Sunday 25 September 2011

Rebuttal to part 4...

Darcia Narvaez has posted part 4 of Cannon's series of articles about circumcision. Let's dive in.

No medical association in the world recommends routine infant circumcision. None.


Technically true, but routine infant circumcision means, literally, circumcision of all newborn boys. Consider what would justify such a recommendation: there would have to be an enormous net benefit to warrant taking such a decision out of the hands of parents.

In practice, most medical associations agree that the matter is suitable for parental choice.

Medicaid spends $198 million each year on routine infant circumcision in the 33 states that still pay for it, a procedure its own guidelines consider to be medically unnecessary. Private insurance programs are reimbursing an additional $677 million, raising prices for us all (Craig 2006.)


Actually, a CDC study was published in 2010 that found that "Newborn circumcision was a cost-saving HIV prevention intervention for all, black and Hispanic males". And that study considered only one benefit. If other benefits were to be considered as well, it would obviously be more cost-saving still.

Doctors have an ethical duty to treat the patient by the most conservative means possible, but removing healthy tissue in the absence of any medical need absolutely harms the patient.


By what logic? Cannon seems to think that asserting this claim is enough, but it isn't. Removal of tissue isn't inherently harmful; nor is it inherently beneficial. It can be either; to determine which the only rational approach is to look at the consequences.

Everyone has a right to bodily autonomy and self-determination. This is a fundamental tenet of international human rights law (UNESCO 2005).


Then it needs to be determined whether circumcision represents a significant violation. Human rights are not absolute, and are not intended to be read as such. Free expression, for example, does not give a person the right to libel another. Applying common sense, could it apply to something as trivial as a foreskin? It deems doubtful.

Parents' aesthetic preferences are not valid reasons for circumcision.


This statement makes sense only if one considers circumcision to be a bad thing that requires a lot of justification. But, since it is widely accepted that circumcision is harmless at worst and beneficial at best, that position seems unsupportable. Would it make sense to demand a valid reason for feeding a child a healthy diet?

If you have never had a foreskin, you cannot possibly know what having one would feel like. You only know what it feels like to not have a foreskin. You cannot know now how your son will feel in 20 or 30 years. If you have your son circumcised, he may grow up to regret the decision you made for him, but circumcision is irreversible. (Yes, men can partially restore their foreskins, but it is difficult and the sensitive nerve endings are gone forever.)


Conversely, if you don't have him circumcised, he might regret that, too. And adult circumcision is much riskier, requires a long period of abstinence, and results in inferior cosmetic results. There's no way to guarantee that he won't resent the decision, unfortunately.

Parents have a duty to educate themselves on circumcision rather than do it just because it was done to them.

For clear, easy and plain-language help making the circumcision decision, try the Circumcision Decision Maker at http://circumcisiondecisionmaker.com/.


That website recommends non-circumcision in virtually every case (the exception, as I recall, being for Orthodox Jews). If you've already decided not to circumcise and want an excuse, use it. Otherwise, it's not recommended.

Slavery and child labor were traditions sanctioned by religions and other authorities. But we abandoned those practices because they were unjust and harmful. Infant circumcision, similarly supported by authorities, should be abandoned by the people who care for children because it is unjust and harmful.


Except, of course, that it is neither unjust nor harmful. Asserting otherwise doesn't change the facts.

You were circumcised because your dad was circumcised because everyone else was circumcised because 140 years ago, some perverted doctors wanted to stop boys from masturbating.


Probably not, but I'm sure this is impressive propaganda.

Being circumcised isn't better, and it isn't popular anymore. The 70% of the world's men who have foreskins almost never choose to have them cut off and consider them to be the best part of the penis.


According to what research?

Circumcision is ending with the generation being born now - only 32% of babies born in 2009 in the USA were circumcised.


Actually, CDC data suggest that the figure is about 55%, and they caution that this is an underestimate. And, of course, rates vary greatly across the country.

22 comments:

Anonymous said...

1. Jake admits it is "tehnically" true that "No national medical association in the world recommends infant male circumcision," but then he changes the subject with a play of words by saying: "but routine infant circumcision means, literally, circumcision of all newborn boys. Consider what would justify such a recommendation: there would have to be an enormous net benefit to warrant taking such a decision out of the hands of parents." Of course this is a red herring. Obviously, "routine" in this instance isn't meant to mean "without parental consent," but "without a specific medical reason." No national medical association recommends circumcising baby males absent such a condition. The British medical association clarified the term "routine" by saying: "routine infant male circumcision, i.e. routine removal of normal tissue in a healthy infant, is not recommended." The context was not about parental consent. It was about whether it is medically justified. Specifically, the report said: "Infant male circumcision was once considered a preventive health measure and was therefore adopted extensively in Western countries. Current understanding of the benefits, risks and potential harm of this procedure, however, no longer supports this practice for prophylactic health benefit. Routine infant male circumcision performed on a healthy infant is now considered a non‐therapeutic and medically unnecessary intervention. . . . Circumcision removes the prepuce that covers and protects the head or the glans of the penis. The prepuce is composed of an outer skin and an inner mucosa that is rich in specialized sensory nerve endings and erogenous tissue. Circumcision is painful, and puts the patient at risk for complications ranging from minor, as in mild local infections, to more serious such as injury to the penis, meatal stenosis, urinary retention, urinary tract infection and, rarely, even haemorrhage leading to death. The benefits of infant male circumcision that have been promoted over time include the prevention of urinary tract infections and sexually transmitted diseases, and the reduction in risk of penile and cervical cancer. Current consensus of medical opinion, including that of the Canadian and American Paediatric Societies and the American Urological Society, is that there is insufficient evidence that these benefits outweigh the potential risks. That is, routine infant male circumcision, i.e. routine removal of normal tissue in a healthy infant, is not recommended."
www.cpsbc.ca/files/u6/Circumcision-Infant-Male.pdf

