Thursday, December 10, 2009

2009 Turning Point: Momentum to Circumcise Grows Worldwide

As the year 2009 draws to a close, history may judge this year as the "turning point" in the movement to achieve universal circumcision -- a world in which the foreskin no longer poses a health threat to a male, his partners, or society as a whole.

Aided by one medical study after another this year, more governments than ever have embraced the goal of 100% male circumcision, knowing that this simple health procedure can reduce the risk of HIV by 60% and dramatically curb the spread of STDs, HPVs, cancers, and other ailments that afflict society.

When the data is finally collected for the year 2009, it will show that more males world-wide are circumcised now than ever before in world history. To be circumcised is not only the "norm" in the USA, it has become the desired norm across the world simply because "the cut" is healthy.

Even in those countries where governments have been reluctant to embrace circumcision (i.e., many European countries), the populace as a whole is joining the circumcision movement. Men are opting for the cut, and parents are wisely choosing to circumcise their sons at birth, knowing this is the safest, most reliable, and inexpensive way to protect their boy for life.

We have also seen a growing appreciation of the value of circumcision in Asia and the Indian subcontinent. I would bet, once the data is in, that more Japanese, more Indians, more Chinese are circumcised than ever before -- joining their counterparts in Korea, Philippines, and Indonesia who are already clean-cut. The best news on that front this year have been reports that Chinese health officials may encourage universal circumcision in the near future. The world's largest country could set a powerful example if it would promote newborn circumcision as an important health measure.

The year 2009 also saw the growing hysteria of the anti-circumcision fanatics, as they try to pressure governments to ignore the medical science and to scare parents against this life-preserving procedure. In my view, the fanaticism of these groups only marginalizes them among the mainstream. That is certainly true in the USA where, despite millions of anti-circ dollars spent on lies and mischaracterizations, I have no doubt that more baby boys were circumcised this year than last year.

Just ask the normal person on the street here in the Midwest about circumcision and the answer is always the same. "Of course. It's the healthy thing to do." -- a statement usually coupled with "Yeah, it prevents AIDs." The latter is not quite accurate -- it reduces the risk of AIDs -- but the public is getting the basic message.

Even those who may be confused on the issue because of anti-circ propaganda usually return to the basics. "It's cleaner. It's easier." -- with the variation "If it was so bad, why does everyone do it?" They do it because, deep down, nobody really wants a filthy foreskin that can cause so much medical havoc.

If 2009 becomes the turning point in the medical goal of achieving universal circumcision, there is still one disappointment which can be remedied in the remaining weeks of this year. Where is the American Academy of Pediatrics? Where is the CDC, Centers for Disease Control? We began the year with hope that -- based on medical science alone -- the AAP and CDC would declare that every male should be circumcised. While insiders say they want to do this because they know it is medically right, pressure from the anti-circs have delayed action. Nothing would complete 2009 more as the "Year of Circumcision" than a strong backbone at the AAP and CDC and a year-end statement encouraging ("voluntarily") the circumcision of males!

So what do you think? Do you agree that, in general, this has been a terrific year for circumcision? I welcome your thoughts.

75 comments:

  1. Yes, it has been a great year for circumcisers! After a lot of work, press conferences, and meetings by the medical community, a significant number of Americans now believe that

    1) circumcision prevents AIDS, or that circumcision will prevent 60% of new HIV cases. Good old American ingenuity!

    2) the foreskin causes HPV, cancer, and urinary tract infections. And besides, a foreskin is icky!

    3) circumcised men are just healthier than men who still have foreskin, and it turns out that routine circumcision was the right thing all along!

    Yes, a great year! I have no doubt that circumcised doctors at the CDC, or their female friends, will make routine neonatal circumcision an official recommendation this December, as promised. Yay!

    You, Jake, and Ben Winkie have won!

    ReplyDelete
  2. Yes, and as you get older the less sensitive the head gets!!

    ReplyDelete
  3. Last anon: there's no medical study proving this, and therefore it must be false (Jake's Razor).

    ReplyDelete
  4. "Just ask the normal person on the street here in the Midwest about circumcision and the answer is always the same."

    A statement like that and you want me to believe you are a "university academic"? Seriously? I notice how you instantly couch the issue in terms of a "normal person," because what if you asked say a grad student from China or some 'liberal wacko' and they didn't mirror your views? Nothing screams confidence in your position like pre-selecting your audience or slanting your question.

    Anyway, this born and bred Hoosier finds infant circumcision a disgusting violation of a children's right and a senseless mutilation of the male body. Luckily the 'abnormal' Big Ten universities I attended for both undergraduate and graduate school were full of 'abnormal' guyssporting their natural body, including the intact Belgian man who is now my husband.

    ReplyDelete
  5. universal circumcision ? what are you some sort of dictator ? no i would guess some you have some sort of sick circumcision fetish. well it aint clever and you are not fully informed because being abnormal as cut people are means a severe loss of approximatly 2/3 of the nerves in your penis so you are missing out , i have done my research but as you are cut you dare not look into the light side where positive information on the natural member lies so stay in the dark but remain quite for you lack real knowledge as you lack foreskin.

    ReplyDelete
  6. Yeah i agree wit the last guy and america is evil too pushin for circumcison every where like that it to make money and its real sick my kids will not have it i told them never go away your jest in it for money and a kid died of bein cut bad real bad. you gotta have a condom too so theres no good in cutting at all. thanks

    ReplyDelete
  7. The first comment is so laughable I thought it was a parody. I was waiting for the punchline. Maybe it's hidden in that mysterious name "Ben Winkie". Who he?

    ReplyDelete
  8. Circumcision made some great inroads this year especially in many African and Asian countries. Even though the number of circumcised adult males may be on the rise worldwide, more work is urgently needed on routine INFANT circumcision. As PD correctly points out, it is much faster, cheaper and effective when the circumcision is performed during the newborn period, usually within the first day (sometimes less) after birth. It simply makes no sense to wait until the male reaches puberty or adulthood (although it's always better late than never!)

    Moving forward, the benefits of infant circumcision should be clearly spelled out to new parents so that they understand how important it is to be good, loving parents and give their baby boy all the health and hygiene benefits he so rightfully deserves - at birth. Medical evidence strongly suggests that those benefits can be best acheived when a baby boy is circumcised.

    2009 was a good year but our work is far from done in the new decade ahead. Based on current trends, I won't be surprised if by the end of the next decade, most (if not all) newborn boys will sport healthy, clean-cut penises of which they can be truly proud.

    ReplyDelete
  9. Thanks, Paul, for your intelligent comments. Do you notice how -- instead of debating the question I posed -- has 2009 been a terrific year for circumcision? -- the anti-circ fanatics want to attack us personally. That is their typical tactic. Having lost on the evidence, especially the medical evidence, they resort to ridicule. I welcome the anti-circs to this blog, but let's stick to the topic -- do you think 2009 has been a good year for you or not? I think Paul is right. By the end of the next decade, almost all newborns in the Americas, Africa, Asia, and even Europe will be clean-cut.

    ReplyDelete
  10. "Non-therapeutic circumcision (NTC). The SMF continues its work towards ending NTC in the UK. At the end of November they chaired a meeting combining senior members from several organisations working to develop a joint strategy and action plan.

    The Daily Mirror reported on a 20 year old man initiating legal proceedings against the doctor who performed a NTC on him as an infant because of his parents’ religious beliefs. The young man has been in regular contact with the SMF.

    The Daily Telegraph reported on a paper recently published in the Journal Clinical Ethics concluding that current GMC and BMA guidance to doctors is itself unethical in that it allows parents to procure a non-therapeutic, irreversible surgical procedure on their children to satisfy their own religious beliefs. The author of the paper, Dr David Shaw, is a lecturer in ethics at Glasgow University.

    The SMF will be contacting both the BMA and the GMC asking them to revisit their respective guidelines. Members of the NSS may wish to contact their MPs, NHS trusts and local media to bring these developments to their attention and to raise public awareness. "

    http://www.secularism.org.uk/116437.html


    GREAT NEWS! Hopefully it is just a matter of time before the United States and other countries follow.

    Here is the link to the Daily Telegraph report for those of you who are interested.

    http://www.telegraph.co.uk/journalists/rebecca-smith/6662199/Circumcising-boys-for-religious-reasons-could-breach-Human-Rights-Act.html

    ReplyDelete
  11. hi i just would like to point out that the fanatics appear to all be on the pro-circumcision side of the discussion because they are trying to promote the procedure whatever. the anti-circs as you term the natural/normal body form people are trying to support the child in its infancy against genital surgery the choosing of which the child is too young to participate or consent to ,this is choosing the do nothing option so they can hardly be called fanatics for supporting the do nothing opinion. fanatics are always those who support doing something.

    ReplyDelete
  12. Oh really, all over the world it's a parental right to cut off sexual tissue from boys or girls for their own good. Hopefully circumcision will become mandatory for both sexes. In women it prevents cancer of the vulva, the same way male circumcision prevents cancer of the penis, and an uncircumcised woman stinks.

    ReplyDelete
  13. i rest my case with the above posting" fanatics are always those who support doing something" said i and the word mandatory is the word of a" fanatic ".mental illness is all around us but the money to treat it is short ,lets
    hope for a better future where no mandatory requirements
    exist and the rights of children are respected.

    ReplyDelete
  14. "According to a new study, women with a family history of breast cancer were 59 percent less likely to develop breast cancer themselves if they breastfed their children.

    "This is good news for women with a family history of breast cancer," says Alison Stuebe, assistant professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill School of Medicine and lead author of the study, which is published in the Aug. 10 issue of Archives of Internal Medicine.
    "Our results suggest a woman can lower her risk of cancer simply by breastfeeding her children," Stuebe says.
    Among women with a mother or sister with breast cancer, the researchers found that those who had breastfed were less than half as likely to develop premenopausal breast cancer as those who had not breastfed.

