Saturday, May 01, 2010

Why I Will Never Attend A Brit Milah

By Shea

[Note: This post is part of Modern Paleo's weekend schedule of blogging on Objectivism on Saturdays and free market politics on Sundays.

This post by Shea Levy concerns the barbaric practice of circumcision. Shea wrote this post for his personal blog, so he didn't spell out the connection between the wrong of circumcision and Ayn Rand's philosophy of Objectivism explicitly. Since that might not be obvious, let me take a moment to explain.

Opposition to circumcision is a straightforward consequence of the Objectivist view of that each person has a right to his own life. That includes the right of the child to be free from bodily mutilation, even when inflicted by loving, well-meaning parents. Moreover, Objectivism does not regard the claims of religion as having any moral authority, and it regards sexual pleasure as good.

I've written a bit about circumcision in this blog post. That includes a transcript of Objectivist philosopher Dr. Leonard Peikoff's podcast question and answer on the topic. I hope that Shea's more detailed analysis offers you some hearty food for serious thought. -- Diana Hsieh]

Given the prevalence of religion in today's society (combined with the proto-philosophical role religion plays), it's not surprising that most life event celebrations (birth, coming of age, marriage, funerals, etc.) have explicit religious aspects. Despite my conviction that religion is a deadly poison to whatever extent it is believed and practiced, I am glad to attend these events in most cases when the celebrants are friends/loved ones. Typically (especially for the kinds of people I consider loved ones), the legitimate value being celebrated far outweighs the religious aspect of the ceremony. So even though I'll wince at mentions of God and wish you'd leave the mindless platitudes out of it, I'll be at your church wedding, baptism, bar mitzvah, or priest-run funeral. There is one life-celebration event, however, which I will never attend again (I've unfortunately been to my own): The Brit Milah.

For those of you who don't know and don't like clicking links, the Brit Milah (often simply called a "briss") is the Jewish celebration of male birth during which the new baby is circumcised. While there certainly are Jews out there whose sons I will want to celebrate, I find circumcision so barbaric, cruel, and unjustified that I refuse to lend my sanction to the practice. Indeed, given the historical roots and mal effects of the procedure, the ceremony is less of a celebration of the child than a partial (and occasionally total) sacrifice of the child.

To understand why I find this practice so abhorrent, let's first examine the typical justifications people (whether Jewish or not) give for circumcision. The easiest one to address, applicable only to Jews and Moslems, is religious justification. Guess what? There is no god. Guess what else? Your 8-day old baby doesn't believe in god. Ready for more? No being that could be considered "just" would punish a baby for something his parents failed to do when he was 8 days old. Still not convinced? Even if there were a god, all the scientific evidence (which he presumably allowed to exist) suggests that not only was the Bible written by man, it was written by at least four distinct groups of men over a fairly long period of time. The commandment to circumcise your babies was inserted into the Abraham story by the last of the groups, P (the priestly text), at a time when the priests wanted to institute mandatory circumcision as a marker of racial belongingness and as an explicit sacrifice by the parent. If, after all that, you still want to circumcise your kids for religious reasons, I kindly request that you get the hell out of my life.

So much for the religious justification. What about cultural ones? These fall into two categories, both boiling down to "but everyone else does it!". The first: "I want my son to look like/have a connection to/be a part of his family/race/society!" This is ridiculous. First of all, your child will have many links to each of these groups: Genetically inherited traits, spoken language, accent, food tastes, musical tastes, shared traditions, and more. Second, and more important, when was the last time you were thinking of your connection to your family/race/culture in association with your genitalia? When I'm urinating, showering, masturbating, having sex, or doing any of the other limited things that involve my penis, I never think "wow, it's so cool that everyone else in my family has anatomy similar to mine!"Do you really think your child will? Do you really want him to? The second category goes something like "but I don't want him to be made fun of and not fit in!" Do you live in a nudist colony? If so, then he already won't fit in, as unfortunate as that may be. If not, then only two groups of people will have opportunity to see if his penis is circumcised are his friends when he's very young, if he's the type to shun clothes, or his sexual partners when he's older. Young kids don't really know or care what your son's penis looks like, and I sure hope you expect his sexual partners to be mature enough not to find extra foreskin significant enough to make any difference. Moreover, if he's feeling really left out by the time he's having sex, he can choose to get himself circumcised!