And the Dutch medical association said: "There is no convincing evidence that circumcision is useful or necessary in terms of prevention or hygiene."
www.norm-uk.org/news.html?action=showitem&item=1306

Obviously, by "routine" they're talking about circumcision without a medical reason.

Anonymous said...

2. CDC study: Jake refers to a CDC study that looked at the 3 African studies regarding HIV. Jake doesn't mention that the study was based on an *assumption*, that is, the study "assumed 60% efficacy of circumcision in reducing heterosexually-acquired HIV over a lifetime," and the study then stated "More data on the long-term protective effect of circumcision on heterosexual males as well as on its efficacy in preventing HIV among MSM would be useful." It does not *conclude* that circumcision is a cost-saver other than based on that assumption, for which it admits more data is needed. And the assumption is based on the 3 African studies that are contradicted by others. For example:

www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e4/html_9

This recent study found no association between circumcision in Kenya and HIV rates. www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0015552?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+plosone%2FPLoSONE+%28PLoS+ONE+Alerts%3A+New+Articles%29

USAID found in 2009 that in 10 of 18 countries with data available, circumcised men were more likely to have HIV than their intact counterparts. www.measuredhs.com/pubs/pdf/CR22/CR22.pdf

The South African Medical Association called infant male circumcision unethical and expressed "serious concern that not enough scientifically-based evidence was available to confirm that circumcisions prevented HIV contraction and that the public at large was influenced by incorrect and misrepresented information. The committee reiterated its view that it did not support circumcision to prevent HIV transmission." www.icgi.org/Downloads/SAMA-NOCIRC-2011-06-25.pdf

Renowed Jewish physician Dr. Dean Edell called the African/HIV conclusions "silly" and warned, "it will backfire." www.youtube.com/watch?v=OlsUg0sdAtE

Anonymous said...

Jake repeatedly says circumcision is not harmful, and even asks, "By what logic?" such a claim is based. He says, "Removal of tissue isn't inherently harmful." Of course, he is again ignoring the national medical associations. The British Columbia College of Physicians and Surgeons' 9/09 report declared: "Circumcision is painful, and puts the patient at risk for complications ranging from minor, as in mild local infections, to more serious such as injury to the penis, meatal stenosis, urinary retention, urinary tract infection and, rarely, even haemorrhage leading to death."
www.cpsbc.ca/files/u6/Circumcision-Infant-Male.pdf

The Royal Australasian College of Physicians report, backed by numerous other medical associations in Australia and New Zealand, stated: "Review of the literature in relation to risks and benefits shows there is no evidence of benefit outweighing harm for circumcision as a routine procedure." www.nocirc.org/position/racp2002.php

The Dutch Medical Association's May 2010 report, backed by 7 other national medical associations, concluded: "Contrary to what is often thought, circumcision entails the risk of medical or psychological complications." www.norm-uk.org/news.html?action=showitem&item=1306

I believe the national medical associations. They represent large associations of medical experts. When none of them recommend infant circumcision and more than ten say it is not medically justified and it's harmful, I think that's pretty credible.

Jake says: "Conversely, if you don't have him circumcised, he might regret that, too. And adult circumcision is much riskier, requires a long period of abstinence, and results in inferior cosmetic results. There's no way to guarantee that he won't resent the decision, unfortunately."

I see more and more men complaining online and in more and more groups about having been mutilated as babies (e.g., see "Men Do Complain," the websites for foreskin restoration, etc.), and I see taht number increasing as awareness increases (the U.S.has not covered covered the issue accurately, so it's taking time. I don't see websites proliferating with men resentful about not being circumcised, mainly because if they want to they can do it. Men in South Korea are often circumcised as adults out of tradition, and that's their right as adults, even though a study found half of them said they lost significant erogenous pleasure. http://onlinelibrary.wiley.com/doi/10.1046/j.1464-410X.1996.85023.x/abstract

Jake said...

"Obviously, "routine" in this instance isn't meant to mean "without parental consent," but "without a specific medical reason."" -- not quite, no. It means "of all newborn boys". Compare the AAP's policy statement:

Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision.

