nature to act on that. Why not act on it?

Mr. Gerson knows the answers, of course, although he only offers one option for the atheist (and non-religious).

Some argue that a careful determination of our long-term interests — a fear of bad consequences — will constrain our selfishness. But this is particularly absurd. Some people are very good at the self-centered exploitation of others. Many get away with it their whole lives. By exercising the will to power, they are maximizing one element of their human nature. In a purely material universe, what possible moral basis could exist to condemn them? Atheists can be good people; they just have no objective way to judge the conduct of those who are not.

It’s not particularly absurd to claim that a fear of bad consequences influences our behavior. If a person has a marginal appreciation for what we consider ethics and morals, however and from wherever they derive, the fear of bad consequences will matter. If that person values something, but is unconcerned with taking from another to acquire it, the threat of prison looms. (Except for politicians, of course.) So he makes a choice. Society responds accordingly, if he chooses what it prohibits.

But that’s not all there is, of course. Mr. Gerson seems compelled to believe that God put in many wonderful features in human nature, yet he implicitly dismisses any concept that atheists might value these features more than the opportunity to cruelly exploit, rage uncontrollably, and so on. If atheists understand that such negatives exist, even if they believe them to be a result of evolution, surely they are capable of understanding and acting on the positives. Such evaluations are subjective. Without God, the evaluation is not doomed to embrace Lord of the Flies.

All of this leads Mr. Gerson to conclude that atheists and theists alike agree that humans “have an innate desire for morality and purpose”. Right, because it’s human nature. This is complicated? But theists are somehow acting rationally because they believe that God is in control of this. Atheists?

In a world without God, however, this desire for love and purpose is a cruel joke of nature — imprinted by evolution, but destined for disappointment, just as we are destined for oblivion, on a planet that will be consumed by fire before the sun grows dim and cold.

Do atheists never find love? Purpose? Meaning? The evidence doesn’t hold up, of course, because there are more than enough atheists to disprove Mr. Gerson’s ridiculous assumption. But it’s pleasant to know that believing in a loving god who has us all “destined for oblivion, on a planet that will be consumed by fire” because we cave to the negative temptations of human nature he presumably gave us is the only reasonable and justifiable position.


Mr. Gerson makes this statement as parenthetical aside in his column, so I didn’t include it in my primary focus. Still, it’s worth mentioning because Mr. Gerson has made this error before.

… An irreverent trinity — Christopher Hitchens, Sam Harris and Richard Dawkins — has sold a lot of books accusing theism of fostering hatred, repressing sexuality and mutilating children (Hitchens doesn’t approve of male circumcision). Every miracle is a fraud. Every mystic is a madman. And this atheism is presented as a war of liberation against centuries of spiritual tyranny.

Forced genital cutting without medical indication is genital mutilation. Forget spiritual tyranny. It is physical tyranny. Mr. Gerson can advocate for the circumcision of male children as often as he likes, and dress it up with as many biblical references as he pleases to justify such mutilation. He will be wrong every time. The medical facts do not support him, but what he implicitly argues here, that circumcision is acceptable because people attach religious meaning to perpetuating it upon male infants, is irrelevant. We live in a civil society of guaranteed, inherent rights. The right to remain free of medically-unnecessary surgery without explicit consent is among those rights.

I will repeat myself as often as necessary. Any god who would demand such an abomination is not a god who deserves respect or allegiance.

Let’s debate, but using only my arguments.

Via Radley Balko comes a bizarre, uninformed attack on libertarians from Amanda Marcotte, at Pandagon. At the entry is a bingo card designed to poke fun at libertarians, except each space is little more than a boiler-plate attack based on uninformed assumptions about libertarians. Mr. Balko calls it trite, which is the perfect description.

I can’t say I’m surprised, though. I had my first introduction to Pandagon and Ms. Marcotte a couple of weeks ago when she blogged her reaction after Egypt banned FGM. We obviously agree on the merits of banning FGM, although I was (and remain) less optimistic about this law’s effectiveness. What irked me then is the same lack of intellectual thoroughness evident in the libertarian bingo card. Her post:

Counting down to the “WHAT ABOUT TEH MEN?!” trolls who want to equate male circumcision with female genital mutilation. Look, you can oppose the former without blowing it all out of proportion. Dan Savage did a bang-up job in The Kid, for one instance of arguing against the practice of circumcision without drawing parallels to a much more horrific practice. And that’s just the first that comes to mind.

