Ban all genital mutilation of children

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Re: Ban all genital mutilation of children

Post by lordpasternack » Tue May 02, 2017 6:41 pm

The issue is, Forty Two, that there are people with vested interests - religious, cultural and financial - in promoting and continuing male circumcision of minors, and the standard of evidence produced in favour of male circumcision is incredibly shaky, and I contend that no other proposed medical intervention as expensive and invasive, and so obviously a risk of infection in itself, as male circumcision is, would get the kind of easy pass that male circumcision has.

And they have, as you note, done just enough, to maintain just enough benefit of the doubt, that the tiny possible benefits (and they are tiny) may outweigh the tiny risks of serious infection or death (when performed in a hospital by a surgeon, with sterile equipment) - not to recommend circumcision as a routine intervention, but just enough to assuage consciences and maintain the status quo.
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Re: Ban all genital mutilation of children

Post by lordpasternack » Tue May 02, 2017 6:49 pm

Forty Two wrote:For the health care costs folks - http://healthland.time.com/2012/08/21/i ... ill-spike/
If circumcision rates were to drop from the current 55% to 10%, urinary tract infections in baby boys may rise a whopping 212%, and in men, HIV infections could increase by 12%, HPV infections by 29% and herpes simplex virus type 2 by 20%. In women, dropping rates of male circumcision could increase cases of bacterial vaginosis by 18% and low-risk HPV by 13%.
It's amazing how alarming and consequential you can make things sound when you talk in terms of relative risk...

What is the change in ABSOLUTE risk, in each of these cases - how does the US compare with Western Europe, which has a circumcision rate of <20%?

Are there possibly far more cost-effective interventions that Western Europe uses, which the US could adopt?

Can't we use the HPV vaccine, for a start?
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Re: Ban all genital mutilation of children

Post by Forty Two » Tue May 02, 2017 6:55 pm

lordpasternack wrote:The issue is, Forty Two, that there are people with vested interests - religious, cultural and financial - in promoting and continuing male circumcision of minors, and the standard of evidence produced in favour of male circumcision is incredibly shaky, and I contend that no other proposed medical intervention as expensive and invasive, and so obviously a risk of infection in itself, as male circumcision is, would get the kind of easy pass that male circumcision has.
Doesn't seem shaky, and the sources that I've cited are rather neutral. The Obama Administration CDC - did it have a "vested interest" in circumcision? What interest was vested? I don't think male circumcision has an easy pass, at all. As noted, even with what the AAP and the CDC called "clear evidence" that the benefits outweigh the downsides, they aren't suggesting it be a recommended procedure. Only that parents be educated on it, and make a decision under consultation with their doctor. Same with the World Health Organization, which called the evidence of HIV risk reduction to be "compelling." Compelling.

As someone with no particularly strong feeling on this one way or the other, and as someone who would have absolutely no problem at all leaving my child uncircumcised, I believe I am looking at this in a rather unbiased manner. I have no religious attachment to it. I have no hang-up about it. I don't care what the penis looks like, and I am quite sure that if I had a son he'd grow up and find plenty of women comfortable with it. None of that is an issue for me.

That being said, when I view the people on both sides of this issue, what I see are the anti-circumcision folks really being very mean and aggressive about the issue, and they use extreme language which leaves no wiggle room. It's not circumcision, it's "genital mutilation." There's generally never a reason to "mutilate" someone. Surgical procedures cut and remove and sew and such, but they aren't thought of as "mutilations." Words like "assault" and "child abuse."

On the other side, I see what appears to be rational weighing of benefits - risk, cost, benefit analyses. That kind of thing. Someone pipes up, like me, and says, "what about the recommendations of these rather prestigious organizations...?" And, the reaction is sarcasm, and hyperbole.
lordpasternack wrote:
And they have, as you note, done just enough, to maintain just enough benefit of the doubt, that the tiny possible benefits (and they are tiny) may outweigh the tiny risks of serious infection or death (when performed in a hospital by a surgeon, with sterile equipment) - not to recommend circumcision as a routine intervention, but just enough to assuage consciences and maintain the status quo.
You say "tiny" but the AAP, CDS, and WHO and NIH, and ACoOaG all say that the benefits are significant, demonstrated, and compelling.
“When I was in college, I took a terrorism class. ... The thing that was interesting in the class was every time the professor said ‘Al Qaeda’ his shoulders went up, But you know, it is that you don’t say ‘America’ with an intensity, you don’t say ‘England’ with the intensity. You don’t say ‘the army’ with the intensity,” she continued. “... But you say these names [Al Qaeda] because you want that word to carry weight. You want it to be something.” - Ilhan Omar

