Science probably doesn’t support your views on abortion

I’ve recently found myself in an incredibly frustrating abortion debate where the other person got a whole host of basic facts wrong while claiming the mantle of science. Even though I agree with him on major conclusions, I’ve never been one to abide by science being misused in any way. I want to set a few basic facts straight in this post.

First, I think it’s important that I make my position clear on abortion. I found my opponent absolutely refused to do this, and I think the reason was because it’s much more difficult to argue in the positive than it is to argue in the negative. That is, it’s harder to defend one’s own position than it is to attack someone else’s position. So my position is this:

I believe abortion is an issue of choice for the mother up through every moment we can confidently say an embryo or fetus is not deserving of moral protection. However, the moment we are able to say a fetus is deserving of moral protection, the issue is one of life versus choice (medical issues notwithstanding). As one might imagine, this is an incredibly unpopular position because it upsets both major sides of the debate. But it’s the only position that makes sense to me. Its sole flaw is that pregnancy is a process of development, so we can’t point to one individual moment where a fetus suddenly deserves protection. But we can logic out the fact that, yes, there is clearly a point where this developing bundle of cells deserves protection. Let me expand on that briefly before delving into the abuse of science that brought me here.

If we are to agree that a newborn is deserving of moral protection, then we can work backwards to ask ourselves some questions. That is, if a baby deserves protection the moment it has fully emerged from its mother and the umbilical cord has been cut, then we have a mutually agreeable starting point for discussion. Working backwards, we can first ask ourselves if that newborn is deserving of moral protection prior to the cord being cut. I’ve heard some extremists say no, but most people are rational enough to see that a connecting tube doesn’t determine the baby’s worth. Next we can ask ourselves if there is a theoretical situation where it would be okay to kill a healthy baby (who isn’t a threat to the health of the mother) while it’s still being birthed. Again, I think most rational people are going to see that it is a baby. Next, let’s back up to 1 minute prior to the mother’s water breaking. Or 5 minutes. Or an hour. Or a day. At each of these points, yes, that’s still a baby and there’s no significant moral distinction to be made; its physical location says nothing of what it is. Now back up a week. A month. Two months. 9 months. At some point, we really are just talking about cells. And so choice becomes the overwhelming issue. But where does choice give way to life? We can’t pick an exact moment anymore than we can say when adulthood begins, but we can choose a reasonable point. Just as we say adulthood starts at 18 for practical reasons, we can say a fetus deserves protection at the second trimester. Or maybe a month before. Or a month after. Whatever makes the most sense is where that number is found. (For me, that number is 5 months based on issues of viability.)

Now I want to address two key issues of science abuse I saw from my opponent. The first has to do with fertilization, and the second has to do with the definition of life itself.

Fertilization is the short process by which a sperm penetrates an egg so that their DNA can bond together. This isn’t a controversial idea on any level or from any side of any debate. Here’s a video that lays out the process in more detail:

I bring this up because my opponent – who is pro-choice, by the way – argued that fertilization is a 2 week process. It isn’t. He’s wrong. Objectively. There’s simply no way around this. To claim fertilization takes 2 weeks is to be wrong, and to hold on to that claim in the face of tremendous evidence otherwise is to be embarrassed without knowing it.

I also bring this up to address what is perhaps the most fundamental part of the pro-life argument: Life begins at conception. The title of the video (which is the first result in YouTube) couldn’t be more on point here: Fertilization and conception are the same thing. This is important to understand. The pro-life side argues that life begins at conception because they believe that the moment new genetic material is created marks the start of a unique human life. There are issues of twinning that can occur, and I think that undermines their argument to a significant degree, but for the overwhelming number of births, their origin can be traced back to the moment when 23 chromosomes from one sperm and 23 chromosomes from one egg combined.

I believe my opponent was trying to stretch the idea of fertilization into 2 weeks because, to him, that allowed for a host of issues to occur where the fertilized egg would be miscarried. But this is entirely a non-issue for the pro-life side. The ultimate viability of a fertilized egg doesn’t change anything about the merging of two sets of chromosomes. At most, this is an issue for religious people to address in terms of why their god allows so many humans to die before so much as developing beyond a tiny bundle of cells. But we aren’t talking about why gods allow people to die.

I also believe my opponent was discussing this idea of viability because he had a questionable definition of “life”. In his own words:

Showing one example of non-viable life after fertilization defeats the notion of life at conception, because it’s wrong to call dead things life.

Of course, this is nonsense. It’s also dodgy. Throughout my debate, I tried to see if “life” was being used as a substitute for “personhood”. Unfortunately, I was met with the same stonewalling I got when I asked for my opponent to argue in the positive regarding his own position; he simply ignored the repeated question.

Without defining our terms, there can be no hope of rational discussion, so I will give definitions here.

If “life” is to refer to living things, then viability is a non-issue. The cell is the simplest unit of life, and if there’s anything anyone should be able to agree on it’s that fertilization forms cells that divide. That is life. It’s life just as much as plants or bacteria or dolphins are life – even with a lack of viability. Cells that fail to develop are living until they aren’t. A fertilized egg that fails to move through the Fallopian tubes or to implant in the uterus is absolutely, without any shred of doubt, unarguably life so long as the individual cells within it are living.

