Thursday, 22 October 2009

Analysing the analysis of analysis of...

Today, I became aware that Tony at RollingDoughnut.com has published an analysis of my analysis of Intact America's propaganda.

Ok, let me roll up my sleeves and dissect Tony's remarks:
Intact America ran an open letter, as an advertisement, in yesterday's Washington Post urging the American Academy of Pediatrics not to recommend that American parents circumcise their infant sons as a strategy against HIV. [Full disclosure: I attended an event hosted by the organization and interact with some of its representatives because I support its cause.] It's a logical request, based on the necessary combination of science and ethics. A pro-circumcision advocate, Jake Waskett¹,
Tony includes a lengthy footnote at this point, justifying his assumption. I'll omit it, because he's correctly guessed my name. It's a shame that he mischaracterises me as a "pro-circumcision advocate", though (I'm pro-parental choice, not pro-circumcision).
has attempted a deconstruction of the letter, labeling it "propaganda".
"Labelling" seems a curious choice of word, implying that the choice of term is dubious. Propaganda is defined as "The systematic propagation of a doctrine or cause or of information reflecting the views and interests of those advocating such a doctrine or cause." Thus, it seems a perfectly appropriate choice of term for an advertisement created by an anti-circumcision organisation for the explicit purpose of promoting their cause to the AAP.
His support for that charge is preposterous, as any approach advocating the circumcision of healthy infant males must inevitably be, but his critique fails because he ignores the central issue involved. After a brief introduction, complete with an absurd assumption about Intact America's motives, Waskett quotes the opening paragraph:
(Quotation omitted. I think we can regard this as "noise"...)
I agree with this, [ie., IA's opening paragraph] although I'm not a fan of appeals to authority. As should be evident with the apparent intention of the CDC to recommend infant circumcision, it only takes one ill-conceived recommendation to distract from the core issue.
This last sentence is utterly incomprehensible.
Despite my misgivings, Intact America structures the argument correctly because it identifies that core: ethics demand not imposing medically unnecessary surgery on normal, healthy children, regardless of gender or potential benefits.
Tony is, of course, free to subscribe to whatever system of ethics he so chooses. However, to my mind he is setting an extraordinary requirement: that an intervention should not merely be medically beneficial, but must actually be necessary. If applied consistently, such a standard would mean, for example, that vaccinations are unacceptable, since they are rarely necessary.
Waskett assesses this with an odd bit of snark about people inventing fire
Not really "odd". IA are essentially arguing that medical organisations shouldn't recommend circumcision because no medical organisations have done so to date. If you apply the same reasoning to the invention of fire, you see how absurd it is.
before issuing a parenthetical aside suggesting that the national medical bodies of African nations now implementing mass circumcision programs implies approval. Perhaps this is the case, which circles back to my reservation about an appeal to authority. But assuming it is not a point of fact. Still, if he's granted the point, what does this prove about Intact America's ethical argument?
IA offer three reasons why (according to them) it is unethical: unnecessary, potentially risky, and not recommended by major medical organisations. As I point out, the last is an extremely weak argument in the context of what the AAP may recommend. I agree with Tony, to some extent, that it is also an appeal to authority.
The risk of female-to-male HIV transmission through vaginal intercourse is a significant problem in Africa. In America HIV transmission risk through sex overwhelmingly involves male-to-male transmission, from which the (voluntary) circumcision of (adult) males has shown no statistically significant reduction.
Tony's words are somewhat misleading here. There haven't been any controlled trials of voluntary circumcision in MSM yet. The American studies to date have mostly compared previously (and probably neonatally) circumcised men with uncircumcised men. Some studies have shown a statistically significant reduction, but others have not.
Even if this wasn't the case, the ethical issue of applying scientific research to healthy children through surgery centers on infant circumcision, not infant circumcision. That's the point Waskett ignores. His defense:
(Quotation omitted.)
(Apparently in relation to my remark that risks need to be weighed against the benefits) No, these risks need to be weighed against the need, or rather, the lack of need. The ethics of proxy consent require parents to choose a balance between the most effective and least invasive solution to remedy their child's malady. But there is no malady when the boy is healthy.
As Tony correctly observes, the situation we're discussing is not one in which there is an immediately pressing need for therapeutic intervention, hence the "most effective and least invasive" criteria for choosing that intervention do not apply. Instead, the situation involves a healthy child, much as with vaccinations. And as with vaccinations, we weigh the risks (adverse reaction) against the future benefits (reduction of risk of disease). Tony is of course free to apply his own ethical standard, but he should not be surprised that others choose not to follow him.
Setting the ability to chase potential benefits as the ethical standard opens the range of allegedly valid parental interventions to include any number of surgeries we recognize as offensive. The science becomes ungrounded by any concern for the individual child as an individual.
Unfortunately, Tony hasn't identified any of these "surgeries we recognize as offensive" that are valid when benefits and risks are properly weighed. I would be interested to learn of any that he - or anyone else - can think of.
Invoking the topic of vaccinations does not change this evaluation. There are similarities between circumcision and vaccination, based on potential benefits. However, the difference rests on how the problems the interventions are meant to prevent occur. For example, becoming infected with measles requires no effort other than participation in society, while acquiring HIV from an HIV+ female through vaginal intercourse requires a very specific action, an action not undertaken by infants. Comparing the two solutions as comparable for parental consent fails.
This is a nonsensical argument: it is absurd to analyse the issue as though children never grow up. Peter Pan is fiction. Children grow up to become adults, and yes, that includes having sex.
Add to this the fact that parents treat the same maladies circumcision is supposed to prevent with less invasive, non-surgical methods when they affect their daughters, and Waskett's argument misses the ethical case against infant circumcision because he's making the case for circumcision devoid of context and ethics. That's a case that works only if it's a voluntary decision by the adult male himself.
This paragraph makes no sense.
Next, Intact America requests that the AAP defend the ethics against infant circumcision rather than considering a revision in favor of the surgery since science necessarily involves ethics when applied to a person's body, particularly via proxy consent. Waskett calls this request "bizarre," despite having failed thus far to address the ethical argument made by Intact America.
If Tony had been paying attention, he would have noticed that I actually identified the three reasons why IA claimed that circumcision was unethical, and addressed each in turn.
[Regarding my statement that the sums saved in disease prevention are probably comparable to those spend on circumcision] Waskett's claim is based on speculation. Perhaps his analysis is correct, but he does not provide proof for his assumption here. We have statistics from other western nations demonstrating the incidence rates for the diseases to which he refers. Since we can analyze circumcision on these terms, "no doubt" is insufficient
Several studies have been published that have compared the costs of circumcision with that of non-circumcision. For example, Schoen et al. The exact findings have varied a little from study to study, but most have shown that, from a cost point of view, the figures are comparable.