    Stuebe and colleagues reviewed data from the Nurses' Health Study II, a long-term study of more than 100,000 women from 14 states. Stuebe's study followed more than 60,000 who reported at least one pregnancy in 1997, when breastfeeding was assessed in detail, and followed them through 2005 to determine how many developed invasive breast cancer.

    Why breastfeeding reduces risk of breast cancer is unknown. The authors suspect that when women do not breastfeed, inflammation and engorgement shortly after birth causes changes in breast tissue that may increase risk for breast cancer. Breastfeeding followed by weaning may prevent this inflammation. "

    Wow. Interesting stuff. With your logic, I guess we should force all women to breast feed. Breast cancer effects many more women than HIV/AIDS does. 12 percent of women will develop breast cancer in their lifetime. I mean it makes more sense doesn't it? A person can't choose what their family history is. HIV/AIDS is, after all, not a spontaneous disease. ( Unless you are in the small percentage of babies born with it because of an infected mother, in which case circumcision would be a moot point anyway). You get HIV/AIDS through having unsafe sex, and using infected needles. Breast cancer can effect women with no risk factors at all. Should we then force all women who have children to breast feed? (assuming they don't have a medical reason not to) Of course not, that would be silly and unethical. It is their body and they should choose whether or not breast feeding is worth the risk reduction.

    ReplyDelete
  15. No, we should enforce neonatal mastectomy. There's no medical study proving that it would be harmful, and it would certainly save a lot of lives, thousands of times more than male circumcision. And in the circumcision department, it is reasonable to assume that female circumcision would have parallel benefits to male circumcision: as the poster above noted, elimination of vulvar cancer; elimination of vulvitis; reduction in genital warts (you can't get warts on tissue you don't have); better hygiene; and so forth.

    ReplyDelete
  16. No, we should enforce neonatal mastectomy. There's no medical study proving that it would be harmful, and it would certainly save a lot of lives, thousands of times more than male circumcision.

    Um, if you engage your brain for a moment, you'll realise that such an invasive procedure will likely have a fairly high complication rate, including the risk of death. Weigh that, along with disfigurement and loss of function, against the benefits and it doesn't look like such a good idea.

    And in the circumcision department, it is reasonable to assume that female circumcision would have parallel benefits to male circumcision: as the poster above noted, elimination of vulvar cancer; elimination of vulvitis; reduction in genital warts (you can't get warts on tissue you don't have); better hygiene; and so forth.

    Speculating is fun, I'm sure, but the real question is whether you can cite any evidence in support of your claims. Probably not, I suspect.

    Educate yourself.

    http://www.who.int/mediacentre/news/releases/2006/pr30/en/index.html

    http://www.ncbi.nlm.nih.gov/pubmed/19065392

    ReplyDelete
  17. Jake, I assume that neither you nor anyone else reading this Blog is taken in by these Anonymous posters who pose as pro-circ and then make outrageous ludicrous statements (like cutting vulvas, forced breastfeeding, etc.). These are anti-circs (under the guise of Anonymous) who post crazy crap as "straw men" so they can return to the Blog (again under the guise of Anonymous) to strike it down and make the pro-circ movement seem silly.

    Those who truly support male circumcision (with appropriate exceptions) are not the fanatics, as hard as these crazy anti-circs try to turn us into them.

    ReplyDelete
  18. Yes, there would be some complications resulting from neonatal mastectomy, as there are with circumcision, but the reduction in breast cancers would be significant: you can't get breast cancer if you don't have breasts. Women don't need breasts, and with formula neither do babies. I think you need to look at the net benefit.

    And in some system of ethics, it might be perfectly permissible to perform this procedure on infants, with informed consent of the parents.

    ReplyDelete
  19. Since male breast cancer is more common than penile cancer, neonatal male mastectomy should certainly be made mandatory before circumcision. Jake's objection about loss of function becomes moot (unless you give weight to those fetishists who enjoy having their nippoles played with). Where is Jake's evidence that this "invasive procedure" will have a high complication rate, or lead to "disfigurement"?

    Men should be proud to sport clean-cut chests, without disgusting, disease-promoting (Eew!) nipples.

    ReplyDelete
  20. Also, we need to make recircumcision mandatory in those cases where any excess inner skin was left the first time. This is where HIV gains entry, and PD has already pointed out that the more foreskin you have, the more at risk you are. This would truly be a harmless operation that could only save lives. The foreskin has no sexual function or sensitivity, so taking a little more off the top couldn't cause any damage. I am really concerned that people are not getting enough foreskin removed. Doctors are taking off less and less for some irrational fear caused by the anti-circ nuts. A proper circumcison, one that saves lives, leaves no inner skin whatsoever. Clean cut and tight! Every boy deserves the best circumcision, and that is a circumcision that is total and complete.

    ReplyDelete
  21. "Um, if you engage your brain for a moment, you'll realise that such an invasive procedure will likely have a fairly high complication rate, including the risk of death. Weigh that, along with disfigurement and loss of function, against the benefits and it doesn't look like such a good idea. "

    Um, does circumcision not also have a risk of death? Does circumcision not also cause disfigurement?

    1. disfigurement - the act of damaging the appearance or surface of something.

    Loss of function? does a circumcised penis still have gliding skin that moves back and forth during intercourse? While one can argue whether or not it is an important function, it is still a function that is lost.

    "Speculating is fun, I'm sure, but the real question is whether you can cite any evidence in support of your claims. Probably not, I suspect. "

    Where is your evidence that there would be a high complication rate of neonatal mastectomy? A higher complication rate than circumcision? or that the death rate would be any higher?

    "Preventive (prophylactic) bilateral mastectomy: Removing both breasts before cancer is diagnosed can greatly reduce the risk of breast cancer (by up to 97%)."

    Those are some pretty astounding numbers, a 97 percent risk reduction of breast cancer would save thousands if not millions more lives than neonatal circumcision, which is a risk reduction of only 60 percent and effects a much smaller percent of the population.

    http://www.cancer.org/docroot/cri/content/cri_2_4_2x_can_breast_cancer_be_prevented_5.asp

    ReplyDelete
  22. "Whenever life insurance companies notice that their clients are dying in increasing numbers of some affliction, The Spectator, insurance publication, sounds an alarm. Investigations are started and remedies devised. It is good business for the insurance companies, a good deed for the public.

    Last week's cause for corporate alarm was appendicitis. From 18,000 to 20,000 people in the U. S. are dying each year from this cause. The national mortality record, like the mortality record for women in childbirth, is, according to Frederick Ludwig Hoffman, consulting statistician for Prudential Insurance Co., the worst in the world. The U. S. appendicitis death rate per 100,000 inhabitants in 1929 was 15.2. Now the rate is even higher. "

    Parents should also remove their child's appendix while they are at it. Removing the appendix is a relatively routine procedure and it could save thousands of lives.

    ReplyDelete
  23. "Mastectomy is very safe surgery, and most patients recover well with no complications. As with any surgery, however, there are risks. Possible complications are listed here, but keep in mind that unless stated otherwise, they usually do not happen.

    The risks of any surgery are bleeding, infection, and injury to nearby tissues. Some post-operative pain and soreness is expected, but can be effectively treated with pain medication. There will also be a scar on the chest wall. Scarring occurs with all surgery, and is unavoidable.

    General anesthesia risks include potential breathing and heart problems, as well possible reactions to medications. For a woman who is otherwise in good health, the risk of a serious complication due to general anesthesia is less than 1%."

    http://health.nytimes.com/health/guides/surgery/mastectomy/overview.html?print=1

    ReplyDelete
  24. And it's a sure bet that mandatory recircumcision to remove the dangerous inner skin remaining on so many partially circumcised men wouldn't be any more dangerous that their first circumcision.

    Just out of curiousity, PD and Jake, how much inner skin do you have remaining? I sure hope it all got cut off to give you the maximum benefits of circumcision!

    ReplyDelete
  25. To respond to PD:

    Jake, I assume that neither you nor anyone else reading this Blog is taken in by these Anonymous posters who pose as pro-circ and then make outrageous ludicrous statements (like cutting vulvas, forced breastfeeding, etc.).

    I think we can safely say that I recognise their arguments for what they are: nonsense. I have this bizarre belief that people will stop making idiotic arguments once it is shown to them that those arguments are idiotic. In spite of evidence to the contrary, I continue to hold this belief. :-)

    And to respond to the anonymous comment dated December 13, 2009 7:50 PM:

    Um, does circumcision not also have a risk of death?

    Yes, it does. The risk of death is about 1 in 500,000. As I said, however, the risk of complications (including death) in the case of mastectomy can be expected to be considerably higher due to the more invasive nature of the procedure.

    Does circumcision not also cause disfigurement? ... . disfigurement - the act of damaging the appearance or surface of something.

    Far from damaging the appearance, I think many if not most people would say that it improves the appearance.

    Loss of function? does a circumcised penis still have gliding skin that moves back and forth during intercourse? While one can argue whether or not it is an important function, it is still a function that is lost.

    No, it is a description, like saying "this rock sits on a lawn". A function is a useful characteristic.

    Where is your evidence that there would be a high complication rate of neonatal mastectomy? A higher complication rate than circumcision? or that the death rate would be any higher?

    Just common sense. I don't have any evidence to hand, though a little browsing revealed this paper which proudly reports reducing the rate of surgical site infections from 33.3% in 2000 to 18.9% in 2005.

    Those are some pretty astounding numbers, a 97 percent risk reduction of breast cancer would save thousands if not millions more lives than neonatal circumcision, which is a risk reduction of only 60 percent and effects a much smaller percent of the population.