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Re: Ban all genital mutilation of children

Post by lordpasternack » Tue May 02, 2017 7:12 pm

Male circumcision is an intervention that can never be subject to a randomised, double blind, placebo controlled trial. Is that clear to you, and is it clear to you why randomised, double blind, placebo controlled trials are the gold standard?

Can you find me an example of any other proposed intervention against HIV that had unblinded and non-placebo controlled trials that ended early, and which were cited by the health authorities after three fucking trials that showed a miniscule reduction in absolute risk?

You have admitted yourself that none of those organisations recommend that it be a routine procedure - and that they only argue that the benefits appear to outweigh the risks.

How big are the risks? How big would the proposed benefits have to be to outweigh those risks? How underwhelming would those benefits have to be, for those organisations NOT to recommend routine circumcision?
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Re: Ban all genital mutilation of children

Post by Forty Two » Tue May 02, 2017 7:15 pm

lordpasternack wrote:
Forty Two wrote:For the health care costs folks - http://healthland.time.com/2012/08/21/i ... ill-spike/
If circumcision rates were to drop from the current 55% to 10%, urinary tract infections in baby boys may rise a whopping 212%, and in men, HIV infections could increase by 12%, HPV infections by 29% and herpes simplex virus type 2 by 20%. In women, dropping rates of male circumcision could increase cases of bacterial vaginosis by 18% and low-risk HPV by 13%.
It's amazing how alarming and consequential you can make things sound when you talk in terms of relative risk...
How so? If circumcision does prevent urinary tract infections, then a reduction from more than half of the population to only 10% of the population ought to have a significant effect. If it did not have a significant effect, then the benefit would not be particularly significant.
lordpasternack wrote:
What is the change in ABSOLUTE risk, in each of these cases - how does the US compare with Western Europe, which has a circumcision rate of <20%?
Data from Europe, based on a largely uncircumcised population, report UTI rates of 1.2% for infant boys.73The number is similar to the rates of 0.7% to 1.4% reported for uncircumcised males in the United States and Canada.72,,74In comparison, UTI rates for circumcised male infants in the United States and Canada are reported to be 0.12% to 0.19%.72,,74 Although these cross-cultural data do not provide information on specific individual risk factors, the similarity of European and American UTI rates for uncircumcised male infants support an association between circumcision status and UTI. Using these rates and the increased risks suggested from the literature, one can estimate that 7 to 14 of 1000 uncircumcised male infants will develop a UTI during the first year of life, compared with 1 to 2 of 1000 circumcised male infants.
http://pediatrics.aappublications.org/content/103/3/686

I.e., the rates of UTI in uncircumcised infants is about the same in Europe and Canada/US. The rates in circumcised males is far lower. The result is that uncircumcised males would have these infections in 7 to 14 out of 1000 infants, while in circumcised males, the rate would be only 1 to 2 per 1000. That appears significant to me. Now that may not be enough to make it a firm recommendation that all infants get it done; however, it's hard to argue that it's not evidence of a benefit which may render the procedure something other than a pointless mutilation and abuse of defenseless children via stabbing assaults....no?

lordpasternack wrote: Are there possibly far more cost-effective interventions that Western Europe uses, which the US could adopt?
I don't know, you tell me.
lordpasternack wrote:
Can't we use the HPV vaccine, for a start?
I don't know, you tell me. I'm not opposed to the HPV vaccine at all. I certainly wouldn't call it stabbing and poking holes in an assault on defenseless child who didn't consent. Although I didn't bother asking my kids if they wanted their vaccines. I just made the decision for them, and authorized the nurse practitioner to do it. They cried too. Apparently it hurt, a lot. And, we received a paper warning of a variety of side effects that could occur, most minor, but in some instances there are more serious side effects. The benefits outweighed the risks, though, by far.
“When I was in college, I took a terrorism class. ... The thing that was interesting in the class was every time the professor said ‘Al Qaeda’ his shoulders went up, But you know, it is that you don’t say ‘America’ with an intensity, you don’t say ‘England’ with the intensity. You don’t say ‘the army’ with the intensity,” she continued. “... But you say these names [Al Qaeda] because you want that word to carry weight. You want it to be something.” - Ilhan Omar

