You recall that nice scarlet letter “A” for atheism t-shirt? I like it so much that I’ve decided to get it tattooed on my forehead. And this is so important to me that I’m also dragging my kids into the tattoo parlor to have it done to them. After all, my beliefs are important and this minor procedure will make my children more attractive, so they shouldn’t object — it’ll also make it easier to find partners with a similar cultural background. This is a win all around; I really don’t understand why Skatje is hiring a lawyer to oppose me.
I’m lying (the kids will be relieved). I think everyone would agree that if I seriously proposed doing something like that, that I had gone insane … I’d come home to find an intervention at best, or the men in white coats at worst, and Skatje would only have to whisper a few words of complaint to get a judge to slap an injunction on me, preventing such a pointless mutilation.
So why is it so difficult to stop a man from mutilating his adolescent son’s genitals against his will?
Oh, right — because it’s religion. It’s OK if God tells you to do it. “Morality” means an invisible imaginary man in your head gives you permission. Religions have spent millennia confusing ethics with obedience, and this kind of nonsense is the result.
Apparently, the circumcision case does not exist. Don’t send money to contribute — it’s almost certainly a scam!
Parents have their children (infant or otherwise) circumcized on spurious “medical” grounds all the time.
Is believing religious nonsense better or worse than using medical excuses for a cultural practice?
Forcing an operation without compelling medical reasons of necessity upon someone who is old enough to voice his opinion that he doesn’t want it is wrong.
I agree that using medical reasons to perpetuate a cultural practice is wrong as well. But this is more wrong.
Two points:
It’s my understanding that when an adult converts to Judaism, the circumcision is a symbolic pinprick. That’s what I’ve read; obviously I could be wrong and the doctor in this case could be planning something more drastic.
I hope you’ll put in a protest for the many sub-adolescent girls who suffer clitoridectomy and worse (“female circumcision,” also called “female genital mutilation“)to make them docile and marriageable. There are people who try to continue that custom in North America.
Monado: No, this is only the case if the person has already been circumcised in a non-religious way. In this case, the pinprick is all that’s needed. If not, the full circumcision is required.
Hey, the Bible says if a kid doesn’t follow his parents’ will, the parent can take the kid to the elders and arrange to have the kid stoned. So get with the program.
Oh, THAT kind of stoned. Sorry. My bad.
I still want to form a church that teaches only the bad parts of the bible. Sort of like Landover, but without the humor.
My suggestion to the boy is twofold:
1) Be brought into the medical office kicking and screaming, requiring you to be forcibly tied up.
2) Look the doctor in the eye and tell him (or her) that once you turn 18 you will be suing him (or her) for everything they have.
That ought to throw a Spaniard in the works.
This is truly egregious, especially at an age where the kid is just coming into puberty. My son was circumcised at birth, just because we knew at that time he would have no memory of a foreskin. I’m circumcised and I kind of like it that way, and when my son was born the issue was not as prominent as it is now.
But I would NEVER DREAM of forcing that on him now, especially if he were to fight me on it. I still have the authority to make him brush his teeth, shower and wear clean clothes, but in no way would I have authority to mutilate his privates for my “conversion.”
When people are shocked that Dawkins claims imposing religion is a form of child abuse, point them to this story.
We do not allow a parent to kill their child on the grounds that child sacrifice was a requirement of their religion, no more should parents or others be allowed to physically mutilate children on anything other than medical grounds. Any religion which encourages and performs such acts on unwilling victims should be called to account before the law.
While it is clear that this action is motivated by religion (and perhaps by spite), it may be incorrect to call it completely “medically unnecessary”, as there is strong evidence that circumcision can cut the risk of contracting AIDS substantially (by approximately 70%). In this regard, it may be as effective in preventing this disease as various childhood vaccinations are, and the anti-vaccination crowd are generally viewed as loonies.
Further, just to amplify an earlier poster’s point, this procedure is in no way like “female circumcision” as practiced in Africa — that procedure usually involves partial or complete removal of the clitoris, and can involve sewing the vaginal opening almost completely shut. Removing foreskin is not at all comparable (although it is still a medical procedure). If male circumcision is objectionable, female genital mutilation is far more worthy of protest.
With all of this said, I am appalled that a father would impose this procedure on his son for purely religious reasons. I am surprised that a mohel would be willing to perform this act on someone who clearly doesn’t want it.
This is horrible. It’s particularly upsetting that the father found a willing doctor so easily – if we can even use the words ‘father’ and ‘doctor’ for men so far removed from loving and healing.
Nobody is saying that female genital mutilation is acceptable. The whole point is that while most people seem to find that female genital mutilation is highly objectionable as a simple truth, male genital mutilation is “acceptable” because of tradition or religion. That makes no sense, and it’s time to stop this barbaric practice.
If people want to remove their foreskin, let them do it themselves when they’re old enough, the same as other forms of self-mutilation (piercings, tattoos, etc.)
I think I’m at least as appallled that he found willing JUDGES.
Yikes.
If it goes through, the son should have his foreskin preserved and go around the country exhibiting it.
Step right up!
See the foreskin!
Forcibly removed to satisfy someone else’s religious beliefs!
Religion shouldn’t be the only thing that should be taking a hit for this.The US government was big on this procedure in World War2.My father was circumsised by the US Navy in 1943 at the age of seventeen.He never was to happy about it.
As usually practiced, female genital mutilation is profoundly worse — the equivalent for men would be cutting off the head of the penis and sewing the remainder flat against the body. Many women die while undergoing this procedure, and those who survive are often incapable of normal sexual relations, or of experiencing pleasure from sex. And the motivations for the practices are far different as well. The whole intent of female genital mutilation is to prevent women from having sex before marriage — it is profoundly misogynous. There is simply no comparison between female genital mutilation and male circumcision.
The adjective “barbaric” gets thrown around, but I think it is excessive. There are demonstrable medical benefits from circumcision, and the negative impact on the individual’s health (in terms of sexuality) is at best slight. There certainly are arguments to be made regarding the autonomy of the individual, and I think these are valid, especially in the case of a 12-year-old. But I don’t think that renders the practice as a whole as “barbaric”.
(Just to be clear, I consider myself an Uppity Atheist, and was a former Catholic, so I don’t have a religious dog in this fight.)
Silly Wabbi! Foreheads aren’t genitals!
There’s some symbolism in the idea of forehead multilation, though, given that a full committment to the religious way of life does require a figurative cutting off of the head.
(am not ignoring or dismissing the very real issue of genital mutilation of both males and females, I just can’t handle it today… traumatic week.)
That ought to throw a Spaniard in the works.
That’s spanner. Or I’m missing a pop culture quote again. But we got a chuckle out of it and appreciated that. :)
You’re missing a pop culture reference. Philistine!
There is no reason to mutilate infants, or adolescents. There is no medical reason for the mutilation!
the AIDS prevention factor is not a valid reason, if the child wants the protection, he can choose to be cut when he comes of age. Besides, condoms offer superior protection.
And the analogy to female circumcision is not far fetched. Some versions of female circumcision only removes the skin surrounding the clitoris, which is comparable to the same abuse against infant boys.
…
…
I always think of it like this:
Imagine performing unnecessary elective cosmetic surgery on a child to make her ears pointed, so later in life she’ll be popular and cute.
Do it when she’s a baby, so she “won’t remember the pain later.” (And hey, after all, babies are like dogs; they don’t really feel PAIN like we do.)
Do it blithely, without a thought, without even considering her own later will, because you own her. She’s YOUR child, you can make these decisions FOR her.
And tell yourself that SURGERY is nothing at all. No chance of infection, no chance of complications. And besides, studies show pointed ears are really cleaner and less prone to problems.
Plus, everybody else is doing it. Why should my little girl be singled out and different?
Besides, they just look better. When she’s grown up, it’ll all be behind her and she’ll be glad we had it done.
…
…
Hank Fox for the win!
Circumcision, even for non-religious reasons, seems to get people riled up almost as much as religion itself. See “The Cruelest Cut” at kuro5shin.org and the ensuing 981 comments.
As for the whole idea of it helping to prevent AIDS, I am deeply sceptical. I don’t recall ever seeing a satisfactory theory of why it would work. Moreover, didn’t AIDS first appear in the USA, a country where practically all males are already circumcised? There’s circumstantial evidence for you!
Moreover, the idea of performing unnecessary genital surgery in situations where hygiene may not be guaranteed (to say the least) strikes me as a disaster just waiting to happen.