(At this point I'll skip a paragraph, since it basically consists of Tony repeating his claims about what is and is not justified. Since this is clearly his opinion, it seems to require little response from me.)
Waskett seems to think that Intact America ignores the randomized controlled trials showing risk reduction in female-to-male HIV transmission from voluntary adult circumcision. The letter noted this fact in an earlier paragraph. Still, as I read the letter, Intact America is not making an argument about epidemiology. Rather, it is making an argument about populations and risk factors.
As a reminder, here is what IA claim: "Doctors have a responsibility to tell parents the truth: circumcision does not prevent disease. Most European nations, with circumcision rates near zero, have lower HIV/AIDS rates than the United States."

As I read that, the second sentence seems to be presented as evidence for the first. If that is so, IA appear to be saying that the most definitive evidence can be found in between-country comparisons.
The risk factors among America's population are similar to those of European nations, not African nations. Our risk is male-to-male transmission and shared needles during IV drug use.
If Tony is confident in his assertions, perhaps he will volunteer to have heterosexual intercourse with an HIV+ woman. Probably not, I suspect, because of course that's a risk anywhere. The main difference, of course, is that the probability of exposure changes dramatically. Put bluntly, if you sleep with a person then your risk of acquiring HIV depends on the probability that they are HIV+.
Circumcision protects against neither.
I wouldn't personally make such an assertion with any confidence.
Is that complete proof that infant circumcision in America, unlike the randomized trials involving adult volunteers in Africa, is irrelevant to the United States? No, and I don't think Intact America is suggesting otherwise. It is simply working from the central fact,
Correction: opinion.
which is that it is unethical to circumcise healthy infant males - who are not sexually active - to prevent a disease for which most of them will face minimal lifetime risk and for which less invasive, more effective prevention methods exist. Europe is an appropriate anecdotal case study that (infant) circumcision is not necessary to achieve the results health officials desire.
I believe that Tony is going beyond a generous interpretation of IA's words here. IA clearly state that "circumcision does not prevent disease". That's not a statement in the context of ethics. It's in the context of science: it poses a testable hypothesis.
The complications of circumcision affect individuals. Those individual have rights. We recognize this for female minors, legislating against parental proxy consent for medically unnecessary genital surgery on daughters for any reason. The ethical argument against infant male circumcision involves the equal rights concept that the same protection should be applied to males. Waskett hasn't yet made a coherent case for denying these rights to male minors.
It is not meaningful to compare female genital cutting to circumcision. Female genital cutting is a net harm, with no known medical benefits, immediate risks, and a considerable chance of permanent harm. Society passes laws to protect the vulnerable from harm, and so it makes sense to protect children from female genital cutting. But - applying the same principle - it doesn't make sense to legislate against circumcision, because there is no net harm. Most reasonable people, weighing the risks and benefits, come to the conclusion that it is neutral or beneficial.

