I saw Rep. Frank by the Capitol today

Michael Kinsley’s opening paragraphs from today’s column made me laugh:

It was, I believe, Rep. Barney Frank (D-Mass.) who first made the excellent, bitter and terribly unfair joke about conservatives who believe in a right to life that begins at conception and ends at birth.

This joke has been adapted for use against various Republican politicians ever since. In the case of President Bush, though, it appears to be literally true.

After laughing, I read the article to understand Mr. Kinsley’s point.

But it is hard — indeed, I would say it is impossible — to reconcile Bush’s absolutism over allegedly human life when it is a clump of unknowing, unfeeling cells with his sophisticated, if not cavalier, attitude toward the loss of innocent human life when it is children and adults in Iraq.

While I agree with the basic idea, I think he could’ve used a better example for comparison: President Bush’s unabashed desire for America to torture anyone he deems our enemy. The underlying “principle” of the President’s stance is that torturing a few individuals has the potential to save the lives of many Americans. If that is acceptable for torture, why is it not acceptable for stem cell research?

By experimenting with a few stem cells, scientists have the potential to save the lives of many Americans. The only difference I can decipher when the debate is framed that way is that geography matters. Put 1,000 Americans together in the ticking time bomb scenario, and torture might (not really) save them. But if 1,000 Americans die in a day from a disease that stem cell research might help cure, that research remains morally unacceptable. Physical harm to an actual human being by torture is less grave than physical harm to cells that will never be an actual human being.

This isn’t how I’d specifically frame the discussion because the underlying principles possess more complexity. Also, the various scenarios aren’t as clean. However, I believe I’ve captured the gist of our president’s positions. He is wrong on both.

The Central Planner’s Handbook for Protecting the Ignorant and Ungrateful

Libertarians understand the stupidity of this action by the New York City Board of Health:

The New York City Board of Health voted unanimously yesterday to move forward with plans to prohibit the city’s 20,000 restaurants from serving food that contains more than a minute amount of artificial trans fats, the chemically modified ingredients considered by doctors and nutritionists to increase the risk of heart disease.

This is absurd, because the eventual “logical” step is banning the sale of packaged foods with trans fats within the city limits. At what point do citizens stand up and demand that government not turn a city into an institution where permission for every decision must be granted by some small group of public officials claiming to be experts? This is lunacy, although not a surprise.

Chicago is considering a similar prohibition affecting restaurants with less than $20 million in annual sales.

Why only restaurants with less than $20 million in sales? Even if this type of policy made sense, it’s counter-intuitive to impose this regulation on the smallest members of the group while leaving the largest free to attack its customers’ arteries offer any menu item its customers desire. The restaurant industry is a small-margin business, so those with lower sales have less fiscal cushion in their budgets. I’m most amused that Chicago loves big restaurants while it hates big stores. But government knows best.

Lynne D. Richardson, a member of the Board of Health and a professor of emergency medicine at Mount Sinai School of Medicine, said yesterday that restaurant owners might still see an advantage in the long shelf life of trans fat products.

“But human life is much more important than shelf life,” she said. “I would expect to see fewer people showing up in the emergency room with heart attacks if this policy is enacted.”

Expects? Obviously the greedy restaurant owners don’t care about their customers (repeat business is insignificant in restaurants, right? No?), but should she support public policy based on hopes rather than logic? If diners want foods with trans fat, and restaurants can’t serve it, diners will stay home and eat their bad oils and margarines and whatever else will no longer be allowed. If When that happens, I’m fairly certain the same people will show up in the emergency room with heart attacks. That gets back to the likelihood that the planners will admit that the policy isn’t having the intended effect, thus justifying the need to ban trans fat products from grocery stores.

If people wanted strictly healthy diets, everyone would be vegans who eat only raw, organic food and exercise every day. They aren’t those people. We can cry about that, but statist public health policies won’t make it any more our reality than it already isn’t.

Update: Based on information provided in by Chris in the comments, the New York Times report about Chicago considering a trans-fat ban affecting restaurants with less than $20 million in sales is wrong. The ban under consideration involves restaurants with greater than $20 million in sales. My analysis is now worthless for the facts, but that doesn’t make the ban any wiser. Screw the poor, screw the rich. It’s still the same stupidity. Regardless, I should’ve checked those facts first.

