Monday, 12 September 2011

Debunking another "myths" article

Anti-circumcision authors seem to have a curious knack for writing articles that purportedly expose myths about circumcision while actually containing a number of incorrect statements. This is no exception. Let's dive in. (Note: I'm reformatting some of what follows for convenience.)

Myth 1: They just cut off a flap of skin. Reality check: Not true. The foreskin is half of the penis's skin, not just a flap. In an adult man, the foreskin is 15 square inches of skin. In babies and children, the foreskin is adhered to the head of the penis with the same type of tissue that adheres fingernails to their nail beds. Removing it requires shoving a blunt probe between the foreskin and the head of the penis and then cutting down and around the whole penis.


First, the average surface area of the foreskin is 36.8 square centimetres, which is 5.7 square inches not 15. Second, it's a gross exaggeration to liken the adhesions between the glans and foreskin to the nail bed. The foreskin and glans are primed to separate, and have often begun (though rarely completed) this process at birth. Separating the two is relatively trivial, requiring little force.

Myth 2: It doesn't hurt the baby. Reality check: Wrong. In 1997, doctors in Canada did a study to see what type of anesthesia was most effective in relieving the pain of circumcision. As with any study, they needed a control group that received no anesthesia. The doctors quickly realized that the babies who were not anesthetized were in so much pain that it would be unethical to continue with the study. Even the best commonly available method of pain relief studied, the dorsal penile nerve block, did not block all the babies' pain. Some of the babies in the study were in such pain that they began choking and one even had a seizure (Lander 1997).


Yes, circumcision without anaesthesia hurts. But the very study cited acknowledged that ring block was effective: "Of the 3 anesthetics considered in this investigation, ring block is clearly superior. It provides satisfactory anesthesia for all stages of the circumcision. While newborns fussed periodically over the restraints or being handled, they typically did not react to the most nociceptive elements of the circumcision (such as foreskin separation and incision)."

Myth 3: My doctor uses anesthesia. Reality check: Not necessarily. Most newborns do not receive adequate anesthesia. Only 45% of doctors who do circumcisions use any anesthesia at all. Obstetricians perform 70% of circumcisions and are least likely to use anesthesia - only 25% do. The most common reasons why they don't? They didn't think the procedure warranted it, and it takes too long (Stang 1998). A circumcision with adequate anesthesia takes a half-hour - if they brought your baby back sooner, he was in severe pain during the surgery.


The cited source (Stang and Snellman) is thirteen years old, and probably doesn't represent current practice very well. A more recent study found considerable differences in use of anaesthesia in only five years: 71% in 1998 and 97% in 2003.

Myth 4: Even if it is painful, the baby won't remember it. Reality check: The body is a historical repository and remembers everything. The pain of circumcision causes a rewiring of the baby's brain so that he is more sensitive to pain later (Taddio 1997, Anand 2000). Circumcision also can cause post-traumatic stress disorder (PTSD), depression, anger, low self-esteem and problems with intimacy (Boyle 2002, Hammond 1999, Goldman 1999). Even with a lack of explicit memory and the inability to protest - does that make it right to inflict pain? Law requires anesthesia for animal experimentation - do babies deserve any less?


There's no credible evidence that circumcision has any such long-term psychological effects. Claims to the contrary are entirely speculative, as can be seen by reading the cited sources.

Myth 5: My baby slept right through it. Reality check: Not possible without total anesthesia, which is not available. Even the dorsal penile nerve block leaves the underside of the penis receptive to pain. Babies go into shock, which though it looks like a quiet state, is actually the body's reaction to profound pain and distress. Nurses often tell the parents "He slept right through it" so as not to upset them. Who would want to hear that his or her baby was screaming in agony?


This "explanation" is amusingly contrived, but of course Occam's Razor favours the alternative explanation: that the baby actually did sleep through the procedure. This is perfectly consistent with studies of adult circumcision under anaesthesia, in which pain is reported by only a few men. For example, pain was reported by 0.83% of men in one study, and 0.2-0.3% in another.