(Tony's final paragraph omitted, as it is essentially repetition of his arguments.)

28 comments:

consult4 said...

Let's check out the claim that circumcision reduces HIV--that is to see if the prediction is fulfilled in the real world:

Circumcision rates:
Japan <1%
USA 80%
Ethiopia ~100% http://www.circumstitions.com/HIV.html#ethiopia


HIV rates:
Japan 0.1%
USA 0.6%
Ethiopia 4.4%

Protective factor: 1/0.5 =2X

US Vs. Japan:

USA: (80% X 2) + (20 X 1) = (160) + 20) = 180

Japan (1 X 2) + (99 X 1) = (2) + (99) = 101

Protected ratio : 180/101 =1.8 LOWER in the USA.

Reality rates: 6X HIGHER in the USA

descrepancy: 6.0 X 1.8 = 11X = 1100% error
************************************************

Ethiopia Vs. Japan.

circumcision rate:

Ethiopia 100%
Japan 0.4%

HIV rate:

Ethiopia 4.4%
Japan 0.1%


Ethiopia (100 X 2) = 200

Japan (1 X 2) + (99 X 1) = (2) + (99) = 101

Protected ratio : 200/101 = 2X LOWER in Ethiopia

Reality rates: 44X HIGHER in the Ethiopia

descrepancy: 2 X 44 = 88 X = 8800% error

The largest acceptable error in science is 1 sigma = 5%

WHERE is this alleged reduction?

************************************

Those advocating circumcision to reduce the incidence of HIV either ignore this empirical and contradicting evidence, or try to dismiss it with various excuses, like: Intravenous drug usage or homosexual activities.

However, they never provide any hard numbers of these factors for various countries or a model that should include them to explain this discrepancy.

For these excuses to be credible, one would need to assume:

That the US has 11X as many homosexuals than Japan; and Ethiopia has 88X as many as Japan—when it is widely accepted that the rate of homosexuality is 5 –>10 % in all cultures…

OR

That even though people in Ethiopia can barely afford food and shelter, they can afford 88X the recreational drugs than Japan and 8X that of the USA.

consult4 said...

"It is not meaningful to compare female genital cutting to circumcision. Female genital cutting is a net harm, with no known medical benefits, immediate risks, and a considerable chance of permanent harm."

This is merely an OPINION.. MGM has NO proven benefit, and PROVEN harm even thought Jake pretends there is not.

There is permanent loss of erogenous tissue with the loss of the majority of the penile nerves as shown by both Taylor and Sorrels.. so this assertion is patently false and cannot be used to differentiate between MGM & FGM.

Jake said...

I'll respond to consult4, but before I do, I'd like to say this: you and I know each other well, and I've spent an awful lot of time in trying to hold a sensible discussion with you. I've found in general that that time has been wasted, because you have avoided my questions and have simply repeated your words again and again. Please don't let that happen here.

Let's check out the claim that circumcision reduces HIV--that is to see if the prediction is fulfilled in the real world:

What prediction are you talking about? Looking at your method of analysis, you seem to be testing a prediction that national HIV rates depend on circumcision rates and only on circumcision rates. Put another way, you seem to assume that every other risk factor is irrelevant and can be ignored. Can you tell me where on earth you obtained this prediction, because to be frank it seems to contradict everything that is known about HIV risk factors?

Since the problem seems to be that you're testing the wrong prediction, there doesn't seem much point in addressing the detail of your post. I would point out, however, that the "circumstitions.com" page you cite states that the prevalence of circumcision in Ethiopia is 91%, not 100% as you state.

