Sunday, January 31, 2010

#i2 is what, exactly?

The #i2 campaign for freedom from non-therapeutic circumcision is thriving on twitter. To date more than 15,000 tweets bear the #i2 tag. For both participants and bystanders, it's fair to ask, what exactly is #i2? Here's my take on it. Yours may be different.

  • #i2 is a call for greater freedom
  • #i2 is a statement of the rights of each individual
  • #i2 represents everybody's individual right to keep their intact genitals
  • #i2 asserts the standard of care for healthy newborn boys contra-indicates non-therapeutic circumcision

#i2 represents all these things and many more.

But most importantly, #i2 is tweeted by an ever-expanding number of users who have their own specific meaning for it.

  • #i2 may mean you regret the poor information which led you to allow circumcision of your child
  • #i2 may mean you know your right to keep your own body intact was violated
  • #i2 may mean equal rights for males and females to unmodified sex organs

The "freedomfromcircumcision" twitter list is just about full. The maximum number of users on one list is 500. Soon, new users tweeting #i2 in support of the campaign will be placed on the "freedomfromcircumcision-2" list.

There are vast numbers of Americans who have not fully vetted these ideas. They are familiar with circumcision as something common in their culture, but have never confronted many of the facts or the idea that it's an improper imposition of parental will on the body of a child.

Many of them, along with those who already support these ideas, will eventually declare their support for #i2 after seeing the facts and argumnents put forward.

Every #i2 tweet is an opportunity to share this information with our friends, family, followers, and people we've never met.

Each of us who supports #i2 is a step on the path to securing freedom from non-therapeutic circumcision for everybody.

Tuesday, January 19, 2010

When, exactly, did Scientific American become Circumcised Americans Magazine?

Is Scientific American exhibiting the sort of bias found generally in American culture regarding circumcision?

First they bought hook-line-and-sinker a new boogeyman, "anaerobic bacteria." More of one class of bacteria (and less of another) became a preventative for HIV with nothing more than an amputative genital surgery, motivated speculation (1), and a gentlemen's agreement to never test or imagine such a hypothesis for females (to whom HIV is equally deadly).

Science shows the most sensitive parts of the genitals are removed by circumcision (Sorrells, et al.). Still waiting for that article.

And now, another data point. Circumcised Americans Magazine writes up a "cost-effectiveness" study concluding that a small African country can circumcise more people for the same money (and, allegedly, ultimately reduce HIV) if they target people who can neither volunteer nor refuse, and on whom the intervention has not been studied: newborns. So much cheaper would newborn circumcisions be, in fact, that the sexually active adults who would (again, allegedly) die of AIDS because they're left intact are acceptable casualties. Why does SciAm fail to note that these models rely on the untested and unproven speculation that newborn circumcision will impact future adult HIV rates? Where is the critical thinking? Where is the science?

This paper reports no hard science. It advocates policy based on economics using speculative models. Despite its policy advocacy, there is no mention of ethics or consent. An accompanying paper, which likens those who question the ethics of removing body parts from non-consenting children to "antiscience and antimedicine extremists" ignores all ethical concerns, too. Circumcised Americans Magazine plays along (just the science, M'am), pretending there are no ethical issues whatsoever.

Scientific Canadian of British Columbia just rejected the idea that this data means their newborns should be circumcised. Scientific Australian is entirely unconvinced newborns under their purview can avoid HIV by having this surgery. Both statements consider the ethical implications extensively. Scientific Brit, Scientific Frenchman, Scientific Swede, Scientific Dane, and Scientific Netherlander all do not believe circumcising their newborns makes any sense after reviewing this data. That is, if the physicians groups in all these countries can be relied upon to review the scientific evidence (as the American Academy of Pediatrics seems poised to do for Americans).

But Scientific American, hailing from the land of modified penises, staffed (one could reasonably guess) predominately by non-intact men (and those who know and love non-intact men) is quite intrigued by the idea of circumcision, at any age, in any place where the dispassionate science shall lead!

Onward, Scientific American! Let microbes which fare better in dry circumcised penises thrive, and let there be no safe quarter for those "oxygen hating" menaces which prefer intact male (and presumably female) anatomy!

Onward, Circumcised Americans! Let no lack of data on newborn circumcision keep us from the tiny, ethically neutral steps from adult volunteers in Africa, to non-adult non-volunteers in Africa, to non-adult non-volunteers in non-Africa (like most American Circumcisees!)

And remember: Observational facts like much higher rates of both circumcision and HIV in Americans, versus much lower rates of both circumcision and HIV in Europeans may be discarded because they are not randomized trials.

And the randomized trials? Don't forget, the stated conclusions of the American researchers who conducted them are so beyond doubt that they can never, ever, ethically be replicated! Not in Africa, and certainly not in the United States! Even if it were ethical, there simply is NO TIME to wait for adult outcomes to newborn circumcisions!

Scientific American? I'd like to believe that. But when it comes to circumcision, where is the evidence?


(1) Guus Roeselers calls it "merely a causation hypothesis that was not experimentally addressed in this study."

Thursday, January 7, 2010

Dr. Amy Tuteur's cloudy view of newborn circumcision

In her blog post The case for neonatal circumcision Dr. Amy Tuteur lashes out at those calling for freedom from non-therapeutic circumcision and displays a culturally biased view while advising the AAP to recommend the surgery for all newborn males.

Joining with Tobian, Gray, and Quinn she discards the careful consideration of physicians around the world who have consisently and recently rejected the arguments they are promoting.

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.

“the RACP does not recommend that routine circumcision in infancy be performed.”

These statements were published in August and September of 2009.

In addition to recognizing the clinical data is insufficient to indicate newborn circumcision, and unlike Dr. Tuteur, these medical organizations give significant weight to the ethical issues involved in a surgery which is irreversible, unnecessary, and occurs without consent of the patient.

Dr. Tuteur uses sloppy language to make her case, for example by claiming "the benefits of circumcision are real and clinically important." In fact, they are only potential benefits which will not materialize, and will not be important for the vast majority of circumcised males. The risks of circumcision are also real and clinically important, but she omits them.

Is data from adult Africans any more applicable to American newborns than to Canadain, Australian, or British newborns? Probably not. The low rate of acceptance and support of newborn circumcision by physicians outside the United States, and relatively high rate of support among American physicians like Dr. Tuteur suggests that the existing culture of male circumcision here is clouding her view of the data, and completely obscuring her view of ethical considerations.

The early days of 2010 have seen a concerted effort by some to upset the trend of falling circumcision rates in the United States. The AAP appears likely to issue a revised recommendation on newborn circumcision in the near future. Hopefully they will avoid the cultural bias which affects Dr. Tuteur and some of her colleagues, but leaves physicians outside the United State largely unaffected.