    Well, I'm not sure why you've chosen to compare with HIV reduction specifically, as there are other benefits of circumcision, but yes, if you look at the benefits only, it does seem like a good idea. But, as I pointed out above, you have to weigh pros against cons.

    ReplyDelete
  26. "Yes, it does. The risk of death is about 1 in 500,000. As I said, however, the risk of complications (including death) in the case of mastectomy can be expected to be considerably higher due to the more invasive nature of the procedure."

    Well you don't know whether or not it is higher do you? You constantly ask people to show evidence or statistics when they make " common sense" arguments. As quoted above, mastectomy is a very safe surgery and has very few complications. Even if the complications are higher, it would have to be SIGNIFICANTLY higher by astounding numbers for the net benefit not to be worth it. Since, after all, it would be saving thousands of more lives than a 60 percent HIV reduction circumcision would. 200,000 thousand women are diagnosed with breast cancer every year, and 40,000 die. A mastectomy would have the same risk reduction for every woman, and not discriminate based on means of contraction. Circumcision has only been shown to be statistically significant in heterosexual sex, and only to men. It can't offer any protection for drug needle transmission, transfusions, receptive anal sex, heterosexual sex in regards to females etc.

    "Far from damaging the appearance, I think many if not most people would say that it improves the appearance."

    That is a completely ignorant statement. Over 80 percent of the world is uncircumcised. Do you know of any studies that say or prove that women or men in those countries where circumcision is not routinely performed prefer the look of a circumcised penis? Even if every person in the entire USA thought they looked better, it would still not be most people. There is also no way of knowing whether or not a two day old infant would prefer the look of being circumcised or not.

    func·tion (fngkshn)
    n.
    1. The action for which a person or thing is particularly fitted or employed.
    6. Biology The physiological activity of an organ or body part.

    Whether or not you think it is important is moot, it still has a function that is important to many men.

    "Well, I'm not sure why you've chosen to compare with HIV reduction specifically, as there are other benefits of circumcision, but yes, if you look at the benefits only, it does seem like a good idea. But, as I pointed out above, you have to weigh pros against cons."

    I point out HIV because it is the main argument that pro circumcision lobbyist use that holds any weight at all, and that weight is arguable. Other proposed benefits of circumcision like UTIs and non life threatening STDs alone are not reason enough to justify routine circumcision, as stated by every word health organization in the world, including the United States. The risks of circumcision outweigh the benefits in those instances. When there is a less invasive and more beneficial way of treating a condition that method needs to take precedence. For example, treating a UTI with a simple antibiotic, which is extremely effective.

    continued..

    ReplyDelete
  27. "With the current exception of HIV, the STDs whose incidence circumcision is supposed to reduce have few serious consequences if transmitted. Antibiotics are very effective at treating most STDs. Genital herpes, may be incurable, but its morbidity is negligible at best, and it is more common among circumcised than genitally intact US males.
    The danger to public health posed by the STDs for which circumcision is supposed to be useful is insubstantial. Because the sexual transmission of HIV and other STDs is usually dependent upon adult lifestyle choices, a programme of amputating a healthy part of the penis from an unconsenting minor as a means of reducing the incidence of STDs is unethical. In marked contrast, the contraction of the diseases for which children are routinely immunised, such as polio and measles, is independent of lifestyle choices and is determined by such accidental, unforeseeable, and casual situations as unknowingly breathing the same air as an infected person.
    Amputating part of the penis is the most invasive method of attempting to achieve the desired public health objective. Circumcision desensitises the penis and immobilises whatever shaft skin remains, thereby destroying the natural and normal means of erotic stimulation.59 The stated public health objectives could be achieved by more conservative means, such as improved sex education, making condoms freely available, or regulating prostitution.
    The alleged benefits of circumcision are not appreciable to the individual because to reap the alleged benefits of the procedure, the individual would have to disregard safe sex warnings and deliberately engage in unsafe sexual practices with infected individuals. Even then, because the claimed benefit of circumcision under these circumstances is not statistically significant, there is no meaningful way to calculate the alleged benefits from circumcision to an irresponsible individual. Most importantly, the public health rational for neonatal circumcision is rooted in the unjustifiable speculation that the child will grow up to be sexually irresponsible. "

    That sums up my opinion on why I think neonatal circumcision is an unethical way of preventing HIV.

    ReplyDelete
  28. how childish to put down people because they remain anonymous ,the fact that they do not identify themselves in no way negates their opinion or the research they have done,a closed mind where one side of the argument prevails is a bad situation and to defend babies from circumcision by zealots when they are too young too make an informed decision themselves can only be an honourable calling .
    jesus himself led the crusade 2000 years ago to make circumcision a redundant practise as we contiue to do to-day.

    ReplyDelete
  29. To respond to the anonymous comment dated December 14, 2009 8:50 AM:

    Well you don't know whether or not it is higher do you? You constantly ask people to show evidence or statistics when they make " common sense" arguments.

    Surely the person making the analogy is responsible for showing that it is comparable? Your apparent position - that you can claim that something is comparable, and then require me to prove that it is not - seems untenable.

    As quoted above, mastectomy is a very safe surgery and has very few complications

    Very safe as compared to what? Something can be "very safe" when compared to a heart transplant, or very unsafe when compared to an ingrowing toenail repair. The real question is, how safe is it when compared to circumcision?

    Even if the complications are higher, it would have to be SIGNIFICANTLY higher by astounding numbers for the net benefit not to be worth it.

    I'd be interested to see statistics on the actual complication rate; I don't think a meaningful analysis can be made without these.

    Regarding appearance:

    That is a completely ignorant statement. Over 80 percent of the world is uncircumcised.

    The correct figure is about 66%, actually, but I don't understand why you think this is relevant.

    Do you know of any studies that say or prove that women or men in those countries where circumcision is not routinely performed prefer the look of a circumcised penis?

    Yes. One that springs to mind is Masood et al. (UK). Westercamp and Bailey is also worth reading.

    Whether or not you think it is important is moot, it still has a function that is important to many men.

    As stated, to qualify a function it would have to be useful in some way. Otherwise you don't have a function, just a description, and it works just as well the other way (as in "a function of the circumcised penis is to hold the shaft skin taut and prevent its motion").

    I point out HIV because it is the main argument that pro circumcision lobbyist use that holds any weight at all, and that weight is arguable.

    The proper comparison to make is all benefits vs all risks, not just those that you wish to attack.

    Other proposed benefits of circumcision like UTIs and non life threatening STDs alone are not reason enough to justify routine circumcision, as stated by every word health organization in the world, including the United States.

    If any benefits are sufficient to justify routine circumcision, it would of course be the sum total of all benefits. But likely as not, even these wouldn't justify making it a routine procedure - I fully expect it to remain an elective procedure.

    ReplyDelete
  30. Now we come to a long, rambing quote from Hodges et al.

    With the current exception of HIV, the STDs whose incidence circumcision is supposed to reduce have few serious consequences if transmitted. Antibiotics are very effective at treating most STDs. Genital herpes, may be incurable, but its morbidity is negligible at best, and it is more common among circumcised than genitally intact US males.

    Their claim here is false. Studies generally have found the opposite. Even if we consider only the source cited by Hodges - their ref 51 - is Laumann et al, it still contradicts their claim. It found "no significant differences between circumcised and uncircumcised men in their likelihood of contracting sexually transmitted diseases."

    When authors have to lie to make their case, one has to wonder whether their case is worth making.

    The danger to public health posed by the STDs for which circumcision is supposed to be useful is insubstantial.

    This is an extraordinarily dubious claim.

    Because the sexual transmission of HIV and other STDs is usually dependent upon adult lifestyle choices, a programme of amputating a healthy part of the penis from an unconsenting minor as a means of reducing the incidence of STDs is unethical.

    By this reasoning, transmission of many other diseases is dependent upon adult lifestyle choices. A person might decide to live in a sealed tin box, isolated from microorganisms. Is it therefore unethical to insert a needle into an unconsenting minor? Silly.

    In marked contrast, the contraction of the diseases for which children are routinely immunised, such as polio and measles, is independent of lifestyle choices and is determined by such accidental, unforeseeable, and casual situations as unknowingly breathing the same air as an infected person.

    See above. If it is realistic to expect a person to make the lifestyle choice to remain celibate for life, it is reasonable to expect them to be sealed in a box.

    Amputating part of the penis is the most invasive method of attempting to achieve the desired public health objective. Circumcision desensitises the penis and immobilises whatever shaft skin remains, thereby destroying the natural and normal means of erotic stimulation.59

    Amusingly, the authors resort to citing an opinion piece by themselves in support of this point, probably because no evidence exists.

    The stated public health objectives could be achieved by more conservative means, such as improved sex education, making condoms freely available, or regulating prostitution.

    Actually, one of the problems in Africa is not so much that condoms are unavailable, but that they tend to be unused. Circumcision is much more acceptable.

    The alleged benefits of circumcision are not appreciable to the individual because to reap the alleged benefits of the procedure, the individual would have to disregard safe sex warnings and deliberately engage in unsafe sexual practices with infected individuals.

    Nonsense. The benefits of circumcision exist regardless of whether condoms are used or not. If condoms are not used then the only protection is circumcision (60%). If condoms are used as well then there is combined protection (92%).

    Even then, because the claimed benefit of circumcision under these circumstances is not statistically significant,

    The authors appear to be deluded.

    there is no meaningful way to calculate the alleged benefits from circumcision to an irresponsible individual. Most importantly, the public health rational for neonatal circumcision is rooted in the unjustifiable speculation that the child will grow up to be sexually irresponsible. "

    Again, nonsense.

    ReplyDelete
  31. "Yes. One that springs to mind is Masood et al. (UK). Westercamp and Bailey is also worth reading."