Myth 6: It doesn't cause the baby long-term harm. Reality check: Incorrect. Removal of healthy tissue from a non-consenting patient is, in itself, harm (more on this point later). Circumcision has an array of risks and side effects. There is a 1-3% complication rate during the newborn period alone (Schwartz 1990). Here is a short list potential complications.


1-3% is a bit of an exaggeration. A recent systematic review found a median of 1.5%, but most are extremely minor.

This section continues:

Meatal Stenosis: Many circumcised boys and men suffer from meatal stenosis. This is a narrowing of the urethra which can interfere with urination and require surgery to fix.


While there's no proof, it seems likely that circumcision is a contributing factor to meatal stenosis. However, it's an exaggeration to say that "many" suffer. The largest study of circumcision and meatal stenosis found 7 cases in 66,519 circumcisions - 0.01%. The next two largest studies found risks of 0.9% (29 in 3,205) and 0.55% (11 in 2,000).

Adhesions. Circumcised babies can suffer from adhesions, where the foreskin remnants try to heal to the head of the penis in an area they are not supposed to grow on. Doctors treat these by ripping them open with no anesthesia.


As with uncircumcised boys, adhesions can occur. And, as with uncircumcised boys, they usually resolve without treatment. See this study.

(I'm skipping discussion of buried penis and infection. Both can occur, though the risk of each is small.)

Death. Babies can even die of circumcision. Over 100 newborns die each year in the USA, mostly from loss of blood and infection (Van Howe 1997 & 2004, Bollinger 2010).


This figure is wrong, as we've discussed previously.

18 comments:

Anonymous said...

Thank you for posting this! I just barely read that other article, and it bothered me how all these "facts" sounded a lot like opinions. It was as if the author was saying "they did this study, and I don't agree". I also had the feeling that the author got a lot of her numbers wrong, so I'm glad you cleared that up.

Shannyn said...

I won't address your entire post, but do not say that separating the foreskin from the glans is trivial and should be simple. There's no reason to do this to a child with an adhered foreskin and his foreskin protects the glans. My son is intact and his foreskin is very much adhered, we will not forcibly retract it ever. You are trivializing the harm that does come from circumcision, it's a shame and I sincerely hope that any uneducated parents who are unfortunately swayed by your false information have no harm come to their children. The foreskin is natural and normal. There is no good reason to perform this surgery on a non consenting newborn.

Anonymous said...

I read that article and thought it seemed quite good. Reading yours helped me to understand better.

Thanks for the clarifications...

Nick said...

Let me say that I do not intend any offense, as everything said is done so respectfully. I'm not going to comment on the matters of anesthesia, shock, meatal stenosis, adhesions, or deaths because those are all red herrings to me.

1: But, you cannot deny that there are pro-circumcision authors that do the same thing and worse yet, characterize us as nuts.

2: I'm not going to argue with you on the size, as I feel that is just nitpicking and serves no purpose other than to detract from the real point of the debate, besides the fact that no two foreskins are the same just as with any other body part. However, you must understand that you haven't actually debunked anything here with the latter comment. Instead, you have just affirmed it with your own spin of minimization. That's not to say that the claim you attempted to disprove isn't exaggerated, just pointing out that you may not be being balanced yourself. It is a fact that the structures of foreskin and glans are fused together at birth, and each person (I consider infants people to be) will have differences in how strong this connection is due to their own unique body. There is no set time period where natures process is supposed to complete itself. Despite this, you DO see doctors (especially american ones) pushing circumcision under the guise of childhood phimosis. Now, bear in mind that humans are not supposed to be sexually mature until at least adolescence, so how can a childs foreskin that won't retract be considered phimotic during that time frame? It just doesn't add up. I am NOT saying that if a child complains of discomfort it shouldn't be looked at, nor that if it is being a physical problem for a teenager it shouldn't be treated. (There are more conservative options than circumcision, though.) I am just stressing how it doesn't make much logical sense to uphold that outlook, when it was never the blueprint nature had in mind for our bodies. And before you might bother to say anything, yes I know that appealing to nature is a logical fallacy, but in this case I think it holds because people are distorting these things.

