C0nc0rdance circumcision follow-up


Apparently, C0nc0rdance posted a followup video to the circumcision video I posted last week, but apparently Youtube took it down for some reason. Some of his friends have been kind enough to mirror it — and, strangely, haven’t gotten taken down themselves yet.

I am still against routine male circumcision, but there are good and humanist arguments for it in areas where viral infection are prevalent. Anti-circumcision zealots notwithstanding.

Comments

  1. julian says

    Haven’t watched the video but

    Seconding Ibi3. Even in places where AIDS is endemic there’s no reason to perform the circumcision at infancy. At best it should be a procedure available for at risk boys entering adolescence.

  2. timberwoof says

    Teeth are the sources of odors. They get cavities and potentially deadly abscesses. Children often bite one another with them, and everybody knows that human mouths are infested with far worse bacteria than dogs’, so such bites have a far greater potential to cause serious infections in the potential victims. Therefore, every child should have all his or her teeth removed, and when the adult teeth arrive they should be removed as well. This can be done in a single session with minimal discomfort. (Doctors who perform these procedures assure us that young people’s nervous systems are not as well developed as adults’. People screaming and crying for days afterwards are just malingering.) Complaints that removing teeth has a deleterious effect on a person’s food life can be dismissed because this is a matter of life and death.

    Do you buy that argument? Of course not. It’s horrific.

    Before circumcision is to be accepted as a means to reduce the transmission of AIDS (or even HPV!), we need some numbers.

    Have studies that support the claim that circumcision is beneficial been filtered for selection bias and followed up to eliminate regression to the mean? Are the samples large enough to eliminate error; have they been followed long enough to be certain; do the studies eliminate cultural effects?

    What is the expected rate of complications resulting from circumcision? Has this rate been adjusted for the differences between sub-Saharan clinics and modern USA hospitals? Is this rate of complications (and deaths) acceptable for the expected reduction in HIV infection?

    Does this form of infant genital mutilation contribute to social acceptance of other (even worse!) forms of infant genital mutilation?

    Is this even ethical? What other amputations are performed on healthy people to reduce the potential of spread of disease?

  3. says

    As I said in the commentary on the previous video (linked in this post), the most perfect solution would be to undo all the anti-condom propaganda memetics that people seem to be programmed with in South Africa and other areas with huge Catholic presence and few resources.

  4. julian says

    @Ibi3

    I’m not sure I understand where you disagree. I’m certainly not trying to say it’s in anyway a superior or even on par with substitute for condoms. Nor do I think it would be appropriate for anyone to present it as such during sexual health education.

    But it has shown some protection from AIDS where it is endemic among men. And it isn’t much different from body modification (scaring, tattoos, ect) so I don’t see why you should keep the option away.

  5. says

    @ Jason

    That’s fine for the most perfect solution (and it is more practicable than most perfect solutions), but no solution should sanctify cutting off anyone’s body parts without their permission unless it’s medically necessary (e.g. amputation of necrotic tissue, removal of an inflamed appendix etc.). Even if the “science” weren’t questionable, you’re talking about a drastic, permanent, surgical procedure on a non-consenting person where a non-invasive, non-harmful, mundane, nearly 100% effective solution is at hand. How is that rational?

  6. says

    @julian

    It’s just a minor quibble as far as I understand your position. I feel that even “entering adolescence” is too young to consent–that’s like, what 11 or 12? Such people are still far too much under the thumb of parents and other adults. It’s not like they could refuse.

    I have no problem with a person who reaches the legal age of consent for sexual activity (usually between 16 and 18 in Africa, 14 and 16 in Asia) deciding to be circumcised. At that point they can at least educate themselves about their choices. They are able to consult other adults (like the doctor) if they feel undue pressure. If worse comes to worst, they can run away or call authorities.

  7. Randy says

    Anti-circumcision “zealots”?

    Circumcision is a cure without a disease (and an injury without a repair). I can’t believe we’re willing to accept chopping off pieces of genitals in order to support idiotic ideas about condoms.