Moving on to your second post:

There is permanent loss of erogenous tissue with the loss of the majority of the penile nerves as shown by both Taylor and Sorrels.. so this assertion is patently false and cannot be used to differentiate between MGM & FGM.

First, a correction: neither Taylor nor Sorrells showed that circumcision resulted in the loss of the majority of the penile nerves.

That tissue is lost, there is no doubt. It may be erogenous, but there's no evidence to establish that. Regardless, whether or not the tissue is erogenous, loss of tissue isn't by itself harmful. It's just loss of tissue. To determine whether that loss of tissue is harmful, beneficial, or neutral, we have to look at the consequences. If circumcision is harmful, then it should be easy to show that there are detrimental, measurable consequences.

consult4 said...

I am testing the inherent prediction in the ASfrican studies that circumcision reduces HIV by 50%.. and that prediction is not fulfilled in the real world--something SCIENCE demands. Empirical evidence trumps questionable evidence.

Now onto the word games--Taylor and Sorrels showed that vast numbers of nerves are lost--along with the sensation and sensitivity those nerves would have supplied..

Now as to erogenous, unless you can supply some other function for these nerves with evidence, they, by default, are erogenous as those alleged by those in the glans are assumed to be erogenous.

You cannot just assume glans nerves are erogenous with no evidence, and then dismiss the foreskin nerves under the same criterion.

Occam's razor still applies.

consult4 said...
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consult4 said...
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Jake said...

To respond to consult4 again:

I am testing the inherent prediction in the ASfrican studies that circumcision reduces HIV by 50%.. and that prediction is not fulfilled in the real world--something SCIENCE demands. Empirical evidence trumps questionable evidence.

Could you please explain where you found a prediction (inherent or otherwise) that circumcision rates are the only factor affecting national HIV rates? It may be reasonable to suggest that there is an implied prediction that circumcision rates affect HIV rates if all other things are equal, but it's quite another matter to suggest, as you seem to be doing, that such a prediction holds regardless of other risk factors.

Now onto the word games--

Please be advised that I expect respectful debate, and I will delete posts that are not civil in tone (as I have done with two of your other posts).

Taylor and Sorrels showed that vast numbers of nerves are lost--along with the sensation and sensitivity those nerves would have supplied..

Incorrect. Sorrells et al. didn't investigate nerves at all: they studied the sensitivity of skin to light touch, not nerves. Taylor established that some nerves are present in the prepuce, but did not attempt to quantify their number. The current evidence does not support the hypothesis that there is a net loss in sensation, and strictly speaking, we don't even know that nerves are lost (unless we can prove that they do not regrow).

Now as to erogenous, unless you can supply some other function for these nerves with evidence, they, by default, are erogenous as those alleged by those in the glans are assumed to be erogenous.

Faulty reasoning. You cannot assume that nerves are erogenous just because of their location. (Indeed, I'm not sure whether a nerve can even be meaningfully erogenous by itself.) The penis as a whole is able to sense a variety of sensations, some of these are erogenous, and some (such as pain) are not, so clearly not every nerve is there to signal erogenous sensation.

consult4 said...

"Could you please explain where you found a prediction (inherent or otherwise) that circumcision rates are the only factor affecting national HIV rates? It may be reasonable to suggest that there is an implied prediction that circumcision rates affect HIV rates if all other things are equal, but it's quite another matter to suggest, as you seem to be doing, that such a prediction holds regardless of other risk factors."

The predicition is that circumcision reduces HIV by 50%. What I have shown is that this alleged reduction of HIV is not found in the real world--it is up to circumcision advocates to explain away this empirical descrepancy with actual numbers and a working model--otherwise we are left with empirical evidence that the theory fails to fulfill its prediction. And fulfillment is the most rigerous test of scientific validity.

"Now onto the word games--

Please be advised that I expect respectful debate, and I will delete posts that are not civil in tone (as I have done with two of your other posts)."

Yes, the way of controlling the content and rebuttals? It is your blog, and if you cannot support your position by logic and science, you are free to delete them.

"Incorrect. Sorrells et al. didn't investigate nerves at all: they studied the sensitivity of skin to light touch, not nerves. Taylor established that some nerves are present in the prepuce, but did not attempt to quantify their number. The current evidence does not support the hypothesis that there is a net loss in sensation, and strictly speaking, we don't even know that nerves are lost (unless we can prove that they do not regrow)."

Yes, but Taylor did show the LOSS of nerves (number lost is irrelevant) --don't forget this. LOGIC determines that lost nerves = lost sensation. Loss of sensation is harm.