SECOND PART UPCOMING

Nick said...

SECOND PART

3: Ultimately, THIS is what it comes down to. Define "credible". Do you mean that, in order for a piece to be taken seriously by you it has to jump through at least five legal hoops AND come out of a laboratory setting? I'll be honest: I don't personally subscribe to that. There is credible evidence out there that can easily be found, provided you are open minded.

http://foreskin-restoration.net/forum/forumdisplay.php?f=61

That website offers mountains of (in my opinion, credible) anecdotal evidence that it can have detrimental psychological effects on a wide scale. Just read a few posts. I can testify, I'm a man that was circumcised as a babe and wishes he wasn't. If you look at the statistics on that forum, it has 7,840 threads, 63,108 posts, 8,675 members, and 4,939 active members, and it is still growing. Not only that, but it is run by a man who sells devices to restore the foreskin. There is an industry for this.

http://tlctugger.com/products.htm

If the existence of such an industry doesn't tell you all that you need to know then I don't know what will. There is certain to be an unreported percentage of the population that shares the same views as these guys. Men are upset about this because they wanted a choice and some even feel emasculated. Considering that, it is really no different from the psychological effects that female circumcision can have. Before you have a knee jerk reaction, just hear me out. That's not to say that it will cause those problems, but it DOES have the potential to do so. Some men even want revenge on their doctors. Note, that the people there have differing standards on what is appropriate and how far they would be willing to go, just like anywhere else.

http://foreskin-restoration.net/forum/showthread.php?t=8318

These are guys that had "successful" operations. All of that is what I feel the main issue comes down to, whether it is a humane thing to do to other people. You can argue the science back and forth all day long, but is it worth a contribution to the suffering that's already out there?

4: And what about those psychological effects that aren't formally considered to be complications of the procedure that I provided examples of? They don't generally consider insufficient skin or hair on the shaft complications either, because those symptoms do not manifest until adolescence as the organ grows. They don't pay much mind to how the person will feel in the future either. Or, do these factors not count simply because they aren't something immediate?

I hope that this hasn't been a waste of my time and that the effort I put into it constitutes sincerity.

Jake said...

Hello Nick,

I'm going to reply to your comments, but before I do, I must point out that in several places it's not obvious what part of my rebuttal you're responding to. That makes it a little difficult to respond in turn, but I'll do my best.

"But, you cannot deny that there are pro-circumcision authors that do the same thing and worse yet, characterize us as nuts." -- that's probably true, yes.

"There is no set time period where natures process is supposed to complete itself. Despite this, you DO see doctors (especially american ones) pushing circumcision under the guise of childhood phimosis. Now, bear in mind that humans are not supposed to be sexually mature until at least adolescence, so how can a childs foreskin that won't retract be considered phimotic during that time frame? It just doesn't add up." -- a foreskin that doesn't retract isn't necessarily a problem in childhood (though if it was previously retractile, it may indicate an underlying problem). However, that doesn't mean that a non-retractile foreskin is inherently problem-free. Phimosis can be diagnosed at any age if there is scarring or pathology such as lichen sclerosus present.

Moving on to your second post:

Here you cite the existence of the "foreskin restoration" community as evidence of psychological harm. I do not consider this to be credible evidence, for several reasons.

First, while I agree that many of these men are angry that they were circumcised, it's reasonably easy to find men angry that they were not circumcised, too. So if we automatically assume a causal association, we reach the conclusion that either choice - to circumcise or not - causes psychological harm.

Second, causation isn't always obvious in psychology. As an extreme example, some people are angry because the CIA are reading their thoughts from outer space, but it would be unfair to blame the CIA for their anger. With reference to the first point, some people are angry with their parents, and find circumcision choices (whatever they were) a convenient way of focusing their anger. Others are having really lousy lives, and would like something to blame, something that isn't their fault. Circumcision's awfully convenient.