If “life” is to refer to “personhood” – and I think it is – then we’ve moved from science to philosophy. There is no objective definition of “personhood”, and it certainly isn’t true that viability is the crux by which we must define the term.

Conclusion

I consider myself to be pro-choice for the first 5 or so months of a pregnancy because it makes sense to me that choice is the basic issue at hand. Through that point, I’m not convinced there’s a reasonable argument for a right to life for the fetus. That is, a fetus doesn’t meet my definition of personhood to that point. After that point, however, I fail to see how we aren’t talking about a person. Certainly, there is no moral difference in what a baby is 1 day after birth versus 1 day before birth…or 2 days…or a week…or a month…and so on. And that tells me the issue isn’t one of choice. At least, insofar as choice is an issue at all, it is entirely trumped by the fetus’ inherent claim to life.

I repeat my position because it is informed by science, but it isn’t science itself. That is, science doesn’t tell us when personhood begins. It can’t. That’s a philosophical concept – and it’s not even guaranteed that a given philosophy is going to value personhood over choice. But science can tell us what fertilization is. It can tell us what life is. It can tell us what viability is. These are all important issues in the abortion debate that only science can resolve. And we can use science’s resolutions to inform our views on what level of life matters, or when viability becomes significant enough to draw our personal concern. What we can’t reasonably do is use science to make up definitions of fertilization or life (or maybe “personhood”…who knows).

Science moves on bodies of evidence

I’ve long made the point that science moves on bodies of evidence, not individual studies. If you don’t have repeatable data, then you don’t have much of anything. This is why the media is frequently so bad when it comes to reporting on recent studies; they report (or at least imply) individual study results as conclusions that are being made by the scientific community at-large. The truth is usually more like, one group of researchers found some interesting results.

And with that in mind, I turn to one of my favorite topics in science, circumcision. My numerous posts are easily searchable, so I won’t bother to link them, but for those who are unfamiliar with my stance, let me be clear: I am hugely in favor of circumcision because the science is in – circumcision saves lives. Furthermore, there is a very clear body of evidence that circumcision does not decrease sensitivity or sensation. In fact, a recent study found just the opposite:

Of 454 circumcised men, 362 (80%) returned for a follow-up visit 6 to 24 months after VMMC (voluntary medical male circumcision). Almost all (98%) were satisfied with the outcome of their VMMC; most (95%) reported that their female partners were satisfied with their circumcision. Two thirds (67%) reported enjoying sex more after VMMC and most were very satisfied or somewhat satisfied (94%) with sexual intercourse after VMMC. Sexual function improved and reported sex-induced coital injuries decreased significantly in most men after VMMC.

For someone like me who is greatly in favor of circumcision, this is great news. While it is only a survey study rather than a research study, it still provides evidence that circumcision is even better than the scientific community thought. However, that’s just not how science moves. Find me another several dozen studies like this using a variety of methods, and if they show a trend that confirms the results here, then I’ll start believing it. But as things stand now? I can’t make the leap. There is a standing body of evidence that says circumcision doesn’t affect sensitivity or sensation one way or the other; for every study that reports positive results, there’s one that reports negative results (and more often, studies report mixed or push results).

Catholicism and evolution

I often hear people trumpeting that the Catholic Church supports science because it supports evolution. The usual rebuttal is a terrible one that points to the Church historically denying science, as if that bears any relevance whatsoever to whether or not it supports it now. Let’s stop with that line of bad argument and instead focus on what the Church currently believes – it turns out it, in fact, does not support evolution.

Evolution has no goal. It isn’t conscious. It operates on a combination of natural selection and random mutation (amongst a few other factors). This is necessarily focused on the level of the individual – or gene, if you want to go down that path, but we needn’t – and generation. An organism replicates or reproduces, passing its genes on to the next generation without regard to how well its great-great-great-great-great offspring will fare. Indeed, it isn’t even passing on its genes with regard to how will its own offspring will fare. It, of course, often does make an investment there, but its concern is in and of itself in the passing of its genes. Fundamentally, that is what matters in evolution. The genes that pass through the sieve of natural selection have done so for the sake of continuing to exist. We would be correct to think of the game as resetting in every generation.

What this means is that there is no long term goal within evolution. Genes have unconsciously seen to it that they will get themselves copied for as long as they can. If that ends with a quickly replicating bacterium or something toothy or something small and quick or something intelligent or something simply huge, then so be it. The only way in which it can be said that evolution has any sort of goal is to say that it has generational goals. These are not conscious and they do not come about with any sort of phenotypic effects in mind. That is, the goal is for genes to continue to exist; there is no goal for genes to produce any particular characteristic or trait. Evolution is truly incidental.

This matters in terms of the Catholic Church’s alleged acceptance of evolution because the Church, like most religions, believes that human are special and/or inevitable. We aren’t. As Stephen Jay Gould famously noted, if we re-ran the tape of life, we would get different results every time. The fact that we exist is incidental in the history of life. Change a few factors here or there and humans don’t exist. The same goes for every species. For instance, if an asteroid didn’t hit Earth 65 million years ago, dinosaurs would quite likely still roam the planet. The rise of the mammals probably wouldn’t have happened since we would have remained as small burrowing creatures that kept out of the way of all the big, toothy animals out there.