Ok, now on to the only justification actually worthy of rational discussion: health. Over the past several decades, a body of research has been forming that seems to suggest that there are significant preventative health benefits to circumcision. Circumcision appears to be an amazing tool to prevent diseases from urinary tract infections to penile cancer to AIDS and other STIs. All of these claims suffer from two significant problems, however: They are probably based on shoddy science, and even if they are completely true they're not enough to medically justify circumcision.

Let me first address the shoddy science aspect. Let me be up front and say that I've not even come close to a comprehensive review of the relevant literature, but what I've seen so far matches very well with what other anti-circumcision activists have said. I want to delve into a single paper about HPV in particular, but before I do I want to talk about AIDS: All of the AIDS claims seem to be based on a study or series of studies correlating circumcision in adult African men and lower AIDS rates. This research does not seem to address the question of WHY the circumcised men got circumcised (possible reason: perhaps there are cultural influences which correlate with healthier sexual practices. At the very least, it seems reasonable to expect that those who undergo circumcision as a medical procedure are more likely to be aware of medical science/advice and therefore to practice safer sex practices). Moreover, the research is based solely on correlation and doesn't explain why the US, which has fairly high rates of circumcision, has high rates of AIDS as well. To my knowledge, no one has put forth and defended a causal explanation as to why circumcision is relevant to AIDS transmission.

Ok, now HPV. I'm going to get a bit technical here, but I think this paper is indicative of wider trends in the pro-circumcision literature. Last night, I tweeted that I was working on this post, and my brother sent me a journal article claiming that HPV resolves quicker in uncircumcised men (EDIT 5/1/10 1:00 PM EST: Thanks to @Qwertz0 on Twitter for catching the typo). Here's the abstract:

The relationship between circumcision and the acquisition and clearance of human papillomavirus (HPV) infection was examined in a cohort of 357 men followed up at 2‐month intervals for an average of 431 days. There were no differences in HPV acquisition by circumcision status. . Clearance of HPV infection, including infection with oncogenic types, was slower in the glans/coronal sulcus of the penis of uncircumcised men than circumcised men. The median duration of HPV infection of the glans/coronal sulcus was significantly longer in uncircumcised men (154 days) than circumcised men (91 days) (P=0.04). Circumcision may protect against HPV‐associated disease by enhancing the resolution of infection.
Just the abstract alone raises a few red flags. 1: "There were no differences in HPV acquisition by circumcision status". So being circumcised doesn't change your risk of infection. 2. The statistic compared between the groups was the median duration, not the mean. Now it's possible that this branch of medical science has different standard tests, but in my experience the tests for statistical difference between groups always depends on the mean. Unless this type of research typically uses medians, the fact that the mean was not used raises the possibility that the desired result was not achieved when the mean was used. 3. The P value was 0.04. Even putting my general misgivings about statistical hypothesis testing aside, this result is only statistically significant at the .05 level, not the stricter .01 level usually used for work with medical implications. But the problems get worse once you look at the actual paper (you'll probably need a university subscription to access the full text):
The duration of infection did not vary by circumcision status for the penile shaft, scrotum, or all genital sites combined... For the glans/coronal sulcus, the median duration of HPV infection was greater among uncircumcised men (154 days) than circumcised men (91 days), although the 95% CIs overlapped.
Read that again. If you didn't get it, I'll try to make it clear: If you consider only HPV on the penile shaft, only HPV on the scrotum, OR HPV across ALL GENITAL SITES, the duration of infection does not depend on circumcision status. It is only if you consider the glans alone that a longer infection duration is found (and the fact that the 95% confidence intervals overlapped just adds to the ridiculousness). One more time: When all genital sites are considered, the duration of infection does not depend on circumcision status. So being circumcised does not decrease your overall chance of infection, nor does it decrease the duration of an HPV infection at an arbitrary site. But wait, weren't we told differently in the abstract?
Circumcision may protect against HPV‐associated disease by enhancing the resolution of infection.
This is straight up intellectual dishonesty, and smacks of fitting the data to a pre-determined conclusion. The abstract claims the research to be a study about "the relationship between circumcision and the acquisition and clearance of human papillomavirus (HPV) infection" with no specification of where the HPV is located, and indeed HPV incidence and clearance was studied across all locations, and yet the only clearance-related result mentioned in the abstract pertains to a subset of the data, the glans/coronal sulcus data. If they really wanted to report the truth about the relationship, isn't the most important result the fact that, when all sites are considered, circumcision showed no effect on either infection or clearance? This sort of scientific finagling is reported by most anti-circumcision activists who have studied the literature claiming various diseases to be prevented by circumcision, to the extent that many facetiously consider circumcision "the cure in search of a disease."