Can you tell I’m going to Blacksburg this weekend?

Looking back at an entry from the archives, I thought I’d update something I said about the Hardee’s Monster Thickburger™:

That’s the effect of consumer choice. If the people don’t like it, they’ll stop buying the burger. No amount of public bitching about corporate responsibility or heart disease or obesity, no matter how tender and earnest, is going to change a consumer’s behavior until the consumer wants to change. The progress might be slow, but it’ll happen. And that change becomes more lasting and permanent when it’s a choice, just like the lasting effect of the quality of Hardee’s food at Squires Student Center. That Hardee’s is now an A&W franchise.

That A&W franchise is now an Au Bon Pain, thanks to the painfully awful food served by that A&W, a fact to which I can unfortunately attest. Despite the obesity “crisis” we’re now facing, I stand by my original assessment that choice is sufficient and essential. People aren’t stupid and do not need the government’s help to make them better. Experience is a much more powerful motivator.

Center for Dumb Conclusions?

Let’s all embrace the feel-good sentiments our government constantly provides:

All Americans between the ages of 13 and 64 should be routinely tested for HIV to help catch infections earlier and stop the spread of the deadly virus, federal health recommendations announced Thursday say.

“I think it’s an incredible advance. I think it’s courageous on the part of the CDC,” said A. David Paltiel, a health policy expert at the Yale University School of Medicine.

Encouraging the FDA to end its ban on blood donations by gay men would be courageous. This recommendation is an example of “more is always better” masquerading as good policy.

The recommendations aren’t legally binding, but they influence what doctors do and what health insurance programs cover.

Some physicians groups predict the recommendations will be challenging to implement, involving new expenditures of money and time for testing, counseling and revising consent procedures.

The idea is not terrible, but its implementation must be based in reality. Raise your hand if you think this will be implemented across the healthcare industry as a new routine. I’m sticking with No because we seem to have already figured out that our “limited” money and effort could be spent elsewhere. How stunning this suggestion isn’t is clear enough in this:

CDC officials have been working on revised recommendations for about three years, and sought input from more than 100 organizations, including doctors’ associations and HIV patient advocacy groups. The CDC presented planned revisions at a scientific conference in February.

Three years to suggest that everyone between 13 and 64 should be tested for HIV. Now raise your hand if you think that government-run healthcare is a good idea. Everyone gets tested for HIV, so someone misses out on a procedure or prevention relevant to her life. I’m sure our grand experiment with government-run (or financed, at a minimum) will be different from other countries, though, so no reason to worry.

Because some government busybody will suggest new public policy eventually, I’ll point this out now to save my ranting time later for rational issues:

Previously, the CDC recommended routine testing for those at high-risk for catching the virus, such as intravenous drug users and gay men, and for hospitals and certain other institutions serving areas where HIV is common. It also recommends testing for all pregnant women.

Some misguided do-gooder will add men with intact foreskins to that list. And I’m not really saving any ranting, because I’ll do it then, as well. Ugh.

Update: Looking over this post, it’s clear I forgot one thing, although I hope it was clear given my comments about what action would be courageous. Lumping gay men into the high-risk category by virtue of being gay is preposterous. Behavior matters. It’s small thinking that equates one with the other based solely generalizations from a generation ago.

No, no, no, a million times no

I’ve cited Andrew Sullivan’s entries on male circumcision in the past as support for my arguments to protect infant males from surgical alteration of their genitals. Today, I’m at a loss for words because of this:

As long-time readers know, I’m a big opponent of male genital mutilation, aka circumcision. But the data are clear on HIV infection, and under those circumstances, as I’ve said before, I’m prepared to make an exception.

I’m not one of the multitudes of routine infant circumcision opponents who denies the results because they somehow don’t fit my argument. Maybe there are methodological flaws in the studies, maybe not. I don’t know, and it doesn’t matter. The studies offer evidence, not recommendations. It takes reasoning to filter the research into a coherent approach to preventing HIV. Circumcising (male) infants to prevent HIV is neither reasonable nor coherent.