Finally, I think it's important to consider the contribution of the anti-circumcision lobby here (and personally I think they've a lot to answer for). If a vulnerable person reads anti-circumcision propaganda, and is told that he's been mutilated, that his sex life has been ruined, etc., then anger is an understandable result, especially if he hasn't the strength to question it. But at the same time, it's misplaced: shouldn't that anger really be directed at the source of the misinformation?

Erika said...

The difference between angry circumcised men and angry intact men is that intact men can go get themselves circumcised! That choice was taken away from circumcised men. Intact is the default. Let men have their own penises.

Kurt Prochnow said...

Circumcision is a barbaric practice that has its origins in bronze age superstitious religious beliefs. The modern American practice got a lot of momentum from a 19th century religious view of sexuality and health practices. It is amazing that there are still some holdouts for this practice in the 21st century western world. It really belongs to a bygone era and backwards cultures.

Rmorris said...

Shannyn Im a 37 years ago I had a circumcision ( I was raised Jewish) never had a problem with it works fine. My grandfather worked out fine too judging by the 4 kids he had. Uncle same thing. My 12 year old and my 1 year old all have had a circumcision and well i haven't seen any of these problems.... Come to think of it hasn't this been around for well since BC. I would think after all this time they would know what they are doing and why Im more then happy to let other people do what ever they like for what they "think" is good for their own children. The previous article seemed to be one person trying to freak people out in to seeing her point of view and scaring new parents in to her way of thinking. That I find trashy.

Nick said...

My apologies. That is because I wasn't able to quote the relevant parts due to the text limitation. 1 is referring to the frequent back and forth vitriol of writers that address the issue obviously, 2 is referring to all of your commentary on the skin fusion, 3 is referring to your claim that there is no evidence of psychological harms, and 4 is referring to your comments on the complication rates. I was pointing out the fact that those detrimental effects aren't kept track of and reported as complications.

Now, I will reply.

"a foreskin that doesn't retract isn't necessarily a problem in childhood." I'm glad you appear to see my point, then. I won't debate you on the last comment, since I agree with it, but I will provide a reminder that there shouldn't be any such pathologies present in a healthy baby.

"Here you cite the existence of the "foreskin restoration" community as evidence of psychological harm. I do not consider this to be credible evidence, for several reasons."

Then what is credible? I've asked you this question before, and it went unanswered. I cited the foreskin restoration community because, to me it is just a matter of common sense. You are cutting off healthy tissue from a persons (remember again that I view the infants as people to be) genitals, usually without their consent, and these are the organs designed to give us pleasure. It seems like no big stretch of logic to assume that, consequentially, you're going to end up with people who are livid about it and will compare it to things you'd rather not entertain the thought of. See FGM.

I mean, it isn't enough for you that there are entire groups centered around opposition? Photographs of men in the middle of restoring, videos, people in the media, attempted legislature, more than just one home based device manufacturer?

http://www.catstretcher.com/ShoppingCATIIQ.html
http://www.foreskinrestore.com/dtr.html

Bear in mind that market wise these are all competing against eachother. There must be a demand in order to make a niche like this profitable.

Anyway, if the citation wasn't good enough and you wanted something more esteemed, here is the most recently updated position (I think) of a medical association. The Royal Dutch Medical Association.

http://knmg.artsennet.nl/Over-KNMG/English.htm

You will have to download it off the page to the right. Unlike the other policy statements who are neutral on the subject, (probably to keep good PR) they flat out recommend against doing it. Still, it is your prerogative to believe what you will. I will address your points now in the second half.

Nick said...

1: Correct, though a part of me doubts you will find as many people who have the opposite interest. Furthermore, it needs to be said that there are strong sociological elements at play here that stem directly from the phenomenon of circumcision and the culture that drives it. There are people and physicians who shame parents for leaving their sons keep it, and in societies where circumcision is widespread, it is more likely (not guaranteed) that a man who still has his foreskin will feel insecure because of all the nasty fear mongering he hears about them. But returning to your point, what else did you mean to say? I'm breaking the essence down to an old saying, "damned if you do and damned if you don't".