With what they say in their "Information for Parents":

Scientific studies show some medical ­benefits of circumcision. How­ever, these benefits are not sufficient for the American Academy of Pediatrics (AAP) to ­recommend that all infant boys be circumcised.

"The British medical association clarified the term "routine" by saying: "routine infant male circumcision, i.e. routine removal of normal tissue in a healthy infant, is not recommended."" -- that doesn't clarify it at all. The word "routine" is used in an explanation of a phrase using the word "routine". Incidentally, you've misattributed that quote to the BMA.

"And the Dutch medical association said: "There is no convincing evidence that circumcision is useful or necessary in terms of prevention or hygiene." Obviously, by "routine" they're talking about circumcision without a medical reason." -- the sentence you quote doesn't even refer to "routine".

"And the assumption is based on the 3 African studies that are contradicted by others." -- these 3 studies are actually the highest quality studies available.

"www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e4/html_9" -- a work of fiction. See rebuttal here

"USAID found in 2009 that in 10 of 18 countries with data available, circumcised men were more likely to have HIV than their intact counterparts. www.measuredhs.com/pubs/pdf/CR22/CR22.pdf" -- yes, observational studies like these are susceptible to confounding, which is why they're considered much less reliable than randomised controlled trials. Nevertheless, about 3/4 of observational studies - and more of the higher-quality ones - have found evidence of a protective effect.

I'll skip the opinions, since they're worthless as evidence.

More in part 2 of my reply.

Jake said...

"He says, "Removal of tissue isn't inherently harmful." Of course, he is again ignoring the national medical associations. The British Columbia College of Physicians and Surgeons' 9/09 report declared: "Circumcision is painful, and puts the patient at risk for complications ranging from minor, as in mild local infections, to more serious such as injury to the penis, meatal stenosis, urinary retention, urinary tract infection and, rarely, even haemorrhage leading to death."
www.cpsbc.ca/files/u6/Circumcision-Infant-Male.pdf"

It's not clear to me why you quote this passage. Does anyone claim that circumcision never causes complications? I don't think so. It can do, on occasion, but that doesn't make it a net harm.

"The Royal Australasian College of Physicians report, backed by numerous other medical associations in Australia and New Zealand, stated: "Review of the literature in relation to risks and benefits shows there is no evidence of benefit outweighing harm for circumcision as a routine procedure." www.nocirc.org/position/racp2002.php" -- that's an outdated policy. Here is their current position.

"I see more and more men complaining online and in more and more groups about having been mutilated as babies (e.g., see "Men Do Complain,"" -- you realise that's a propaganda site created for the purpose of making it seem that way, don't you?

aunursa said...

Jake, per the RACP link: I'm glad to see that a medical association has acknowledged a point that I've previously noted:

"Parents and doctors have to decide the basis of their own evaluations of benefits and burdens, being aware that they are making predictions and that nothing is guaranteed. A boy circumcised as an infant may deeply resent this when he grows older; he may want what he cannot have – not to have been circumcised. But it is also possible that a boy not circumcised as an infant (so that he can make his own decision later), may also deeply resent this. He may also want what he cannot now have – to have been circumcised as a baby.

Anonymous said...

I have to post in parts b/c it's too long to post.

Jake said: "not quite, no. It means "of all newborn boys". Compare the AAP's policy statement:
"Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision." With what they say in their "Information for Parents":
"Scientific studies show some medical ­benefits of circumcision. How­ever, these benefits are not sufficient for the American Academy of Pediatrics (AAP) to ­recommend that all infant boys be circumcised."

Marc's Reply: The author said no national medical associations recommends routine infant male circumcision. You responded that this is technically true but only because "routine" means without parental consent (in other words, you're saying it's only because the national medical associations don't recommend it without the parent's consent). That's just not true, and it's a play on words. There is no national medical association that recommends infant circumcision, even *with* parental consent, absent a specificl medical need for it. That's what the author meant, and that's still the truth. Some of the national medical associations say it should be a parental choice, but that's *not* saying the national medical associations *recommend* infant circumcision. They do not. They say it's not recommended, but it's up to the parents.

In fact, the new policy of the Australian medical association, which you link in your reply to me, states: "Circumcision of males is legal in Australia, New Zealand, the UK, USA and Canada.
However, routine neonatal circumcision has been declared unlawful in South Africa,
Sweden (except on religious grounds) and Finland."

By "routine" they certainly aren't saying "without parental consent," because otherwise that would be true in lots of places, including the U.S. Obviously, by "routine" they must mean without a specific medical need. This play on words is only a distraction from the simple fact that no national medical association recommends infant male circumcision absent a medical need.

Anonymous said...

Jake said: "the sentence you quote doesn't even refer to "routine"."

Marc's Reply: That's correct. But it's in a separate paragraph and is not referring to the quote immediately above it. It's stating a conclusion to the overall position about what is being meant by "routine."