Sorry, but the regrowth speculation has to be proven to exist for this speculation to be of any improtance.

"Faulty reasoning. You cannot assume that nerves are erogenous just because of their location. (Indeed, I'm not sure whether a nerve can even be meaningfully erogenous by itself.) The penis as a whole is able to sense a variety of sensations, some of these are erogenous, and some (such as pain) are not, so clearly not every nerve is there to signal erogenous sensation."

Fine, but YOU are dismissing the sensations of the foreskin BECAUSE of the location. Then, WHY do you assume the glans nerves ARE erogenous and the foreskin nerves are not?

Glans erogenous -substantiation by assumption..

Foreskin erogenous -rebuttal by speculation

An interesting double standard?

"I would point out, however, that the "circumstitions.com" page you cite states that the prevalence of circumcision in Ethiopia is 91%, not 100% as you state."

Quibbling over small number differences hardly explains away the empirical discrepancy, does it?

So when can we expect this explanation that contains hard numbers and a working model?

consult4 said...

"What prediction are you talking about? Looking at your method of analysis, you seem to be testing a prediction that national HIV rates depend on circumcision rates and only on circumcision rates. Put another way, you seem to assume that every other risk factor is irrelevant and can be ignored. Can you tell me where on earth you obtained this prediction, because to be frank it seems to contradict everything that is known about HIV risk factors?"

No, I am only pointing out a descrepancy between prediction and reality..

IF there are other risk factors that are involved in this descrepancy, please quantify them and use them in a working model to expalin away this empirical descrepancy.

SCIENCE requires fulfillment of prediction..not some vague excuse of some other unknown and speculative factors.

"That tissue is lost, there is no doubt. It may be erogenous, but there's no evidence to establish that. Regardless, whether or not the tissue is erogenous, loss of tissue isn't by itself harmful. It's just loss of tissue. To determine whether that loss of tissue is harmful, beneficial, or neutral, we have to look at the consequences. If circumcision is harmful, then it should be easy to show that there are detrimental, measurable consequences."

Loss of nerves IN this tissue means loss of sensation--unless you can prove otherwise--so there is inherent harm. This is using logic, quantity of loss is irrelevant.

Just as there is no evidence that the glans is erogenous--just that it is tissue?

Jake said...

The predicition is that circumcision reduces HIV by 50%.

Please be more specific. Is the prediction that circumcision is the only thing affecting HIV? Or is the prediction that HIV is affected by circumcision and other factors?

Yes, the way of controlling the content and rebuttals? It is your blog, and if you cannot support your position by logic and science, you are free to delete them.

As I stated, I expect I respectful, civil debate. That's very easy to do. If you choose not to, your posts get deleted. It's up to you.

"Incorrect. Sorrells et al. didn't investigate nerves at all: they studied the sensitivity of skin to light touch, not nerves. Taylor established that some nerves are present in the prepuce, but did not attempt to quantify their number. The current evidence does not support the hypothesis that there is a net loss in sensation, and strictly speaking, we don't even know that nerves are lost (unless we can prove that they do not regrow)."

Yes, but Taylor did show the LOSS of nerves (number lost is irrelevant) --don't forget this.


Not quite, as noted above.

LOGIC determines that lost nerves = lost sensation. Loss of sensation is harm.

No, the effect on sensation cannot be deduced from the fact that nerves are severed, because that is an oversimplification. |If you could prove that nerves do not regenerate, and if you could prove that no other effect of circumcision increases sensation, it might be possible to make such a deduction, but that isn't the case.

Fine, but YOU are dismissing the sensations of the foreskin BECAUSE of the location. Then, WHY do you assume the glans nerves ARE erogenous and the foreskin nerves are not?

I haven't claimed that the nerves of the glans are erogenous. I've simply questioned the assertion that those in the foreskin are.

Ron said...

Foreskin feels REALLY good. I don't know or care what motivates Jake to pretend this is not true.

Circumcumsion removes immensely valuable pleasure-receptive tissue.

Jake said...

To reply to Ron:

Foreskin feels REALLY good. I don't know or care what motivates Jake to pretend this is not true.

Circumcumsion removes immensely valuable pleasure-receptive tissue.


Then prove it.

If what you say is true, then studies of adult circumcision patients should consistently reveal reduced sensation and lower sexual satisfaction levels following circumcision.