And yes, clitoridectomy is orders of magnitude worse than male circumcision, but both are barbaric in my opinion.
Hank, and bind the little sweetie’s feet while you’re at it. We all know that men prefer women with dainty feet. Dainty feet, and an aversion for big books.
Actually, various forms of FGM are exactly comparable to MGM (or, ‘female circumcision is comparable to male circumcision’. You can have either, but no mix & match).
The clitoris is a more-or-less indiscrete, largely internal organ. You couldn’t ‘remove’ anyone’s entire clitoris without taking a sharp melon baller under their public bone. Plenty of women that have been circumcised say that there’s nothing wrong with their sexual response, that they’re JUST FINE, thank you.
And anyone that chooses, as an adult, to get their own genitals hacked at is fine by me.
You just don’t get to choose that for other people. Even if the voices in your head tell you to. (Or the voices in other people’s heads a very long time ago. Allegedly.)
Hank, you’re so close. It’s already being done, very commonly, with just a slight twist on your description.
Ear piercings. Haven’t you seen them on babies? Maybe more common in the Midwest, but I used to see them all the time. The only way I can see it as at all justified is when there are multiple identicals who need to be told apart easily (different color earrings and all).
Isn’t the clitoral hood the female analogue of the foreskin? Why is it then that removal of the clitoral hood counts as genital mutilation and is illegal but the removal of the foreskin is not?
“Moreover, didn’t AIDS first appear in the USA,”….
No. People didn’t get excited about it until then, but AIDS had been killing Africans for twenty years or so before.
Just to be clear, I am by no means defending performing purely elective surgery on adolescents against their will. In the specific case PZ raises, I think it is horrific that the father would force his son through the procedure for what are clearly religious and personal reasons, unrelated to the boy’s health.
However, I think that, in certain environments (such as Africa), the reduced risk of AIDS might well justify the procedure, just as the risk of various childhood diseases justifies the risks associated with vaccination (which are not zero). As for the validity of the AIDS protection claim, the Beeb says it is so, and this source (with an admitted religious interest in the matter) says there are over 40 studies showing this, along with summarizing the potential mechanisms involved. In places like Africa, I think it is arguable that infant circumcision is just as supportable as vaccination against smallpox — perhaps more so, since the likelihood of coming in contact with HIV is vastly greater than exposure to smallpox.
As for the comparability of male and female genital mutilation, I will re-emphasize that they are done for radically different reasons, that the female procedure is often (although not always) far more invasive and radical, and that women are vastly more likely to die from the procedure than men. In my book, that makes them incomparable.
John J. Rynne is correct — people get extremely emotional about male circumcision, and in my view, often all out of proportion to the actual issue. (I think that’s in part because, these days, it is chic to be a victim, and it’s a way men can grab a piece of that.)
Again, just to be clear, a 12-year-old should get to decide what happens to his foreskin.
“I will re-emphasize that they are done for radically different reasons, that the female procedure is often (although not always) far more invasive and radical…”
Tulse, in cases where it is not “far more invasive” but on par with the male version would you then support it?
Since the recent study on AIDS infection and circumcision I’ve changed my position somewhat. I used to be completely anti, in all circumstances except a voluntary, adult decision. Now I’m swayed in favour of involuntary circumcision of infants in some circumstances, at least in areas with very high incidence of AIDS. But it certainly should be anaesthetised.
“the AIDS prevention factor is not a valid reason, if the child wants the protection, he can choose to be cut when he comes of age”
Yes, but it’s not all about the person getting cut, is it? What about his sexual partner(s)? In many parts of Africa at least, women aren’t in a position to refuse their husbands’ sexual advances if they don’t want to use a condom, even if they are available. Combined with cultural acceptance of multiple partners at the same time, you’ve got a recipe for rapid spread of STDs. You can’t rely on the men to get cut as adults, because as their other behaviour demonstrates, they’re not (as a group – obviously this isn’t universal) sexually responsible. Once the culture has been changed so that responsibility becomes ingrained, as they’re trying to do in Uganda for instance, then you could probably phase out circumcision.
But there are also demonstrable medical benefits from abstaining from circumcision [bold addresses the above topics]:
– Is circumcision beneficial?
It depends.
Apparently it will protect millions of people from death in areas with a massive HIV infection and low condom use. The WHO decision to support this on pure medical grounds seems correct.
There are also small investigations (not so much interest there) that uncircumcised males are efficiently protected against chlamydia. This would be a concern in other areas, not least because untreated chlamydia lowers fertility. On the same grounds as above, and considering the risks, circumcision here should be acted against.
– Is circumcision a mutilation?
By default it is a body alteration. And male circumcision removes functional tissue.
First, the foreskin presents antigens to the immune system. [I’m not going to provide references to all of this – and they are easy to google.] It could even conceivably prepare sperm for impregnation as much as sperm prepares the female body, but I’m not aware of any published research here.
Second, sensitivity changes. There are some reports of loss of sensitivity.
Third, the mechanics of sex changes appreciably when the penis can’t slide inside the foreskin. IIRC presented data such as it is seems to say uniformly that females reports less satisfaction.
Fourth, protective tissue is removed.
…
There are a few remaining issues as well:
– Should circumcision be done in presexual and/or dependent individuals?
No and no.
– Is circumcision an esthetic operation?
In cultures where it is seen as mutilation it seems to be mostly seen as unesthetic.
In other cultures, religious and esthetic purposes seems conflated. It is also hard to understand why the corresponding female ‘light’ circumcision of labia isn’t likewise considered to be default religious and esthetical.
…
A recent thread that seems to have cover these issues comprehensibly is http://scienceblogs.com/aardvarchaeology/2007/03/circumcision_and_clean_syringe.php . It contains some specific criticism on the HIV report and WHO decision.
But there are also demonstrable medical benefits from abstaining from circumcision [bold addresses the above topics]:
– Is circumcision beneficial?
It depends.
Apparently it will protect millions of people from death in areas with a massive HIV infection and low condom use. The WHO decision to support this on pure medical grounds seems correct.
There are also small investigations (not so much interest there) that uncircumcised males are efficiently protected against chlamydia. This would be a concern in other areas, not least because untreated chlamydia lowers fertility. On the same grounds as above, and considering the risks, circumcision here should be acted against.
– Is circumcision a mutilation?
By default it is a body alteration. And male circumcision removes functional tissue.
First, the foreskin presents antigens to the immune system. [I’m not going to provide references to all of this – and they are easy to google.] It could even conceivably prepare sperm for impregnation as much as sperm prepares the female body, but I’m not aware of any published research here.
Second, sensitivity changes. There are some reports of loss of sensitivity.
Third, the mechanics of sex changes appreciably when the penis can’t slide inside the foreskin. IIRC presented data such as it is seems to say uniformly that females reports less satisfaction.
Fourth, protective tissue is removed.
…
There are a few remaining issues as well:
– Should circumcision be done in presexual and/or dependent individuals?
No and no.
– Is circumcision an esthetic operation?
In cultures where it is seen as mutilation it seems to be mostly seen as unesthetic.
In other cultures, religious and esthetic purposes seems conflated. It is also hard to understand why the corresponding female ‘light’ circumcision of labia isn’t likewise considered to be default religious and esthetical.
…
A recent thread that seems to have cover these issues comprehensibly is http://scienceblogs.com/aardvarchaeology/2007/03/circumcision_and_clean_syringe.php . It contains some specific criticism on the HIV report and WHO decision.
For aesthetic or cultural or religious reasons? No, but I don’t support forced male circumcision in those cases either. I think both practices are only defensible if there is evidence of health benefits. I think there is such evidence for male circumcision in certain environments, but I’m willing to be convinced otherwise.
And sure, there are likely downsides to male circumcision (as there are with almost any medical procedure or body modification). My point is not to defend circumcision at all costs, but merely to point out that one can be rational about this issue, rather than emotionally labelling it “barbarism”.
(And, again to be completely clear, when a father tries to force his 12-year-old boy to undergo the procedure purely for religious reasons, that is indeed barbaric.)
Newborn girls with a family history of breast cancer should have their “breasts” immediately amputated. You know…for health reasons.
OK, I’m just a little disappointed that P. Zizzy isn’t really going to have a big ‘A’ tattooed on his forehead. That would be like totally radical.
BTW, as someone who underwent the operation when I was ~10, circumcision hurts like hell.
“I think both practices are only defensible if there is evidence of health benefits.”