Jake said: "these 3 studies are actually the highest quality studies available.
"www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e4/html_9" -- a work of fiction. See rebuttal here"

Marc's Reply: Well evidently the South African Medical Association doesn't think so. And I'd say they're a credible group, not to mention that they're in Africa and have reason to care. www.icgi.org/Downloads/SAMA-NOCIRC-2011-06-25.pdf

And there is at evidence that it in fact is increasing HIV. http://allafrica.com/stories/201105050159.html

And other evidence that there it does not change anything. www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0015552?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+plosone%2FPLoSONE+%28PLoS+ONE+Alerts%3A+New+Articles%29

I'd say there is controversy surrounding those studies. But even if they're true, I don't see how that would justify it. There is evidence that cutting the clitoral hood can reduce HIV in women, but we don't cut baby girl's clitoral hoods for that reason. Again, the WHO did not recommend infant circumcision.

Jake said: "that's an outdated policy. Here is their current position.

Marc's Reply: Even the new policy, while saying it's reasonable for parents to weight the benefits and decide for themselves, still does not recommend it. It states: "After reviewing the currently available evidence, the RACP believes that the frequency of
diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia
and New Zealand."

"you realise that's a propaganda site created for the purpose of making it seem that way, don't you?"

Marc's reply: I'd say that's your perception of it. I see it as a forum for men to speak out against it. The "Beyhond the Bris" site does the same thing. So do alot of FB pages that have thousands of members. That's a growing number that I see increasing as the issue gets more attention. Men haven't complained in the past because they have no way to know the difference when they're cut as babies. The Korean study, which was not done on men who came from the African clinics that make money off the circumcisions, found that of men cut as adults, about half said they lost a significant amount of sexual pleasure.

Jake said...

"The author said no national medical associations recommends routine infant male circumcision. You responded that this is technically true but only because "routine" means without parental consent" -- actually I didn't mention consent, but I did point out that "routine" means "of all newborn boys", and that would be quite an extreme recommendation.

You make the interesting observation that another organisation (RACP) has used the term in such a way that implies a different intended meaning.

[Re "www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e4/html_9" -- a work of fiction. See rebuttal here"] "Marc's Reply: Well evidently the South African Medical Association doesn't think so. And I'd say they're a credible group, not to mention that they're in Africa and have reason to care. www.icgi.org/Downloads/SAMA-NOCIRC-2011-06-25.pdf" -- first, I've been unable to confirm that this letter was actually written by the South African Medical Association. Second, it doesn't refer to Van Howe's paper anyway.

"And other evidence that there it does not change anything. www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0015552?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+plosone%2FPLoSONE+%28PLoS+ONE+Alerts%3A+New+Articles%29" -- I've already explained why observational studies are susceptible to confounding, so I'm a little bit puzzled as to why you're continuing to cite them.

"I'd say there is controversy surrounding those studies." -- there's no serious controversy in the scientific community.

"But even if they're true, I don't see how that would justify it. There is evidence that cutting the clitoral hood can reduce HIV in women, but we don't cut baby girl's clitoral hoods for that reason." -- well, actually, the overwhelming majority of available evidence indicates that female genital cutting doesn't protect against HIV.

"Even the new policy, while saying it's reasonable for parents to weight the benefits and decide for themselves, still does not recommend it. It states: "After reviewing the currently available evidence, the RACP believes that the frequency of
diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia
and New Zealand."" -- haven't we already agreed that's the case?

"The Korean study, which was not done on men who came from the African clinics that make money off the circumcisions, found that of men cut as adults, about half said they lost a significant amount of sexual pleasure." -- if you're going to hint at researcher bias, I'm surprised you didn't mention the fact that Kim and Pang are both NOCIRC activists who've been active for a long time.

Anonymous said...

Jake said: "actually I didn't mention consent, but I did point out that "routine" means "of all newborn boys", and that would be quite an extreme recommendation."

Marc's Reply: Not at all Jake. "All newborn boys" means all regardless of whether their parents consent, doesn't it? What else would "all newborn boys" mean?

Again, the point is that no national medical association recommends infant male circumcision absent a medical purpose.


Jake said: "first, I've been unable to confirm that this letter was actually written by the South African Medical Association. Second, it doesn't refer to Van Howe's paper anyway."

Marc's Reply: Ok, well then the only alternative is that it's "faked," which I highly doubt, but ok. And no it doesn't refer to Van Howe's paper and I didn't say it did. I don't know why that's relevant at all. I posted the link to that letter to show it *is* controverted within the medical community. The South African Medical Association does not believe those studies are conclusive. Even the CDC study you posted that references those three African studies said more research is needed.

Jake said: "there's no serious controversy in the scientific community."

Marc's Reply: Well then the South African Medical Association must not be a serious organization.

Jake said: "well, actually, the overwhelming majority of available evidence indicates that female genital cutting doesn't protect against HIV."

Marc's Reply: I'd be interested in seeing those studies, though I'm not disagreeing since I haven't researched that fully and I think it's somewhat of a side issue, though interesting.

Jake said: "if you're going to hint at researcher bias, I'm surprised you didn't mention the fact that Kim and Pang are both NOCIRC activists who've been active for a long time."