2: True enough, but as for the rest... I strongly disagree with the notion that they are angry simply because its convenient. Who WANTS to be angry? Who WANTS to deal with this when such thick mental barricades exist? The topic is discussed very uncomfortably in general. For that matter, my patience is limited as well. This will probably be my last lengthy reply.

3: So, you're suggesting that the anti-circumcision movement is in the wrong here? Fair enough, but how else are they supposed to get their message across? How am I supposed to get my message across in a society that simply doesn't want to hear it and has no interest in acknowledging the damage it has done? It is not black and white. What you perceive to be a harmful effect on society, I perceive as a growing awareness. What you perceive to be a lack of strength to question, I perceive as an open mindedness to question what we have been conditioned towards and a willingness to accept other lines of thought. The fact of the matter is, its a painful truth for some and bringing it to light can cause problems. That is just the nature of the beast. I'll agree, in that there is a difference between political statements and what is actually truthful, but some of those statements are based upon discoveries that not even the medical profession can come to a consensus on. I don't think that constitutes misinformation. Merely exaggeration to serve a political end. I'll continue to be forthright with you. I would like to see circumcision legally prohibited in cases where there is no therapeutic purpose to it.

Now that I have finished droning on and on, let me just show you something a little more interesting. These are two third party sources, there is no taint of pro or anti lobby bias to them.

This is a finding that circumcised African men are suffering higher rates of infection. It is jus tone of their statistics but they have a few others with the same result.

http://www.measuredhs.com/pubs/pdf/FR202/FR202.pdf

And this is a finding that the Langerhans cells may not be as vulnerable to infection as is commonly believed.

http://www.washingtonpost.com/wp-dyn/content/article/2007/03/05/AR2007030500357_pf.html

http://www.ncbi.nlm.nih.gov/pubmed/20309013

Yet, despite this, one of the favorite arguments circumcision advocates use is that it reduces HIV beyond a doubt. Ignorance much?

Jake said...

Nick:

"Then what is credible? I've asked you this question before, and it went unanswered." -- how about peer-reviewed studies that record and compare frequencies of psychological problems in both circumcised and uncircumcised males, thus permitting tests for statistically significant differences. It's unrealistic to ask for RCTs, but preferably such studies should attempt to minimise potential biases (by, for example, ensuring that the two groups are as similar as possible), and adjust for potential confounding factors.

"I mean, it isn't enough for you that there are entire groups centered around opposition?" -- no, that's not enough. "Some people are opposed to X, therefore X is bad" is a logical fallacy.

"Anyway, if the citation wasn't good enough and you wanted something more esteemed, here is the most recently updated position (I think) of a medical association. The Royal Dutch Medical Association." -- thank you, I've already read it. They're entitled to their opinion, of course, but I think they're mistaken.

"But returning to your point, what else did you mean to say?" -- if you could quote the relevant passage, I'd be happy to answer, but I'm afraid I'm slightly lost.

"I strongly disagree with the notion that they are angry simply because its convenient. Who WANTS to be angry?" -- I think some people are just predisposed towards being angry. It might be more accurate to say that they're angry first, look for something to be angry about second.

"So, you're suggesting that the anti-circumcision movement is in the wrong here? Fair enough, but how else are they supposed to get their message across?" -- honesty would work, I think. Saying, "I think circumcision is wrong because it denies a child a foreskin he might have wanted" is a perfectly valid argument, and probably one of the strongest in favour of your position. I don't personally find it compelling, but many do.

"This is a finding that circumcised African men are suffering higher rates of infection. It is jus tone of their statistics but they have a few others with the same result" -- yes, there are a few such studies, though most (probably about 75%) studies find the opposite. Observational studies are inherently imperfect (they're susceptible to confounding), so it's not reasonable to expect them to find the correct result every time. On average they're pretty good.

"And this is a finding that the Langerhans cells may not be as vulnerable to infection as is commonly believed." -- yes, they have a self-defence mechanism, though as lab studies have shown, they're still a port of entry.