When you look into the non-religious history of the practice it’s quite shocking to discover just what the promoters actually claimed circumcision “cured”.
“A remedy for masturbation which is almost always successful in small boys is circumcision. The operation should be performed by a surgeon without administering an anesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment. In females, the author has found the application of pure carbolic acid to the clitoris an excellent means of allaying the abnormal excitement.”
(John Harvey Kellogg, M.D., “Treatment for Self-Abuse and its Effects,” Plain Fact for Old and Young. Burlington, Iowa: F. Segner & Co. (1888). P. 295)
“It (self abuse) lays the foundation for consumption, paralysis and heart disease. It weakens the memory, makes a boy careless, negligent and listless. It even makes many lose their minds; others, when grown, commit suicide…. Don’t think it does no harm to your boy because he does not suffer now, for the effects of this vice come on so slowly that the victim is often very near death before you realize that he has done himself harm. It is worthy of note that many eminent physicians now advocate the custom of circumcision…”
(Mary R. Melendy, MD, The Ideal Woman – For Maidens, Wives and Mothers, 1903.)
My favourite funny circumcision story (everyone has one of those, right?) comes from my discussion with my wife on the issue, around the time our son was born, and we were mulling pros and cons…
My wife is of Arab/Moslem background… realizes early in the conversation she didn’t actually recall if she’d ever even heard that particular religion’s argument for circumcision…
So I look into it. I find out it comes from one of the Hadiths… stories of the life of Mohammed. Seems the practice is regarded as a good thing principally because a Hadith says Mohammed had said, at some point, that Abraham had performed his own circumcision…
At the age of eighty.
With an adze.
(An adze, as I expect some of you might know, is a sort of axe with the blade mounted horizontally, so the axis of the shaft is perpendicular to the plane of the blade. You generally swing it overhand, sorta toward your feet… between your legs…)
I tell this to my wife. I can see we’re both thinking the same thing. She says it first:
“At eighty? With an adze? Maybe he just slipped!”
So I figure they’re reading the Hadith entirely wrong. No, it doesn’t mean circumcision is a good thing…
It means that, when you get to eighty, you should probably leave the heavy woodworking to someone younger, with steadier hands.
Regarding circumcision and aids in Africa – I agree this MIGHT be a possibility, but what has that got to do with circumcision in the US (or western Europe where I am placed)?
Is this case for real? The story itself is very skimpy on details, and the links provided as “verification” provide no information about the case. A Lexis-Nexis search in Oregon news sources for “Misha” or “Boldt” (apparently, the parents’ surname) or various forms of “circumcize” retrieve no relevant hits. Google searches only retrieve various repostings of the “Doctors Opposing Circumcision” story. And why are donations going to that organization, instead of some fund set up by the attorney and his client?
The story is terrible if it’s true, but before I start sending my lunch money to “Doctors Opposing Circumcision” I’d like to know a little more.
Correct me if I’m wrong, but I remember that female circumcision is a preadolescent rite in Africa that involves not only a clitoridectomy but also cutting of the labia, which are then sewn together, leaving a single small opening for urine and menstrual fluid to escape. In addition, it is often performed not only without any anesthesia, but with any sharp object that happens to be available, like a brokend piece of glass. The ritual is done by a designated woman, when the girl is beginning to develop, but before menses, with relatives holding her down because that has significance to the ritual as well. of course, the labia will tear apart during intercourse, assuring her husband that she was a virgin, and also causing further pain that would discourage her from adultery. When she gives birth, the opening is again torn, often leading to infection and sometimes death, but if the woman survives, the labia are sewn back together.
Yeah, it’s a little bit different.
SCAM ALERT
The story is a scam. “Misha” and the forced circumcision story come from the novel “Absurdistan.” The Oregon Courts show no records of any such case. And finally, “Doctors Against Circumcision” appears to be two or three people, one a lawyer, one or two doctors, pushing this everywhere. It was pretty thoroughly debunked over at Daily Kos in January. I tried to post more detail, but comments were rejected.
Well, it does beat an ice pick lobotomy… still reeling over this NPR interview from more than a year ago. http://www.npr.org/templates/story/story.php?storyId=5014080
While circumcision is nowhere near the horrible female mutilations which have been recorded it is a form of genital mutilation and most assuredly has an effect on sexual function Why the hell do you think ancient people did it. Especially in light of the danger of infection, why would they cut away at their sons penis if they did not expect some beneficial change to come from it?
Exposing the part of the penis normally protected by the foreskin is deleterious to sexual function, even if it has no effect on reproductive capability.
You could get by with half your lips cut away, but what do you think kissing would be like, with the tissues which normally kept protected areas moist and, well, protected, gone and the inside of your mouth all dried up?
Circumcision is a barbaric and deleterious to the individual. I should know- they did it to me! (and if I ever catch that motherf**king mohel I’ll circumsise him, but good.
While it is clear that this action is motivated by religion (and perhaps by spite), it may be incorrect to call it completely “medically unnecessary”, as there is strong evidence that circumcision can cut the risk of contracting AIDS substantially (by approximately 70%).
Tulse
Wow!!! Only one problem; the link you gave substantiating this piece of fantastic prophylaptic therapy doesn’t seem to work. Could you give it to us again? Please?
The adjective “barbaric” gets thrown around, but I think it is excessive. There are demonstrable medical benefits from circumcision, and the negative impact on the individual’s health (in terms of sexuality) is at best slight
I’m sorry, but the citations for those assertions must have gotten lost in the computer. Could we have them again?
My God! I mean, if we are made in his image and all, who was God’s mohel? Is He a Self-circumciser? Is that what the clouds are made of, God’s foreskin?
So God made us so greviously imperfect we need to cut off part of our son’s penis?
Of course, medical science has advanced to the state of perfect knowledge about every part of our body, so if they say c. is beneficial, or at worst, the foreskin is just an extra, why, off it goes. The thought that maybe we could leave well enough alone must be banished.
Once again: my ancestors were, among other things, very practical people; If they were willing to start hacking away at their son’s whacker, they expected results! Now, take a look at those pratical people and their concerns (Thou shalt not commit adaultery) and ask yourself: ‘What the hell do you think they were looking for when they hacked off a part of the penis? (Yeah, hacked, they may be glat kosher but I’ve never seen a set of sharp cooking knives in a Jewish home, and I’ve saw plenty, before I got excommunicated)
Excision or, worse, infibulation, isn’t practised everywhere, nor am I sure it is only done on preadolescents. ( http://en.wikipedia.org/wiki/Female_circumcision )
Excision or, worse, infibulation, isn’t practised everywhere, nor am I sure it is only done on preadolescents. ( http://en.wikipedia.org/wiki/Female_circumcision )
Odd, the links seem to work for me when I click them. Here are the raw URLs:
The BBC story:
http://news.bbc.co.uk/2/hi/health/background_briefings/aids/434880.stm
Summary of a British Medical Journal article on the mode of protection:
http://findarticles.com/p/articles/mi_m0999/is_7249_320/ai_63089402/print
And yes, given that circumcision seems to protect primarily by toughening the vulnerable skin on the penis, I will grant that there may well be an impact on sexual pleasure for the male from the procedure.
Some high-risk adult women have chosen to do just that for themselves, so your example isn’t that far off. And we routinely vaccinate children for diseases that are now relatively rare and where there are non-negligible risks from the vaccine itself.
Again, I’m not defending circumcision as a religion practice. And even in the case of potential health impacts, there are negatives as well as positives, and it is really only defensible in those environments where there are significant health risks. My only point is that, as rationalists and scientists, we should actually consider all the evidence rather than condemning a practice with emotional arguments.
My anthropologist SO did a major paper on Genital Cutting/Mutilation and one of the interesting this is that the nature of the discourse changes depending on who is doing the cutting, and to whom. (Did I get that who/whom thing right? I can never remember…)
She contrasted and compared “traditional” FGM with non-gendered specific surgeries done as part of “sex reassignment” to babies in the developed world. Many FGM activists are unwilling to accept such comparisons, probably because the FGM discourse pretty much rejects genital surgeries if approved by (Western) doctors.
This, even in the face of sexual reassignment drastically (I can’t remember the number, but it was much larger than one might expect) in favour of male-to-female surgeries because of so-called “micro-penises”. That is, the overwhelming majority of sexual reassignments done were doctor recommended procedures to reassign healthy, genetically male babies to physical females, even though there is little evidence that a baby’s penis that happens to be in some lower percentile of size actually corresponds to gender issues or reproductive problems as an adult. That is, genitals will only become their adult size with the onset of puberty, and there is no correlation between adult genital size and the size at birth.