Marc's Reply: I'd say that financial-incentive bias is far more influential in outcomes than the personal opinions of the researchers. In fact, when they did the Sorrels study, the researchers invited pro-circ researchers to participate, but they all refused. I wouldn't be surprised if the same happened with the Korean study, though I haven't confirmed it.

aunursa said...

I believe the national medical associations. They represent large associations of medical experts.

Your acceptance of the recommendations from national medical associations is pretty selective...

"Parents and physicians each have an ethical duty to the child to attempt to secure the child's best interest and well-being. However, it is often uncertain as to what is in the best interest of any individual patient. In cases such as the decision to perform a circumcision in the neonatal period when there are potential benefits and risks and the procedure is not essential to the child's current well-being, it should be the parents who determine what is in the best interest of the child. In the pluralistic society of the United States in which parents are afforded wide authority for determining what constitutes appropriate child-rearing and child welfare, it is legitimate for the parents to take into account cultural, religious, and ethnic traditions, in addition to medical factors, when making this choice."

"In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child."
-American Academy of Pediatrics

The AAP policy statement is supported by the American Medical Association and the American Congress of Obstetricians and Gynocologists.

Nonprofit health care provider Kaiser Permanente agrees...

"How will you know if circumcision is right for your son?
Circumcision is not usually medically needed... It is your decision whether to keep your son's penis natural or have your son circumcised."

Jake said...

"Marc's Reply: Not at all Jake. "All newborn boys" means all regardless of whether their parents consent, doesn't it? What else would "all newborn boys" mean?" -- the AAP's recommendations do not have the force of law, and their recommendations are just that: recommendations.

"Marc's Reply: Ok, well then the only alternative is that it's "faked," which I highly doubt, but ok. And no it doesn't refer to Van Howe's paper and I didn't say it did." -- you implied that it did when you said "Well evidently the South African Medical Association doesn't think so" in response to the rebuttal to Van Howe. If that wasn't your intent, fine - let's not waste further time arguing about it.

"Marc's Reply: Well then the South African Medical Association must not be a serious organization." -- don't you think that, before citing them in such a way, one should verify that their position is what ICGI say it is?

"Marc's Reply: I'd be interested in seeing those studies, though I'm not disagreeing since I haven't researched that fully and I think it's somewhat of a side issue, though interesting."

Sure. Here are references for you (rescued from an old Wikipedia page, hence the odd formatting).

Increased risk:

Monjok E, Essien EJ, Holmes L (April 2007). "Female genital mutilation: potential for HIV transmission in sub-Saharan Africa and prospect for epidemiologic investigation and intervention". Afr J Reprod Health (African Journal of Reproductive Health / La Revue Africaine de la Santé Reproductive, Vol. 11, No. 1) 11 (1): 33–42. doi:10.2307/30032486. JSTOR 30032486. PMID 17982946.

No significant difference:

^ Pepin J, Plamondon P, Alves AC, Beaudet M, Labbe AC (2006). "Parenteral transmission during excision and treatment of tuberculosis and trypanosomiasis may be responsible for the HIV-2 epidemic in Guinea-Bissau". AIDS 20 (9): 1303–11. doi:10.1097/01.aids.0000232239.05545.33. PMID 16816560.
^ Mboto CI, Fielder M, Davies-Russell A, Jewell AP (2009). "Prevalence of HIV-1, HIV-2, hepatitis C and co-infection in The Gambia". West Afr J Med 28 (1): 16–9. PMID 19662739.
^ Msuya SE, Mbizvo E, Hussain A, Sundby J, Sam NE, Stray-Pedersen B (February 2002). "Female genital cutting in Kilimanjaro, Tanzania: changing attitudes?". Trop. Med. Int. Health 7 (2): 159–65. doi:10.1046/j.1365-3156.2002.00838.x. PMID 11841706.
^ a b Klouman E, Manongi R, Klepp KI (January 2005). "Self-reported and observed female genital cutting in rural Tanzania: associated demographic factors, HIV and sexually transmitted infections". Trop. Med. Int. Health 10 (1): 105–15. doi:10.1111/j.1365-3156.2004.01350.x. PMID 15655020.
^ Kapiga SH, Bang H, Spiegelman D, Msamanga GI, Coley J, Hunter DJ (2002). "Correlates of plasma HIV-1 RNA viral load among HIV-1-seropositive women in Dar es Salaam, Tanzania". J Acquir Immune Defic Syndr 30 (3): 316–23. PMID 12131569.
^ a b c Yount KM, Abraham BK (June 2007). "Female genital cutting and HIV/AIDS among Kenyan women". Stud Fam Plann 38 (2): 73–88. doi:10.1111/j.1728-4465.2007.00119.x. PMID 17642409.
^ Foglia G, Langat L, Langat W, et al. "Community based study of HIV-1 infection among plantation workers in Kericho, Kenya in preparation for HIV-1 vaccine trials (3rd IAS Conference on HIV Pathogenesis and Treatment)". International AIDS Society.

cont'd.

Jake said...