If you're still with me here, you may be thinking "Ok Shea, maybe those particular studies were flawed, but you haven't read all or even most of the literature, and there may be real evidence out there!" True enough. For the purposes of the rest of this discussion, I'll grant that all of the health risk claims are true. In fact, let's assume that remaining uncircumcised triples your risk of UTI, and quintiples your risk of every STI (except AIDS, it septuples the risk for AIDS). Even given this obviously ridiculous stacking of the deck in favour of circumcision, I would still claim that circumcision is unjustified. To see why, I'll need to describe some of the definite and possible problems that result from circumcision (after all, if circumcision came with no downsides then it would make sense if there was even the slightest increased risk).

First, the definite problems, which occur even if everything goes right: the foreskin is jam-packed with nerves just like the rest of the penis, so cutting it off is both excruciatingly painful for the child (the one time I was shown a video of my Brit Milah, I winced when I heard my ear-piercing scream) and results in a less sensitive penis, lowering the amount of physical pleasure possible from sexual activity. The glans, the most sensitive part of the penis, is permanently exposed for circumcised men, leading to increased chafing and irritation and possibly decreasing the sensitivity of the glans, further reducing physical pleasure from sex (As an aside, it is reported that the original secular justifications for circumcision in the 19th century revolved around limiting masturbation. I feel no need to say anything to those who view sex or masturbation as an evil needing deterrence). And what if things don't go right? While circumcision is a fairly routine operation today, it is still a surgery and does carry risks. An improper cut may result in deformation or loss of the penis, the child may have difficulty urinating, hemorrhage may occur, infection may develop, and in rare cases (~100/year) death may result.

Given these effects (both the certain and the possible), is circumcision for preventative purposes justified? My answer is a resounding NO! All of the diseases which are supposedly more likely for uncircumcised men have either much less drastic prevention methods, much less drastic treatment methods, or both. Worried about UTIs? Rather than slicing off the flesh of your newborn, why not wait and see if UTIs develop (a fairly small risk in any case) and use the normal, non-surgical treatment: antibiotics. AIDS concerns? Rather than hobbling his sexual organ, teach your child safe sex practices and discrimination when it comes to sexual partners (condom usage and regular testing go orders of magnitude farther to prevent HIV spread than even the wildest claims of circumcision benefits, and anyone relying on the fact that he's circumcised as an HIV preventative is a fool.) In the context of the rest of our medical practice, culture-wide preventative surgery involving removing part of the body is completely unprecedented. Doctors don't remove the appendices or gall bladders of newborns, even though these are prone to medical problems and, in the case of the appendix, may not even do anything at all. In fact, due to the risks we typically try to avoid surgery at all costs, even when a body part is ALREADY causing problems: you certainly don't see doctors advocating removal of extremities that suffer from loss of blood flow unless it's absolutely impossible to avoid gangrene. Given the risks and damage involved in circumcision, scientists would have to find very STRONG proof that lack of circumcision SIGNIFICANTLY increases the risk of a disease that has effects FAR worse than those of circumcision, has no other known prevention methods, and has no cure or a cure FAR worse than circumcision. Of course, such a disease has not yet been identified, nor is it likely that it will ever be found.

As a closing point, I want to ask a question that doesn't apply to every concern above, but does apply to many: Why do you need to make this choice for your son? Why can't he decide by the time he expects to be showing his penis to others whether or not he wants to risk ridicule or take the surgical route? Why can't he decide by the time he's old enough to choose his religious views whether he wants to obey god's commandment to be mutilated? Why can't he decide by the time he's old enough to have sex whether he wants to slice off his skin to reduce the risks? Why is it so important to do it at birth?

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