Aussie Guys & Circumcision

gettingonwithit

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The debate has flared again today in newspapers around Australia. Don't think many parents will start 'snipping' though.

Doctors' new challenge: foreskins have got to go


That Brian Morris should have his face scalped. Heard him on the radio yesterday he is a dickhead. Was treating the whole thing like a joke, laughing and giggling about chopping off babies foreskins.
 
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D_Miranda_Wrights

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The debate has flared again today in newspapers around Australia. Don't think many parents will start 'snipping' though.

Doctors' new challenge: foreskins have got to go

I don't think "debate is flaring" is the same thing as "some newspaper dude interviewed Brian Morris without bothering to find out he's a hack."

There are a lot of pro-circumcision academics I think are serious academics (even if I think their rationale is lazy), but Brian Morris seems useless to me.
 

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That Brian Morris should have his face scalped. Heard him on the radio yesterday he is a dickhead. Was treating the whole thing like a joke, laughing and giggling about chopping off babies foreskins.

He seems to be the only one really flying the flag for mutilating boys in Australia, but he gets a hell of a lot of media coverage. It's a worry if indecisive parents are swayed by his message.
 
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deleted23084

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I wouldn't be so quick to dismiss this piece of work. The newspaper article doesn't reference the original article, but you can find it with a quick google search. It's in an open journal, not one of the majors, so that needs to be taken into account, but in terms of the authors, I'm surprised. We all know that Brian Morris has a very fixed view on the benefits of circumcision but from scanning the list of other authors, there are eminent figures who I wouldn't expect to have an axe to grind either way other than to comment objectively on the evidence. I've got a couple of decades of experience in public health and there are authors here that I look up to, so I think this is worth consideration.

The crux of the article is not so much that all boys should be circumcised, but that public hospitals should remove the ban on circumcision so that if parents want to make a choice informed by the evidence, they can do so in an affordable, accessible way. They also say that pain relief should be given - not something we got as kids. Frankly I think it's a reasonable conclusion from the evidence.

People on either side get too bogged down in the emotion of it. When I was a kid, parents were called hippies or neglectful if they didn't get their sons circumcised. Now they're called child abusers. Let's get real, look at the evidence and let people make informed decisions. Let's be honest, if you start using emotive language about immunisation you can easily turn people off that too (oh no, you're not going to hold my kid down and inject them with a disease while they scream) but we let the evidence of a dramatic drop in disease speak for itself. Why can't we do the same for circumcision and let parents make their own informed decision?
 

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The so called U.S. MEDICAL EXPERTS also said that there's a lesser change of contacting HIV if the male partner is uncircumcised. I have only one question. If the United States has the highest number of circumcised males, WHY does it also have one of the highest HIV rates in the world?

As for disease: Wash the wee wee before use.

As to transmission: Bag-it.
 

D_Miranda_Wrights

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I wouldn't be so quick to dismiss this piece of work. The newspaper article doesn't reference the original article, but you can find it with a quick google search. It's in an open journal, not one of the majors, so that needs to be taken into account, but in terms of the authors, I'm surprised. We all know that Brian Morris has a very fixed view on the benefits of circumcision but from scanning the list of other authors, there are eminent figures who I wouldn't expect to have an axe to grind either way other than to comment objectively on the evidence. I've got a couple of decades of experience in public health and there are authors here that I look up to, so I think this is worth consideration.

The crux of the article is not so much that all boys should be circumcised, but that public hospitals should remove the ban on circumcision so that if parents want to make a choice informed by the evidence, they can do so in an affordable, accessible way. They also say that pain relief should be given - not something we got as kids. Frankly I think it's a reasonable conclusion from the evidence.

People on either side get too bogged down in the emotion of it. When I was a kid, parents were called hippies or neglectful if they didn't get their sons circumcised. Now they're called child abusers. Let's get real, look at the evidence and let people make informed decisions. Let's be honest, if you start using emotive language about immunisation you can easily turn people off that too (oh no, you're not going to hold my kid down and inject them with a disease while they scream) but we let the evidence of a dramatic drop in disease speak for itself. Why can't we do the same for circumcision and let parents make their own informed decision?