(continued from above post)

Complex:

^ a b Maslovskaya O, Brown JJ, Padmadas SS (November 2009). "Disentangling the complex association between female genital cutting and HIV among Kenyan women". J Biosoc Sci 41 (6): 815–30. doi:10.1017/S0021932009990150. PMID 19607733.
^ a b Brewer DD, Potterat JJ, Roberts JM, Brody S (March 2007). "Male and female circumcision associated with prevalent HIV infection in virgins and adolescents in Kenya, Lesotho, and Tanzania". Ann Epidemiol 17 (3): 217–26. doi:10.1016/j.annepidem.2006.10.010. PMID 17320788.

Decreased risk:

^ a b Stallings, R.Y., Karugendo, E.. "Female circumcision and HIV infection in Tanzania: for better or for worse? (3rd IAS conference on HIV pathogenesis and treatment)". International AIDS Society.
^ a b Kanki P, M'Boup S, Marlink R, et al. (October 1992). "Prevalence and risk determinants of human immunodeficiency virus type 2 (HIV-2) and human immunodeficiency virus type 1 (HIV-1) in west African female prostitutes". Am. J. Epidemiol. 136 (7): 895–907. doi:10.1093/aje/136.7.895. PMID 1442755.

"Marc's Reply: I'd say that financial-incentive bias is far more influential in outcomes than the personal opinions of the researchers." -- really? What about the 9/11 hijackers? Do you suppose they flew planes into skyscrapers for financial reward? Or because of deep personal conviction (however twisted)? I'd say that personal conviction is at least as powerful a motivator, if not more so, than money.

Anonymous said...

Aunursa said: "Your acceptance of the recommendations from national medical associations is pretty selective..." and then quotes the part where they suggest it's up to the parents. I said I trust the national medical associations with regard to whether circumcision is medically recommendable. They have said it is not. The fact that some of them also say it's a parental choice does not mean the associations recommend it. IMO some of them say it's a parental choice because there is tremendous religious/political pressure on them to not say it should be illegal. Even the Dutch Medical Association, which flat-out said there is good reason to make it illegal, still folded to that pressure by saying they fear making it illegal would push it underground. IMO that's just an excuse. They said the same about banning female genital mutilation. It's not likely to happen especially where most circumcisions are non-religious. So, again, when I said I trust the national medical associations more than, say, Jake, that is about their position on whether it can be harmful, and whether it's medically justified. That is what we were debating at that moment, not parental choice.

Anonymous said...

Jake said: "the AAP's recommendations do not have the force of law, and their recommendations are just that: recommendations."

Marc's Reply: Jake, I wasn't talking about the AAP. The whole argument about "routine" started when the author said "no national medical association supports routine infant circumcision." You responded by saying that's technically true but only because nobody would recommend circumcising "all" newborn babies. I responded that that is not what the author meant by "routine," because that would be obvious. Yes, obviously, few countries would recommend circumcising all babies regardless of what their parents want. But the author obviously meant "routine" as in circumcising babies without a medical need. That's fine if you want to disagree that that is what the author meant, but whether the author meant it the way interpret, or the way I interpret it, they are both *true*. That is, it is true that no national medical association recommends circumcising "all" infant males even without parental consent (and that's so obvious I doubt the author would bother saying it). And it's *also* true (as I interpret it) that no national medical association recocmmends infant circumcision absent a specific medical need. If that's untrue, then show me a national medical association that recommends circumcision absent a specific medical need. Because that's what we're discussing. Your arguments about the meaning of the word "routine" come off as complete distractions from the point.

Jake said: "you implied that it did when you said "Well evidently the South African Medical Association doesn't think so" in response to the rebuttal to Van Howe."

Marc'e Reply: No, jake. I said that in response to your statement that the African studies are not controverted within the scientific community. My response was that the South African Medical Association *does* consider those studies controverted, as they state in their letter. For some reason you keep mis-stating what I say.

Jake said: "don't you think that, before citing them in such a way, one should verify that their position is what ICGI say it is?"

Marc's Reply: I've seen the letter from them, and it's on the website of the National Organisation of Circumcision Information Resource Centres South Africa. To me, that's sufficient to cite their position. But of course, you can be skeptical of the letter's authenticity if you want.

Jake said: "really? What about the 9/11 hijackers? Do you suppose they flew planes into skyscrapers for financial reward? Or because of deep personal conviction (however twisted)? I'd say that personal conviction is at least as powerful a motivator, if not more so, than money."

Marc's Reply: Yes there are always religious fanatics, but I don't find that comparable to peditricians and scientists who publish in peer-reviewed medical and scientific journals like the British Journal of Urology, especially when their views are backed by the Dutch Medical Association and 7 other national medical associations in the Netherlands, the South African Medical Association, and others. And when they invite pro-circ researchers to participate, I'd say that's a good sign of wanting to be fair and objective, unlike those who financiall benefit from circumcisions. Obviously this is a matter of opinion, and that's mine.

Jake said...