Children do not engage in sex until well beyond the period in which they can be taught responsible behavior and an understanding of consequences. Their intact genitals do not expose them to HIV. They do not need to fret over whether or not condoms will provide them adequate protection. For each boy, HIV will not jump onto his penis, crawl in between his glans and foreskin, and burrow through the susceptible cells. His intact foreskin will not create a public health crisis.

That’s what makes Mr. Sullivan’s statement so frustrating. He does not say if his exception is limited to adult circumcision or includes infant circumcision. Perhaps his limit is adult circumcision, but reading the linked article, I suspect he’s willing to concede on infant circumcision. If it is the former, he should note that distinction to avoid confusion (I noted an example here). If it is the latter, he is wrong.


Richard Feachem, executive director of the Global Fund to Fight Aids, Tuberculosis and Malaria, said research revealing the protective effect of circumcision against HIV was set to change parental expectations and medical practice across the world. Instead of viewing the operation as an assault on the male sex, it was increasingly being seen as a lifesaving procedure which every parent would want for their sons.

Show me how routine infant circumcision is considered an assault on the male sex, outside of opponents such as myself. Unfortunately, I must concede that I am in the minority. So, again, show me how public opinion will now reverse to make the procedure so desirable.¹ One caveat: you must use science instead of fear. Will circumcision alone be enough? Are there better, less invasive methods of prevention? Does circumcision in conjunction with other methods of prevention add a significant increase in protection? Is this solution targeting those most at risk?

Removing the foreskin is thought to harden the glans (head) of the penis, making it less permeable to viruses. Research conducted in 2005 showed the transmission of HIV from women to men during sex was reduced by 60 per cent if the men were circumcised.

Hardening (thickening, really, through keratinizationexplicit warning: NSFW) of the glans used to be understood and accepted as an outcome of circumcision. Punishing masturbation is much easier when the penis loses sensitivity. Then it became a lie propagated by circumcision opponents, presumably because knowledge of the foreskin as mucous membrane disappeared among physicians. Also, selling surgery is easier if the supporter pretends that there will be no harm from removing the “useless” flap of skin. Now keratinization is a feature again? Using reduced sensitivity to sell routine infant circumcision is like pretending that the Ford Pinto had a secondary heating system. At least they’re honest now.

And what about female-to-male transmissions?

CONCLUSION.–The odds of male-to-female transmission were significantly greater than female-to-male transmission. The one case [from 379 couples] of female-to-male transmission was unique in that the couple reported numerous unprotected sexual contacts and noted several instances of vaginal and penile bleeding during intercourse.

How about another study? This back-and-forth could go on.

Dr Feachem said: “We know the factors that cause HIV to spread rapidly in a country – the number of concurrent sexual partners, the use of condoms, the presence of other sexually transmitted diseases and male circumcision. Other things being equal, in a circumcised population you have a low and slowly developing epidemic and in an uncircumcised [sic] population you have a high and fast developing epidemic.”

Beware conclusions drawn from poorly phrased assumptions and questions. All other things are not equal. The other three factors listed are not consistent. Two of them can be taught. The other is also a function of individual responsibility. But not included here is why there is a disparity in the populations. The studies include only Africa, which is not particularly analogous to Europe and the United States. The U.S., for instance, has the highest HIV infection rate among industrialized nation. We’re primarily circumcised. European nations have lower incidences of HIV infection. Those nations are predominantly intact. The researchers should explain the difference before so quickly assuming that boys must lose healthy tissue.

He added: “Circumcision is growing strongly in popularity in South Africa and in North America. We see males seeking circumcision very commonly in South Africa. The news of its protective effect caused a substantial increase in demand for adult male circumcision.

I reiterate my point from earlier. North America (i.e., the United States) has had a love affair with circumcision for more than a century, so growing strongly in popularity is absurd. Facts matter, no? But what’s important is the key word in Dr. Feachem’s statement, adult. Adults can consent; infants can not. There is also a significant difference in the penile development of infants and adults. Adults do not require tearing of the foreskin from the glans to remove the foreskin, as is necessary with infants. Making the leap from what’s appropriate for adults into what’s appropriate for infants without considering intellectual and anatomical differences is absurd.

“Circumcision fell out of favour in North America and the UK as an unnecessary operation. Following this research, I think it extremely probable that parental d
emand for infant male circumcision will grow as a consequence.”