Human inevitability is necessary for virtually all religions, including Catholicism. If humans are only incidental, then we lose any sort of special status. That’s exactly what reality is, though. We know this for a fact. The only way to reconcile Catholicism and evolution is to say that God guided evolution towards humanity in a way which appears consistent with a natural process. For my money, that’s an unsatisfying God-of-the-Gaps explanation; in this argument, God is indistinguishable from nature.

Round-Up is not in plant DNA

I wrote the following in response to someone on social media who said Round-Up gets into the DNA of GM crops. Several other people in the same thread made the same claim. I know a great number of people out there believe a whole host of things about genetically modified organisms for one reason or another. In most cases, the people don’t have a basic background in the issues at hand. That would be fine if the topic stayed on safety – we can all read the summaries of scientific papers – but time and time again, people insist on making outlandish claims that betray an ignorance of biology. Here’s what I wrote:

DNA is composed of four nucleotides: guanine, cytosine, adenine, and thymine (plus a few things to help glue it all together). These are the molecules that compose that double-helix structure we all know so well. Guanine (G) and cytosine (C) bond while adenine (A) and thymine (T) bond. Each strand of the double helix has some given order of these letters (GAACATTAC) that goes on for some time. The corresponding strand has the matching letters (CTTGTAATG). These are called base pairs. Every three base pairs correspond to an amino acid. TGG, for example, corresponds to the familiar tryptophan we find in our turkey every Thanksgiving.

That’s a crash course in what DNA is. Next, it’s necessary to understand what a gene is (on a biological level). Knowing that DNA is composed of nucleotides that form an amino acid every three base pairs, we can understand what a gene is. Those base pairs continue to form a double helix structure between start and stop codons. These are specific sequences of 3 base pairs which indicate where a gene begins and ends:

AUG GAC TGA AAA GCG TAG

The start codon is AUG and the stop codon is TAG here. All the letters in between code for amino acids. (Those letters tend to get into the hundreds or thousands.) These amino acids are folded into a specific 3D shape that catalyzes reactions. If there is some sort of error anywhere along the line, the 3D shape won’t form correctly and thus won’t work. That’s what Round-Up does to most plants. If you spray it on some weeds in the cracks of your driveway, you’ve inhibited the synthesis of necessary amino acids plants use. Without those amino acids, the ultimate 3D structure is mal-formed, if it forms at all.

I’ve bored you with all this because I want to be clear: Round-Up is not present in the DNA of GMOs. GMOs are able to synthesize the aforementioned amino acids via a naturally occurring gene that has been inserted into them.

In other words, the active ingredient in Round-Up is glyphosate. This is not a nucleotide and it does not attach to or compose DNA. It attaches to a specific enzyme (which is produced by DNA) and inhibits a pathway that is only found in plants. (That is, a given enzyme is needed to catalyze a given process, but it is inhibited from doing so. It’s similar to a key being needed to open a door, but someone has stuffed the keyhole with other junk. You aren’t opening that door.) As a result, a number of necessary amino acids cannot be synthesized, causing the plant to die. GM crops have a slightly different enzyme, however. Recall that enzymes form specific 3D shapes. The enzyme in GM crops form a different shape than the enzyme in other crops. That means the glyphosate cannot attach, and thus it cannot inhibit the synthesis of those amino acids.

At no point is Round-Up a part of anything’s DNA. It couldn’t be. The double helix structure works with nucleotides. That’s just what DNA is. Glyphosate is a synthesized molecule which interrupts the enzymatic process of plants. Those interrupted enzymes are products of genes and they also contribute to the production of amino acids which are necessary for the replication of more genes.

Why circumcision is a very good thing

I’ve written numerous posts about circumcision and its benefits, but I want to write one more big one. My goal here is to gather together all the relevant information to the debate in one place. Certain myths need to be dispelled in some places while the details of arguments need to be laid out with ridiculous clarity; the anti-circumcision crowd is as stubborn as young Earth creationists. As such, this post isn’t so much directed towards the entrenched anti-circumcision folk as it is towards the people on the fence. Perhaps there are a few people out there who have simply bought into easy arguments, and so their commitment to their position can be swayed. I would equate these people with the occasional church patron that grows up learning the Universe is 6,000 years old, only to later shed that false belief when engaged on the matter. I hope I’m able to adequately mount a defense of circumcision and change the minds of any such people who end up reading this post.

There are several topics that should be addressed when discussing circumcision. Safety, efficacy, and ethics are the broad categories, and each one contains its share of details. Let’s start with safety.

Safety:

As with any surgery, complications are possible. The most common complication due to circumcision is minor bleeding, which can be fixed with a little bit of gauze. Infections occasionally happen, but they’re rare. Circumcision should always be done under sterile conditions to maintain this rarity. (That means the Rabbis and other non-medical professionals out there who do these things need to be stopped.)