    If we can’t win the war of words on this one, we don’t deserve to speak.

  8. says

    The only argument I’ve seen so far for doing it only when kids are young is that that’s the best time to do it with the best chance of bouncing back without complications. I reiterate — I still do not approve of it used prophylactically and routinely.

  9. Irene Delse says

    The best thing one can say for male circumcision is that it can help reduce a little the transmission of AIDS to men in regions where condoms are not easily available and/or strongly condemned by “moral” authorities.

    Not very inspiring data. I’d say, let guys choose to do it to themselves or not once they’ve attained the age of consent!

  10. says

    The problem I see with the AIDS prevention is that it might very much backlash: Men who think that they’re “immune” against AIDS will probably be more unwilling to put on condoms which are, in the end, our only hope to fight AIDS if we don’t get a vaccine.
    So it would probably “slow down” HIV transmission at its best.
    Still, it has about zero bearing on routine neonatal circumcission in the first world.

  11. Mark Lyndon says

    Even in areas where viral infections are prevalent, circumcision doesn’t make sense.

    From the USAID report “LEVELS AND SPREAD OF HIV SEROPREVALENCE AND ASSOCIATED FACTORS: EVIDENCE FROM NATIONAL HOUSEHOLD SURVEYS”
    “There appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher.”
    http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf

    The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups “believe that circumcised men do not need to use condoms”.
    http://www.info.gov.za/issues/hiv/survey_2009.htm

    From the committee of the South African Medical Association Human Rights, Law & Ethics Committee :
    “the Committee 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.”

    The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw:
    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60998-3/abstract

    ABC (Abstinence, Being faithful, and especially Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.

    Or does that make me an “anti-circumcision zealot”?

  12. says

    “that’s the best time to do it with the best chance of bouncing back without complications.” What is the basis of that claim? The only attempt to justify it scientifically that I have seen in on the manifesto of the egregious Brian Morris, and he references two papers, one for adult, one for child, from very different populations, with no indication that they are using the same definition of complications. Preposterous.

    The counterargument is that adult circumcision is much more likely to give a good result because the penis has finished growing. Any mistake on a baby’s penis is magnified when he grows up, like writing on a balloon. The adult can have input into what kind of cut he wants and he can control his own pain-relief. Of course he can also give immediate negative feedback too, which the newborn can’t.

  13. says

    @ #12 Irene Delse: “it can help reduce a little the transmission of AIDS to men” – heterosexually. It certainly doesn’t protect men during receptive anal sex and the claim that it protects insertive men from anal transmission is based on a small, high-risk subsample in one study. Transmission in the other direction is a much bigger problem for both sexes.

  14. Mark Lyndon says

    Even if circumcision was a good idea, doing it right after birth is the worst possible time since :

    a) you have to separate the foreskin from the glans (the most painful part of the procedure – think of removing your thumbnails only worse). This also results in adhesions, skin tags and skin bridges. If you wait a few years, then the foreskin separates naturally. This also results in better cosmetic results.
    b) it’s smaller so more chance of a seriously botched job. It’s very rare, but some babies die or suffer amputations because of circumcision (google “David Reimer” and read about his/her story if you don’t know what I’m talking about)
    c) you can’t use general anesthetic on a newborn, so it hurts more. Watch a video of an operation if you don’t know how much it hurts. Just because babies don’t remember, it doesn’t mean it hasn’t affected them. They have more problems breastfeeding, and also show more reaction to injections years later.
    d) newborns don’t have much of an immune system, so they can die of things that are harmless to adults or older children. A baby died after circumcision in New York recently of the coldsore virus for instance, and another got brain damage.
    e) a newborn can die of blood loss after losing about three tablespoons of blood – way less than will be absorbed by a modern diaper.
    f) a newborn can’t tell you if he actually wants to have the most sensitive part of his penis removed or not. It’s HIS body after all.