Repeating the notion that circumcision is out of favor in the United States (specifically) does not make it true. It’s falling, but the majority of newborn males still have their healthy foreskins surgically removed.

Returning to the impact of a male’s sexuality as he grows from infancy into young adulthood, when he reaches an age where he may become sexually active, the presence of his foreskin could potentially cause him problems. Responding to that calls for parenting. Parenting might include a discussion of sexual promiscuity and HIV. It might also include consideration of circumcision. What’s important is that the boy will have input. If he is against it as a preventive measure, it should not be forced upon him. Short of medical necessity, the decision should remain his alone. When he reaches adulthood, he can make the decision based on his understanding of his HIV-risk.

If that scenario had occurred for me, I’d be intact today. I understand my sexual history and risk enough to make informed decisions. I have never put myself in a position where HIV was a significant risk worthy of pre-emptive amputation. I do not intend to do so. How has genital surgery helped me? How can parents know which scenario their child son will live? Permanent medical decisions should not be made for infants/children based on fear of the unknown. That is not science, that is superstition and ignorance.

Instead of writing what I’ve said enough times already, consider this counter-balance:

Deborah Jack, chief executive of the UK-based National Aids Trust, said the research findings were encouraging.

“It is clear the promotion of voluntary circumcision can play an important role in reducing the risk of HIV transmission,” she said. But she warned: “People who are circumcised can still be infected with HIV and any awareness campaign would have to be extremely careful not to suggest that it protects against HIV or is an alternative to using condoms.”

I didn’t volunteer for circumcision any more than the one million infant males circumcised in America every year volunteer. Or the millions of infant males around the world who will now be circumcised as a result of this research. Parental demand for prophylactic surgical amputation was never sane, is not sane, and will never be sane, regardless of the various wonderful explanations we can create to justify it. In America we do not allow female circumcision (calling it female genital mutilation) for any reason other than specific medical indication. Boys, however, are subject to parental whim. Parental whim is subject to scientific discovery open to expansive interpretation. Radical surgical amputation should not be the first response to imagined future risks involving infants.

Post Script: More on this topic here.

¹ The article is from a British newspaper. Noted. However, it will be apparent in a moment that the target audience for routine infant (male) circumcision as a preventive measure against HIV includes the United States.

He served us, but I might have that backwards

Nothing like ambitious standards:

U.S. Surgeon General Richard H. Carmona let it be known yesterday that he is stepping down, saying in a letter that he would judge himself successful if he had persuaded one student to make good health choices or one mother to stop smoking.

I suspect he was working more to persuade politicians to force all students to make “good” health choices and all mothers to stop smoking.

Your bloodstream is mine, and mine is yours

First, some background:

A new vaccine aimed at halting the spread of a common sexually transmitted virus that can lead to cervical cancer should eventually be given to both sexes, doctors said Monday.

The vaccine, Merck & Co.’s Gardasil, was licensed in June by the U.S. Food and Drug Administration for use in women and girls 9 to 26 years of age.

Gardasil protects against four types of the human papillomavirus, also known as HPV or human wart virus.

Yay, science! I couldn’t be happier (or less surprised) that modern science has triumphed again to make our lives better. Treating progress as good seems to be a generally advisable position. As such, I have no qualms about this vaccine’s availability. Some people can’t leave it at that:

Bradley Monk, associate professor in gynecologic oncology at the University of California at Irvine, said the best use of the vaccine would include giving it to girls and boys and all women and men, regardless of individual risk factors.

“To have a vaccine that prevents cancer and not use it would be one of the greatest tragedies,” Monk said.

I’m not going to turn this into a rant against vaccinations of any kind, because that’s not my position. But as I’ve pointed out before in numerous different ways, the person undergoing medical procedures should have input, whether direct consent or indirect assumptions based on evidence. It might be useful to include an HPV vaccine in routine childhood immunizations. In all likelihood, after some thought on the subject, I’d agree. However, I will discount any scientist who uses regardless of individual risk factors as a dismissal of intelligent objections. The public good is important, but we’re not at a point where individual lives are less than the whole. HPV is sexually transmitted, unlike polio, for instance. Personal behavior matters. As such, individual risk factors matter and must be included in the decision.