But they don't. And when evidence contradicts a hypothesis, it often indicates that the hypothesis needs to be rethought.

consult4 said...

"Please be more specific. Is the prediction that circumcision is the only thing affecting HIV? Or is the prediction that HIV is affected by circumcision and other factors?"

Again, the predicition is tthat circumcision reduces HIV by 50%--this is not seen, so until and unless you can explain this descrepency, the theory is invalid--and if the real world numbers contradict this assertion, then YOU must supply numbers to explain away this descreancy.

"Yes, but Taylor did show the LOSS of nerves (number lost is irrelevant) --don't forget this.

Not quite, as noted above."
No, above you ignored the anatomical study by Taylor

LOGIC determines that lost nerves = lost sensation. Loss of sensation is harm.

"No, the effect on sensation cannot be deduced from the fact that nerves are severed, because that is an oversimplification. |If you could prove that nerves do not regenerate, and if you could prove that no other effect of circumcision increases sensation, it might be possible to make such a deduction, but that isn't the case."

IF you are trying to use this idle speculation of nerves regrowing, then YOU must prove that they DO--speculation is not a rebuttal. I don't have to disprove any specualtion you might dream up.

"Fine, but YOU are dismissing the sensations of the foreskin BECAUSE of the location. Then, WHY do you assume the glans nerves ARE erogenous and the foreskin nerves are not?

I haven't claimed that the nerves of the glans are erogenous. I've simply questioned the assertion that those in the foreskin are."

Great, then I can question that all nerves of the penis might not be erogenous--hence one can simply say that amputating the whole penis has no permanent effect..

consult4 said...
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consult4 said...

"I would point out, however, that the "circumstitions.com" page you cite states that the prevalence of circumcision in Ethiopia is 91%, not 100% as you state."

I used the 100% number from THIS on the site:

"
...circ of boys is more or less universal - including among the Coptic Christians. They do the circ early - usually at one to a few weeks of age. The same applies to the girls - most of them were circ at 1 week of age - which is different from customs in other parts of Africa where it is made much later. When I worked in Addis Ababa as a pediatrician we had a lot of complications with both these types including many deaths from bleeding and infection - and occasionally amputation of the penis.

- Yngve Hofvander, Professor Emeritus
in International Child Health
at Uppsala University,
personal communication

However, IF we use the 91% you found elsewhere on the site, the numbers for Ethiopia would only reduce the discrepancy by 9% and still needs to be accounted for..

Interestingly, the 91% you found was in a table that showed quite a few African countries ALSO had the HIV rates higher among circumcised men than intact men--leaving you with yet another discrepancy or failure to fulfill prediction that you need to account for..

When can we expect you to account for BOTH discrepancies?

consult4 said...

"But they don't. And when evidence contradicts a hypothesis, it often indicates that the hypothesis needs to be rethought."

AHEM!! like in the circumcision/HIV reduction hypothesis!! :)

Jake said...

"Please be more specific. Is the prediction that circumcision is the only thing affecting HIV? Or is the prediction that HIV is affected by circumcision and other factors?"

Again, the predicition is tthat circumcision reduces HIV by 50%--this is not seen, so until and unless you can explain this descrepency, the theory is invalid--and if the real world numbers contradict this assertion, then YOU must supply numbers to explain away this descreancy.


Please answer my question.

IF you are trying to use this idle speculation of nerves regrowing, then YOU must prove that they DO--speculation is not a rebuttal. I don't have to disprove any specualtion you might dream up.

It was Xin et al., I believe, who originally suggested that nerve endings regrow. They made this suggestion, as I recall, as a result of noting that the predicted reduction in sensitivity was not observed in practice. Neither you, I, nor anybody else have any obligation to prove or disprove it, but in the absence of proof it seems rather foolish to make assertions that depend on regrowth not occurring.

I used the 100% number from THIS on the site:

Okay, fine. That wasn't clear.

Interestingly, the 91% you found was in a table that showed quite a few African countries ALSO had the HIV rates higher among circumcised men than intact men--leaving you with yet another discrepancy or failure to fulfill prediction that you need to account for..

Yes, there are probably others, too. Given the inherent unreliability of observational studies, it would be unrealistic to expect the correct results every time. So it should not be surprising that a certain fraction of observational studies yield results that are inconsistent with more reliable evidence.

consult4 said...

"Moderation" now? The ultimate argument--censorship?

Looks like I have to spread the word on your actions elsewhere. People should know HOW you choose to debate.

consult4 said...