I think this question is pretty well-answered. In the First World, circumcision is insanely cost-inefficient. Do you really dispute that? The so-called "dramatic drop in disease" would be something to the order of several hundred thousand dollars to prevent one case of HIV. That's even viewing circumcision's prophylactic benefits in isolation. It completely ignores the risks and side effects. Most important, it ignores that circumcising a child at birth eliminates his autonomy to decide what he wants.

If circumcision has health benefits in net, they're marginal. There are also doubtlessly more efficient ways to use the health resources than neonatal circumcision. We don't preemptively remove other potentially desirable body parts for such marginal, inefficient health returns. Considering that, how can we defend infant circumcision?

We're really concerned about public health! But not enough so to pursue a more cost- and resource-efficient public health policy. Instead, we're going to pursue a less efficient public health policy that also eliminates individual bodily autonomy.

Doesn't really sound very compelling, does it?
 
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gymfresh

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I wouldn't be so quick to dismiss this piece of work. The newspaper article doesn't reference the original article, but you can find it with a quick google search. It's in an open journal, not one of the majors, so that needs to be taken into account, but in terms of the authors, I'm surprised.

Worse. It's in a pay-for-play journal, and purports to be an evidence-based meta-analysis. The most solid way to evaluate an intervention in an evidence-based context is to look at what's going on in the real world. Australia and New Zealand have already done the experiment: going from the highest non-religious circumcision rates in the world 40 years ago to rather low today. And what's been the outcome? More disease? More complications? More sexual problems? None of these. In fact, Dr. Robert Darby has done a good job of showing that there's a very positive correlation in Australasia between the cessation of circumcision and male paediatric health, now spilling over into improved adult health. It may or may not be causation, but no one can claim with any credibility that an evidence-based approach makes the case for circumcision as a valid public health intervention... precisely what Morris and colleagues insist it is.
 

D_Miranda_Wrights

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Worse. It's in a pay-for-play journal, and purports to be an evidence-based meta-analysis. The most solid way to evaluate an intervention in an evidence-based context is to look at what's going on in the real world. Australia and New Zealand have already done the experiment: going from the highest non-religious circumcision rates in the world 40 years ago to rather low today. And what's been the outcome? More disease? More complications? More sexual problems? None of these. In fact, Dr. Robert Darby has done a good job of showing that there's a very positive correlation in Australasia between the cessation of circumcision and male paediatric health, now spilling over into improved adult health. It may or may not be causation, but no one can claim with any credibility that an evidence-based approach makes the case for circumcision as a valid public health intervention... precisely what Morris and colleagues insist it is.

Where's this study at? I'm a little dubious, both because I doubt circumcision status relates to health status overall more than at the extreme margins, and because pediatric health has increased worldwide during the same period.
 
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deleted23084

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The so called U.S. MEDICAL EXPERTS also said that there's a lesser change of contacting HIV if the male partner is uncircumcised. I have only one question. If the United States has the highest number of circumcised males, WHY does it also have one of the highest HIV rates in the world?

I haven't looked at the figures in the US, but there's a high proportion of HIV transmitted through IV drug use as the US declined to implement a needle and syringe program for drug users, so that could well account for some of the high prevalence of HIV.

You could also argue the opposite. At the time HIV hit in Australia, we had a very high circumcision rate, and we have maintained a very low population prevalence of the virus, so circumcision has been protective. (I don't really think this is true, but it goes to show that correlational associations are pretty dodgy.)
 
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deleted23084

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Worse. It's in a pay-for-play journal, and purports to be an evidence-based meta-analysis. The most solid way to evaluate an intervention in an evidence-based context is to look at what's going on in the real world. Australia and New Zealand have already done the experiment: going from the highest non-religious circumcision rates in the world 40 years ago to rather low today. And what's been the outcome? More disease? More complications? More sexual problems? None of these. In fact, Dr. Robert Darby has done a good job of showing that there's a very positive correlation in Australasia between the cessation of circumcision and male paediatric health, now spilling over into improved adult health. It may or may not be causation, but no one can claim with any credibility that an evidence-based approach makes the case for circumcision as a valid public health intervention... precisely what Morris and colleagues insist it is.