    There are only two countries in the world where more than 50% of newborn boys are circumcised – the USA and Israel.

  15. Rich Wilson says

    there are good and humanist arguments for it in areas where viral infection are prevalent

    There are good and humanitarian arguments for removing appendixes everywhere. There are better arguments not to.

  16. Anat says

    The only argument I’ve seen so far for doing it only when kids are young is that that’s the best time to do it with the best chance of bouncing back without complications.

    Many years ago I read an interview with an Israeli mohel. He said circumcision is easier to perform on an adult – the bits are bigger and the prepuce is separated. He said that typically mohalim start with adults or adolescents – either those muslims who wait to an older age or immigrants from the former Soviet Union who often weren’t circumcised for assorted reasons. According to this interview most mohalim start operating on infants only after performing several procedures on older people.

  17. sumdum says

    I have no problem with a person who reaches the legal age of consent for sexual activity (usually between 16 and 18 in Africa, 14 and 16 in Asia) deciding to be circumcised.

    16 and 18? I think you are ignoring the fact that kids will have sex long before that age, especially in third world countries. Hello, they’ll likely have kids of their own.

  18. says

    I continue to be indifferent on the issue of male circumcision. Almost all of the arguments against (save the issues of pain and mutilation, which are legitimate but statistically small concerns) seem to boil down to “snipping the tip makes you less manly”, and almost certainly has antisemitic undertones for some people.

    To my mind, if you’re worried about the mutilation issue, then don’t snip. If you want to leave it up to your son, don’t snip. If you just don’t want to snip, don’t snip. Those justifications are all you need without resorting to veiled threats of emasculation.

  19. Mark Lyndon says

    Are you equally indifferent to female genital cutting? Many forms of it do considerably less damage than the usual western form of male circumcision.

    The pain isn’t really the issue and it’s nothing do with making anyone “less manly” – I don’t even know where you got that idea from. The point is that people are having their genitals permanently altered, and the most sensitive parts are being removed. It’s not just there to protect the glans, but includes the most sensitive parts of the penis. Even on a circumcised man, the most sensitive part isn’t the glans (it’s normally the scar line, or the frenulum if that wasn’t removed).

    Why shouldn’t everyone be able to decide for themselves if they have parts of their genitals cut off? It’s their body.

    The issue has become far more important now that people are trying to raise two billion dollars to circumcise 38 million males in Africa in the mistaken belief that it will help fight AIDS.

    I’ve never met an intactivist who was anti-Semitic btw, and I’ve met several who are Jewish.

  20. says

    Mark:

    No, I am not indifferent to female genital cutting. It’s a very different procedure with much more drastic effects. (And yes, I’ve heard of ceremonial nicking and that sort of thing. Not the same.) It’s also irrelevant.

    As for the manliness thing: I don’t believe you. Plain and simple. Even if people won’t admit to it.

  21. Mark Lyndon says

    The only people that think there’s a fundamental difference between cutting parts off male genitals and cutting parts off female genitals are the people that practice one, but not the other. People in countries that cut both or neither don’t see a difference, and neither did the US doctors who were still promoting extreme forms of female circumcision up until the 1960’s.

    There are (rare) forms of female cutting that are much worse than male circumcision (though over 100 young men died of circumcision in the Eastern Cape Province of South Africa last year), but cutting parts off a boy’s genitals isn’t really that different from cutting parts off a girl’s genitals. Many forms of female cutting don’t touch the clitoris, and do considerably less damage than the usual form of male circumcision. One form just removes the female prepuce (the clitoral hood or female foreskin), so is the exact equivalent of US-style male circumcision. In most countries where it’s done, it’s performed by doctors in operating theatres who use pain relief. Take a look at what they do in places like Brunei, Malaysia, Indonesia etc. Even a pinprick or a symbolic nick of the clitoral hood is banned in the US though, and I think boys should get the same protection.

    Its not like it has to be done before the owner gets to have a say. The only two countries in the world that circumcise more than 50% of baby boys are the USA and Israel.