    The Masood study is a very small sample of the population, only using 150 and men and excluding men with erectile dysfunction, which could have made the results of the study vastly different if they had been included. Also, I only saw that 44 percent of the men thought the appearance improved, which is not a majority. Only 38 percent of the partners thought the appearance improved, which is an even smaller number. So how exactly is a study of 150 men proving that the majority of people like the look of a circumcised penis?...

    "As stated, to qualify a function it would have to be useful in some way. Otherwise you don't have a function, just a description, and it works just as well the other way (as in "a function of the circumcised penis is to hold the shaft skin taut and prevent its motion")."

    A description would be if I said " the foreskin is a loose skinned tube covering the tip of the penis." Some functions of the foreskin are to protect the glands from rubbing against clothing, and to keep the glands moist and lubricated during intercourse. While it may not be a VITAL function, it is still a function. It would be ignorant of anyone to say that NO man thinks the foreskin has an important sexual function.

    The danger to public health posed by the STDs for which circumcision is supposed to be useful is insubstantial.
    " This is a dubious claim."
    How is this a dubious claim? The majority of STDs ( HIV aside) are easily treatable with antibiotics and are non life threatening.

    "By this reasoning, transmission of many other diseases is dependent upon adult lifestyle choices. A person might decide to live in a sealed tin box, isolated from microorganisms. Is it therefore unethical to insert a needle into an unconsenting minor? Silly."

    HIV/AIDS is a sexually transmitted disease. You don't have to remain celibate to not contract it, you just have to practice safe sex. If you like to be with lots of women, make sure they have been tested and wear a condom. Get tested yourself twice a year. Don't use drug needles, which is the second most prevalent way of contracting HIV in the US.

    In contrast, there is nothing you can do to prevent yourself from getting diseases like polio other than living in an underground shed your whole life, which is very different from practicing safe sex. Also, a vaccine offers a high lifelong protection for everybody, it doesn't discriminate like circumcision. A vaccine does not alter the appearance or function of any body part, so it cannot be compared to circumcision when talking about a human rights issue.

    continued...

    ReplyDelete
  32. "Actually, one of the problems in Africa is not so much that condoms are unavailable, but that they tend to be unused. Circumcision is much more acceptable."

    Actually there are many many parts of Africa where condoms are not readily available. A survey done in some remote parts showed that over 60 percent of women didn't even know what a condom was.(or if they did they weren't going to admit it, since women are not supposed to talk about sex in many African cultures, even to their husbands and even about condoms) And if people are not using them, that is what should be focused on, improving condom usage and distribution. Not mass circumcision.

    "Nonsense. The benefits of circumcision exist regardless of whether condoms are used or not. If condoms are not used then the only protection is circumcision (60%). If condoms are used as well then there is combined protection (92%). "

    Ok I have seen you use this 80 percent model many times. If you look at the WHO website, there is an interview by one of their doctors that stated that the 80 percent model was a combination of consistent condom users and inconsistent condom users.

    "Let me describe the sorts of scientific evidence that is gathered and then also give some programmatic experience. The best information on the effectiveness of condoms comes from looking at large numbers of couples where one person is infected and the other is not, and following those over time, and comparing the rates of transmission of infection in those groups - comparing high condom users and people who did not use condoms. Such studies - and there have been a fair number of them, and they have all been put together and analysed collectively - such studies suggest that condoms are at least 80% and possibly more effective in reducing the transmission of HIV for co-habiting couples."
    http://www.who.int/hiv/topics/condoms/interview2009/en/index.html

    Here is another exert from the WHO website:

    "Laboratory studies have found that viruses (including HIV) do not pass through intact latex condoms even when devices are stretched or stressed.

    In Thailand, the promotion by the government of 100% condom use by commercial sex workers led to a dramatic increase in the use of condoms (from 14% in 1990 to 94% in 1994); an equally dramatic decline in the nation-wide numbers of bacterial STD cases (from 410,406 cases in 1997 to 27,362 cases in 1994); and reduced HIV prevalence in Thai soldiers.

    The most convincing data on the effectiveness of condoms in preventing HIV infection has been generated by prospective studies undertaken on serodiscordant couples, when one partner is infected with HIV and the other is not. These studies show that, with consistent condom use, the HIV infection rate among uninfected partners was less than 1 percent per year."
    http://www.who.int/mediacentre/factsheets/fs243/en/

    Surely if the protection of condoms was only 80 percent you would have seen a much greater number of people getting infected from their partner than just under one percent per year. Since, after-all, that article was published in year 2000 and as far as I know, condoms haven't gotten any UNSAFER since then.

    ReplyDelete
  33. To reply to anon. again:

    (Re non-US studies of penile appearance.)

    The Masood study is a very small sample of the population, only using 150 and men and excluding men with erectile dysfunction, which could have made the results of the study vastly different if they had been included.

    If you wanted a minimum sample size or a particular methodology, you should have said. It is difficult to see, incidentally, why excluding men with ED would make a difference to the results.

    Also, I only saw that 44 percent of the men thought the appearance improved, which is not a majority. Only 38 percent of the partners thought the appearance improved, which is an even smaller number. So how exactly is a study of 150 men proving that the majority of people like the look of a circumcised penis?

    I actually said "many if not most people" prefer the appearance, and in response to your claim that circumcision damages the appearance. For men, the figures were 44% better, 25% worse, and 31% no change, so nearly twice (1.76 times) as many men thought it was better. Put another way, for every person who shared your belief that the appearance was harmed, three disagreed. For women, the figures were 38%, 19%, and 43%. To again express this in terms of testing your statement, for every person who agreed with your position, four did not.

    A description would be if I said " the foreskin is a loose skinned tube covering the tip of the penis."

    That would be another description, yes.

    Some functions of the foreskin are to protect the glands from rubbing against clothing

    Oh, and what terrors await the glans that lacks the benefit of this "protection"? (By the way, the correct spelling is 'glans'.)

    How is this a dubious claim? The majority of STDs ( HIV aside) are easily treatable with antibiotics and are non life threatening.

    Or, put another way, HIV is life-threatening and essentially untreatable. Claiming that its danger to public health is "insubstantial" is, therefore, a dubious claim.

    HIV/AIDS is a sexually transmitted disease. You don't have to remain celibate to not contract it, you just have to practice safe sex.

    Nonsense. There is no such thing as "safe sex"; only "safer sex". The only way to guarantee that you won't contract an STD is to remain celibate.

    ReplyDelete
  34. Ok I have seen you use this 80 percent model many times. If you look at the WHO website, there is an interview by one of their doctors that stated that the 80 percent model was a combination of consistent condom users and inconsistent condom users.

    I'm referring to this Cochrane review, which is currently (to my knowledge) the most thorough systematic review on the subject. The authors conclude that: "This review indicates that consistent use of condoms results in 80% reduction in HIV incidence." (emph. added)

    ReplyDelete
  35. Jake's claim about functions is incomprehensible. To avoid admitting that foreskin has function, he redefines the meaning of function. Imagine what ludicrous results follow from his position regarding other body parts.

    The appearance of medical and humanitarian concern vanishes when Jake hauls out the argument that a circumcised penis just looks better.

    ReplyDelete
  36. "I actually said "many if not most people" prefer the appearance, and in response to your claim that circumcision damages the appearance. For men, the figures were 44% better, 25% worse, and 31% no change, so nearly twice (1.76 times) as many men thought it was better. Put another way, for every person who shared your belief that the appearance was harmed, three disagreed. For women, the figures were 38%, 19%, and 43%. To again express this in terms of testing your statement, for every person who agreed with your position, four did not."

    If you read the study you linked you would notice it said this :
    "One hundred and fifty men between the ages of 18 and 60 years were identified as *being circumcised for benign disease* between 1999 and 2002. Patients with erectile dysfunction were excluded from the study."

    First of all, if a person is being circumcised for a benign disease, they hardly represent an accurate proportion of the normal population. Of course if someone had scarred tight foreskin or inflammation or any other infection the likelihood that they would prefer the look and feel of their penis after getting the abnormal part removed makes sense.
    Second, taking out any man with erectile dysfunction makes the study even less reliable. Many circumcised men with ED could have had that issue because of the desensitization of their glans after circumcision. But since they were not included, we don't know. To link a study in an attempt to show that "many if not most" people prefer the look of a circumcised penis, the study should at the very least be a random sample of the population in which the study is taking place. Only Selecting men that were circumcised later in life could represent a bias in itself. Also, 150 people? Really? Sorry but if you are going to make dubious claims like " many if not most" people prefer the look of a circumcised penis you are going to have to link a better study than that.

    "I'm referring to this Cochrane review, which is currently (to my knowledge) the most thorough systematic review on the subject. The authors conclude that: "This review indicates that consistent use of condoms results in 80% reduction in HIV incidence." (emph. added)"

    So are you saying the date from the World Health Organization are fabricated or wrong? If condoms only showed an 80 percent effectiveness in preventing HIV transmission surely you would have seen more than just under one percent per year of partners contracting the virus.

    "According to the CDC, studies examining sexually active people at high risk for contracting HIV have found that “even with repeated sexual contact, 98-100% of those people who used latex condoms correctly and consistently did not become infected. The CDC recently issued prevention guidelines for state health departments that state “correct and consistent use of latex condoms can reduce the risk of sexually transmitted infections. On August 16, 2001, the United Nations Joint Programme on HIV/AIDS and the World Health Organization issued a statement that said that condoms were “the best defense” in preventing sexually transmitted diseases, including HIV/AIDS. "

    ReplyDelete
  37. "Many circumcised men with ED could have had that issue because of the desensitization of their glans after circumcision. "

    Sorry let me clarify that. What I meant to say was that if men had a reduction in sensation after circumcision, that could have lead to their ED which in turn could have lead to a higher likelihood of being unsatisfied with their penis.