Actually, there is a major study funded by Australia's National Health and Medical Research Council, the ACE prevention project, that determined that circumcision was a valid public health intervention to prevent HIV. However, the recommendation is only for adults who are having sex with other men, so it doesn't make a case for circumcising everyone.

Personally I think the evidence is mixed. I'm not saying there aren't good ethical reasons why you wouldn't circumcise as a preference, but I can also see why parents would choose it. I think it's a fascinating topic, but not one to get hot under the collar about.
 

D_Miranda_Wrights

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Personally I think the evidence is mixed. I'm not saying there aren't good ethical reasons why you wouldn't circumcise as a preference, but I can also see why parents would choose it. I think it's a fascinating topic, but not one to get hot under the collar about.

I'm not sure what you're arguing. You're saying the ethical case against infant circumcision is strong, but you can also see why parents would choose it. I can also see why well-intentioned parent would choose it, but are you arguing that's somehow an acceptable/rational choice?
 

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Personally I think the evidence is mixed. I'm not saying there aren't good ethical reasons why you wouldn't circumcise as a preference, but I can also see why parents would choose it. I think it's a fascinating topic, but not one to get hot under the collar about.

There's still a glaring issue here: surgery has never been endorsed or even condoned for prophylactic health purposes absent a rather compelling medical determination (like removing breast buds of a female minor because of a rare family propensity toward breast cancer). Parents don't get to "choose" to cut off part of their children, for either prospective health or cosmetic reasons. It's most certainly not reasonable to offer this as a choice to parents, and the medical profession ethically should counsel parents that amputation or excision of any body parts is simply not an option on a healthy child.

The fundamental problem is that circumcision has not been considered surgery per se by the medical community. This needs to be corrected. Circumcision is not so special that it gets to violate an entire medical maxim. (And that's without getting into all the ramifications of personal body autonomy.)
 
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SirConcis

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Circumcision is not as effective for gay men because circumcision does not reduce the odds of cathing it via the anus. And circumcision does not prevent one frm getting HIV thorugh infected needles.

Howver, a circumcised male who never lets a penis in his anus would see some protection from being circumcised. But remember that ciorcumcision only reduces the odds of getting. Have sex often enough with an infected male and odds are you'll eventually get it.
 

D_Miranda_Wrights

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I want to step back on the Brian Morris crack a little. The cosigners on this study are some impressive names (although not all of them.) I think Morris himself wrote it, and I'm guessing the coauthors just signed off. I'll need to scour the references in the paper more thoroughly, but from an initial read, it appears he's cherry-picking studies. This frustrates me a little...I don't understand why anyone would bother to do an intensive statistical analysis while knowingly choosing studies that represented a given conclusion. However, it's certainly a good way for Morris to garner credibility.

I mean, Morris is promoting his work and fashioning his studies in a way that's conventionally accepted in the profession. It's just not necessarily the same way one works when ascertaining the truth in medicine.
 

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The debate has flared again today in newspapers around Australia. Don't think many parents will start 'snipping' though.

Doctors' new challenge: foreskins have got to go

Morris is widely known as a circumcision fetishist.
He will say anything to get someone circumcised.
He has said thing to the effect that is is saving their life, to have them circumcised. A truer nutter never lived.
 