What happened to this post?..:)

"Please answer my question."

Better yet, please provide evidence to account for the empirical discrepancy.

"It was Xin et al., I believe, who originally suggested that nerve endings regrow. They made this suggestion, as I recall, as a result of noting that the predicted reduction in sensitivity was not observed in practice. Neither you, I, nor anybody else have any obligation to prove or disprove it, but in the absence of proof it seems rather foolish to make assertions that depend on regrowth not occurring."

Until there is evidence to show regrowth, it remains nothing but idle speculation--whether or not it is your speculation or someone else's. I am making no assertion other than it is idle speculation--it is YOU that is trying to assert something might exist without any evidence to support it. Speculation is not substantiation nor is it a rebuttal...it is what we call a non-starter. It is foolish to assume that idle speculation is substantiation or rebuttal in the absense of any actual objective evidence.

Sorrels, did show that there was no sensitivity in the missing foreskin..so here does that leave Xin's speculation?

"Yes, there are probably others, too. Given the inherent unreliability of observational studies, it would be unrealistic to expect the correct results every time. So it should not be surprising that a certain fraction of observational studies yield results that are inconsistent with more reliable evidence."

But we still have the scientific requirement that a hypothesis always fulfill it requirement--and from the empirical evidence it is not fulfilled--and further, all the vague excuses you are providing do not show HOW it is fulfilled.

IF you claim that the numbers are unreliable--then please provide reliable ones to explain the observed discrepancy.

So science and myself are still awaiting the hard numbers and a working model to account for this failure.

Jake said...

Yes, I've enabled moderation for comments on this blog. At the same time, I've also enabled anonymous comments.

I don't like having to enable moderation, but unfortunately it seems like the best approach. As I said in my initial reply to you (dated 22 October 2009 17:21), I've spent an awful lot of time in the past in trying to hold a discussion with you, but that time has been wasted since you have evaded my questions. You've already started to do that in this thread, too. I'm not prepared to have another so-called discussion with you in which I spend 20-30 posts trying to get you to answer a simple question. Nor am I prepared to endure post after post of low-grade rudeness.

Everybody, including you, is free to comment on this blog, but I expect such comments to follow the normal conventions of civil discussion. That includes being polite and using a respectful tone, answering questions, and avoiding excessive repetition. It's not much to ask, and I hold myself to the same standard.

Jake said...

What happened to this post?..:)

I had planned to reject it. However, at the time you posted this, you didn't know that I had enabled moderation. I've therefore made an exception this time.

"Please answer my question."

Better yet, please provide evidence to account for the empirical discrepancy.


Evasiveness does not facilitate discussion. If you wish to continue discussing this issue, please answer the question.

Until there is evidence to show regrowth, it remains nothing but idle speculation--whether or not it is your speculation or someone else's. I am making no assertion other than it is idle speculation

Actually, you have made such an assertion. It was this: "LOGIC determines that lost nerves = lost sensation." As I pointed out, that statement is only true if certain assumptions are made.

Sorrels, did show that there was no sensitivity in the missing foreskin..so here does that leave Xin's speculation?

That doesn't make any sense - Sorrells didn't test the sensitivity of the missing foreskin, so how could they show such a thing. Do you mean "show that there was sensitivity in the foreskin"?

consult4 said...

"That doesn't make any sense - Sorrells didn't test the sensitivity of the missing foreskin, so how could they show such a thing. Do you mean "show that there was sensitivity in the foreskin"?"

Sorrels did test the sensitivity of the foreskin and compared it to the total lack of sensitivity of it in circumcised men..and found the difference to be infinite.

THIS does make OBVIOUS sense!

Sensitivity in the foreskin vs no sensitivity in the missing foreskin.

I wonder if this post will be allowed?

Ron said...

Foreskin feels REALLY good. -Ron

Then prove it.

studies of adult circumcision patients should consistently reveal reduced sensation and lower sexual satisfaction levels following circumcision. -Jake

- - - - -
What studies? You're asking for a broad unbiased sampling of men who were healthy and normal and then were forced to have a body part amputated so we could ask them if it made sex better? No such inhumane study could ever be done.

In places where nobody is trying to justify barbaric mutilation of minors, nobody thinks about such "studies." It is taken as self-evident that when you amputate a sense organ the sense is degraded. There are no studies about how much better people see before their eyes are accidentally gouged out, or how much better they were able to read Braille before they lost their hands to a punch press.

