Replies to This Discussion

Permalink Reply by Kris Feenstra on July 9, 2012 at 2:42pm

The problem is, many of the arguments against circumcision were as bad as the arguments for circumcision.  Bad analogies, overly assertive statements on inconclusive science, hyperbole etc.: as long as that keeps up, the debate can go on endlessly, because there's always an argument left open for criticism on either side. 

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Permalink Reply by Heather Spoonheim on July 9, 2012 at 2:44pm

@Kris

I did return to this thread asking for a summary of hard data for the pros and cons.  Has there been any?

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Permalink Reply by Arcus on July 9, 2012 at 2:51pm

http://en.wikipedia.org/wiki/Medical_analysis_of_circumcision#Poten...

http://en.wikipedia.org/wiki/Medical_analysis_of_circumcision#Poten...

I don't think any strong ethical arguments can be made in favor.

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Permalink Reply by Heather Spoonheim on July 9, 2012 at 3:10pm

The risks of not being circumcised are hard to judge without knowing the rates of the cancers studied, but it seems you have to circumcise a very large number of men to see benefit.

On the other hand, the potential hazards of circumcision are there for every single subject, and the results seem pretty catastrophic.

I just can't stop thinking about a fellow from Canada who was an identical twin, but raised as a girl because of a botched circumcision.  He committed suicide while his brother evaded a very small increased risk of some health problems.  Anecdotal I know, but I would need to hear at least a thousand success stories to make up for that one failure.

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Permalink Reply by Kris Feenstra on July 9, 2012 at 3:21pm

If memory serves, gender reassignment used to happen with some cases micropenis as well (with the same bad outcomes).  I would hope that medical professionals have learned at this point that you cannot satisfactorily force someone to live against their neurological gender (or whatever biological definition of gender is most relevant here).

I don't see why you would need to hear the success stories when the data will not reasonably be presented that way.  You've set up an unreasonable standard for being swayed. As a matter of opinion, I think it is inconsequential here.  I don't believe that compelling evidence with emerge to sufficiently redeem the practice of circumcision so your mind likely doesn't need to be swayed.  That said, I still think you've set things up in a bad way.

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Permalink Reply by Heather Spoonheim on July 9, 2012 at 3:34pm

Well, how hard would it be to cite some rates of the various conditions prevented by circumcision, and then cite some rates of change in the occurrence of said conditions in circumcised men, presenting the math to indicate how many circumcisions need to be performed to statistically eliminate one occurrence of that condition?

In that way, the 'opposing party' could cite some sources of number of complications per x number of circumcisions so the two data sets could be compared?

I'm completely indifferent to the outcome as I don't ever plan on being in the position to make such a decision, but if I were that is the sort of data map I would try to make.  I've only popped back in because I can't believe this thread is still going on.

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Permalink Reply by Kris Feenstra on July 9, 2012 at 5:02pm

...presenting the math to indicate how many circumcisions need to be performed to statistically eliminate one occurrence of that condition?

That seems like it could work to some extent, though one would still have to do quite the balancing act at the end to put the data in perspective.

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Permalink Reply by Kris Feenstra on July 9, 2012 at 3:02pm

No and there won't be, at least not in the form you asked as we can't collect meaningful data on what didn't happen in this case.  We could look at the incidence of relevant STIs in circumcised versus uncircumcised men, but that has debatable value.  I won't rule out that the data exists, but it might not with the depth and quality we would like because this is a statistically insignificant issue.  It is also difficult to weigh that data.  The two scenarios are difficult to compare.

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Permalink Reply by Ross O'Neil on July 9, 2012 at 6:16pm

@ Heather I must agree that this argument seems to me like one that should be over.  Like creationism...this issue is clear and is only being bantered about because of religious belief and empassioned opinion...the science is done.   Interestingly it has taken a long time to bring the "truth" to the collective majority.

The data is difficult to report as most of the studies as Kris point's out are statistically insignificant yet newspapers rarely care about that.

The prostate cancer data is certainly not conclusive and very insignificant.  Poor study methodology with self reported circumcision.  This is frought with error.  Yes, men lie about their circumcision status or just get it wrong.  That error alone requires a huge sample size to produce a statiscally significant result. No conclusion can be made and media should not be permitted to promote the results either way.

Risk of death in the U.S. is reported by most pro-circ organizations as 2.6 per 1.3 million circumcisions.  I extrapolated the data from South Africa and U.S. as best I could. (this would include large confidence intervals) You would need to circumcize 6984 boys in the U.S. to prevent 1 case of HIV given 2009 incidence rates.  I couldn't find more recent data on the web.  Another way to look at that would be 72 cases of HIV prevented for every infant death.  Not enough in my book especially considering we are insane to think the circumcision could confer any reliable protection.  This african mandate and funding has since been withheld since the cost:benefit ratio wasn't enough.   Men will get the idea that they are indeed safer when they aren't.  Just like some people believe the world will end in their lifetime, some people are strongly misguided by no evidence and by wrong evidence and just by hunch.

The data on other STI's  equally as inconclusive.  Even if the rate of urinary tract infection is reduced by 10% its a very large number number needed to circumcise to reduce one UTI in males who already have a very low incidence rate to start with.

There is no conclusive scientific evidence that conclusively demonstrates a benefit over the risks.

There is no ethical argument certainly that favours circumcision.

The personal opinion regarding father/son matching is non other than cultural self consciousness.  If you can't tell your son, "you have a foreskin because society and doctors practiced this surgery for the wrong reasons in the past and I will teach you how to take care of your penis so it will be healthy your whole life", you shouldn't have children.  If you don't know how to teach him, get a book, get on the web or talk to a healthcare provider.

Slowly but surely in my open-minded healthy skeptic career as a physician whom has done circumcision and involved on both sides of the debate as a student I am now convinced that non medical circumcision is bordering on child abuse.

Like Heather, I would like to see this thread/discussion be much more unilateral in opinion but that is the beauty of human beings we all want a choice and want to explore our conviction and justify and promote those convictions.

Good luck to those of you making this decision.  It will continue to be done less and less in the western world and eventually the entire world.  I certainly know that it a very small minority of physicians who still perform it and every one of them I know is religious.

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Permalink Reply by Heather Spoonheim on July 9, 2012 at 6:37pm

Indeed, Ross - I can't imagine how anyone can take a wide sampling of the information available and think circumcision is necessary, or even very likely beneficial.  In the end it puts the future sexuality and possibly life of the infant at risk for tradition.

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Permalink Reply by Dogly on July 9, 2012 at 2:42pm

Good, it will give her time to decide.  What is done or not done will be up to her.  I can't imagine a doctor performing a circumcision on a baby over the objections of his mother.

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Permalink Reply by CaperMel on July 9, 2012 at 2:45pm

Not over the objections of his mother, however where I live most doctors refuse to do the procedure and in fact alot of hospitals won't do it.

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