    ReplyDelete
  38. Whoa, say it ain't true Jake! So you cherry picked a study about circumcision, and then pawned it off as applying to "many if not most people." As you said

    When authors have lie to make their case, one has to wonder whether their case is worth making."

    ReplyDelete
  39. First of all, if a person is being circumcised for a benign disease, they hardly represent an accurate proportion of the normal population. Of course if someone had scarred tight foreskin or inflammation or any other infection the likelihood that they would prefer the look and feel of their penis after getting the abnormal part removed makes sense.

    Yes, such a study might plausibly be biased in favour of circumcision. But perfect studies are hard to find, and this is the best we have that meets your stated criteria (namely, not conducted in the US).

    Second, taking out any man with erectile dysfunction makes the study even less reliable. Many circumcised men with ED could have had that issue because of the desensitization of their glans after circumcision. But since they were not included, we don't know.

    Even with your later clarification, this still makes no sense whatsoever. Why would it affect satisfaction with the appearance of the penis?

    To link a study in an attempt to show that "many if not most" people prefer the look of a circumcised penis, the study should at the very least be a random sample of the population in which the study is taking place. Only Selecting men that were circumcised later in life could represent a bias in itself. Also, 150 people? Really? Sorry but if you are going to make dubious claims like " many if not most" people prefer the look of a circumcised penis you are going to have to link a better study than that.

    I'm sorry - I seem to have forgotten which study or studies you cited in support of your assertion. What were they, again?

    Or is the situation that you cited nothing whatsoever, and I at least made an effort to supply evidence, admittedly imperfect, in support of my position?

    So are you saying the date from the World Health Organization are fabricated or wrong? If condoms only showed an 80 percent effectiveness in preventing HIV transmission surely you would have seen more than just under one percent per year of partners contracting the virus.

    You think so?

    By my reckoning, the seroconversion rate would be:

    C x S x A

    Where C is the relative risk for condom users, S is the probability of seroconversion per unprotected sex act, and A is the number of sex acts per year.

    Using data from Wikipedia's HIV article, the value of S for insertive penile-vaginal intercourse is 5 per 10,000, which is 0.05% (or 0.0005 as a probability). If we assume that C is 20% (0.2), and assume sex every other day (that is, A = 182), we would therefore expect 0.0005 x 0.2 x 182 = 0.0182, or 1.8%.

    ReplyDelete
  40. "I'm sorry - I seem to have forgotten which study or studies you cited in support of your assertion. What were they, again?

    Or is the situation that you cited nothing whatsoever, and I at least made an effort to supply evidence, admittedly imperfect, in support of my position?"

    Which assertion are you referring to? I gave a definition. "disfigurement - the act of damaging the appearance or surface of something." I doubt anyone can argue that circumcision is damaging the appearance of the natural foreskin that babies are born with. Whether you think the damage improves the appearance is moot, it is still damage and amputation of skin. Second, reading many of your earlier posts on this forum you constantly berate people for making comments similar to yours without citing studies or statistics. It should only be fair that you provide decent unbiased statistics when you make similar claims.

    You said in the comments of this post : "Speculating is fun, I'm sure, but the real question is whether you can cite any evidence in support of your claims. Probably not, I suspect. "

    Can we not all agree that making a claim that "many if not most" people prefer the look of circumcision without any unbiased or unflawed studies or statistics to back it up is a speculation? I think it is. Unless, of course, you meant as long as you link to any old study regardless of its flaws or biases would suffice.

    ReplyDelete
  41. "Even with your later clarification, this still makes no sense whatsoever. Why would it affect satisfaction with the appearance of the penis?"

    Forgot to add this to my past post. If a man is circumcised and believes as a result lost sensitivity in his penis and was not performing sexually to his liking, I think it is safe to say that there is a very high likelihood that he would be unsatisfied with his penis and the result of his circumcision, which includes the physical changes made. Again, I am not claiming this to be a fact, I am just stating that excluding certain men and cherry picking others you want in your study is poor form when trying to show accurate data.

    ReplyDelete
  42. Which assertion are you referring to? I gave a definition. "disfigurement - the act of damaging the appearance or surface of something."

    This assertion (phrased as a question, but still evidently an assertion): "Does circumcision not also cause disfigurement?"

    I doubt anyone can argue that circumcision is damaging the appearance of the natural foreskin that babies are born with. Whether you think the damage improves the appearance is moot, it is still damage and amputation of skin

    You seem to want to have your cake and eat it, too. Either circumcision damages the appearance, or it improves the appearance, or it has no effect.

    Second, reading many of your earlier posts on this forum you constantly berate people for making comments similar to yours without citing studies or statistics. It should only be fair that you provide decent unbiased statistics when you make similar claims.

    You haven't answered my question - what studies did you cite in support of your original claim? If you supplied strong evidence in support of your position, it's perfectly reasonable of you to ask me to match the quality of your own evidence. However, if you didn't supply any, then it seems that you're in no position to complain.

    Can we not all agree that making a claim that "many if not most" people prefer the look of circumcision without any unbiased or unflawed studies or statistics to back it up is a speculation? I think it is.

    I think it's proven that many people prefer the appearance of a circumcised penis. Whether most of humankind do is not proven, but the evidence does suggest that the preference is widespread.

    Forgot to add this to my past post. If a man is circumcised and believes as a result lost sensitivity in his penis and was not performing sexually to his liking, I think it is safe to say that there is a very high likelihood that he would be unsatisfied with his penis and the result of his circumcision, which includes the physical changes made.

    The appearance? You're still not making any sense.

    ReplyDelete
  43. "You seem to want to have your cake and eat it, too. Either circumcision damages the appearance, or it improves the appearance, or it has no effect."

    Circumcision damages the foreskin and the natural appearance of an intact penis. Whether or not someone thinks the damage improves the appearance is irrelevant. If a woman gets a nose job, which entails breaking the bones in the nose and readjusting them to suit her liking, there is still going to be damage to the bones and tissue in her nose. You make the assumption that if you like the appearance of a procedure or operation then injury cannot also exist. Whether or not she likes the outcome of her nose job does not change the fact that there was still injury to her nose and surrounding areas.

    Also, my statement was in response to "Um, if you engage your brain for a moment, you'll realise that such an invasive procedure will likely have a fairly high complication rate, including the risk of death. Weigh that, along with disfigurement and loss of function, against the benefits and it doesn't look like such a good idea."

    Then you said "You haven't answered my question - what studies did you cite in support of your original claim? If you supplied strong evidence in support of your position, it's perfectly reasonable of you to ask me to match the quality of your own evidence. However, if you didn't supply any, then it seems that you're in no position to complain."

    Where were your studies when you made the same statement about mastectomy? You used words like " will likely" have a high complication rate. I didn't see any links to support your assumption. What about when you said that mastectomy causes disfigurement. Where was your study to support that claim? So, based on your statement "If you supplied strong evidence in support of your position, it's perfectly reasonable of you to ask me to match the quality of your own evidence. However, if you didn't supply any, then it seems that you're in no position to complain." I suppose it is safe to assume that since you originally did not supply any evidence of your claims, I should not be expected to show any for mine.

    ReplyDelete
  44. Circumcision damages the foreskin and the natural appearance of an intact penis. Whether or not someone thinks the damage improves the appearance is irrelevant.

    On the contrary, it's completely relevant, because disfigurement and improving the appearance are mutually exclusive. Disfigurement implies harm to the appearance.

    Where were your studies when you made the same statement about mastectomy? You used words like " will likely" have a high complication rate. I didn't see any links to support your assumption.

    I cited one in my post dated December 14, 2009 5:31 AM.

    What about when you said that mastectomy causes disfigurement. Where was your study to support that claim?

    Are you seriously saying that it's a matter of dispute?

    I suppose it is safe to assume that since you originally did not supply any evidence of your claims, I should not be expected to show any for mine.

    In which case, the fact that you are now demanding evidence from me seems a little hypocritical, wouldn't you say? Expecially when you consider that my remarks were, in turn, in response to your assertion that "there's no medical study proving that it would be harmful, and it would certainly save a lot of lives, thousands of times more than male circumcision" - for which you offered no evidence whatsoever.

    ReplyDelete
  45. I agree with Jake that the disfigurement of my penis is completely relevant. Nobody could argue that the wide ring of scar tissue around my penis is not disfigurement, and the scars certainly don't improve the appearance.

    Since when is it okay to cut off perfectly functioning body parts from people without their consent? I would prevent that from happening now with deadly force, if necessary.

    ReplyDelete
  46. "In which case, the fact that you are now demanding evidence from me seems a little hypocritical, wouldn't you say? Expecially when you consider that my remarks were, in turn, in response to your assertion that "there's no medical study proving that it would be harmful, and it would certainly save a lot of lives, thousands of times more than male circumcision" - for which you offered no evidence whatsoever."

    That was not said by me. That was another anonymous poster, so that point is moot.

    "I cited one in my post dated December 14, 2009 5:31 AM."

    Cited what? And you didn't site anything when you made the claims.

    If you read the posts, you will notice that you were the first person to ask for sources. Even though in that very same post you made the comments about neonatal mastectomy "likely" having high complication rates with no sources of your own to back it up. Hypocritical don't you think?

    "Are you seriously saying that it's a matter of dispute?"
    No more than saying circumcision causes disfigurement is up for dispute.
    "disfigurement - the act of damaging the appearance or surface of something."
    I think we can all agree than circumcision falls in that category. Since I have already pointed out that just because the outcome of any given damage done is good or bad doesn't make the damage go away or not exist.
    Also, look up images of botched circumcisions on google and tell me that does not fall into your idea of disfigurement. Many men (including my husband) are left with horrible scars from their circumcision along with skin tags, and bent penises from having uneven scar tissue.
    Unfortunately, once a circumcision is botched there is no way to make it look 100 percent normal afterwards. You can't go back and reverse time and get uncircumcised. However small the risk may be, there is still a risk and you don't know whether or not you will be one of those statistics until it is too late.