    Don’t get me wrong. I’m totally against female circumcision, and I probably spend a lot more time and money trying to stop it than most people. If people are serious about stopping female circumcision though, they also have to be against male circumcision. Even if you see a fundamental difference, the people that cut girls don’t (and they get furious if you call it “mutilation”). There are intelligent, educated, articulate women who will passionately defend it, and as well as using the exact same reasons that are used to defend male circumcision in the US (hygiene, cosmetic, cultural etc, they will also point to male circumcision itself (as well as labiaplasty and breast operations), as evidence of western hypocrisy regarding female circumcision. The sooner boys are protected from genital mutilation in the west, the sooner those peoples that practice FGC will interpret western objections as something more than cultural imperialism.

  22. Rich Wilson says

    pain and mutilation, which are legitimate but statistically small concerns

    I’m assuming you meant the statistically small to refer to mutilation (and mutilation to be un-anticipated mutilation, as opposed to anticipated mutilation). But having watched a ‘howto’ video of a baby being circumcised, by an experienced doctor, with pain killers, it was a pretty statistically significant amount of pain for that baby.

  23. Mark Lyndon says

    I should have said “fundamental difference”. I can’t give a citation, but almost everyone that defends female genital cutting compares it with male circumcision, and almost everyone in Europe I’ve spoken about it with at least thinks there’s a comparison. Talk to people who defend and promote FGC, and try to convince them there’s a significant difference.

    http://www.noharmm.org/CircintheFemale.htm
    Circumcision in the Female: Its Necessity and How to Perform It
    Benjamin E. Dawson, A.M., M.D. – Kansas City, Missouri
    President, Eclectic Medical University

    http://www.noharmm.org/femcirctech.htm
    Female Circumcision: Indications and a New Technique
    W.G. Rathmann, M.D. GP, vol. XX, no. 3, pp 115-120 , September, 1959

    http://www.noharmm.org/circumfemale.htm
    Circumcision of the Female
    C.F. McDonald, M.D. – Milwaukee, Wisconsin
    GP, Vol. XVIII No. 3, p. 98-99, September, 1958
    (“If the male needs circumcision for cleanliness and hygiene, why not the female?”)

    Blue Cross/Blue Shield had a code for clitoridectomy till 1977.

    More recently, the AAP’s Bioethics committee changed its policy on female cutting in 2010 saying “It might be more effective if federal and state laws enabled pediatricians to reach out to families by offering a ritual [clitoral] nick as a possible compromise to avoid greater harm.”
    They were forced to retract this about six weeks later:
    http://www.medscape.com/viewarticle/722840

    Dr Diekama, the chair of the committee said “We’re talking about something far less extensive than the removal of foreskin in a male”.

    The worst forms of female genital cutting are unquestionably worse than the usual form of western male circumcision, but the worst forms of male circumcision are also worse than the lesser forms of female cutting. Over 100 males died of circumcision in the Eastern Cape Province of South Africa in 2010, and there were at least two penile amputations. Compare that with this:
    http://aandes.blogspot.com/2010/04/circumcision.html

    Why would the procedure in that most recent link be illegal in most western countries, yet this is legal:
    http://video.google.com/videoplay?docid=-6584757516627632617

    Do you think there’s much of a difference between trained surgeons removing the prepuce of a male or the prepuce of a female?

  24. Erin says

    So I had a link to this sent to me by Intact America and they were pissed. They wanted people to write to NYT and tell them that circumcision does not prevent HIV.

    This is a section from the email that they sent:

    The tone of the article shows a shocking disregard for the pain and risk involved in circumcision, the loss of functional tissue, and the negative impact on sexual function—not to mention the overwhelming proof that circumcision at best lowers the transmission rate of HIV from women to men, but not from men to women, and that the only way to prevent the spread of sexually transmitted HIV is to practice safe sex. Rather, the focus is solely on the use of American tax dollars to pay for mass circumcisions.

  25. says

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