So, it isn’t just religious situations and proscriptions that set up these cultural issues we hear about. There are indications that, at least in the developed world, established medical practice coupled with a basically unchallenged set of unfounded assumptions by a male-dominated professional class has led to similar unrealistic and unfair situations for many people.
I’m glossing over some of the details, of course (I didn’t write the paper, but I was their for the many revisions!) but I definitely took away from it that when culture intersects with practice the results are not always simple to deconstruct.
For more info (I can’t share the paper, because it is under peer review) you can go to http://isna.org/
You know, the problem with the whole 70% decrease in AIDS infection BS *fails* to consider what problems arise from not having it, as well as, sadly, relying on the same, as near as I can tell, nonsense of, “One study says its good at this, so it must be.”, type argument. Point of fact, other studies done in Europe on the subject show two different outcomes. I.e., one implies that it might help prevent some diseases, while another study found no correlation at all. Worse, still other studies showed an *increase* in childhood bladder infections and other problems, arising from the “lack” of protection that the penis normally has, in stopping things like feces or urine getting back in. One can presume that other additional diseases might represent dangers in situations, for the same reason, in earlier times when clothing wasn’t so prevalent. The irony being that the prevailance of clothing *in* modern society has created other diseases, increased the exposure to some other diseases and even can arguably cause a lot of the social and psychological problems like bolemia and anorexia, as well as other less dangerous, but still abnormal, problems, which are a result of constantly comparing oneself to non-existent ideals, which are created as much by “hiding” most of the body.
The argument for AIDS is that the foreskin traps some of the virus where it has more time to infect someone. The opposite argument can be made for ***any*** other disease that has the urinary track as an entry point. And, its not at all certain, based on one sole study, that the supposed gain is even accurate, or makes up for the added risks from other factors, let alone the other issues it creates.
People are *not* being rational about it. That is the whole problem. And its not just the ones calling it “Barbaric” that are being irrational. Its the, “1,000 people surveyed said that Zinc cures the cold, so it must be true!”, types that are also being irrational. Show me where multiple studies have been done that show the same valid correlation. Then show me if *any* of them might have a bias and what other issues they chose to “ignore” in favor of only looking at that one factor. Then we can have a “rational” discussion about it.
After all, we know damn well that “some” groups constantly publish supposed “studies” on just about everything imaginable, to try to prove that something they are already doing and think other people should be doing is a good thing. And most of those studies are really vague on just how did them, why, when, how, or anything else useful in assessing their validity. They simply want us to believe that video games are bad, AIDS can be prevented by some significant amount by circumcision, etc. One study doesn’t count, especially if no one else can replicate it, other studies show the opposite or no real result, or they can be shown to have intentionally ignored things to make sure it came out the way they wanted it to.
At this point, we have the word of one poster, about a study we can’t read about, since the link is broken, and no suggestion that anyone else has conducted a similar study. For all we know, there may be some situations where “having” a foreskin actually decreases the chances of AIDS too, but that isn’t the conclusion they where looking for.
so… would female circumcision be ok if we only removed the labia? wouldn’t that cut down on “infection” the same way a male circumcision would?
I bet most people still think that’s pretty appalling. Why? because it isn’t part of our culture, which is in a large part formed by our religious experiences. Yet we can come up with all SORTS of reasons to do the same thing to young boys becuase it’s part of our cultural schema.
Yeah, yeah, yeah. I hear this all the time, but there AREN’T any conclusive studies, never have been. This is a Judeo-Christian practice that, like Christmas, has become so widely accepted that we try to divorce it from it’s religious roots in order to excuse the practice.
Whether or not we use a surgical instrument or a stone knife our INTENT, to mutilate the genitals of our young in order to comply with a norm established by religion.
We need to be reconsidering this… or at LEAST be honest about WHY it’s done.
Kagehi, if you Google “AIDS circumcision”, you will find any number of reports on the research I mentioned — it’s not like it’s hidden. And it seems to be a relatively well-supported finding, so much so that three separate studies were stopped early for ethical reasons because the protection offered was so profound and obvious. Both the US National Institute of Health and the World Health Organization recognize circumcision as an effective component in fighting heterosexual transmission. (Just Google “AIDS circumcision NIH” and “AIDS circumcision ‘World Health Organization'” if you doubt me.)
No, from the link I provided, the argument is that there are more Langerhans cells underneath the foreskin, and that these white blood cells are especially prone to infection from HIV. (Google “AIDS circumcision Langerhans” if the link to the British Medical Journal article I provided doesn’t work.)
There may very well be negatives to circumcision, but the evidence seems very solid that, in environments where there is an AIDS pandemic transmitted primarily heterosexually, circumcision offers a profound level of protection.
WHAT?
WHAT?
People, I got sick from reading this thread and had to lie down. Methinks there are even more profound cultural differences across the big pond than the idea that having a gun will protect you from being shot.
~:-|
Tract.
WHAT?
WHAT?
People, I got sick from reading this thread and had to lie down. Methinks there are even more profound cultural differences across the big pond than the idea that having a gun will protect you from being shot.
~:-|
Tract.
I just love how the minute anyone blogs about problems with male circumcision, immediately there are a handful of ‘track-jumpers’ who rush in and try to knock the discussion into FGM. Like talking about male infant genital mutilation precludes opposition to and outrage over FGM.
What frakkin kooks.
Hey, people, I was circumcised at a couple of days old, if that. At age 62, having a senior moment, I hardly can recall it. Not like female genital mutilation at all. I think of it as being streamlined. If you’re not, it’s kinda like your basset hound’s ears flapping in the wind when it sticks its head out the car window. (Is that too icky an image?)
It would be really nice to see the myth supporting circumcision in our country brought to light, tied down, and executed like the piece of nonsense that it is.
If the beliefs promoted which support it (aside from the “I think it looks better”, which just deserves a good smack in the face) were shown to be untrue, which I am pretty certain they are…
hmm.
I’m sorry, but I am just having a hard time feeling violated and mutilated because I don’t have a foreskin. Sex works for me, and feels pretty good. I don’t think my parents were barbaric, either.
@stogoe: Comparing cross-culturally there is some correlation between male and female circumcision. That is, among those cultures where ritual cutting of the genitals was an expression of adulthood (or personhood) extreme forms of female cutting often correspond with extreme forms of male cutting (when cutting does take place for both genders).
I think it’s important to widen the net a little when we talk about this sort of stuff, because it is not at all certain that the discourse leading from Western activism and academia on (say) Africa is not clouded by other issues, such as development and neo-liberalism (in the “World Bank” sense of that word).
The fact is that male circumcision in the West comes from a particular expression of theism invented by pastoralists who were coming into conflict with agrarian cultures in (what is now) Middle East and North and East Africa. It may have been codified as a medical procedure as part of popular and governmental health crazes in the early part of the 20th century, but there are still a fair number of early cultural signifiers that reinforce the practice.
The more extreme forms of genital cutting, most obviously the forms of FGM that have been recently reframed (oops, was I not supposed to use that word?) and politicized still share some of these signifiers.
When viewed as a cultural phenomena, there is no reason to engender genital cutting /any further/. In fact, there is evidence that this actually harms the people that FGM activism intended to help. If anyone is intending to help women in the developing world over FGM, they would do well to pay attention to what they have to say, and think about what their own culture says (either tacitly or not) about genital cutting in general, and what this says about sex, personhood and gender in the specific.
In most places in the US, circumcision is considered part of the standard treatment of neonates that parents must consent to in order to enter the hospital. Although many places have moved towards permitting parents to refuse it, there are many cases where it happens anyway.
It sometimes happens to adults, too. I remember one case of a man who went in for heart surgery, the surgery was cancelled after the prep had been completed, and he woke up without the operation – and sans foreskin. The doctors claimed they had to remove it in order to put in a cathether, which is grossly wrong.
I have an idea for a great application of stem cell technology AND framing: foreskin restoration through tissue engineering. Grow the neo-foreskins in a tissue culture frame.
“Some high-risk adult women have chosen to do just that [have their breasts removed] for themselves, so your example isn’t that far off. And we routinely vaccinate children for diseases that are now relatively rare and where there are non-negligible risks from the vaccine itself.”
The key word in this sentence is “chosen.” No one has a problem with individuals voluntarily choosing to be circumcised.