    ReplyDelete
  47. I'm a Bosnian man of mixed (my father muslim-my mother catholic) origin, and my parents unfortunately left me uncircumcised, since only pure Muslims in Bosnia circumcise their boys at an early age, and Christians don't.

    I decided to get circumcised as a grown person when I joined Bosnian military in 1993, since I didn't want to stick out among my fellow soldiers in the military barracks, and since we were fighting an uncircumcised infidel in ortodox christian Serbs and roman catholic Croats.

    The procedure itself was not painful, and I recommend it to all man, of all religions.

    It was clear to me that when I started living in Europe, circumcised people, and in general people with Muslim origin, are frowned upon.

    Only by emigrating to the USA, I finally realized that there's a country where majority of the people do the right thing with their infant boys.

    The world's Muslim population is rapidly growing, and already there are almost a billion of people in the world circumcised, which is a high percentage, and this percentage has a tendency to grow in the future.

    I sincerely recommend this procedure to every grown man who still have their foreskins, and with God's help the proportion of the right vs wrong will soon turn into our favor.

    "Allah will not change a state and well-being of the people, until the people themselves change their attitude towards Allah."
    (Qur'an)

    ReplyDelete
  48. That was not said by me. That was another anonymous poster, so that point is moot.

    Then I am sure you will agree with me that sources should have been offered.

    Re: "I cited one in my post dated December 14, 2009 5:31 AM."

    Cited what? And you didn't site anything when you made the claims.

    I cited a paper by Vilar-Compte et al.

    If you read the posts, you will notice that you were the first person to ask for sources. Even though in that very same post you made the comments about neonatal mastectomy "likely" having high complication rates with no sources of your own to back it up. Hypocritical don't you think?

    If I had introduced the subject of neonatal mastectomy, I think it would be reasonable to expect me to cite sources. It was introduced by an anonymous poster, who presented it with the implication that it was comparable to neonatal circumcision. That poster made a very definite statement ("it would certainly save a lot of lives") for which it is perfectly reasonable to demand evidence.

    In reply, I wrote: "if you engage your brain [ie., think about it] for a moment, you'll realise that such an invasive procedure will likely have a fairly high complication rate, including the risk of death". This is a less definite statement; rather than presenting the conclusion as proven fact, clearly indicates that it is a probable conclusion that is the outcome of thinking about the situation. I later provided supporting evidence that indicated that my reasoning was correct, but there was no need to present evidence at the time since my reasoning was not presented as unassailable fact.

    No more than saying circumcision causes disfigurement is up for dispute.
    "disfigurement - the act of damaging the appearance or surface of something."
    I think we can all agree than circumcision falls in that category. Since I have already pointed out that just because the outcome of any given damage done is good or bad doesn't make the damage go away or not exist.


    No, I don't think we can agree that. Why on earth do you think we would agree that circumcision damages the appearance of the penis?

    Also, look up images of botched circumcisions on google and tell me that does not fall into your idea of disfigurement

    Certainly circumcision can disfigure, but that doesn't mean that it inherently disfigures.

    Unfortunately, once a circumcision is botched there is no way to make it look 100 percent normal afterwards. You can't go back and reverse time and get uncircumcised. However small the risk may be, there is still a risk and you don't know whether or not you will be one of those statistics until it is too late

    Quite true. The same is true of risks associated with lack of circumcision, too.

    ReplyDelete
  49. The opponents don't care about the risks associated with lack of circumcision.

    Regardless, it has indeed been a pretty good year for circumcision, and it will of course be better if the AAP and CDC encourage the procedure, which I feel they should do because of the medical and sexual benefits.

    Happy holidays, everyone.

    ReplyDelete
  50. I wholehartedly agree Carlos.
    I sincerely hope that universal circumcision will help wipe out the differences between people of different religions and bewtween the countries and continents, and God willing bring us much closer to the world peace.


    Happy holidays!!!!!

    ReplyDelete
  51. Jake said

    The only way to guarantee that you won't contract an STD is to remain celibate.

    Wrong. If your sex partner has no STD, then your chance of contracting an STD with that sex partner is exactly zero. Jake is confusing actual probabilities with his estimates of probabilities. His claim is a comforting rationalization given by those who put themselves at risk for sexual disease. Sorry Jake: millions of people have risk-free sex, and can guarantee they won't "contract" an STD. I suspect you are not one of them.

    ReplyDelete
  52. Wrong. If your sex partner has no STD, then your chance of contracting an STD with that sex partner is exactly zero.

    And how do you propose to guarantee that your sex partner will never acquire an STD from somebody else? You can't: it's beyond your direct control. You might, with any luck, choose a partner whom you trust, but statistically speaking an awful lot of infidelity happens, even among people who are trusted.

    ReplyDelete
  53. "And how do you propose to guarantee that your sex partner will never acquire an STD from somebody else? You can't: it's beyond your direct control. You might, with any luck, choose a partner whom you trust, but statistically speaking an awful lot of infidelity happens, even among people who are trusted."

    Infidelity may happen often, but what is the risk of a heterosexual man getting HIV while having an affair? Here is a number from an Australian study, which has HIV rates much more akin to the US than Africa.

    "An Australian-born man is estimated to have a 0.02% (0.0002) risk of HIV acquisition if he does not
    inject drugs or have sex with men.11 This very low risk means that the population health benefit of an
    intervention like generalised circumcision programs would be negligible. However it has been argued
    by Professor Alex Wodak in the mainstream press, that circumcision would play a valuable role in
    assisting to prevent the emergence/development of a heterosexually mediated epidemic in Australia.
    This view is not currently supported by a consensus or statement from any organisation currently
    involved in Australia’s HIV partnership. "

    11
    This estimate was supplied by the National Centre in HIV Epidemiology and Clinical Research in February 2009, based on median lifetime
    partners, sexual acts within partnerships over time, estimated prevalence within the female population of 0.03-0.05%, and average transmission
    rates and condom use within partnerships

    Even with infidelity, the overall risk of your spouse cheating on someone and getting infected with HIV is minimal.

    ReplyDelete
  54. Even with infidelity, the overall risk of your spouse cheating on someone and getting infected with HIV is minimal.

    I agree that it's a small risk, but it is non-zero. And thus, as I said, the only way to guarantee that you won't contract an STD is to remain celibate. Could we agree on this point and move on?

    ReplyDelete
  55. Why on earth would you think we can agree on this point? The probability of my spouse giving me an STD is about the same that she is an axe murderer. Sure, you can quibble that this is a non-zero probability if you think reduction to absurdity is a clever way to argue. There's a chance the earth will end tomorrow, too. Neither of these - axe murderer or end-of-world - have any numerical value that has any meaning.

    ReplyDelete
  56. Jake said

    with any luck . . .

    There you go again. Luck has nothing to do with it, but to hear some people tell it, getting HIV is just a matter of bad luck. At least outside of countries where neonatal rape is believed to be a cure for AIDS, nobody has to get an STD, and you have complete control over your risks. Take responsibility.

    ReplyDelete
  57. Why on earth would you think we can agree on this point? The probability of my spouse giving me an STD is about the same that she is an axe murderer

    If you think about it, it's likely that relatively few people who get an STD from their partners were expecting it. It happens. I'm not saying that it will happen, just that it's possible. You can't guarantee that you won't get an STD. You can reduce the risk, certainly, but you can't eliminate it unless you abstain from sex altogether.

    ReplyDelete
  58. As the year 2009 draws to a close, history may judge this year as the "turning point" in the movement to achieve universal circumcision -- a world in which the foreskin no longer poses a health threat to a male, his partners, or society as a whole.

    I'm dubious. With government statistics telling us that Texas and Utah last circumcised a majority of their boys in 2005, we are likely to see the same kinds of declines in those states as have happened in other states when their rates fell below 50%. If Texas experiences the same sort of decline as we saw in Florida, Oregon and Washington, there would be a 0.1% per anum decline in the national circumcision rate even if we held constant the various state populations and every other state's circumcision rate. In reality, the high circumcision Midwest is in relative decline while many of the states which are seeing rapid population increases are low or lower circumcsion states. (The obvious exception to the rule being South Carolina.) You need a significant increase in a lot of small Midwestern states to counter the influence that the Texan decline will have on the national circumcision rate over the next two decades. I'm not sure how you expect to achieve that since the Midwest hasn't experienced a significant decline in the circumcision rate which could be reversed and with a declining population can't indefinitely counteract the declining rate in large and high growth staes like Texas and Florida even if it achieves universal circumcision.

    When the data is finally collected for the year 2009, it will show that more males world-wide are circumcised now than ever before in world history.

    This is lieing with statistics. Given the increase in the world population, there inevitably will be an increase in both the number of circumcised and uncircumcised males. I do not see any reason to expect that the proportion has greatly changed since some of the very rapidly growing countries don't circumcise the majority of their males (e.g., India.) There is evidence that parts of Africa have had a significant increase in their circumcision rates, but at the same time, countries like the US, UK, Canada, Australia and New Zealand have all experienced declines. South Korea, which experienced a very rapid increase in its circumcision rate in the 70's, 80's and 90's seems to have now stabalized (at an admittedly very high rate.)

    In any case, most countries do not collect circumcision statistics so we can't do more than guess at global circumcision statistics.