"Marc's Reply: Jake, I wasn't talking about the AAP." -- I wasn't willing to say that it's true of all medical associations, since it's conceivable that in some country somewhere such recommendations do have legal force. Hence my use of an example.

"That is, it is true that no national medical association recommends circumcising "all" infant males even without parental consent (and that's so obvious I doubt the author would bother saying it). And it's *also* true (as I interpret it) that no national medical association recocmmends infant circumcision absent a specific medical need. If that's untrue, then show me a national medical association that recommends circumcision absent a specific medical need." -- I can't think of any, but with around 200 countries in the world, often with several such associations in each, it should be obvious that my knowledge is limited.

"Because that's what we're discussing. Your arguments about the meaning of the word "routine" come off as complete distractions from the point." -- on the contrary, there's wholly relevant, because the overwhelming majority of associations use that word in their recommendations.

"Marc'e Reply: No, jake. I said that in response to your statement that the African studies are not controverted within the scientific community." -- that may have been your intent, but you said it immediately after quoting my words "a work of fiction. See rebuttal here", which implies relevance to that.

"Marc's Reply: I've seen the letter from them, and it's on the website of the National Organisation of Circumcision Information Resource Centres South Africa. To me, that's sufficient to cite their position." -- so if I put a letter on my website, with the letterhead of, say, the American Medical Association, you'll believe it? Remarkable.

"Marc's Reply: Yes there are always religious fanatics, but I don't find that comparable to peditricians and scientists who publish in peer-reviewed medical and scientific journals like the British Journal of Urology,"

Seems a bit of a moot point re Kim and Pang's study. Kim is an astronomer, and Pang a vet, I believe.

"especially when their views are backed by the Dutch Medical Association and 7 other national medical associations in the Netherlands, the South African Medical Association, and others." -- again, a moot point. Even if we assume that the SAMA letter is genuine, it doesn't refer to Kim & Pang.

"And when they invite pro-circ researchers to participate, I'd say that's a good sign of wanting to be fair and objective, unlike those who financiall benefit from circumcisions." -- what evidence do we have that Kim and Pang did so?

Jake said...

Regarding Marc's comments to Aunursa:

"The fact that some of them also say it's a parental choice does not mean the associations recommend it. IMO some of them say it's a parental choice because there is tremendous religious/political pressure on them to not say it should be illegal. Even the Dutch Medical Association, which flat-out said there is good reason to make it illegal, still folded to that pressure by saying they fear making it illegal would push it underground."

The mistake you're making here is to reason (for want of a better word) from the Dutch policy and extrapolate from that to other medical associations. That's a mistake because the Dutch are atypical in that, unlike most associations, they're opposed to parental choice (and indeed to circumcision). Most organisations are neutral with respect to circumcision, and are generally supportive of and in favour of parental choice. Consequently it's a mistake to treat the Dutch as representative.

Anonymous said...

Jake said: "on the contrary, there's wholly relevant, because the overwhelming majority of associations use that word in their recommendations."

Marc's Reply: So far I haven't seen one that uses the term "routine" to mean circumcising all babies regardless of parental consent. Even the AAP quote you give me, IMO, is not using it that way. I read it to mean circumcising babies regardless of a medical need, the way the Australian medical association meant it. Maybe some do use it the way you're saying but I haven't seen it yet.

Jake said: "that may have been your intent, but you said it immediately after quoting my words "a work of fiction. See rebuttal here", which implies relevance to that."

Marc's Reply: I just went back and looked. I was specifically responding to this comment: "these 3 studies are actually the highest quality studies available."
My response was: "Well evidently the South African Medical Association doesn't think so. www.icgi.org/Downloads/SAMA-NOCIRC-2011-06-25.pdf"

I do see that just after your comment you linked the rebuttal to Van Howe, but that's not what I was referring to in my reply.

Jake said: "so if I put a letter on my website, with the letterhead of, say, the American Medical Association, you'll believe it? Remarkable."

Marc's Reply: Yes I would. If it's on their letterhead and appears to be credible, as this one does, I would believe it. I'm not saying I would conclude with certainty, but I wouldn't have reason to believe it was faked unless the content of the letter was outlandish or something that appeare fake. I don't think this letter appears fake at all, so I believe it. I don't think that's "remarkable" at all, but ok.

Anonymous said...

Jake said: "Even if we assume that the SAMA letter is genuine, it doesn't refer to Kim & Pang."

Marc's Reply: Of course not. That isn't the point. The view experessed in the SAMA letter coincides with what you way Kim and Pang's beliefs are (I don't know I haven't checked but I have no reason not to believe you on that). Having an opinion that is in line with major medical associations is not the same or even comparable to religious fanaticism,IMO.

Jake said: "what evidence do we have that Kim and Pang did so?"

Marc's Reply: I'm not saying Kim and Pang did. Sorrels et al did. The view that Kim and Pang allegedly have (again, I believe you on that) is similar to that of Sorrells et al., which, to me, is not comparable to religious fanaticism. I should have clarified that I didn't mean Kim and Pang did that.