"Yet, despite this, one of the favorite arguments circumcision advocates use is that it reduces HIV beyond a doubt. Ignorance much?" -- it's difficult to make sense of your argument here. It does reduce the risk of HIV. I can't see how a cherry-picked study or two affects that.

turtlebird said...

I'm curious - what are your reasons for being pro-circumcision? As far as I can tell here, you've only gone so far as to minimize or call into question the facts presented in this article. I don't feel like it's been "debunked," however, as I still don't feel that showing inadequacies in some of the PT author's references is the same thing as proving her wrong. I hope this doesn't come across as disrespectful - I'm genuinely interested in knowing your arguments in favor of circumcision.

Jake said...

Hello Turtlebird,

I'm sorry that you don't feel that my blog post qualifies as "debunking".

I don't really think of myself as "pro-circumcision", which to my mind implies the position that parents should circumcise their sons. I prefer the label "pro-parental choice", as although I'd personally choose to circumcise a boy, I think either choice is perfectly acceptable.

Interestingly, back in 2003 or so when I first entered the circumcision debate, I was actually weakly opposed to neonatal circumcision (I was mostly interested in adult circumcision, originally having entered the debate as a result of being irritated by anti-circumcision websites giving misleading information). My views shifted over time, mainly as a result of in-depth research into the medical risks and benefits of the procedure.

Nick said...

Well, I'm not going to entertain this farce of a civil debate much longer. I will make a few choice ending jabs at your argument, though.

"how about peer-reviewed studies that record and compare frequencies of psychological problems in both circumcised and uncircumcised males, thus permitting tests for statistically significant differences. It's unrealistic to ask for RCTs, but preferably such studies should attempt to minimise potential biases (by, for example, ensuring that the two groups are as similar as possible), and adjust for potential confounding factors." -What a naive outlook you seem to have. The peer review process can be just as susceptible to bias and suppression. Enshrined it may be, but it definitely has its flaws.

http://www.eurekalert.org/pub_releases/2004-08/cu-bse081204.php

http://post.queensu.ca/~forsdyke/peerrev1.htm

http://www.who.int/bulletin/bulletin_board/84/letters/en/index.html

http://www.nature.com/nature/peerreview/debate/nature05007.html

http://www.guardian.co.uk/science/2003/jan/16/science.research/print

Read all of those. Multiple sources, so you can't say I am cherry picking. I would be surprised if they don't shake your faith in the system. Want to know what I find credible? What we can observe from nature. Fact is, evolution has selected for the prepuce, the existence of which is a practically universal trait among mammals. Do you see any other animals suffering horrible problems from their prepuce on a regular basis? Didn't think so. Definitely not frequent enough for evolution to select against it. I would rather put my trust in that, as compared to the fallible human perspectives that oftentimes are too skewered even though they claim not to be. I'm a fan of methodologically sound science too, but like you said, it's unrealistic to expect that. Especially when unfavorable results could be censored or dismissed as "flawed".

Nick said...

"no, that's not enough. "Some people are opposed to X, therefore X is bad" is a logical fallacy." -Shrug. I suppose you're satisfied that you picked that apart like an opportunistic vulture. That's fine, I was aware of it and it certainly wasn't the highlight of my arguments anyway.

"thank you, I've already read it. They're entitled to their opinion, of course, but I think they're mistaken." -A shame, because I think you're the mistaken one here. You could learn a lot from them.

"if you could quote the relevant passage, I'd be happy to answer, but I'm afraid I'm slightly lost." -There is a saying, damned if you do, and damned if you don't. I was breaking this part of your argument, "So if we automatically assume a causal association, we reach the conclusion that either choice - to circumcise or not - causes psychological harm." down to that. I can easily argue that a man who hasn't been circumcised has the choice available to him. Conversely, it is a much weaker argument to say that he could just restore should negative feelings arise the other way around. It is currently an impossibility to regain the original equipment and a scar will always be there.