    RP

    ReplyDelete
  59. "I'm dubious. With government statistics telling us that Texas and Utah last circumcised a majority of their boys in 2005, we are likely to see the same kinds of declines in those states as have happened in other states when their rates fell below 50%. If Texas experiences the same sort of decline as we saw in Florida, Oregon and Washington, there would be a 0.1% per anum decline in the national circumcision rate even if we held constant the various state populations and every other state's circumcision rate. In reality, the high circumcision Midwest is in relative decline while many of the states which are seeing rapid population increases are low or lower circumcsion states. (The obvious exception to the rule being South Carolina.) You need a significant increase in a lot of small Midwestern states to counter the influence that the Texan decline will have on the national circumcision rate over the next two decades. I'm not sure how you expect to achieve that since the Midwest hasn't experienced a significant decline in the circumcision rate which could be reversed and with a declining population can't indefinitely counteract the declining rate in large and high growth staes like Texas and Florida even if it achieves universal circumcision."

    That is great news about Texas if it is true! :) Do you by any chance have the site that gave that information? Because last I checked I thought it was closer to 60 percent. Thanks!

    ReplyDelete
  60. Sure. It's on the AHRQ web site -- AHRQ is part of the CDC and gathers data from many, but not all, states. The URL is http://hcupnet.ahrq.gov/

    It tells us that in 2007 there were 196,373 male births in Texas and that 93,175 circumcisions were performed.

    93,175 /196,373 = 47.5%

    RP

    ReplyDelete
  61. I should correct my previous -- these numbers are their samples, not the total numbers of actual male births and circumcions in Texas. So, as with all samples, there is some margin of error.

    RP

    ReplyDelete
  62. It tells us that in 2007 there were 196,373 male births in Texas and that 93,175 circumcisions were performed.

    Two questions:

    First, could you be more specific about how you obtained this information?

    Second, are these figures derived from NIS or NHDS data? These samples generally only include procedures performed in hospital, and would exclude those performed in a doctor's office, as is often the case for circumcision.

    ReplyDelete
  63. 1) I selected the database for Texas in 2007 and ran queries on the numbers of circumcisions performed and the number of births, male and female.

    2) I'm very leery of adding additional fudge factors to get the "right" numbers. (I've already added a fudge factor by counting *all* circumcisions, not only neonatal ones.) As the people now engulfed by Climategate are learning, if you don't have serious reasons to defend those fudge factors your data will be seriously disputed.

    However, if you have a reasonable argument as to why the limited fudge factor that I've already added doesn't increase the numbers sufficiently, and some sort of evidence that the official statistics are significantly undercounting the number of circumcisions performed, I'd be happy to consider including them.

    Please note, however, that with some subpopulations having circumcision rates in the mid 90s, I'm not convinced that the CDCs statistics are far off the mark.

    RP

    ReplyDelete
  64. However, if you have a reasonable argument as to why the limited fudge factor that I've already added doesn't increase the numbers sufficiently, and some sort of evidence that the official statistics are significantly undercounting the number of circumcisions performed, I'd be happy to consider including them.

    With pleasure.

    Here is the National Hospital Discharge Survey data for the entire US for the period 1979-1999. I'd like to draw your attention to the fact that, in the 1980s, the average recorded circumcision rate for "all races" was 63.4%.

    Now I'd like to draw your attention to this report based on NHANES data. This is also a nationally representative dataset, also including males born in the 1980s, but this time the circumcision status of participants was determined by examination at the time of sampling (1999-2004, so males born in the 1980s would have been 10-24 at the time). 84% of those born in the 1980s were circumcised.

    This means that nearly half of the males that were "uncircumcised" according to NHDS data were actually circumcised by the time that they were ten or more.

    To explain this, then, we have to conclude that either a) the childhood circumcision rate is (very roughly) 50%, which is 4-5 times the reported rate in the US, or b) a substantial number of neonatal circumcisions are not recorded in NHDS data.

    ReplyDelete
  65. My first thought was "intersting", however digging into the sources (I like raw data since that lets me see patterns in the numbers) I'm throughly confused about the source of data:

    The abstract that you pointed to only references 6,174 men interviewed from 1999-2004. However, if we look at http://www.cdc.gov/nchs/data/nhanes/RRT0304MF.xls we see that the total sample of males for the 2004 survey alone was 6,294.

    Is it possible that the abstract is misleading when it states that "As part of National Health and Nutrition Examination Surveys from 1999 to 2004 . . ." and that this was a side study, which was not based upon national statistics, but rather on a single local sample? That would explain the much smaller sample size, and might be the reason why there is such a discrepency between it's circumcision rate and the national ones that you also cited. After all, 84% for men born in the 1980's and 91% for those born in the 1970's would not seem out of place in much of the Midwest.


    My concerns that we may be comparing apples to oranges is heightened because the NHANES sample report of findings (http://www.cdc.gov/nchs/data/nhanes/nhanes_07_08/ROF_07_08_eng.pdf), while clearly designed for a male, does not identify circumcision status.

    Without more information, I believe that it is premature to claim that This means that nearly half of the males that were "uncircumcised" according to NHDS data were actually circumcised by the time that they were ten or more.

    However, if you can find additional information that supports your contention that we need to add an additional fudge factor to the CDC's data I'd be very interested in seeing it. I'd be particularly interested in datasets that correspond to the CDC's so we can compare payer, race/ethnicity, patient residence, as well as the hospital owner, teaching status location and bedsize within a state.

    RP

    ReplyDelete
  66. The abstract that you pointed to only references 6,174 men interviewed from 1999-2004. However, if we look at http://www.cdc.gov/nchs/data/nhanes/RRT0304MF.xls we see that the total sample of males for the 2004 survey alone was 6,294.

    If you consider males aged 14-59*, though, the total for 2003-2004 is 3,409 (and to save you the trouble, the grand total for all applicable years is 10,113).

    * - I estimated the lower age bound at 10 above, but checking the full text this was the age range they used.

    Is it possible that the abstract is misleading when it states that "As part of National Health and Nutrition Examination Surveys from 1999 to 2004 . . ." and that this was a side study, which was not based upon national statistics, but rather on a single local sample?

    No, it was part of the nationally-representative sample. However, it does state that a subset of the full NHANES sample were examined in the Mobile Examination Centres, and continues: "During NHANES 1999 –2004, 6,898 men born from 1940 to 1989 and aged 14 to 59 years at the time of the survey were examined at MECs. A participant who was examined at MECs might skip the ACASI module due to time restraints; 6313 (92%) were interviewed about circumcision status (“Are you circumcised or uncircumcised?”). Of these, 53 refused to answer the question and 86 responded with “Don’t know,” leaving a sample of 6174 persons (90% of those examined at MECs) for further analyses."

    My concerns that we may be comparing apples to oranges is heightened because the NHANES sample report of findings (http://www.cdc.gov/nchs/data/nhanes/nhanes_07_08/ROF_07_08_eng.pdf), while clearly designed for a male, does not identify circumcision status.

    Yes, apparently it is not included in the report. Nevertheless, one can clearly find questions about circumcision status in the NHANES files. See, for example, page 7 here.

    However, if you can find additional information that supports your contention that we need to add an additional fudge factor to the CDC's data I'd be very interested in seeing it.

    I think I've already provided more than adequate evidence. Speculating that this might not be the NHANES dataset (when it plainly is), and speculating that it might be a local sample (when it plainly isn't) is a rather pitiful response, I'm sorry to say.

    ReplyDelete
  67. I think I've already provided more than adequate evidence.

    Of course not. You have provided one piece of evidence which you insist needs to be interpreted in the way that will maximize your agenda (e.g., "This means that nearly half of the males that were "uncircumcised" according to NHDS data were actually circumcised by the time that they were ten or more" implying that we should half the number of uncircumcised boys, rather than, for example, suggesting that we increase the nominal circumcision rate by an additional 20%, let alone acknowledging that there are almost certainly going to be differences between high and low circumcision states, that circumcision practices may have changed during the course of the past generation, etc.)

    You are upset that I am asking questions before agreeing to add a fudge factor to the CDC's raw data. But, if one of the antis were to provide me with one piece of evidence on the other side and insisted that it be interpreted in the way that furthered his agenda, wouldn't you expect me to ask exactly the same kinds of questions?

    While I've already included a fudge factor in the numbers that I posted, and I'm willing to contemplate adding another one if enough evidence is presented to support doing so, the burden of proof needs to rest with your argument that the CDC's stats are artificially reducing the rate. Out of curiosity, why you think that the CDC would release an inaccurate circumcision rate? After all, they have access to multiple databases, but are not using your favored one.

    * - I estimated the lower age bound at 10 above, but checking the full text this was the age range they used.

    I'd be happier to use the full text, but that's not what you linked to. I am therefore limited to arguing based upon the information disclosed in the abstract or that I can dig out of the CDC's web site.

    If you consider males aged 14-59*, though, the total for 2003-2004 is 3,409 (and to save you the trouble, the grand total for all applicable years is 10,113).


