I posted my recent post on circumcision to my Facebook wall. It very quickly got a response, one being a number of links. I doubt the person was intentionally doing a Gish Gallop, but that was the effective result. Unfortunately, I felt compelled to respond in an effort to show just how wrong all linked studies and papers were. As I’ve said before, the only legitimate response the anti-circumcision crowd has to the practice of circumcision is one of ethics. Denying the lowered HIV transmission rate or rejecting the effectiveness of using circumcision as yet another tool in the fight against HIV just won’t fly.
Here is the link to all the studies. I responded to 10 out of 21 before I felt I had made my point. Each number matches the order in which the studies appear in the link:
1. This first study doesn’t address actual sexual sensitivity. It works off the hypothesis that there are nerve endings in foreskin. It shows nothing.
2. The second study’s “methods” was to solicit input from online sources using self-selected participants. If there’s anything I’ve learned about the anti-circumcision crowd, it’s that they will do anything to make circumcision look bad.
3. The circumcised men in this study had far more sexual partners than the uncircumcised men. I question how similar the sample groups actually were since there’s no reason one should be more sexually active than another simply due to circumcision.
4. This study also found a link between premature ejaculation and being from India. The results are more than dubious.
5. This isn’t a scientific critique, but rather one of economics. It’s wrong, first of all. Circumcision is very cost effective and lasts for life. Second, the article talks about the “haste” in the studies connecting HIV transmission and circumcision. I can only conclude that the authors aren’t aware that these studies go back at least 25 years.
6. Wow, where do I start with this one? The first point is simply false. Studies show exactly the opposite. The second point is misleading. They may have looked at three specific studies and had issues over how well they reflect real world conditions, but there are dozens upon dozens of studies on this matter, looking at it from the perspective of different ethnic and religious groups, different nations, different regions, etc. The evidence is robust here. The third point simply misunderstands what science is. Science works on a body of evidence, not individual studies. I can find maybe 5-10 studies questioning global warming. That doesn’t mean they’re right or worth mentioning compared to the thousands of others. The fourth point is hugely misleading. The problem of HIV transmission in the U.S. is largely focused on the homosexual community. Circumcision doesn’t offer much protection, if any, for anal intercourse. The point they are drawing is one of the most frustratingly invalid ones I hear. The fifth point 1) makes up a stat and 2) ignores that condoms aren’t always available in remote regions where HIV is the biggest problem. The sixth point is the only argument the anti-circumcision crowd has. The science is in, so they have to stick with ethics.
7. This claims a national survey showed that circumcision had no preventative effect. The evidence? First of all, it links to the wrong paper. The paper given from your site directs me to a paper which itself cites the actual paper. Second, the survey simply found similar rates of HIV infection amongst circumcised and uncircumcised men in South Africa. It said nothing of total numbers, of sexual partners, of religious and ethnic background, or any other factors.
8. This study compares the universal use of condoms to the universal use of circumcision then concludes that condoms are more effective. This isn’t news, nor is it a reflection of reality. Yes, condoms are more effective, but no, their use is not universal, nor will it ever be. We can’t even get American teenagers to use them universally. Do we expect to convince dozens of unique cultures to adopt them 100%? Of course not. This is a multi-pronged approach.
9. This study discusses issues I’ve addressed, including looking at real world conditions (again, it limits itself to 3 particular studies) and cost.
10. This study finds conflicting results as to the pleasure and enjoyment of sex/masturbation for circumcised men. Many men had less, some had more. Curiously, they seem happy to attribute the lessened pleasure to circumcision but fail to say anything about the increased pleasure. The better guess? There are cultural factors and stigmas at work here.
Filed under: Science | Tagged: Circumcision |
For the Sake of Science 
You make good points. My response only goes part-way, due to lack of information-gathering on my part. I’m mainly aiming at the “yet another tool” claim. A hand axe is a great tool. But in this century most people wouldn’t even recognize it, and would probably toss it out, because we have other tools. How can I be convinced that circumcision is a tool men should use, instead of throw out?
I assume we’re talking about adults, as the issues of consent and religion don’t appear to have been raised on this page. A man can make a decision to be circumcised, and that’s fine. Still, even adults need adequate information to base a decision on. Although an ethical argument, similar reasoning is present in the scientific method, seeking information, and basing narrow conclusions solely on that information.
If someone is going to be told to remove a part of their body for health reasons, they need to be able to measure the risks. The cost-benefit analysis should show that it’s the best solution for the main group this is being recommended for, and not too bad when applied to the few extra others it may also include, that it doesn’t benefit.
I’d want to compare the numbers. How many more vagina-penetrating men (per 100,000) do we expect to become ill, or die early because they caught HIV, because they still had foreskin? I say vagina-penetrating instead of straight, because you noted that circumcision doesn’t offer much or any protection against HIV during anal sex. I don’t think we yet have reason to suspect that male and female anuses differ, regarding HIV transmission. I think you’ll concede that circumcision will do next to nothing for straight men who prefer anal sex with their women. Further, men who are asexual or gay need not take on the minimal, but present, risk of circumcision, yet not doing so may require them to out themselves (not only verbally, but visibly in their own uncircumcised body) in areas where not being clearly straight could endanger their life. This need not be about ethics, but simply about service quality. Over-circumcising is not a high-quality result.