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Re: Ban all genital mutilation of children

Post by Forty Two » Tue May 02, 2017 7:37 pm

lordpasternack wrote:Male circumcision is an intervention that can never be subject to a randomised, double blind, placebo controlled trial. Is that clear to you, and is it clear to you why randomised, double blind, placebo controlled trials are the gold standard?
Placebos are used for drug testing. You can't have a placebo for a surgical procedure. Same with double-blind, because the patient is always going to know what his circumcision status is. However, such a study is not necessary to determine the reduced risk of cancer or urinary tract infections.

The association with penile cancer, for example, is not disputed. Larke NL, Thomas SL, Santos Silva I dos, Weiss HA. Male circumcision and penile cancer: a systematic review and meta-analysis. Cancer Causes Control. 2011;22:1097–1110. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139859/ and https://www.ncbi.nlm.nih.gov/pubmed/21695385

A double blind, placebo controlled test would not be required for circumcision to note the benefit regarding penile cancer, because the patient isn't going change the result (give himself cancer or keep himself from getting cancer), and neither will the doctor or the person conducting the study. Either they get cancer or they don't.
lordpasternack wrote:
Can you find me an example of any other proposed intervention against HIV that had unblinded and non-placebo controlled trials that ended early, and which were cited by the health authorities after three fucking trials that showed a miniscule reduction in absolute risk?
I disagree with your characterization as "miniscule," and with your description of the limited amount of evidence. The AAP found a list of benefits, each of which had support. But once again, let me be clear on this - I have the evidence in perspective. I am not a "pro circumcision" person. All I am saying is that it's not unreasonable to do it. It's not a mere mutilation and an assault and/or child abuse. There are medical reasons to do it which are supported by reasonable evidence.

Can you point to any proof that the AAP and its task force, the CDC, and the other groups mentioned had some sort of pro-circumcision bias that they were seeking to promote? What are they, stockholders in Mohelsanto or something? :biggrin:

lordpasternack wrote: You have admitted yourself that none of those organisations recommend that it be a routine procedure - and that they only argue that the benefits appear to outweigh the risks.
Admitted? I've said it since my first post or first few posts on the topic. I've been quite clear, repeatedly, that I was generally opposed or leaning opposed to having it done on my own kids, if we had boys. And, there's nothing to "admit." The recommendation is what it is. I quoted it, and I linked to it. I'm not hiding anything which I later admitted and you've found me out.
lordpasternack wrote:
How big are the risks? How big would the proposed benefits have to be to outweigh those risks? How underwhelming would those benefits have to be, for those organisations NOT to recommend routine circumcision?
Pretty small. There is some risk of infection in the procedure, as with any surgical procedure, but the links I've posted address that too. When done in a clinical environment by a doctor, there is a very very small risk of any complication and the vast majority of those complications are minor.

Underwhelming, overwhelming, etc. - I'm not telling anyone to get it done. The thread was started by someone telling everyone not to get it done. How underwhelming would the opposing arguments have to be to have the AAP and CDC etc. state that there is clear and compelling evidence that the benefits outweigh the downsides? How underwelming must the evidence for the procedure being a pointless, mutilation and assaultive bit of child abuse be for major medical organizations and the Centers for Disease Control to basically say that it's a reasonable procedure with medical benefits which justify doing it?

