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.

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