Thought of the day

The reason I don’t find the anti-cosmetic argument of anti-circumcisionists convincing is that these people usually aren’t arguing from any solid principle they’re willing to consistently hold. That is, the anti-circumcisionist argument states that a person’s bodily autonomy is important and should not be violated against his or her will except when medically necessary. That means if your baby has a potentially fatal or life-altering heart defect, for example, surgery is an okay thing to demand. Having foreskin, on the other hand, is not fatal or life-altering, and so circumcision is unjustified. But here’s the problem: vaccines cause the body to create antibodies that otherwise would not be there. This is a change to the body which, depending on the vaccine, may last forever. It isn’t an outward change like circumcision, but that is neither here nor there. If the anti-circumcisionists want to premise their argument on bodily autonomy, then any permanent change to the body is fair game.

Let’s review. Circumcision is not necessary for a quality life, nor is a lack of circumcision inherently fatal or life-altering. Vaccines, too, are not necessary for a quality life, nor is a lack of vaccination inherently fatal or life-altering. The differences that exist between these two examples are plenty, but when we’re talking purely about bodily autonomy? There isn’t a bit of difference. Circumcision permanently changes a part of the bodily. Vaccines permanently change the body’s antibodies. Each example, strictly speaking, can be argued to be a violation of a person’s bodily autonomy. Yet, except for the kooks and quacks, we never hear of any anti-circumcisionists wailing on about vaccines. Funny that. It’s almost as if their primary argument is a lie that isn’t based upon any principle at all.

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5 Responses

  1. You’re arguing that vaccines are not medically necessary for a particular individual, just because we cannot predict who will benefit directly the most from the vaccines? Hopefully you haven’t gone full Bill Maher on us. (Although you say you’re “talking purely about bodily autonomy”, your earlier statement “….except when medically necessary” is more accurate and honest).

    What is “necessary”? X is necessary to achieve a desired Y when you can’t get to Y without at least X. With empirical methods, we can’t actually prove necessity, so this amounts to: we only see Y when we have seen X, in a population with a reasonable mix of X and not-X. And there’s always some fudge factors involved, so it becomes: when we see Y, we have almost always seen X, in such population. Depending on how “almost” that is, some things may be more necessary than others.

    In the case of vaccinated people, when we see resistance or immunity to a particular bug in a healthy person with no other known reason to be resistant to the bug, we have usually seen that person be vaccinated against that (or similar) bug. So vaccines are necessary because they are likely to produce immunity without meaningful harm (leading to increased work days, income, decreased expenses, and other factors). How likely?

    It’s worth noting at this point that probability of a positive outcome is something of real value. Consider a lottery. Until the outcome is made concrete by the drawing, a person benefits some small but real amount from receiving a typical lottery ticket as a gift (more than the value of the paper and ink, and probably on the order of a dollar). The value only drops to near-zero (or rises to some other value) after the drawing.

    In the context of vaccines, the benefit of a likely positive outcome can be calculated, by estimating the total net benefit to the vaccinated population (no need to include the unvaccinated, although they do benefit from herd immunity and a case might be made that saving a great many of their lives may justify vaccination), and dividing the result by number of individuals who received the vaccine. (One would expect this has been done by the large payers paying for the vaccines, as spenders like to know what they’re getting for their money, if they have the means to find out. I would be surprised if this result turned out to be negative or near-zero, under even the most unfavorable methods of estimating it.).

    For most vaccinated people (i.e. those that didn’t die as a result, or suffer other impairment) the net benefit is positive until:

    * they die, or

    * while they remain alive, the disease vanishes (by being eradicated, or evolving away, and leaving nothing recognizable by original antibodies)

    I’m not aware of the frequency of the second case, but I think it’s sufficiently rare in relation to the first case (100%) that I’m going to ignore it.

    As long as the vaccinated person is alive, they have some protection against that particular bug, and similar ones. Until we actually know that a person absolutely will not benefit from the vaccine (i.e. that person, or the bug, is dead) we must attribute
    some benefit based on probability. This is true, even if the future is written in stone, because we do not yet have a means to know the future.

    Now I know you’ll want to apply my argument here to circumcision. But I doubt circumcision provides a net benefit anywhere near that of vaccines. After all, the US was one of the places HIV was first noticed, despite the then-high circumcision rate.

    To return to your opening statement, I don’t know what you mean by “anti-cosmetic argument”. When I think of “cosmetic argument”, I think of people who say the reason they want to circumcise boys is because they think it looks better. So “anti-cosmetic argument” would be against that, because it’s not an adult’s business to obsess about the look of a boy’s healthy penis, to the point of having it surgically modified. It’s hard to see how that’s not sexual abuse, even if it happens only once (largely because it can only happen once.. can you imagine what would happen if it grew back?).

  2. You’re arguing that vaccines are not medically necessary for a particular individual, just because we cannot predict who will benefit directly the most from the vaccines?

    Not exactly, though I see the plausibility of that interpretation of what I said. Let’s take a vaccine with a near 100% efficacy, such as the one for yellow fever (a vaccine which I have). (For the sake of argument we can even say it is actually 100%.) While it may be incredibly effective, it isn’t medically necessary anymore than exercise is medically necessary. A person isn’t guaranteed to get yellow fever, just as a person isn’t guaranteed to get heart disease or diabetes.

    What is “necessary”?

    If we go down the philosophical road on this one we’ll never get an answer. However, if we go with normal medical practices, something is necessary when it’s required to stop disfigurement, return a person to normal, every day activities, or prevent otherwise imminent death (at least in general). So chemo is necessary for a cancer patient, a drug cocktail is necessary for someone who is HIV positive, and amputation is necessary for someone with severe gangrene.

    Now just to be clear, I haven’t gone Bill Maher at all. Just a few posts ago I was telling people to get vaccinated. I’m personally protected against a whole host of things from when I visited Africa; if I had to do it all over again, I absolutely would. Vaccines are an important part of any nation’s health policies because they save lives better than any single thing in history.

    Now I know you’ll want to apply my argument here to circumcision. But I doubt circumcision provides a net benefit anywhere near that of vaccines.

    In talking strictly about bodily autonomy, we don’t get to talk about probabilities. It doesn’t matter if a vaccine is better or worse than circumcision for any given thing since the argument is about a person’s right not to have his body altered in a way which is medically unnecessary. (Incidentally, though, circumcision provides about 60% protection against HIV in male-to-female intercourse. The flu vaccine was 48% effective during one of the recent flu seasons, but can be upwards of 80% effective depending on the year.)

  3. You’re using a very odd definition of ‘medically necessary’ if you think vaccines aren’t.

  4. By the way, what is the argument FOR circumcision? I’ve never run across one beyond “tradition” or some vague promise of possible future medical benefits that are no different from recommending an earectomy at birth to avoid dirty ears.

  5. If they are, it’s only insofar as circumcision or liposuction are also medically necessary.

    EDIT: I was responding to your first post as you typed the second.

    Arguments for circumcision which depend upon tradition or religious values are obviously invalid. But the argument that works – especially for developing nations – is the one for health reasons. The science is in when it comes to the protection circumcision offers: there’s a 60% reduction in HIV transmission in male-to-female intercourse. That’s upwards of 18 million saved lives before we even calculate the lowered overall transmission that would result from fewer cases.

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