Jake said: "The mistake you're making here is to reason (for want of a better word) from the Dutch policy and extrapolate from that to other medical associations. That's a mistake because the Dutch are atypical in that, unlike most associations, they're opposed to parental choice (and indeed to circumcision). Most organisations are neutral with respect to circumcision, and are generally supportive of and in favour of parental choice. Consequently it's a mistake to treat the Dutch as representative."

Marc's Reply: I'm not treating the Dutch as representative. I said, *even* the Dutch medical association, which IMO was the most honest and the least influenced by religious politics, still folded to religious politics by saying it shouldn't be banned b/c that might drive it underground. My point was exactly that even in their atypical-ness they're still somewhat influenced by religious politics, while the others are more so. I agree with the medical associations' general conclusion about there being no medical justification for it, but I think most of them, except for the Dutch and the South African ones, are very weak on their medical ethics. The Dutch Medical Association was the only one I saw that actually made a comparison to female gential cutting and recognized the double standards. From what I've seen, the other ones avoid that issue altogether, probably afraid to even go there because they know the double standard is obvious when you really examine it. That's regigious politics right there. The Dutch and South African medical associations were far more honest IMO.

Jake said...

"Marc's Reply: So far I haven't seen one that uses the term "routine" to mean circumcising all babies regardless of parental consent. Even the AAP quote you give me, IMO, is not using it that way." -- it does, as I pointed out above through the two different quotes that clearly mean the same thing.

"I do see that just after your comment you linked the rebuttal to Van Howe, but that's not what I was referring to in my reply." -- okay, I realise it wasn't your intent. I trust you understand how it was misunderstood.



Jake said: "Even if we assume that the SAMA letter is genuine, it doesn't refer to Kim & Pang."

"Having an opinion that is in line with major medical associations is not the same or even comparable to religious fanaticism,IMO." -- here's a simple question: do you agree that some people are passionate in their anti-circumcision activism? Do you agree that some of these people believe they are "saving" babies from "mutilation" and "human rights violations"? Would you not agree that such beliefs might act as a significant motivator?

"Marc's Reply: I'm not saying Kim and Pang did. Sorrels et al did." -- I don't quite see the relevance (since we were talking about Kim and Pang), but I'd be interested to see some evidence in support of this.

"The view that Kim and Pang allegedly have (again, I believe you on that) is similar to that of Sorrells et al., which, to me, is not comparable to religious fanaticism. I should have clarified that I didn't mean Kim and Pang did that." -- this argument doesn't make a lot of sense to me. Are you saying that one should suspect bias if a source expresses one opinion, but not if the source expresses another opinion? Isn't that itself biased?

Jake said: "The mistake you're making here is to reason (for want of a better word) from the Dutch policy and extrapolate from that to other medical associations. That's a mistake because the Dutch are atypical in that, unlike most associations, they're opposed to parental choice (and indeed to circumcision). Most organisations are neutral with respect to circumcision, and are generally supportive of and in favour of parental choice. Consequently it's a mistake to treat the Dutch as representative."

"Marc's Reply: I'm not treating the Dutch as representative. I said, *even* the Dutch medical association, which IMO was the most honest and the least influenced by religious politics," -- let's agree to disagree on that. :-)

"still folded to religious politics by saying it shouldn't be banned b/c that might drive it underground." -- I'm not so sure it's fair to characterise that as "folding". It's not an unreasonable position (if you take their opinion of circumcision as a starting point, that is).

"The Dutch Medical Association was the only one I saw that actually made a comparison to female gential cutting and recognized the double standards." -- not a very persuasive argument, in my opinion. The two really aren't comparable.

Anonymous said...

Parents' aesthetic preferences are not valid reasons for circumcision.


This statement makes sense only if one considers circumcision to be a bad thing that requires a lot of justification. But, since it is widely accepted that circumcision is harmless at worst and beneficial at best, that position seems unsupportable. Would it make sense to demand a valid reason for feeding a child a healthy diet?


see here's the problem with that. You are wrongly assuming that only anti-circ parents think this way. Some people such as myself do not deny the potential health benefits nor do we have some great fear of the baby is going to suffer from pain etc etc.


I am against doing it to a child because he can't consent. Its the same reason I wouldn't get my babies ears pierced. (even though it happened to me as an infant and I think they are cute)
Whether you want to admit it or not, it is a permanant change and I do not think its one that I should make for anyone else without their consent.

Btw, One of our kids plans on getting it done when he's older. (We don't Lie about the benefits or anything)

aunursa said...

"Whether you want to admit it or not, it is a permanant change and I do not think its one that I should make for anyone else without their consent."

The issue of consent goes both ways. There are many boys and men who are happy to have been circumcised AS INFANTS - or who would wish to have been circumcised AS INFANTS. Besides the potential medical benefits of infant circumcision, the procedure is simpler and easier; there is no memory of pain or trauma; and since babies are not sexually active, there is no waiting period for the patient to resume sexual activity.

Either way - whether they choose to circumcise or not circumcise - parents must make a decision with the risk that their child eventually may not agree with the decision.