Several additional points:
1) vaccines are hardly as invasive as elective surgery
2) the diseases prevented by vaccines are fairly serious and are not preventable by any other means
3) If you are in favor of infant circumcision in Africa to reduce the likelihood of HIV infection then logic compels that you be in favor of infant female breast removal for infants with a high risk of developing breast cancer. Somehow I doubt anyone favors such an action.
Except the people from societies in which female breast removal is considered normal, who argue that they’re just fine without breasts.
Tulse, just saying ‘they are not comparable’ does not make it so.
http://www.circumstitions.com/FGM-defended.html
A Nigerian doctor on the FGM Bill:
‘It is not true that every type of genital ritual has the same implication or is practiced consistently across Nigeria or Africa. I am not aware of any Edo woman – for example – who has been properly circumcised whose clitoris or labia was amputated. What is removed is the prepuce – a small piece of the sheath that extends from the clitoris. That sheath has no sexual function. [There is no evidence for this claim.] It is the same sheath that is removed in males. In fact in many cases the “removal” is symbolic – and is part of a traditional marriage ceremony.’
Furthermore, there is absolutely no evidence that maternal and child mortality in Nigeria is increased because of properly performed circumcision. [Confining mortality to “properly performed” FGM defines it out of existence.] I challenge anyone to come out with randomized data that even remotely proves such a cause and effect relationship. [If this hasn’t been studied, it certainly should be.] This is only the latest of a series of frivolous rationalizations that have been offered.
First the Women’s liberation movement in the West said it was a male custom done to “control” women.
Then they discovered that female circumcision was done for women by women to women. [This is a common phenomenon -“slaves come to love their chains.”] Next they said it limited sexual enjoyment – a fundamental right. But it is evident that most women who do not enjoy sex are not even circumcized. There are numerous reasons why a woman may not enjoy sex – including the competence of her male partner. Many post menopausal women suffer such problems. Pessaries widely used for reasons other than circumcision cause plenty of genital damage to women in Nigeria and Africa (including gynaetresia) – but I haven’t seen any legislation to ban use of pessaries. Now maternal and child mortality is being blamed on circumcision. It is just another case of intellectual fraud.’
Arguing that it was done to you & your penis is JUST FINE is not a cogent persuader to someone who’s heard it all already on the other side of the equation.
http://www.fgmnetwork.org/authors/samialdeeb/Mutilate/indexhtml
Try this link by Sami Aldeeb.
There are as well many different kinds of female circumcision:
‘The female circumcision called sunnah or according to the tradition of Mohammed. The religious circles in favour of this type of female circumcision do not always give details on what is done. According to a classical author, Al-Mawardi, “it is limited to cutting off the skin in the shape of a kernel located above the genitalia. One must cut the protruding epidermis without performing a complete ablation” 25. For Doctor Hamid Al-Ghawabi, it is the ablation of the clitoris as well as labia minora 26. According to Doctor Mahran, the hood of the clitoris is excised as well as the most important parts of the labia minora 27.’
African girls die from the ‘horrific, brbaric practice of FGM.’ African boys die during ‘botched circumcisions’.
The history of masturbation in the west is clearly tied to the popularization of secular circumcision- myths that the diminished pleasure would stop boys from the practice of masturbating. This whole ‘but girls are different, they do it to stop pleasure!’- how do you say this with a straight face?
Let’s all stop cutting off the genitals of the unwilling, shall we?
Dave wrote:
That is certainly true, but vaccines carry a non-zero risk to health with them as well. (I don’t have any figures, but I’m willing to bet that more kids in the US die from reactions to vaccines than do from circumcisions.)
You don’t think AIDS is serious? You don’t think that distributing condoms to the whole of the African male population, and getting them to use them, might be fairly impractical? You don’t think that reducing the risk of a fatal disease by 70%, one that in some cases infects over a quarter of a country’s population, is important?
Keep in mind that, with AIDS, we are talking about a communicable disease, so this is not just an issue of individual health, but public health. And if a quarter of the female population (the AIDS infection rate in some countries) could be saved from death by breast amputation, then yes, I think it would be worth at least discussing that. Do you think it would be better to let people die while some less radical alternative is developed?
Susan, as you are clearly far better informed on this matter than I am, I will defer to your expertise on the practice of FGM. And yes, I do understand that the history of male circumcision is freighted with religious and moral overtones. That said, the efficacy of the practice in preventing AIDS is so great that the largest AIDS prevention organizations have endorsed it as a key strategy. I think it would be short-sighted to let past motivations militate against reasoned consideration of possible life-saving procedures.
(Everyone seems to get worked up about naughty bits — if we were talking about snipping off earlobes, I doubt people would care nearly as much. I wonder if that’s isn’t due to a holdover of our Puritan past.)
Tulse, why did people perform circumcisions before they learned about AIDS?
Caledonian, on which site in Washington, DC shall the Foreskin Atrocity Museum be built?
(Don’t get mad; I’m just joshing.)
Caledonian…can you give references to these hospitals which REQUIRE parents to consent to circumcision before admitting the mother to the hospital? In my 20+ years as an OB nurse, I never came across this. Most parents have discussed circumcision and made their decisions long before they come to the hospital. I have never seen a parent coerced into signing that consent. Most docs–peds or obs–hate to do them anyway (and the insurance reimbursement sucks…it’s not a moneymaker). The hospital staff doesn’t give a damn if you want the baby circumcised or not, they’ll teach you how to care for the baby either way, but you do need to sign a consent before the procedure if you do want it done and they need to know if you want to have it done so they can prepare things accordingly.
I’d like to see the documentation of the man circumcised because they couldn’t get a catheter in, too. Except in cases of severe phimosis or meatal stenosis, ANY man is easy to catheterize. To be honest, this sounds like an urban legend.
I don’t mean to put you on the spot, but I am very curious.
You didn’t read very carefully.
You’re also remarkably ignorant for a nurse. Authorization for circumcision used to be part of the general consent forms for women in labor.
Try a Google for Robert Banks.
Caledonian, why does it matter? Yes, circumcision was historically tied to religious ritual — so what? Does that somehow make it less efficacious in fighting AIDS in Africa? Were the WHO and NIH and major AIDS organizations somehow religiously biased when they promoted the practice? Was the Lancet and British Medical Journal lying about the results of studies demonstrating its efficacy? Surely scientists of all people should be able to separate the context of discovery from the context of justification.
And once again, to be really clear: I am not endorsing circumcision as a regular practice. I am not saying that religious or cultural reasons are sufficient to justify it. I am not denying that in the past it has been performed for said reasons. I am not denying that there may be negative impacts to it.
All I am saying is that there is extremely solid evidence, published in medical journals of the highest reputation, that say the procedure drastically reduced AIDS infection from heterosexual contact. That isn’t a religious justification, that is cold hard scientific evidence of a potentially life-saving procedure. All I am asking is whether we can’t offer reasoned, dispassionate consideration of it as an appropriate tool in the fight against a deadly epidemic. This is what is meant by evidence-based medicine.
Put another way, if your infant son had a 25% chance of dying from a disease, and removing an earlobe could cut that risk by 70%, would you balk at doing it? Perhaps you would, but would it be irrational to at least consider it?
No, Tulse. In America, Western Europe, and Canada – why did they do it? Not because of religion, and not because of AIDS.
Why don’t you care why?
I trained under a paediatric surgeon whose take on male circumcision was that it should be discouraged as a routine, but if the parents were really determined for religious reasons (practising Jew/Muslim etc.) then the surgical profession had an obligation to do the procedure with a view to causing the least possible distress and risk of complications for the child.
As for female genital mutilation/clitorectomy, my views are straightforward: anyone found doing, or having done or colluded in, this barbarism should be shot.
Because the history of the practice has absolutely no impact on its efficacy against AIDS infection. That’s the only issue I’ve been addressing, and I still haven’t seen any credible scientific argument against that efficacy. Surely, if we want interventions to mitigate the mortality of a deadly epidemic, all that matters is the evidence for their efficacy, no?
Circumcision has a 100% rate of loss of penile tissue. Why, exactly, does the fact that parents are determined to cause this for religions reasons matter?
But the history of the practice provides a great deal of insight into why people practiced it, and that gives us insight into why people practice it – particularly given that the evidence for effectiveness against HIV infection is so very poor.
Why aren’t the equally-statistically supported increased risks to women being publically discussed? Why are people in First World nations concluding that the intervention which is supposedly of some effectiveness in Third World nations will do the same at home? Why hasn’t the reality that the purported effect even in those Third World nations will diminish the more times the dice are rolled been acknowledged?