Pain and Trauma:

A favorite of the anti-circumcision crowd is to find awful looking restraining devices doctors use to keep infants steady. Aside from the fact that those devices aren’t the iron maidens people make them out to be, circumcision needn’t be painful in the least. Any search will find a mix of estimates for how frequently anesthesia is used during circumcisions, but it is certainly used a majority of the time, and its use is always increasing. Any parent worried about the pain their baby may feel can simply request anesthesia be used. This 100% addresses any pain argument the anti-circumcision crowd wants to raise. Indeed, it also addresses any trauma argument they wish to raise, but it isn’t necessary for that purpose. Trauma is something which has lasting physical or psychological damage. Since no infant can possibly remember being circumcised, there’s no way any amount of pain could be traumatic here. Moreover, the pain of being squeezed through a vaginal canal just days earlier is clearly much more significant than any minor medical procedure.

Nerve Ending Hypothesis:

There is a popular hypothesis that because the foreskin has 10,000 to 20,000 nerve endings, any removal of it must affect sensitivity. It makes sense and it’s worth investigating. Unfortunately, it’s that investigation aspect that many in the anti-circumcision crowd don’t like; for many, the hypothesis is conclusive. Occasionally, though, they may point to a study or two they incidentally find – so long as it supports their beliefs, of course. These studies (which are usually actually just subjective surveys) sometimes indicate decreased sensitivity in circumcised men. Other times, they show just the opposite. (The anti-circumcision crowd ignores those.) Mostly, though, they show statistically insignificant differences. Moreover, the better studies and meta-analyses out there show the same wash. Since science operates on bodies of evidence rather than individual studies – if you can’t repeat your data, it’s bullshit – the correct conclusion here is that not only is there no body of evidence that circumcision decreases sensitivity, but there is actually an active body of evidence which shows it has no effect.

Efficacy:

This is where the majority of this debate centers. It isn’t enough to look at all the evidence and conclude that circumcision is low-risk, painless, non-traumatic, and inconsequential in sexual sensitivity and performance. That’s all great, but none of that adds up to a reason to circumcise someone, much less to implement it as a public health policy. What we need is data which show circumcision offers some sort of benefit. You’ll never guess what we’ve had for the better part of a decade.

Three randomized control studies were undertaken and completed between 2005 and 2007. These studies looked at the effect of circumcision on HIV transmission rates from women to men during heterosexual intercourse. (Prior to these studies there was a body of observational studies which indicated a likely link between circumcision and HIV, but it wasn’t nearly concrete enough to enact any type of policy.) These studies concluded that circumcision significantly reduces HIV transmission in the aforementioned context; one study went so far as to compare the reduction to what would be achieved by “a vaccine of high efficacy”. Between the studies, the relative risk reduction was 60%.

Relative versus Absolute

For some time I had an anti-circumcision troll around here. He enjoyed raising the issue of relative risk versus absolute risk. I’m not sure he understood the difference, though. Whereas the relative risk reduction for circumcised males was found to be 60%, the absolute risk reduction is between 1.3% and 1.8%. Choosing the latter of these numbers is a good way to muddle the discussion. Here’s what these numbers mean.

Relative risk reduction is how much a given treatment, behavior, or characteristic reduces a given risk in one group versus another. This is the number that matters most of the time in lay terms. Absolute risk reduction, on the other hand, looks at an entire population and takes into account its susceptibility to some given condition. For instance, most people aren’t going to get the flu. It doesn’t matter whether a person has the vaccine or not. Odds are low that he or she will catch anything. That’s why anti-vaccine quacks love to use absolute numbers. The flu vaccine is generally somewhere near 60% effective, but absolute numbers are closer to 1.5%. That isn’t an argument against getting vaccinated, though.

Problems with the Studies

The three aforementioned studies were robust and have been largely accepted by the scientific community. The WHO, UNAIDS, the CDC, the Bill and Melinda Gates Foundation, and a dozen and a half African health ministries have all embraced their results. Of course, that isn’t going to stop the anti-circumcision crowd from coming up with something to question. Most commonly, the issues raised are non-issues. For instance, I’ve frequently seen the point raised that condoms are more effective. This is like when a creationist tries to argue against evolution by talking about the Big Bang. It just isn’t on topic. Other issues include the region where the studies took place, the early termination of the studies, and control and intervention groups being treated differently. Let’s start with where these studies took place.

It should first be noted that, as I mentioned earlier, there is a large body of observational studies on the effectiveness of circumcision in HIV transmission reduction. This body is global; what it indicated panned out in these trials. Second, Africa is massive. Uganda and Kenya are neighbors, but South Africa isn’t even close. These places have commonalities, but they are also significantly different in a host of aspects, including culturally. Repeated results across a wide swath of area cannot be simply dismissed out of hand: the limited region of each individual study could be a confounding factor, but when taken as a whole, the studies necessarily reduce any potential confounding factor due to regional affect.

Each study was halted early on ethical grounds. The results were so overwhelming, the monitoring boards for each study had no choice but to put an end to the trials and recommend that all the uncircumcised men be circumcised. Regardless, the studies still all lasted between about a year and a half and two years. Potential bias as a result of these abrupt endings were taken into account. From the Kenya study:

Because the Data and Safety Monitoring Board recommended to stop the trial after the intermediate analysis, it was not possible to follow all the participants as initially planned, and, as a consequence, only those participants recruited at the beginning had a full follow-up. This potential bias was taken into account by adjusting the analysis for the recruitment period; such an adjustment cannot fully account for the confounding effect associated with partial follow-up. When restricting the analysis to those participants who had a full follow-up, the intervention had an effect that was similar in size and significance, suggesting that this potential bias had a negligible impact.