That’s a very typical response I encounter. Unfortunately, it’s a weak argument that seems to indicate a willingness to shout down debate rather than engage in a debate open to ideas.

I’ve never said anything contrary to the fact that FGM is almost always worse than male genital mutilation. It’s important that almost always doesn’t get lost in the focus on worse. It does. The World Health Organization recognizes four types of FGM. Not all are more severe than MGM. And not all are practiced specifically to reduce or eliminate the female’s capacity for sexual pleasure. (The outcome doesn’t depend on good intentions, but that could be said about male circumcision, too.) The overwhelming majority of cases are worse, of course, and many are done specifically to affect the female’s capacity for sexual pleasure. But we must not ignore the exceptions. Our ignorance permits us, as a society, to turn a blind eye. That is wrong.

Intellectually, the argument is obvious. Forced genital cutting for non-medical reasons on a non-consenting invdividual is wrong. The violence involved is still violence, and the mutilation is still mutilation, no matter how much the cut individual eventually likes the result or how much society approves. Gender is irrelevant.

Disagreeing is understandable and the precursor to enlightening debate. But squashing dissent before it arrives is little more than forced intellectual conformity. Such non-thinking stifles progress.

To her credit Ms. Marcotte makes several statements in the comments – where the comparison did erupt, to much bandying of the term troll – that she doesn’t support male circumcision, labeling it “a mildly barbaric practice that is cruelty to children”. She is open to more than just what our society believes about cutting the genitals of children. That’s what makes the original statement in her entry so frustrating, and what makes several of her other remarks in the comments section disconnected. For example:

Ah, I figured the false equivalence trolls would come out. Shameless. They probably think cutting off the foreskin is worse that slicing girls apart and letting many die, but they at least know better than to say that. Instead, they just equate the two and imply that anything less than calling circumcision the worst crime ever is supporting the practice.

No, I don’t think cutting off the foreskin is worse than slicing girls apart and letting many die. But that’s not really a fair comparison, is it? As I mentioned, not all forms of FGM are worse than MGM. But where they are, I’m not making a quantitative comparison. We don’t judge whether an action is wrong on the amount of wrong. It is or it isn’t. Qualitatively, genital cutting is genital cutting. That’s the argument, and why there is no “false” equivalence.

In the same comment where she labeled male circumcision “mildly barbaric”, she offered this:

It also troubles me to describe circumcised penises as mutilated when so many owners of them like them that way. Again, they don’t know any different and I think that they should stop to consider that they might be prejudiced, but still, it’s hardly mutilation to the same degree as FGM. …

… I think the proper analogy is to other minor cosmetic surgeries, like Botox injections. My opposition to it is that it’s better to leave well enough alone when the results of interference are dubious at best.

Ms. Marcotte’s absurd comparison to Botox aside, I don’t need to convince happily circumcised men that they’re damaged. If they like it, great. But mutilation is still mutilation. Not everyone is happy with it, and most who aren’t wouldn’t dream of having it done. That and it’s almost universal lack of medical necessity are enough for us to know that both are wrong. Again, both are wrong because they are the same action, medically unnecessary genital cutting forced on a non-consenting individual.

Does milk do the brain good?

Find the mistake in this logic defending milk:

We’re pretty darn sure that how much calcium you consume up to a certain age is a key factor in your life-long bone density. More calcium, denser bones, less chance for osteoporosis. All available evidence shows that milk still has a bunch of calcium in it.

Sentence one, no problem. Sentence two, no problem. Sentence three, no problem. But putting them together requires more than those three sentences. Just because milk has a bunch of calcium does not automatically mean it’s effective or efficient at building stronger bones. This is shallow analysis getting a free pass because it’s commonly accepted.

Link courtesy of Veg Blog.