When we think critically about the available information, we cannot conclude that circumcision is being advocated for rational reasons. History can give us an idea of what irrational reasons exist.
Circumcisions have been known to go wrong. One infamous case resulted in the necessary “sexual reassignment” of a male infant. He was surgically, umm, repaired, and raised as a girl. But, to make a long story short, his maleness was innate. Ultimately, he rejected the gender identity that was imposed upon him in his first weeks of life, had some kind of prosthesis installed, and married a woman.
I read this years ago in a magazine, I apologize for not remembered the names, dates, or places involved. It really blew my mind when I read it, I was maybe 13 or 14 at the time.
Oh, wait. Google to the rescue.
QUOTE”In most places in the US, circumcision is considered part of the standard treatment of neonates that parents must consent to in order to enter the hospital. Although many places have moved towards permitting parents to refuse it, there are many cases where it happens anyway.”
im the mother of a 27 year old ..when he was a newborn, the doctors never asked me, just presented his circumcision as a fait accompli ..i remember being shocked by the sheer arrogance but being too exhausted to make a fuss
with the second, 6 years later,they asked but i just went along with the program ….i wouldnt have consented to the 2nd if i had had the info i have now …btw this was the same hospital for both kids
Ok, let’s talk AIDS. First of all, there is a study associating FGM with a lower risk of HIV. (I’m too lazy to cite it this late & don’t agree anyway, but it exists, lol).
Second of all, do you know about the practice of dry sex? In certain areas of Africa, wet, sloshy sex is considered not as good as dry, tight, uncomfortable sex (see the above Nigerian doctor’s reference to ‘pessaries’). A bundle of herbs & drying substances is inserted in a woman’s vagina to make it as dry as possible.
We’re all grownups with logical minds, right? What happens with rough, dry sex, my friends? Tears. How does Hiv most easily enter the bloodstream? Tears. Rent flesh. ‘I fucked her raw!’ ‘I was so sore.’
The soi-disant study only had one possible outcome; they were determined to promote universal circumcision. Fiddle the math, folks- it’s not my specialty, but did you see the numbers? The percentages are misleading- maybe one vs two, over a very short period of time (including the time the crcumcised man abstained from sex while healing!) As time went on, the person who initially didn’t catch it statistically would STILL catch it. (Assuming the Langerin in the cells didn’t protect as it has been shown to do; try the study without peripheral herpes & chancres & dry sex, & let’s just see what a normal unscathed penis does in a normal vagina.)
DRY SEX. That’s the ‘secret’ of heterosexual transmission in Africa (besides other factors, of course, like other untreated venereal diseases, possibly immune factors in European populations re: black plague).
What makes more sense: Magic dick-cutting rite warding off Evil Powers, or tears and abrasions from little-known but common sexual practices offering a blood-to-blood transmission route?
You’d think it wouldn’t be that simple- but with the weight of a lot of dick-cutting doctors out there that will do just about ANYTHING but admit cutting dicks is pretty stupid & unreasonably cruel, it’s a blind spot(and screwed up the way a penis is supposed to function besides; yes, most circumcised women manage to ‘function’, too- I still don’t want anyone near my genitals with a scalpel).
I expect the athiest community to be able to look behind the hogwash. Check the facts, Jack. The people who propagate lies are the people who’d rather we didn’t think about it, because logic bears out that routinely cutting people’s genitals is just farking ridiculous. This is one place I don’t want to have to pander to the stupid & unwilling to think. I have high hopes for y’all, lol.
Caledonia, I greatly respect your track record of contribution on this blog, but here you are simply wrong. The evidence for its effectiveness is overwhelming — the NIH, WHO, and CDC all recognize this:
http://www.nih.gov/news/pr/dec2006/niaid-13.htm
http://www.who.int/mediacentre/news/releases/2007/pr10/en/index.html
http://www.cdc.gov/hiv/resources/factsheets/circumcision.htm
Its efficacy is acknowledged by large international agencies that fund AIDS relief, including PEPFAR, and by other major AIDS organizations, such as the AIDS Vaccine Advocacy Coalition:
http://www.pepfar.gov/press/77790.htm
http://www.avac.org/pdf/AVAC_statement_on_Male_Circumcision_13_december.pdf
To deny that circumcision is effective against the spread of AIDS is on par with denying global warming (and the evidence for it is far more straightforward that what exists for climate change, since its effects have been demonstrated in controlled clinical experiments).
If it is irrational to believe research published in the Lancet (multiple articles) and the British Medical Journal, if it is irrational to accept the recommendations of an international panel of experts and stakeholders, if it is irrational to acknowledge the findings of large-scale NIH-sponsored trials, then all hope for evidence-based medicine is lost. The efficacy of circumcision in preventing AIDS transmission is as solid as medical research gets — to deny that is to be truly irrational.
“DRY SEX. That’s the ‘secret’ of heterosexual transmission in Africa (besides other factors, of course, like other untreated venereal diseases, possibly immune factors in European populations re: black plague).”
Yes, the dry vagina preference is probably a big contributing factor.
Another mode of transmission may be local ‘healers’ who give injections with contaminated needles.
However, I’m still pro-circumcision.
The differences are that global warming is happening globally, while the anti-HIV effects have been demonstrated only in dirt poor countries – that warming has been found in study after study, while there are only a few showing effectiveness – that the effects of global warming are projected to be disruptive to catastrophic, while the benefits from circumcision are modest at best.
Before this claim, there was no lack of people making other medical claims about circumcision. Where are those people, Tulse? What about those claims?
They haven’t gone away, they’ve just switched claims.
Caledonian, to address your points in order: a) the CDC link I provided discusses three studies in the US, and all show a numerical advantage for circumcision (in two that advantage was statistically significant); b) it is absurd in the extreme to suggest that dozens of peer-reviewed studies, including three large-scale, internationally sponsored research efforts, are dismissable as “a few” — there are more studies, showing larger effects, than for many other medical interventions practiced routinely; c) the benefits of circumcision reduce risk of contracting a fatal illness that will kill millions by anywhere from half to three-quarters, and it is currently the most effective practical method of intervention — I find it bizarre that anyone could call that “modest”.
I think you are too fixated on the history of this practice. The science is crystal clear. If you don’t think it is, attack the science — the history is irrelevant. (If a proven, tested pharmaceutical agent were derived from an herb used in traditional Chinese medicine, that history should have absolutely no impact on your assessment of its efficacy.)
I’ve always taken one of the major messages of this blog to be that scientific evidence is the final arbiter of truth, and that ideology and cultural history are no excuse to ignore such evidence. This issue seems a perfect opportunity to transcend cultural and ideological blinders and simply evaluate the evidence, which in my view (and in the view of the WHO, and UNAIDS, and the CDC, and the NIH, and PEPFAR, and AVAC, and the Lancet, and the BMJ) is practically unassailable.
Fifteen years ago I spoke with people making the same stupid arguments you are – except that they were wringing their hands over penile cancer.
All the while, of course, there was loads of data from Europe that circumcision (and the lack thereof) had no significant effect on penile cancer.
Do you understand the difference between ‘statistically significant’ and ‘clinically significant’, Tulse? Do you have any idea how important it is to identify how and why a medical result comes into being before implementing treatments to take advantage of it?
When people do a thing despite there being every indication that their justifications are wrong, the justifications were never what they were supposed to be – they’re just excuses for the action which is being taken for entirely different reasons.
Even if we accept that the most extreme claims about HIV are absolutely true, circumcision was ubiquitous in my society long before those claims were ever made, and the presented justifications were obviously and grossly wrong.
Are you willing to acknowledge that there’s a powerful set of psychological forces that induced people to circumcize, Tulse?
I was circumsized as an infant, although I don’t know whether it was because of religious reasons or because of the medical advice du jour. Is there any way to reverse the process? If it actually does reduce sensitivity and there’s no way to reverse it, is there any way I can sue?
No. Nerve endings lost are gone for good.
I wouldn’t hold my breath if I were you.
Yes, Caledonian, I do understand statistical and clinical significance, as I worked for a number of years as a researcher in a large psychiatric research facility after obtaining my PhD, and published a number of papers in peer-reviewed journals while doing so. I don’t mean to be pissy here, but I think my scientific bone fides are pretty damned sound.