Another common complaint is that a large number of participant follow-ups were lost due to the early terminations. The effect was likely negligible since the numbers actually weren’t that significant for these type of studies, plus many of the follow-ups were actually lost for reasons unrelated to HIV infection (such as moving from the area). Knowing this is one of the benefits of having actually read the studies rather than agenda-driven websites.

Finally, I frequently come across Internet comments that declare the control and intervention group were treated differently. The claim is that the intervention (circumcised) group was given education, condoms, and counseling over and above what the control group was given. This is simply a lie. I’m not sure of its origin, but I’ve seen it enough that I feel it deserves to be killed. The groups were given and/or offered consistent treatment. The only reason to say otherwise is for the same reason Lyndon Johnson told one of his aides to spread the story that one of his opponents fornicated with pigs. He knew it wasn’t true, but if he could make the other guy deny it, he would be giving it credence by simply addressing it. As usual, I’m willing to forgo the public perception in favor of assuming a literate readership.

How It Works

The evidence is in when it comes to circumcision, but how it works is still up for question. One hypothesis says that the foreskin offers a relatively damp environment that is friendly to various pathogens. Another hypothesis says that Langerhans cells are a target of HIV, causing them to act as a vector. Since the relatively thin foreskin has these cells, that means there is an increased surface area and number of these cells where HIV can attach.

Other Benefits

Circumcision has been found to have a host of other health benefits (.pdf). UTI’s are decreased among newborns, penile cancers are reduced, general infections are reduced, and HPV is 30% less prevalent. One study from 1954 to 1997 that looked at cases of invasive penile cancer found that 87 out of 89 (98%) of the men were uncircumcised. Other studies have found a 30% decrease in contracting herpes.

Developed World Efficacy

The CDC has recently come out as endorsing circumcision has a healthy decision for parents to make. It’s a one time cost for a procedure with a low incidence rate of what are only minor complications anyway. The child feels no pain, there is no trauma, sensation isn’t affected at sexual maturation, and a host of diseases are reduced. If the CDC didn’t stop short of recommending circumcision as a health policy for political reasons, then they only did it because STD’s are not an epidemic in the United States. But, then, neither is the flu.

Condoms and Hygiene

The anti-circumcision crusader may get to this point and say, “Fine, even if everything to this point is true, it’s still undeniable that condoms, education, and basic hygiene can best take care of the major health issues raised here where Africa is concerned.” And that’s fair enough. Condoms are 97-99% effective at preventing sexual transmitted diseases. Retracting the foreskin and washing with soap and water will prevent most (maybe even all) infection. But this is a poor understanding of reality.

Let’s start with condom use. Even with wide spread education campaigns, millions of Americans have unprotected sex with untested partners every single day. STD’s are still transmitted here and teen pregnancy (and other unintended pregnancies) still exist. It strikes me as near-racist to assume that we can throw education and condoms at people in Africa and get great results. They aren’t monkeys we first worlders get to train. People in Africa will largely behave how people around the globe behave. Some will use condoms. Some won’t. Some will be willing but unable. Sometimes people run out of condoms and want to have sex. Sometimes they will have sex where they don’t happen to keep their condoms. Sometimes they want to take a risk because it feels better. The “they” here is global.

It’s obviously true that condoms and education are key components in the fight against HIV. However, we should never limit ourselves to one option simply because it may be the most effective option. This fight isn’t a zero sum game; we can – and should – use every tool available. Doing so will literally save lives.

As for hygiene, even with rigorous cleaning practices, infections can still happen. I have a friend who got circumcised in his early 20’s for this exact reason. He showered every day and was specific about his cleaning regimen, but he still had issues. That won’t be the case for everyone, but it will certainly be the case for many. It’s far easier to entirely prevent this issue after birth than to force men to see doctors later in life for something that needn’t be an issue.

Ethics

The anti-circumcision crowd has lost on the scientific front. Circumcision protects against HIV and other STD’s. It reduces penile cancers and other infections. It doesn’t hurt and it doesn’t alter sensitivity. Aside from the minor risks of surgery (which exist largely by virtue of what surgery is in the first place), it literally has zero physiological drawbacks. That leaves the anti-circumcision folks with limited recourse in the debate. Enter the ethical argument.

There is effectively only one ethical argument against circumcision. It isn’t a good one, but it does have a basis in established ethical theory. However, before I address that argument, I want to address a common philosophical argument I hear. It isn’t technically about ethics, but we’re in the same ballpark. It’s the argument that says removing the foreskin in order to protect against disease is like removing a foot to prevent foot cancer or gout. Eventually, the argument usually ends with the suggestion of death in order to prevent all disease. Even without the especially absurd end, this is nothing more than an argumentum ad absurdum. Removing a piece of skin which has no discernible function and the loss of which has no negative consequence is not the same as removing a significant body part or altering the body in a way which affects quality of life negatively.