The closest I can think of would be Kim and Pang 2006, but the subjects weren't healthy normal males. They had medical problems which circumcision was proposed to remedy. As such, you might expect them all to find relief from symptoms and report improved penile function and sexual satisfaction. Most reported no significant change. Of the remainder who cited a difference, three-fourths said sex got worse and only a fourth said sex got better after circumcision.

Regardless of what evidence it would take to satisfy you that foreskin feels good, it is irrelevant to the question of circumcising minors. If even one man in ten would answer the question "Does your foreskin feel really good?" in the affirmative, then circumcision can be said to irreversibly damage some men. Absent an emergency, there is no threat to the minor that legitimizes proxy consent to a cosmetic amputation. He can make a rational informed choice when it becomes relevant to him.

Jake said...

To reply to Ron:

What studies? You're asking for a broad unbiased sampling of men who were healthy and normal and then were forced to have a body part amputated so we could ask them if it made sex better? No such inhumane study could ever be done.

Actually, I can't think of any reason why participants should be forced to be circumcised, and that might introduce unnecessary bias. Voluntary adult circumcision seems more than sufficient.

The closest I can think of would be Kim and Pang 2006, but the subjects weren't healthy normal males. They had medical problems which circumcision was proposed to remedy. As such, you might expect them all to find relief from symptoms and report improved penile function and sexual satisfaction.

I disagree. It seems unlikely that every medical condition for which circumcision is indicated would adversely affect sexual satisfaction: a medical problem involving the penis is not necessarily a sexual problem. So it would not seem reasonable to expect improvement in every case on that basis alone.

Also, if the consequences of removal of the foreskin were all that terrible, one might reasonably expect to see evidence of this whether or not medical conditions were present beforehand.

Most reported no significant change. Of the remainder who cited a difference, three-fourths said sex got worse and only a fourth said sex got better after circumcision.

Kim and Pang's study was rather unusual in this regard. Masood et al., for example, found improved satisfaction in 61% of subjects, worsened satisfaction in 17%, and no change in 22%. These again were cases in which circumcision was medically indicated. If you want studies of volunteers, you could take a look at Krieger et al. or Kigozi et al..

Hugh7 said...

"If what you say is true, then studies of adult circumcision patients should consistently reveal reduced sensation and lower sexual satisfaction levels following circumcision.

But they don't."

They would have to random samples of healthy men, not volunteers for circumcision (who would be predisposed to find benefit), nor men who needed to be circumcised for some medical condition that impacted on their sexual satsifaction and sensation.

So far as I know, no such studies have been done, and outside a totalitarian state, it is hard to see how they could be.

Jake said...

To respond to Hugh7:

They [ie., studies] would have to [be] random samples of healthy men, not volunteers for circumcision (who would be predisposed to find benefit), nor men who needed to be circumcised for some medical condition that impacted on their sexual satsifaction and sensation.

I disagree, for several reasons.

First, I disagree that volunteers for circumcision would be predisposed to find sexual benefit from it. That might make sense if there were an expectation of sexual benefit beforehand. But if, for example, someone volunteers to be circumcised in hopes of reducing his risk of HIV, then why should he expect sexual benefit?

Second, your implication is that any medical condition that is an indication for circumcision will necessarily affect sexual sensation and/or satisfaction. While that may well be the case for some conditions to some extent, I don't think it's likely to be true of all.

Third, if what Ron says is true (in other words, if the foreskin makes a substantial contribution to sexual pleasure) then this ought to be apparent in studies whether or not some or all of these studies have a bias in favour of benefit. Put another way, saying that the results of these studies can be attributed to biases is equivalent to saying that the contribution of the foreskin is fairly small, sufficiently so that relatively minor biases like these can compensate for its loss. And that itself contradicts Ron's argument.

Finally, as an aside, I have a question for you. Do you honestly believe that the difference betweeen a circumcised man having an awful sex life and having an enjoyable one can be nothing more than expectation? And if so, how can you justify spending so much time on the Internet telling circumcised men that circumcision has damaged them? How can it be ethical to act in a way that, you believe, is damaging to others?

consult4 said...

"If what you say is true, then studies of adult circumcision patients should consistently reveal reduced sensation and lower sexual satisfaction levels following circumcision.
But they don't."

If the studies on HIV and circumcision are true, then the rates of HIV in circumcising countries should consistently be lower than in intact countries, but they are not.

Tony said...

My response is here.