And all your points sound reasonable, but completely fail to address the actual evidence. If you believe there is bias in the dozens of studies by multiple research teams from several nations published in various top-notch, peer-reviewed journals, then provide evidence of that bias, demonstrate how it could have impacted the results in these multiple independent findings. That’s how science is done, and that’s how evidence-based medicine is practiced — not by vague impugning of motives or allusions to history, but by addressing the scientific evidence.
As the CDC does, and the WHO, and UNAIDS, and the NIH…
Of course — I’ve explicitly expressed that sentiment, and said I don’t agree with those motivations. I don’t defend circumcision in general, I don’t defend its practice as part of religion, I don’t defend its routine practice in North America. I thought I’d been very clear on that, but if not, I just have.
My only point is that there is solid scientific evidence that, for heterosexual sex, circumcision can greatly reduce the risk of transmission of the HI virus. This evidence is so strong that the largest international organizations involved with AIDS have endorsed it as a primary strategy in reducing infection in Africa. Whatever the sordid history of the practice, whatever objections one might have to why it was done in the past, it seems to me that to attack this strategy one has to address the science to have a credible argument. I’ve yet to see anyone provide any argument that the science itself is questionable, and to me, that is the only relevant issue in this matter.
If we toss out scientific evidence, we might as well take up with the ID folks, or the anti-fluoridation crowd, or the anti-vaccination loonies. In this case, as in those, scientific evidence is all that matters.
Other ScienceBloggers, including razib and Rundkvist, have already discussed the quality of that scientific evidence.
The simple truth is that rationalizations capable of causing people to do a clearly stupid and harmful thing without any good cause while staunchly believing that they’re helping render even reasonable-seeming claims profoundly suspect.
At best, the results suggest that circumcision reduces the chance of males being infected by HIV – in various Third World countries.
A video presentation on the PURPOSE of the foreskin:
http://www.doctorsopposingcircumcision.org/video/prepuce.html
If (((anyone))) can watch this essential educational video and STILL think it’s alright to sexually assault a minor male by permanently mutilating his genitals, then maybe a video of the (((actual))) procedure (not edited by muting the screams of horror and adding in elevator music) would help: http://www.intact.ca/
People used to make very similar claims about penile cancer, Tulse. If you actually read the studies and examined their methodology, the flaws were obvious, and the evidence to the contrary blatant, but no one was interested. People wanted an excuse, and so they ‘found’ one.
It wasn’t so very long ago that doctors would solemnly proclaim the old canards, because doctors aren’t taught to analyze evidence and investigate their methods, merely to use them by rote. Medical researchers, in contrast, do – there’s a reason circumcision fell out of favor in most parts of the civilized world, and there’s a reason it didn’t in the US (mostly because the US is only nominally civilized).
You can’t even repeat the findings of the studies correctly. How can we expect you to look at the studies themselves with an unjaundiced eye?
I was suspicious about that 70% number and looked into it. The original press releases from NIH and WHO do not anywhere inthem contain the number 70%. Instead they rate the effectiveness of circumcision in fighting AIDS in Africa at 48% and 53%. So where does the 70% Tulse reverberates come from? It’s not in the BBC article. The only reference to ‘70%’ in the British Medical Journal article is this:
That seems very different from saying that circumcision is 70% effective in combating aids.
There still seems to be a great deal of debate about what exactly the prophylactic benefits are, if any, to infant circumcision, but the statistics in one study I read about suggested the number of cases of medical benefit are lower than the number of cases of complications from doing the procedure.
Most if not all of the surgeons I trust are reluctant to offer surgery as the first option.
blockquote> At best, the results suggest that circumcision reduces the chance of males being infected by HIV – in various Third World countries.
Honestly, Caledonia, have you actually read what I’ve posted? That is precisely my claim, that it reduces transmission of HIV to males involved in heterosexual sex in areas of high HIV infection. (There are studies which suggest it reduces risk in men who have sex with men in the US, and some studies have also shown that it may reduce the risk of transmission to women, but there are fewer studies supporting those claims.)
I haven’t said that circumcision in general is great and wonderful, that everyone should get circumcised, that circumcision has a respected and loving history. I have explicitly said it is not a practice that I would endorse as a general rule.
So provide the counter evidence in this case, if the evidence is so easily refuted. Address the science, don’t just mutter vague ad hominems and allusions to other, unrelated areas of research.
If I’ve been inaccurate (which is certainly possible), I’d be happy to have you point out the specific error I’ve made.
Because I honestly have no interest in promoting circumcision in general. Because I have done research in clinical domains, and have published in peer-reviewed journals. Because I currently work in an area that involves behavioural epidemiology (although not in infectious diseases). These are all pretty much arguments from authority, which are lousy, but if you won’t engage the actual science, they’re pretty much all we’ve got to talk about.
(Man, people seem to be really working out issues around their naughty bits.)
I am especially contemptuous of people who don’t know what an ad hominem is.
The first link that comes up when one Googles “AIDS circumcision Africa 70%” is:
http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2005/07/06/MNGANDJFVK1.DTL&type=printableL
“The study’s preliminary results, disclosed Tuesday by the Wall Street Journal, showed that circumcision reduced the risk of contracting HIV by 70 percent — a level of protection far better than the 30 percent risk reduction set as a target for an AIDS vaccine.”
(And it should be noted that the lower figures cited of 48% and 53% are still a huge effect with potentially enormous practical impact.)
Honest, it’s really not that hard to find this information. I was no expert before this whole issue popped up here. Google is your friend.
Very well, then, Tulse. Let’s discuss the science.
Tell us about the flaws in the African studies. All studies have weaknesses, limitations, provisos, et cetera. You’re setting yourself up as an unbiased reporter of the findings – so be unbiased.
Sorry Tulse, but Googling to find newspaper articles doesn’t explain why you cite 70% when the institutions doing/sponsoring the research cite completely different values in their press releases. If you have any interest in the science, then ignore the newspapers and address the studies. Under what circumstances were reductions of 48% and 53% found? How do those numbers compare to the effectiveness of condoms? How many condoms can be distributed for the cost of one circumcision? Please note that application of a condom is not permanent, whereas circumcision is. While you’re at it, please address the effect of Catholic missionaries in Africa who do not object to circumcision, but do object to condom use.
You claim to have done scientific research, but all of your cites to date have been to the popular press. Why?
The three controlled trials may be found in the following links. I’m including PubMed abstracts for those who have not registered at the Lancet’s website:
Auvert et al. (abstract)
Bailey et al. (abstract)
Gray et al. (abstract)
Caledonian:
“I think the research conclusions suck, but I don’t want to bother to do the digging that would provide evidence of that, so why don’t you do that for me.” No thanks. I think I’ll trust the scientific process and peer-review system here just as much as I do for other public health strategies and medical interventions that have been vetted in precisely the same way. If you think that there is some extraordinary reason not to trust this process, then be my guest and attack it, but don’t make me do your heavy lifting. This is how science works — if you have an objection, make it. I don’t have time to do your research for you.
Ray S:
The Google reference was in response to the problem you seemed to have of finding any reference to that figure — as I pointed out, it was in the first link that popped up on Google for the appropriate search terms. But given that you looked into this so carefully, I’m surprised you didn’t run across this in the CDC link I previously provided above (where the NIH and WHO links were):
“Three randomized, controlled clinical trails have been undertaken in Africa to determine whether circumcision of adult males will reduce their risk for HIV infection. The study conducted in South Africa [10], was stopped in 2005 and those in Kenya [11] and Uganda [12] were stopped in 2006 after their interim analyses found that medical circumcision reduced male participants’ risk of HIV infection.
“In these studies, men who had been randomly assigned to the circumcision group had a 60% (South Africa), 53% (Kenya), and 51% (Uganda) lower incidence of HIV infection compared to men assigned to the wait list group to be circumcised at the end of the study. In all three studies, a few men who had been assigned to be circumcised did not undergo the procedure, and vice versa. When the data were reanalyzed to account for these deviations, men who had been circumcised had a 76% (South Africa), 60% (Kenya), and 55% (Uganda) reduction in risk of HIV infection compared to those who were not circumcised. “
So I suppose you’re correct that I was wrong about the 70% figure — for the one study, it more properly should be 76%.
I wouldn’t count the CDC, WHO, and NIH links I provided several times to be “popular press”. Your mileage may vary. In any case, the CDC link has a full reference section, so if you want to look up the original papers, be my guest.