Now, compare the number of men (per 100,000 from above) with the number of people (per 100,000) who we expect will become disabled or will die by participating in cheerleading, BASE jumping, or commercial fishing. These are all encouraged activities, with high death rates. If these numbers are similar, how can we explain encouraging these activities (particularly the entertainment-based ones) while discouraging men from keeping their own foreskins? Is this ethics? Or is it just math? (And I don’t know the numbers, so I may not actually have a point here. I don’t know how to translate “reduces female-to-male HIV transmission rates by around 60%” into a number of lives extended or improved per 100,000 men.)
We currently know that abstinence, reducing the number of sexual partners (“be faithful”), and proper condom usage (together: ABC), do reduce the spread of HIV in frequently-affected populations. When you add circumcision to this, is the benefit cumulative? For example, how can circumcision matter, when ABC is used? Or, how does ABC matter, if circumcision is used? Importantly, could circumcision to reduce HIV transmission result in a feeling of invulnerability, and increased STD transmission due to abandonment of ABC? In this age of increased antibiotic resistant STDs, might some of these in fact be worse than HIV? How do men feel, knowing that even after removing their foreskin, they still need to stick by ABC? Before implementing a permanent change on men, we should know these answers, to understand what outcomes to expect. Further, since you acknowledge we don’t know why circumcision may reduce HIV transmission, you will probably concede we also don’t know what other foreskin-related methods (e.g. application of some sort of gel, or keeping the skin retracted over the long term) might also reduce HIV transmission, without harm. This might be an ethical argument, but I think it’s also a scientific one, in that we need further information before making a decision. “I don’t know” is an acceptable answer in science (often resulting in more science).
There is another argument, and you alluded to it yourself in passing. “… the anti-circumcision crowd… will do anything to make circumcision look bad.” I think we can agree that circumcision has had a negative impact on some circumcised men’s emotional lives, and they respond in this way. The only alternatives I can come up with are that they’re lying, or incapable of assessing their own feelings (which may tend to support your opponent’s claim). It’s not the best argument, but it adds to the cost-benefit analysis. Not all of the costs to circumcision are physical.
Studies, yeah for sure. A US Government study in 2009 of 18 African nations found that in 10 of 18 countries in the comprehensive survey of many areas, the rate of HIV among the circumcised vs. the uncircumcised was greater, much to the dismay of the surveyors. If you take the 2009 NIH survey of new HIV infections and remove MSM, women, the newborn and intravenous drug users, you are left with about 11% of the total being men. It would be extremely useful for US citizens to know the following breakdown of that percentage: How many were circumcised vs. uncircumcised and what was the ratio of black to white? My point is that the real world, despite those who want to deny it, circumcision doesn’t do very much if anything to prevent HIV. You might also consider that the United States, with a circumcision rate of at least 75% has the highest incidence of STDs in the developed world. Circumcision is a cultural phenomenon and has little to do with public health.
None of what you said is correct, Gio, but this was the most infuriating:
First of all, the North American STD rate was 19 per 1,000 in 1999. Western Europe? 20 per 1,000. Central and Eastern Europe? 29 per 1,000. Sub-Saharan Africa? 119 per 1,000.
http://www.avert.org/std-statistics-worldwide.htm
Second of all, the correlation of these stats, particularly as they pertain to HIV, is dishonest at best. Different populations have different sexual practices, experience different external factors, and often have different population segments which account for the majority of problems. In the US, for example, HIV is most prevalent amongst male homosexuals. The same isn’t true for other regions.
I believe the HIV stats on the CIA’s statistics page, not only are they more accurate but they are more current. And the USA is #1 in all first world nations 2, 3 and even 4 times the infection rates of European countries of the same caliber. Secondly the HIV trials showed that there was no reduction in HIV transmission in homosexuals due to circumcision status, so by your own admission circumcision has no relevance in the US. The new thing circumcision seems to be praised for reducing is HPV, I’ll believe Oxford and their recent study on this that showed HPV had the same prevalence from the tip of the penis down to the testicles no matter if you had a foreskin not. I just don’t understand why some people will only look at studies bought and paid for by promoters of circumcision that go out and try to find reasons to keep the practice going (like what happened with the 3 debunked trials in Africa) and spend more time on unbiased tests.
The US has an HIV rate of about 0.6%. Much of Europe clocks in around 0.3%. If we’re to believe this means circumcision has no positive protective properties (or even negative properties), then one wonders why Japan has an <0.1% infection rate despite having similar circumcision practices to much of Europe. Clearly the answer is more complex.
Pointing out the lack of difference circumcision makes in anal intercourse is hardly the same as saying it makes no difference in the US. Heterosexuals still get the disease. Moreover, the CDC has calculated that circumcision has a health policy in the US would be cost-effective.
Few people outside religious circles show a bit of motivation to promote circumcision for any reason other than its effectiveness. It’s one of those things that has a very vocal minority against it, but virtually no one else cares much one way or the other. That is, they didn’t care until the science began to swing towards the effectiveness of circumcision in HIV prevention. If anything, it’s hard to imagine why anyone would trust members of the anti-circumcision crowd. It ought to be curious to any impartial observer that when one side sets up website after website after website to express disapproval of circumcision while the other side almost exclusively sticks to the scientific literature, something is amiss with one of the sides.
Criticism =/= debunked. As you can see, even when the anti-circumcision websites attempt a Gish Gallop, they consistently misrepresent the evidence (sometimes even failing to check that they’re actually directly linking to their source and not just something that sounds good to them).
The circumcision rate in Japan is about 2% unless you look at data posted by the GilGal society like circ info and circ list run by pedophiles, where is this data on Japanese circ rates coming from?
The high rates of STD’s in Africa and North-America are the result of poverty.