    The following is the raw data for the three reports. Sample Size is the number of males in that age group:

    2003-2004 Response Rates
    http://www.cdc.gov/nchs/data/nhanes/RRT0304MF.xls
    Gender / Age Group Screened Sample
    Control Totals Sample Size 1

    Male All ages 139,726,681 6294
    <1 year 1,767,469 279
    1-5 years 10,296,460 714
    6-11 years 12,377,047 589
    12-15 years 8,832,639 686
    16-19 years 8,023,567 693
    20-29 years 19,086,334 547
    30-39 years 20,108,683 516
    40-49 years 21,791,869 537
    50-59 years 16,943,327 430
    60-69 years 10,213,398 521
    70-79 years 6,987,155 452
    80+ years 3,298,733 330
    2001-2002 Response Rates
    http://www.cdc.gov/nchs/data/nhanes/RRT0102MF.xls
    Gender / Age Group Screened Sample
    Control Totals Sample Size 1

    Male All ages 136,042,720 6386
    <1 year 2,024,602 294
    1-5 years 9,485,102 728
    6-11 years 12,809,332 696
    12-15 years 7,966,117 654
    16-19 years 8,376,604 726
    20-29 years 17,897,905 507
    30-39 years 20,478,528 518
    40-49 years 23,115,145 605
    50-59 years 16,206,952 467
    60-69 years 9,070,984 497
    70-79 years 5,888,761 393
    80+ years 2,722,689 301
    1999-2000 Response Rates
    http://www.cdc.gov/nchs/data/nhanes/RRT9900MF.xls
    Male All ages 133,166,794 6003
    <1 year 1,880,205 265
    1-5 years 10,697,871 679
    6-11 years 12,914,931 642
    12-15 years 8,135,651 706
    16-19 years 7,864,543 688
    20-29 years 18,013,123 451
    30-39 years 23,235,707 501
    40-49 years 18,835,768 491
    50-59 years 13,827,634 390
    60-69 years 9,380,156 521
    70-79 years 6,051,173 410
    80+ years 2,330,033 259


    Please note that birth year is not recorded, so we're limited to getting ranges that are either larger than, or smaller than, the total number of men born in a given year. That's the first problem with the sample that you are asking me to use.

    (cont)

    RP

    ReplyDelete
  68. Of these, 53 refused to answer the question and 86 responded with “Don’t know,” leaving a sample of 6174 persons (90% of those examined at MECs) for further analyses."

    And here we start to add increasingly large errors into the numbers. You tell us that we initially had a group of 10,113. That's just been reduced to 6,898 (roughly 68% of the initial group). Finally, when we exclude those who wouldn't answer/didn't know, we're down to 6,174 -- a mere 61% of the initial population. Why were almost 40% of the initial sample excluded? The deltas that have been created are *huge*. Moreover, with 6,174 participants, we're talking about an average 123 or 124 men per state. That's such a small sample that you are going to get an enormous amount of noise in it even before the delta.

    The CDC datasets show that the biggest factors in determining the circumcision rate are race, payer, and patient residence. With such a small dataset, I couldn't correlate those with any chance of getting useful data.

    Yes, apparently it is not included in the report. Nevertheless, one can clearly find questions about circumcision status in the NHANES files.

    Hmm. You are right. But, then why don't they have a place to record the information in the report of findings? I really want to see the raw data - there's something odd going on.

    The underlying problem, though, is that I cannot find any reference to circumcision in any of the three data sets:

    http://www.cdc.gov/nchs/nhanes/nhanes2003-2004/exam03_04.htm
    http://www.cdc.gov/nchs/nhanes/exam01_02.htm
    http://www.cdc.gov/nchs/nhanes/exam99_00.htm

    I can't even find a non-public datasets which could be assumed to include the data:

    http://www.cdc.gov/nchs/nhanes/nhanes2003-2004/non_public_03-04.htm
    http://www.cdc.gov/nchs/nhanes/nhanes2001-2002/non_public_01-02.htm
    http://www.cdc.gov/nchs/nhanes/frequency/non_public_99-00.htm

    I'm open to the idea that there are non-hospital RICs. For example, in a state like New York, with a large Jewish population, I'm absolutely certain that the CDC's datasets underestimate the circumcision rate. (I'd guestimate that appropriate fudge factor would be an additional 7.5%) However, given the lower birthrate among Jews than Hispanics, chances are that the undercounting is decreasing along with the base circumcision rate.

    I'm willing to add an additional fudge fact. But, I'm going to insist that we don't add a fudge factor that we cannot explain and defend.

    RP

    ReplyDelete
  69. Of course not. You have provided one piece of evidence which you insist needs to be interpreted in the way that will maximize your agenda (e.g., "This means that nearly half of the males that were "uncircumcised" according to NHDS data were actually circumcised by the time that they were ten or more"

    Which is a factual statement. And the figures are similar to those of Cheng et al (Neonatal circumcision in Maryland: a comparison of hospital discharge and maternal postpartum survey data), who reported that, in their local sample, "Hospital discharge data showed that 75.3% of male infants were circumcised, and survey data showed that 82.3% of male infants were circumcised." So of the 24.7% that were uncircumcised according to hospital discharge data, about a third were actually circumcised.

    implying that we should half the number of uncircumcised boys,

    Which does seem a rational, evidence-based response.

    rather than, for example, suggesting that we increase the nominal circumcision rate by an additional 20%,

    That wouldn't be rational. What if you wanted to apply a correction to a sample in which the reported rate was 90%? You can't have a circumcision rate of 110%.

    let alone acknowledging that there are almost certainly going to be differences between high and low circumcision states,

    Not applicable. We're talking about national samples.

    that circumcision practices may have changed during the course of the past generation, etc.)

    Quite possible, but without data we can't make a prediction.

    You are upset that I am asking questions before agreeing to add a fudge factor to the CDC's raw data.

    Not at all. I'm just amused that you're so eager to reject the evidence.

    Out of curiosity, why you think that the CDC would release an inaccurate circumcision rate?

    I don't believe that they've done so. Their page (cited above) refers to the "percent of newborn males with circumcision performed in short-stay hospitals", and I have no reason to believe that this is inaccurate. The error lies in thinking that the percentage of males circumcised in neonatal hospital stays is the same as the circumcision rate. And the CDC can't be held responsible for errors of interpretation. As I stated above in my post dated December 18, 2009 6:32 AM, "These samples generally only include procedures performed in hospital, and would exclude those performed in a doctor's office, as is often the case for circumcision."

    The following is the raw data for the three reports. Sample Size is the number of males in that age group: ... Please note that birth year is not recorded, so we're limited to getting ranges that are either larger than, or smaller than, the total number of men born in a given year. That's the first problem with the sample that you are asking me to use.

    The problem being what, precisely? CDC researchers have already analysed this information and supplied the sample size in the paper.

    (continued)

    ReplyDelete
  70. And here we start to add increasingly large errors into the numbers. You tell us that we initially had a group of 10,113. That's just been reduced to 6,898 (roughly 68% of the initial group). Finally, when we exclude those who wouldn't answer/didn't know, we're down to 6,174 -- a mere 61% of the initial population. Why were almost 40% of the initial sample excluded?

    Why don't you write to the authors and ask?

    The deltas that have been created are *huge*.

    Doesn't matter, unless you're suggesting that this would make the results non-representative. And if you have evidence that NHANES is non-representative then you really should publish that evidence.

    Moreover, with 6,174 participants, we're talking about an average 123 or 124 men per state. That's such a small sample that you are going to get an enormous amount of noise in it even before the delta.

    It's 61.7 men per percentage point. :-)

    The CDC datasets show that the biggest factors in determining the circumcision rate are race, payer, and patient residence. With such a small dataset, I couldn't correlate those with any chance of getting useful data.

    Either a) both the NHDS and NHANES datasets are nationally representative, in which case they're comparable, or b) one or the other is not, in which case they're fundamentally broken.

    The underlying problem, though, is that I cannot find any reference to circumcision in any of the three data sets:

    I'm guessing that the problem is that you haven't looked properly. For 1999, the documentation is at:
    http://www.cdc.gov/nchs/data/nhanes/frequency/sxqdoc.pdf

    And there is a data file at:
    http://www.cdc.gov/nchs/nhanes/frequency/sxq.xpt

    I haven't even tried to open the data file myself. I've no reason to believe that the CDC researchers are incompetent, and presume that their analysis is correct.

    ReplyDelete
  71. Hi Jake:

    First off, I'd like to thank you for finding the raw data for me. While I'm afraid that it is somewhat limited in scope (no age, location or ethnic/racial information was included), it has helped.

    The deltas that have been created are *huge*.

    Doesn't matter, unless you're suggesting that this would make the results non-representative. And if you have evidence that NHANES is non-representative then you really should publish that evidence.


    By definition, creating huge deltas makes the sample unrepresentative *unless* the authors show that their selection of a subset of the data was still representative. In cases like this, where they are looking at pre-existing datasets, this selection of a different data set was a red flag. I would have been foolish not to pursue it. See below.

    Unfortunately, looking at the entire dataset, I'm getting very different information than the authors did with the 68% of the dataset that they used:

    A total of 1186 men, aged 18-59 are part of it.

    Of these men, we got the following breakdowns:

    765 men reported being circumcised. That is 64.5% of the sample
    375 men reported being uncircumcised. That is 31.6% of the sample
    14 men refused to answer. That is 1.2% of the sample
    32 men didn't know their status. That is 2.7% of the sample size.

    These figures are broadly in line with the in patient circumcision figures published by the CDC since the late 1970's.

    Now you understand why I insisted in looking at the raw data -- there were too many warning signs that the authors of the study that you published were manipulating the data.

    Having said that, I did come across another interesting study (http://www.hcup-us.ahrq.gov/reports/statbriefs/sb45.pdf) which states that the outpatient circumcision rate was about 6% in 2005. If we can find the source data for that information, it would presumably justify adding an additional 3-5% fudge factor depending upon state. (I'm somewhat leery of adjusting state rates based upon national figures because there may be significant regional variation, but it does give us an idea what the "real" range may be.)

    RP

    ReplyDelete
  72. 765 men reported being circumcised. That is 64.5% of the sample

    Stop right there.

    You've obviously misunderstood the study design. It's a weighted sample. That means you must apply the weights. You can't simply use the raw numbers of respondents, otherwise you're no longer working with a nationally representative sample.

    ReplyDelete
  73. To circumcise a healthy male baby for future health reasons is the equivalent of cutting off a persons ears because at some time in their life they might get ear infection. This is such a ridiculous idea. And to suggest that circumcision will actually cut the rates of stds and aids is obsurd. Those diseases can be acquired with or without a foreskin. Cleanliness is what should be promoted, not circumcision.

    ReplyDelete