The primary ethical argument against circumcision – the argument from bodily autonomy – is slightly better. This argument says that it is wrong to permanently alter a person’s body without their consent for non-medically necessary reasons. That means a haircut is fine, or even a piercing (though there may be other objections to the latter). Indeed, any life-saving procedure is allowed under this argument. Like with most ethical arguments, there will be examples that raise gray areas (and those will generally come down to personal judgement calls more than anything), but there are certain things that are black and white. Tattooing one’s infant wouldn’t be allowed, for example. The child necessarily cannot consent and the procedure is absolutely not medically necessary, so there is not justification for it.

With circumcision, it is true that the procedure is not medically necessary. All the benefits laid out above are still very much true, but that doesn’t make the procedure necessary. A person who doesn’t get circumcised can live a perfectly happy life, free from all sexually transmitted diseases and infections. Indeed, billions have done and are currently doing it. Furthermore, it cannot be reversed. Once that foreskin is gone, it’s gone. Some people will say it can be returned, but it will simply be extra skin, at best.

Now let’s make a comparison.

Vaccines are some of the greatest achievements of science. Everyone should get at least the basic vaccines we expect people in the 21st century to have. And for those who live in certain areas or travel to certain areas, a number of other vaccines are recommended. For instance, I have a vaccine for yellow fever because I visited Tanzania about 5 years ago. If I visit any similarly at-risk location 5 years from now, I’ll get a booster shot first. All that said: vaccines are not medically necessary. Again, they’re fantastic and everyone should get them. Public policy should dictate all students must get them. These are things which save lives. But, again, they are not medically necessary. Even when polio was a significant public health concern, very few people actually died from the disease. Only a small minority of the population ever contracted it, and of that small minority, only a minority became sick at all. It was great when a vaccine became widely available. Lives were saved. But being unvaccinated did not put someone at active risk of sickness or death; being unvaccinated was a passive risk. This exactly mirrors the issue with circumcision. Furthermore, vaccines cause permanent change to the body via the addition of anti-bodies. This again mirrors the permanent change of circumcision.

The first counter to this comparison is generally to note that anti-bodies aren’t a visible change whereas removal of the foreskin is. The argument from bodily autonomy makes no such exception. The argument doesn’t say it’s wrong to permanently alter a person’s body without their consent unless you totally can’t see it. That would entirely gut the argument, making it into nothing more than a cosmetic argument. Something so superficial doesn’t pass any sort of ethical muster in my book. Besides, I’m not so sure the anti-circumcision crowd should be making a cosmetic argument anyway.

The second counter to the circumcision-vaccine comparison is to note that whereas vaccines add something to the body, circumcision actually removes something. I suppose that’s true, but I don’t see where such a distinction would matter within the argument from bodily autonomy. We can no more rid ourselves of anti-bodies than we can rejuvenate foreskin.

Before I reach the end of this post, I want to quickly recap the argument from bodily autonomy. The argument says it’s wrong to permanently alter a child’s body without his consent unless it’s for a medically necessary procedure. Neither circumcision nor vaccines are medically necessary. Both are highly effective and both save lives. Without either, we would have fewer people in the world, that’s for sure. However, neither one is required to live a long, happy, and healthy life. This, of course, is not an argument against either one. This is an argument against this incantation of the argument from bodily autonomy. That isn’t to say bodily autonomy isn’t important. It is. But it isn’t an argument that works under the auspices of libertarian ethics as applied to global health issues. That is, bodily autonomy is important because it is the best way to protect the individual and populations at-large; it isn’t important in and of itself/because it maintains liberty. (Dead people don’t have liberty.) Or to put it another way, bodily autonomy only works under a utilitarian framework.

Conclusion

This one is simple. Circumcision is a safe procedure that needn’t cause pain, doesn’t cause trauma (indeed, it can’t cause psychological trauma by definition), and it doesn’t affect sexual sensitivity, satisfaction, or performance. Furthermore, it reduces female-to-male HIV transmission, invasive penile cancers, UTI’s, STD’s, and general infections. Along with education and condom use, circumcision is a phenomenal tool in the fight against HIV; circumcision literally saves lives. The World Health Organization, UNAIDS, the Bill and Melinda Gates Foundation, a dozen and a half African health ministries, the CDC, and the AAP all support it as good health practice. The science and the ethics are in: Excepting for the minor (and rare) risks inherent with surgery by virtue of what it is, there are literally zero drawbacks to circumcision; when performed under sterile conditions and by medical professionals, circumcision increases the odds a boy will have a disease and infection free life.

Thoughts of the day

I’ve created a separate blog (with the creative title “Michael Hawkins Maine”) where I’ve gathered the random ‘Thought of the day’ posts I’ve made here and elsewhere. The topics range from science to politics to hiking to my hatred of spicy food. It’s more a collection for me since I like to go back to some of my writings to get thinking about a topic that may have been out of my mind for a little awhile, but I hope it’s at least mildly interesting to other people.

Check it out.