Don't circumcise your male infants. That's fine with me. Just don't ask me to support a "ban" on circumcision, when the evidence is what it is above.
“When I was in college, I took a terrorism class. ... The thing that was interesting in the class was every time the professor said ‘Al Qaeda’ his shoulders went up, But you know, it is that you don’t say ‘America’ with an intensity, you don’t say ‘England’ with the intensity. You don’t say ‘the army’ with the intensity,” she continued. “... But you say these names [Al Qaeda] because you want that word to carry weight. You want it to be something.” - Ilhan Omar

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Re: Ban all genital mutilation of children

Post by lordpasternack » Tue May 02, 2017 7:47 pm

Can you outline your background in clinical biology, or statistical epidemiology? :coffee:

I do at least have a Bachelors degree...

Edit: Bringing this up not as an argument from authority, but because what you wrote above is utter rubbish, and maybe intellectual humility would be good for you.
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Re: Ban all genital mutilation of children

Post by Forty Two » Tue May 02, 2017 8:02 pm

lordpasternack wrote:Can you outline your background in clinical biology, or statistical epidemiology? :coffee:
Oh, I have an engineering degree and an advanced degree beyond that. As part of my engineering degree, I took several statistics courses, and basic biology.
lordpasternack wrote: I do at least have a Bachelors degree...
In what?
lordpasternack wrote:
Edit: Bringing this up not as an argument from authority, but because what you wrote above is utter rubbish, and maybe intellectual humility would be good for you.
What are you on about? Feel free to point out a couple of examples of rubbish and demonstrate that what I've said is false.
“When I was in college, I took a terrorism class. ... The thing that was interesting in the class was every time the professor said ‘Al Qaeda’ his shoulders went up, But you know, it is that you don’t say ‘America’ with an intensity, you don’t say ‘England’ with the intensity. You don’t say ‘the army’ with the intensity,” she continued. “... But you say these names [Al Qaeda] because you want that word to carry weight. You want it to be something.” - Ilhan Omar

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Re: Ban all genital mutilation of children

Post by Brian Peacock » Wed May 03, 2017 7:24 am

Removing the appendix of infants would reduce the risk of appendicitis to zero.
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Re: Ban all genital mutilation of children

Post by mistermack » Wed May 03, 2017 10:01 am

It's perhaps no coincidence that the AAP and it's members make money out of circumcision.
Circumcision is the most common surgical procedure carried out by doctors in the US. It's a real money-spinner for them.
Huffington Post wrote:Do the benefits of male circumcision outweigh the risks? The U.S. Centers for Disease Control — echoing the 2012 policy statement of the American Academy of Pediatrics — have recently suggested that they do. What many Americans are not aware of, however, is the fact that the United States is not just unusual, but actually unique among developed nations in finding such widespread medical support for infant male circumcision. This support originated in the late 1800s, when doctors promoted the operation as a “cure” for masturbation; today it comes primarily from doctors’ trade associations — such as the AAP — that protect financial and other interests of physicians who continue to perform such surgeries. Doctors in peer nations, by contrast, along with the medical associations that represent them, tend to see the U.S. circumcision ritual as more of a cultural habit, not something rooted in sound medical science.
http://www.huffingtonpost.com/morten-fr ... 31972.html

One interesting point he makes is that parents of uncircumcised boys in the US have a custom of pulling back the foreskin and washing UNDER it. Which is probably why they get more urinary infections. AMERICA, LEAVE THE DICK ALONE !!

The bottom line is that if American men want all the so-called benefits, (of which the evidence is still missing) then they can opt for being chopped themselves, when they reach 18. That's the moral way to do it.

Edit : By the way, isn't it odd that it originally started out as a cure for masturbation, when it has no effect at all on sensitivity? Weird or what ???
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Re: Ban all genital mutilation of children

Post by pErvinalia » Wed May 03, 2017 11:22 am

You're supposed to wash under it. Well that's the medical advice that I've heard widely.
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Re: Ban all genital mutilation of children