"I think some people are just predisposed towards being angry. It might be more accurate to say that they're angry first, look for something to be angry about second." -Well that's not what happened to me. Depression is what happened. I still disagree that they are searching for something to be angry about, and I don't know why it seems so difficult for you to believe that they can feel legitimate, righteous anger specifically from being circumcised with no strings attached.

"honesty would work, I think. Saying, "I think circumcision is wrong because it denies a child a foreskin he might have wanted" is a perfectly valid argument, and probably one of the strongest in favour of your position. I don't personally find it compelling, but many do." -Then I shall continue to honestly challenge circumcision for as long as I live. You can rest assured that I will be doing my part to minimize the promotion of a non therapeutic surgery that has questionable worth at best. The espoused prevention is so dubious in effect as to be taking a shot in the dark, honestly.

"yes, there are a few such studies, though most (probably about 75%) studies find the opposite. Observational studies are inherently imperfect (they're susceptible to confounding), so it's not reasonable to expect them to find the correct result every time. On average they're pretty good." -75%? I wouldn't be so sure of that. Theres a lot of studies out there.

"yes, they have a self-defence mechanism, though as lab studies have shown, they're still a port of entry." And I hope you realize that the mainstream publications which claim a preventative benefit to circumcision conveniently leave out that genetic component. The importance of genes cannot be discounted. Some people are genetically fortunate enough to have teeth that are extremely resistant or immune to decay, and others live to be 100 or more years of age. If you happen to have the bad genes necessary to be predisposed to infection, do you really think circumcision will avail you much? There is nothing you can do short of removing all the mucosa, which is impossible to do since the glans is comprised of that tissue type. There is a cost to the circumcision centric focus: It overshadows that studies very important suggestion that they could exploit these defense mechanisms by strengthening them to reduce HIV, in turn potentially rendering circumcision obsolete. That should be getting more publicity than it is.

Jake said...

Nick:

[Re peer review] "What a naive outlook you seem to have. The peer review process can be just as susceptible to bias and suppression. Enshrined it may be, but it definitely has its flaws." -- I certainly agree that the peer review process is no guarantee of perfection (I've seen some utter junk that somehow survived the process), but for now at least it's the best we've been able to devise. By all means propose something better, but in the absence of that, we'll have to fall back on peer-reviewed science, in spite of its imperfections.

And what you offer isn't anything better; it's a jumble of the naturalistic fallacy, wild assumptions, and fails utterly to address the same question (which, to remind you, is whether circumcision has adverse psychological consequences). But I'll address it anyway:

"Fact is, evolution has selected for the prepuce, the existence of which is a practically universal trait among mammals. Do you see any other animals suffering horrible problems from their prepuce on a regular basis? Didn't think so." -- actually, I haven't a clue, and neither, I suspect, have you. A veterinary epidemiologist might be able to supply some numbers, but an argument based on an assumption that the number is near zero is inherently flawed.

"Definitely not frequent enough for evolution to select against it." -- and how frequent would that need to be? The answer is that it would depend on the pros and cons of the prepuce in a given environment. Humans have of course drastically changed our environment within the last few thousand years (we now wear clothes, for a start, so the penis no longer needs protection from thorns and long grasses).

"I can easily argue that a man who hasn't been circumcised has the choice available to him. Conversely, it is a much weaker argument to say that he could just restore should negative feelings arise the other way around. It is currently an impossibility to regain the original equipment and a scar will always be there." -- not a very persuasive argument, because an adult circumcision inevitably has an inferior cosmetic result to one performed in infancy. So the non-ideal choice available to a dissatisfied circumcised man is comparable to the non-ideal choice available to his uncircumcised counterpart.

"75%? I wouldn't be so sure of that. Theres a lot of studies out there." -- I think it's a reasonable estimate. In Weiss' 2000 meta-analysis, for example, 21 of 27 studies (78%) found a protective effect.

Man With Eyes said...

You can use all the justification you please, to cut a child, but that's all it is; the actions of a child cutter. Your beliefs mean nothing if you are wrong.