Circumcision: The evidence still isn’t vanishing

Increasingly, circumcision is becoming a health policy in places where it is needed most. WHO, UNAIDS, and especially The Bill and Melinda Gates Foundation are some of the groups are the forefront of this fight against deadly diseases and infections. More recently we’ve seen American groups such as the American Academy of Pediatrics come out in favor of circumcision. This is in large part due to three extremely strong studies that came out in 2006, but those were really just the final straw. Evidence has been building for the effectiveness of circumcision in fighting disease and infection since the late 70’s, and more specifically it has been building against fighting HIV since the late 80’s. The evidence is in: Circumcision helps protect against infections, penile cancer, and STD’s, including HIV. It’s an extremely important tool that should be promoted around the world. And so, as the debate quickly pivots from whether or not circumcision is effective to figuring out why it is so damn effective, more organizations are coming out in favor of it in ever stronger terms:

U.S. health officials on Tuesday released a draft of long-awaited federal guidelines on circumcision, saying medical evidence supports the procedure and health insurers should pay for it.

The Centers for Disease Control and Prevention guidelines stop short of telling parents to have their newborn sons circumcised. That is a personal decision that may involve religious or cultural preferences, said the CDC’s Dr. Jonathan Mermin.

But “the scientific evidence is clear that the benefits outweigh the risks,” added Mermin, who oversees the agency’s programs on HIV and other sexually transmitted diseases.

I went into the circumcision debate many years ago without a dog in the fight. I was neither passionately against the practice nor fervently in favor of it; my general indifference parted greatly with what any Google search will show. However, as I began to hear more and more about the topic, and as I began to study global health issues more and more (especially during the time I was studying and volunteering my time in Haiti), I found my position slowly shifting. But it was indeed a very slow shift. With degrees in both biology and philosophy it was easy to be torn. The evidence had clearly tilted – at the least – in favor of circumcision, but what about the ethical arguments against it? I would need to resolve those concerns before I would support circumcision as a health policy. And that I did. The sole argument the anti-circumcision crowd has against circumcision is that it violates bodily autonomy. But so do other things which many in that crowd clearly support. Namely, vaccines can and do permanently change a person’s body for life without their consent. Looking at circumcision and vaccines, then, under the isolation of the argument from bodily autonomy, what’s the difference? They both change the body forever and neither is done with consent when done to infants/toddlers. The only responses I ever get to this is that vaccines are more effective or that the changes aren’t visible. Pshaw. They aren’t always more effective, and even where they are, so what? The argument from bodily autonomy doesn’t get to be put on the shelf when it’s convenient to ignore. The effectiveness of a procedure is irrelevant; all that matters is the necessity of the procedure. Vaccines and circumcision are both necessary to a healthier world, but neither is an absolute necessity to survival. Yes, more people will die without either, but that’s immaterial. And as for the changes being internal, I guess I wasn’t aware how aesthetics-focused the anti-circumcision crowd was.

I went on a bit of a rant there, but I hope it was effective. The ethical argument – singular, not plural – is weak. Yet the biological argument is strong. And as I learned more, it became quite clear that it was stronger than I initially thought. I freely admit that by the time I became involved in this debate (likely 2009, and as early as 2010 on NBS) I should have done all the proper research; I could have easily found myself where I am right now rather than going through a slow shift.

One of the things which always kept me tilted towards being pro-circumcision was the dogmatic attitude of the anti-circumcision crowd. It didn’t matter what evidence was presented to them, their ethical stance trumped everything. That would be fine, of course, since it would be a valid basis for opposition (even if I or anyone else disagrees with it). Unfortunately, this crowd has a habit of attacking perfectly valid science. PZ Myers did this back in 2011 when he said the following:

The health benefits. Total bullshit. As one of the speakers in the movie explains, there have been progressive excuses: from it prevents masturbation to it prevents cancer to it prevents AIDS. The benefits all vanish with further studies and are all promoted by pro-circumcision organizations. It doesn’t even make sense: let’s not pretend people have been hacking at penises for millennia because there was a clinical study. Hey, let’s chop off our pinkie toes and then go looking for medical correlations!

Emphasis mine. Clearly, whereas the organizations promoting circumcision as a health policy or recommendation have had a history of different positions on the matter, it’s ridiculous to say they’re inherently pro-circumcision. Moreover, the irony meter here is off the charts. The anti-circumcision crowd is incredibly vocal, despite being a scientific minority. Indeed, whereas the pro-circumcision groups came to their conclusions only after being presented with evidence, the anti-circumcision groups are composed entirely of people who oppose the practice on ethics first; they cherry-pick the science after the fact.

But that isn’t the important point here. As the title of this post says, the evidence of the benefits is not vanishing. It’s not vanishing with further studies. It’s not vanishing with time. It’s not vanishing at all. All we’ve been seeing is 1) more and more groups coming out in favor of the practice and 2) research focused on why it’s so effective. (Of course, all this criticism is coming from a guy who once had a debate with Jerry Coyne where he said that no evidence could ever convince him of the existence of God. While I share his lack of theistic belief, I don’t share his position here. I can’t imagine a more anti-scientific thing to say than that there is no possible evidence that could convince me of something. I could be convinced unicorns exist. I greatly doubt that will happen, but it’s possible; denying these possibilities when speaking in abstract terms is doltish.)