Post by Forty Two » Wed May 03, 2017 11:30 am

mistermack wrote:It's perhaps no coincidence that the AAP and it's members make money out of circumcision.
They also make money out of vaccinations.
mistermack wrote: Circumcision is the most common surgical procedure carried out by doctors in the US. It's a real money-spinner for them.
This same potential bias applies to all medical recommendations of procedures to be done by medical doctors.
mistermack wrote:
Huffington Post wrote:Do the benefits of male circumcision outweigh the risks? The U.S. Centers for Disease Control — echoing the 2012 policy statement of the American Academy of Pediatrics — have recently suggested that they do. What many Americans are not aware of, however, is the fact that the United States is not just unusual, but actually unique among developed nations in finding such widespread medical support for infant male circumcision. This support originated in the late 1800s, when doctors promoted the operation as a “cure” for masturbation; today it comes primarily from doctors’ trade associations — such as the AAP — that protect financial and other interests of physicians who continue to perform such surgeries. Doctors in peer nations, by contrast, along with the medical associations that represent them, tend to see the U.S. circumcision ritual as more of a cultural habit, not something rooted in sound medical science.
http://www.huffingtonpost.com/morten-fr ... 31972.html
The prestigious, peer-reviewed medical journal, known as "The Huffington Post" outweighs peer reviewed research and publications.

Moreover, I'm happy to concede for the sake of argument the accuracy of what you just quoted. That still does not mean we should "ban" circumcision because it is "mutilation" and whatnot. This is not the only area where reasonable minds differ.
mistermack wrote:
One interesting point he makes is that parents of uncircumcised boys in the US have a custom of pulling back the foreskin and washing UNDER it. Which is probably why they get more urinary infections. AMERICA, LEAVE THE DICK ALONE !!
the numbers I quoted a few posts above are that the US and Europe get about the same rate of UTI in uncircumcised penises, not a higher amount. And, the US gets far lower UTI overall, because the circumcised ones get UTI at a fraction of the rate. I posted a block quote with the numbers.
mistermack wrote:
The bottom line is that if American men want all the so-called benefits, (of which the evidence is still missing) then they can opt for being chopped themselves, when they reach 18. That's the moral way to do it.
Oh, so we're talking morality, are we? You keep your morality, and I'll keep mine. In my world, it's moral for parents to make medical decisions on behalf of their minor children.

If in your world it's not, then good for you. I guess then the moral thing would be to not allow, say, sex change operations until the child is 18, and not allow parents to authorize them. Or, to not allow any other procedure. Parents should not be allowed to authorize Erythromycin Ophthalmic eye ointment at birth, or to allow Hepatitis B vaccination or vitamin K injection at birth. Wait until the child is 18, that's the moral way to do it.
mistermack wrote: Edit : By the way, isn't it odd that it originally started out as a cure for masturbation, when it has no effect at all on sensitivity? Weird or what ???
Kellogg's corn flakes was also started out as a cure for masturbation, because he thought healthy eating habits was a cure for masturbation. That means whole grain cereals should be banned, even though they are quite healthy.

Now, why should circumcision be "banned" again?
“When I was in college, I took a terrorism class. ... The thing that was interesting in the class was every time the professor said ‘Al Qaeda’ his shoulders went up, But you know, it is that you don’t say ‘America’ with an intensity, you don’t say ‘England’ with the intensity. You don’t say ‘the army’ with the intensity,” she continued. “... But you say these names [Al Qaeda] because you want that word to carry weight. You want it to be something.” - Ilhan Omar

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Re: Ban all genital mutilation of children

Post by NineBerry » Wed May 03, 2017 11:56 am

pErvin wrote:You're supposed to wash under it. Well that's the medical advice that I've heard widely.
Not babies and young children. It is only after some years that the foreskin is severed from the glans and can be pulled back without a risk of damaging.

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Re: Ban all genital mutilation of children

Post by mistermack » Wed May 03, 2017 12:01 pm

Forty Two wrote: This same potential bias applies to all medical recommendations of procedures to be done by medical doctors.
No it doesn't.
It depends how they get paid doesn't it?
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Re: Ban all genital mutilation of children

Post by mistermack » Wed May 03, 2017 12:08 pm

Forty Two wrote:
mistermack wrote: Edit : By the way, isn't it odd that it originally started out as a cure for masturbation, when it has no effect at all on sensitivity? Weird or what ???
Kellogg's corn flakes was also started out as a cure for masturbation, because he thought healthy eating habits was a cure for masturbation. That means whole grain cereals should be banned, even though they are quite healthy.

Now, why should circumcision be "banned" again?
The point was about sensitivity, which you change to corn flakes.
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