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I wouldn't be so quick to dismiss this piece of work. The newspaper article doesn't reference the original article, but you can find it with a quick google search. It's in an open journal, not one of the majors, so that needs to be taken into account, but in terms of the authors, I'm surprised. We all know that Brian Morris has a very fixed view on the benefits of circumcision but from scanning the list of other authors, there are eminent figures who I wouldn't expect to have an axe to grind either way other than to comment objectively on the evidence. I've got a couple of decades of experience in public health and there are authors here that I look up to, so I think this is worth consideration.
Go for it! A quick scan shows Morris's hand all over it, suggesting the others just signed it off. Several of the references are to Morris's previous rambles. (I've tried tracing them back in the past.) Some are to opinion pieces by fellow circumcisionists. One study I'm familiar with doesn't say what Morris says it does, about the incidence of recurrent UTIs. It couldn't because they only established the circumcision status of about half the 68 boys who got any UTIs, and 5 of the 8 boys with recurrent UTIs out of the ~35,000. (And in the US, they'd notice when a boy with UTIs was not circumcised, but not when he was.)

In an earlier piece he said one intact boy in three would need medical treatment for something foreskin-related in his lifetime. (He got that by taking the upper outlier of every estimate.) Now it's gone up to one in two, without explanation. That's a figure you don't see for other parts of the body, but I suspect it's comparable all over. (Eyelids? I've had styes. Ears? A papilloma, and there's a solar keratosis there right now. And so on.) This seems like shroud-waving to me.
The crux of the article is not so much that all boys should be circumcised, but that public hospitals should remove the ban on circumcision so that if parents want to make a choice informed by the evidence, they can do so in an affordable, accessible way.
Morris is on record as saying "circumcision should be made compulsory" and referring to"universal circumcision".

They also say that pain relief should be given - not something we got as kids.
They all say that now. It's a sop. Circumcision can't be made painless, especially not for the whole 10 days or so it takes to heal.

Frankly I think it's a reasonable conclusion from the evidence.

People on either side get too bogged down in the emotion of it. When I was a kid, parents were called hippies or neglectful if they didn't get their sons circumcised. Now they're called child abusers. Let's get real, look at the evidence and let people make informed decisions. Let's be honest, if you start using emotive language about immunisation you can easily turn people off that too (oh no, you're not going to hold my kid down and inject them with a disease while they scream) but we let the evidence of a dramatic drop in disease speak for itself. Why can't we do the same for circumcision and let parents make their own informed decision?
Because the penis doesn't belong to them. Vaccination doesn't irrevocably cut part off. Vaccination demonstrably, strongly reduces contagious, fatal diseases of children (now rare precisely because of vaccination). None of that is true of circumcision.

Here is an antidote to Morris.
 
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SirConcis

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With regards to health costs. Lack of circumcision visibly increases the number of minor infections in childhood. Once a male makes it to adulthood with a functioning foreskin, the number of complications is small (short of acquired phimosis from infections/diabetes).

Note that many of the childhood infection are not serious, but as longa s parents of nervous and bring the boy to the hospital, it counts towards the health care costs.

In a society where parents have proper education on the care of foreskin (not the anti circ "leave it alone" stiff) and are not shy to teach their son about how to care for his foreskin, the incidence of foreskin problems is greatly reduced.

So 2 countries iwth different culture/taboos may have different experience when they stop circumcising boys because one may have a population that is too shy/taboo to discuss foreskin care to their son while the other has no problem with it.
 

D_Miranda_Wrights

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With regards to health costs. Lack of circumcision visibly increases the number of minor infections in childhood. Once a male makes it to adulthood with a functioning foreskin, the number of complications is small (short of acquired phimosis from infections/diabetes).

Note that many of the childhood infection are not serious, but as longa s parents of nervous and bring the boy to the hospital, it counts towards the health care costs.

In a society where parents have proper education on the care of foreskin (not the anti circ "leave it alone" stiff) and are not shy to teach their son about how to care for his foreskin, the incidence of foreskin problems is greatly reduced.

So 2 countries iwth different culture/taboos may have different experience when they stop circumcising boys because one may have a population that is too shy/taboo to discuss foreskin care to their son while the other has no problem with it.

This has hardly caused systemic problems in Canada or Australia and, despite the U.S.'s reputation for being prudish and Victorian, I doubt we're substantially less willing to discuss pediatric care of the penis than Canadians or Aussies.