Anyway.

[The new guidelines] are likely to draw intense opposition from anti-circumcision advocacy groups, said Dr. Douglas Diekema, a Seattle physician who worked on a circumcision policy statement issued by the American Academy of Pediatrics in 2012.

“This is a passionate issue for them and they feel strongly that circumcision is wrong,” said Diekema, a professor of pediatrics at the University of Washington.

Indeed, the head of one group did argue against the CDC’s conclusions on Tuesday, saying they minimize potential complications from the procedure.

The guidelines “are part of a long historical American cultural and medical bias to attempt to defend this traumatic genital surgery,” said, Ronald Goldman, executive director of the Circumcision Resource Center.

Notice the name of the anti-circumcision group in that quote: Circumcision Resource Center. Hmm, what other group of people try desperately to sound legitimate despite everything they hold dear? Perhaps it’s the people who run sites and groups like Evolution News and the Discovery Institute and the Geoscience Research Institute – creationist groups. Honestly, I’m not sure who should be insulted more by this association.

Some times the quackery makes me laugh

There’s a lot that distresses me about naturopaths and other quacks. They are a genuine danger to the health of all those who encounter them. This may be in the form of an active danger – cases abound of them prescribing contra-indicated drugs – or it may be in the form of a more passive danger, such as when someone with an easily treatable but potentially deadly disease is misdiagnosed by one of these poorly trained charlatans – but they are a danger any way one wishes to look at it. That said, that doesn’t mean the ineffective methods of these quacks can’t be hilarious. Take this interview with Portland quack Sarah Kotzur:

To determine the best course of treatment, including an appropriate homeopathic remedy, Dr. Kotzur spends two hours with a new patient. “I’m trying to know you as a whole person,” she says. “I’m going to ask about what kind of dreams you have, what kind of food you crave. What is your body temperature? Do you sweat? Are you thirsty?”

Emphasis mine, hilarity Kotzur’s. One wonders how she decides to interpret this arbitrary information when ‘treating’ one of her ‘patients’. If the person has dreams where they can’t run fast, does that mean she prescribes a dose of treadmill time? Tough to tell, but I’d venture a guess that most of her ‘treatments’ come down to garlic, some sort of berry, and/or what is basically water.

The rest of the article goes into attempting to legitimize the practice by noting how it works with insurance and licensing:

Naturopathy has come a long way since the 1980s. There are currently six accredited schools of naturopathic medicine in the United States and 16 states now offer practice licenses. Maine has been licensing naturopathic doctors since 1996.

What the article failed to mention, and what naturopaths don’t want people to know, is that naturopathy is specifically banned in South Carolina and Tennessee. It isn’t medicine, it isn’t related to science, and every single one of its practitioners is a quack.

Anti-science quacks find success in Maine in their fight against health and vaccines

Vaccine rates for young people entering school has been declining in recent years:

The rate of unvaccinated kindergartners in Maine continues to climb and is now the fifth highest in the nation, according to a U.S. Centers for Disease Control and Prevention report released Friday.

The percentage of Maine parents voluntarily opting out of vaccines for their children is alarming state public health officials who have been working to bolster immunization.

Nearly 800 public school kindergartners in Maine started the 2013-14 school year without receiving the required vaccinations for diseases such as whooping cough and measles because their parents opted not to immunize. That represents 5.2 percent of all kindergartners in the state, up from 3.9 percent the previous year.

This is in large part due to the anti-vax movement that has been steadily gaining ground since the 90’s. Indeed, although disgraced British doctor Andrew Wakefield had his 1998 study linking vaccines and autism debunked – no one ever reproduced his results, and it was no wonder since he outright made them up – he remains a hero of the anti-vax crowd.

One of the more favored canards of anti-vax quacks is to call herd immunity a myth. Do a quick search and one is liable to find any given quack claiming that herd immunity makes no difference to the health of a state. I recall reading some random anti-vax nobody argue that because vaccines are between 60-80% effective, even with 100% compliance, we could still see an epidemic. Of course, while he spoke of vaccines at-large in an intentionally general sense, he actually linked to CDC statistics on the flu vaccine. I guess it was a coincidence that he found it inconvenient to tell his readers that he was talking about one specific vaccine, huh? So is the high bar set by quacks.

At any rate, for herd immunity to be effective, there needs to be about a 95% vaccination rate. Of course, 100% would be the ideal because we’re talking about saving human lives, but with all the anti-government and anti-science kooks out there, 95% is actually a very achievable number that allows for some bumper space. Unfortunately, sometimes we see areas that fall well below that bumper space. For instance, when vaccine rates for whooping cough fell to 91% in California, communities there saw an outbreak in the disease. Thousands got sick and at least 10 infants died. What makes this all the more heart-breaking is that these infants were too young to be vaccinated, meaning they relied upon the herd immunity around them to remain safe. Anti-vax parents and the quacks they trust are at fault for these deaths. Frighteningly, Maine is on a similar path.

This is incredibly impressive

Daniel Radcliffe (perhaps better known as Harry Potter) recited “The Element Song” on The Graham Norton Show several years back. It’s damn impressive.