And yes, all of your questions about the research are valid ones, and should be asked and addressed. Which is precisely what we can do when we don’t rule out circumcision a priori as a possible intervention. It may very well be that further diligent investigation would reveal that the conclusions are not as solid, or that there are cultural or other biases involved, or that it is not cost-effective. Those are things that can all be discussed, and evidence brought to bear in a scientific fashion, but only if we don’t cut off discussion because of ideology.
Speaking for myself, I’m reasonably convinced that very smart people from various backgrounds who know the science and cultural issues think that this is a good approach and the research is solid, and I’m willing to take their word on it, just as I am willing to take the word of medical researchers that vaccines work and are safe, or the word of climate scientists that their models and measurements really do show climate change, or the word of paleontologists and geneticist that their published papers on evolution really were conducted properly. There are certainly groups of people who doubt the validity of the scientific research on vaccines, climate change, and evolution (among other topics), and who evince that distrust by demanding detailed aspects of that research, or deny that the scientists involved can be at all objective. If some folks want to go down that route on this issue as well, that’s fine, but just look at the company you’re keeping along the way.
And they thought the same, and said the same, for medical arguments which we know now are utterly bunk. The evidence demonstrating that they were utterly bunk was always there – it’s just that people paid no attention to it because it didn’t match the conclusion they wished to reach.
Studying medical errors is kind of a hobby of mine, and the field of medicine is remarkably poor at evaluating the usefulness of its own actions. Furthermore, on this particular subject, it is a simple fact that past claims have been grossly wrong, and so we should be even more skeptical of them that we would be otherwise. It’s intervention that needs to be justified, not the lack thereof – it’s the people who say this is safe, effective, and better than comparable alternatives who need to prove their case, not their critics.
You’re relying on authority, when history shows that authority to have feet of clay in general and feet of sand on this particular issue. That means that you’re either quite gullible, stretching to justify the conclusion that you prefer, or both.
This conversation seems to have gone off the rails.
The issue is the fact that we are cutting body parts off of individuals who cannot consent. Doing so is a very serious violation that can only be justified by a damn good reason.
To my mind, infant circumcision in Africa isn’t justified by even a 70% reduction in likelihood of HIV. This is because the 70% chance only applies until the person is of consentable age (which in this case I would put at age 12…YMMV). Once they can consent, they are free to be circumcised if they wish.
I understand that the consequences could conceivably be significantly more HIV infections. I just think that the sanctity of one’s body is to valuable to give up (without cosnent) even at such a cost.
I distinguish vaccines because they protect a child while it is at an age where it cannot consent. I think that if children were immune from communicable disease until age 12 we would not vaccinate them until they reached that age and if alternatives to vaccination existed we would give that 12 year old a choice of those alternatives.
And I can’t believe anyone would be in favor of removing the breasts of infant girls even if they had a 100% chance of developing breast cancer later in life. Wouldn’t we all leave it up to the individual women once they reach a consentable age?
Why should we treat foreskin differently than breasts?
I think we need to acknowledge that we are all doing a cost/benefit analysis. Absent such analysis, wouldn’t the proper responses to the HIV crisis be to outlaw/regulate sex? Segregate the sexes? Remove peoples sexual organs?
Apologies for the long post. I just though we should discuss whether any % of protection justifies certain acts before we argue about what % of protection the science actually shows.
dave, my impression is that a lot of the people who say that circumcision is justified to avoid AIDS aren’t considering the costs of amputating the prepuce because they think foreskins are “dirty”, unappealing, and have no effect on sexual function for either men or women.
These ideas seem to be common only among Americans, Jews, various groups in Africa, and Muslims. Most other societies have different positions.
Claims of the efficacy of circumcision against AIDS infection? What research are you referencing?
And the researchers have done so in the way that this is always done in science, by conducting research and publishing that research in respected peer-reviewed journals. What more should they have done?
The same words come out of the mouths of creationists every day. If you think the science is wrong on this issue (and you raise some reasons to be skeptical), then argue with the way the science was done, don’t insult people who report the research in the same way that climate change or evolution research gets reported. Otherwise, you’re closing in on tinfoil-hat territory.
And honestly, I really don’t care about the particular conclusion — I’m no fan of circumcision, and before this discussion started here I was only vaguely aware of this research. But looking into it in this fashion has convinced me that, at very least, this strategy is worth researching in far more detail, as it seems to save lives. I really don’t have an investment in circumcision beyond that. Honest.
But… YTF?
Not that I’m very informed about that matter, but I’m not aware of any case of circumcision in Europe not done to a Jew or Muslim. Was it done routinely sometime in the early 20th century, or what? ~:-|
Over here that would cause a revolution, and not just in France.
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The dry sex hypothesis is interesting.
But… YTF?
Not that I’m very informed about that matter, but I’m not aware of any case of circumcision in Europe not done to a Jew or Muslim. Was it done routinely sometime in the early 20th century, or what? ~:-|
Over here that would cause a revolution, and not just in France.
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The dry sex hypothesis is interesting.
My problem here is simply this; a figure is thrown out in post 9. Cites to support it are given in post 28 pointing only to popular media. More popular media support in post 47 followed by a repeat of the figure in posts 63 and 68. Finally in post 77 the cites to actual studies from NIH, CDC and WHO appear. My question of the original figure appears in post 90 (apparently cross posted since I hadn’t yet seen your institutional cites). The 70% figure is again supported in post 93 by appeals now to additional popular media sources. This by someone who claims to have a PHD and work in a science field. Most who start reading this entry will never get this point and take the 70% number as correct when it plainly isn’t.
Now that I’ve briefly looked at the abstracts, I see what troubles me about these studies. For every 100 African men encouraged to undergo circumcision, 2 will still get HIV, whereas 3 who would have contracted the disease will not. There’s your 60% reduction. 95% of the men lost their foreskins for no appreciable benefit.
I am concerned that the interaction with the men in the study was at the initial exam where they either got an immediate circumcision or didn’t, followed by interviews at six month intervals. Any medical doctor can tell you about patients who forget to mention important relevant things during the Q&A period of the exam. I also wonder what benefit was derived just from men abstaining from sexual activity until their wound healed.
I get this nagging feeling that those who find no detriment to circumcision are similar to those who insist the appendix has no function other than to get infected (why not cut it out at birth?) or those who formerly asserted the tonsils provided no benefit (though I’ve lived without mine for quite a while, tonsillectomy is not nearly as common as it once was).
For men past the age of majority, I don’t care which parts of their body they remove or modify, nor do I care what their reasoning is. I do think losing one’s foreskin is a loss. I just hope that men encouraged to take this step are truly fully informed.
Ray S, I pointed you directly to where the study information, including references, could be found for the efficacy figures. I’m not clear why you have a problem with this, or why you still think that the original figure was substantially incorrect.
And yes, there may indeed have been methodological issues with the studies. Isn’t it a much better form of dialogue to talk about those specific scientific issues, rather than yell about circumcision being mutilation?
Tulse, I haven’t yelled. You yourself admit 70% is incorrect in post 97. I’ve not used the m-word in this thread. I haven’t suggested anywhere that the studies are faked or that there cannot be any benefit in the populations studied. I have suggested that men be fully and accurately informed prior to consenting to such a procedure, as it seems to me that 97% of the men do not get a different outcome. I do oppose it being forced on minors and you appear to concur.
This is presently a non-reversible surgical procedure. If a man finds that he is unhappy with the results, what do you then suggest he do? Other non-permanent solutions are available. Shouldn’t we encourage those first?
I have heard anecdotes that some parents still desire that it be done to their children, and some people choose to have it done in adolescence/adulthood – one prominent example that springs to mind is the UK’s Prince William.
Oh, earlier than that – think Victorian era.
Prince William? Interesting. (Or maybe not. The royals already get more attention than is good for them.)
The attitude that the appendix and the tonsils are only there to get infected has been widespread until rather recently. When I was in hospital for middle ear infection, it was suggested to take out my tonsils “while they were at it”; fortunately a doctor recommended against that. — The appendix at least is something similar to a lymph node, it seems; not utterly necessary, but it helps.
Prince William? Interesting. (Or maybe not. The royals already get more attention than is good for them.)
The attitude that the appendix and the tonsils are only there to get infected has been widespread until rather recently. When I was in hospital for middle ear infection, it was suggested to take out my tonsils “while they were at it”; fortunately a doctor recommended against that. — The appendix at least is something similar to a lymph node, it seems; not utterly necessary, but it helps.
This circumcision case just showed up in the news:
http://www.oregonlive.com/oregonian/stories/index.ssf?/base/news/1177644329102660.xml&coll=7&thispage=1
thanks..