don’t tell people what to do with their foreskin, thanks

Hanna Rosin continues to polish her trophy as the least thoughtful person, and worst reader, to ever blog in any capacity for the Atlantic.

In a post as hectoring as its title, Rosin writes,

But the procedure is only “controversial” because people have emotional, psychological and religious reactions to it. Scientifically speaking, it’s not remotely controversial.

Not only is this nonsense, it’s insulting nonsense. The first thing to say is that, in fact, there are very many rational reasons to oppose routine circumcision. The first is to point out the simply bizarre notion of recommending preventative surgery to all Americans to prevent a condition that afflicts a tiny minority of Americans. Something along the lines of a third of a percentage point of our population has HIV. (All stats courtesy of the CDC.) I know that the efforts to raise AIDS awareness is undertaken in good faith, but the simple fact, obscured by people with good intentions, is that AIDS and HIV are extremely rare in the United States, and theaverage American has very little to fear contracting HIV. That’s just the numbers.

Appendicitis, meanwhile, afflicts some 680,000 Americans a year; for comparison, the CDC estimates that there are a total of 1,168,000 people living with HIV in the United States.  Yet no one proposes routine appendectomies to prevent appendicitis. Obviously, appendectomy is a far more invasive procedure, although it is entirely routine and extraordinarily safe. The point is that there is something bizarre about preventative surgery, and particularly when the disease in question is so rare. Remember, too, what we take for granted with every other category of medicine but circumcision, that medical science needs to demonstrate a compelling, repeatable benefit that is likely to be needed by a particular patient in order to recommend a treatment, particularly one that is surgical and permanently changes the patient’s body. “First do no harm” also means “leave well enough alone” unless there is a compelling medical benefit. Circumcision is still a surgical procedure; it’s permanently altering to those with no capacity to choose or ability to prevent the surgery; and it is changing the natural human form in the service of pursuing health gains that benefit a statistically tiny portion of the American population.

Rosin speaks, meanwhile, as all circumcision boosters do, as though the studies demonstrating a benefit for HIV transmission prevention from circumcision aren’t subject to further review and future study. To take less than a half dozen studies, released in the last five years, as permanently dispositive is a joke to anyone with even a cursory understanding of medical research. Medical studies are notorious for being released to great fanfare and subsequently being discredited or mitigated by new research. Even those who advocate the use of circumcision in sub-Saharan Africa caution that circumcision is not a magic bullet for solving the spread of HIV in the Third World. A 50% reduction in the infection rate, meanwhile, does not come close to matching the efficacy of using condoms and spermicidal lubricant, still the best solution in America and the rest of the developed world.

Even if we take all of the findings of these new studies at face value, they don’t, actually, make it clear that the United States should recommend circumcision for all male babies. Why? Because the studies all deal with sub-Saharan Africa, where unique sexual practices increase the risk of infection, and, crucially, because they deal with the HIV infection rates of the American demographic among the least likely to become infected, heterosexual men. Circumcision does not improve the risk of infection for a female partner, and as the very New York Times story that Rosin links takes pains to point out– and Rosin, revealing her fundamental dishonesty on the topic, does not– gay men do not enjoy any benefit in rates of infection from circumcision.

And in America and the rest of the developed world, that’s what matters, because– and I’m sorry that this is a fact that we remain almost completely unwilling to admit in polite company– in the developed world, heterosexual men who don’t use intravenous drugs, with very few exceptions, don’t get HIV or AIDS. They don’t. Heterosexual men in America have an even smaller rate of HIV infection than the already small general American infection rate. The rate of infection for men who don’t have sex with men and don’t use intravenous drugs is minuscule, and always has been. (Circumcision, of course, would do nothing to prevent infection from sharing needles.) This has not been a popular view do to our dedication to political correctness, but it is in fact the truth. In America, the people who get HIV and AIDS are homosexual men and intravenous drug users, precisely the people who will see no benefit from circumcision. If there were a medical rationale for routine circumcision that overwhelmed the basic wisdom of not surgically altering the body when it is unnecessary, the number of people who benefit would have to be high enough that we could reasonably say that some large percentage of them were receiving a benefit from the surgery. And as the number of men who acquire HIV from heterosexual sex is statistically close to zero (and, perhaps, inflated by men unwilling to admit to having sex with other men or taking intravenous drugs), that simply is not the case.

Rosin is the latest in a long line of pro-circumcision commentators who attempt to paint all of those who are opposed to routine circumcision as a hysterical fringe. That’s an empty rhetorical tactic, of course, but at times an effective one. Yet it seems clear to me that the people who have the burden of proof are those who want to enforce a permanent and body-altering surgical procedure on an entire gender, and it equally seems to me that they have not even begun to meet that burden of proof. I do believe that there is promise in using circumcision in sub-Saharan Africa, where vastly different logistical realities make the use of circumcision, as part of a comprehensive campaign against AIDS, an intelligent strategy. But to extend that wisdom in an incredibly tenuous way to the, yes, tiny risk of HIV and AIDS for the people who would benefit does not follow, and I find that they case as argued is laughably thin.

So why does such a powerful pro-circumcision movement in the United States exist? Because here, unlike in the rest of the world, circumcision is the norm, and people– particularly people who believe themselves to be socially liberal– love to use the language of science and medicine to enforce norms. Religious and cultural preference (“it looks weird if you don’t do it”) pushes Americans to circumcise their children when there is no rational benefit to doing so, and those most interested in enforcing that norm have been grasping around for justification in the realm of medicine. That’s the only reason I can imagine for a movement so incredibly zealous and assured about statistical and logical information that is so obviously insufficient to make the argumentative case they are trying to make.

I am opposed, on libertarian grounds, from enforcing medicine on anyone. And, despite Rosin’s use of the word “requiring,” forced circumcision, thank goodness, is not on the table. We do, however, recognize that there are medical benefits to certain kinds of treatments, namely vaccination and quarantine, that are in the best interests of society at large, and act with coercion at times to ensure that they are used. But in those instances, we are protecting other people from illness and disease. We recognize a right to the regulation of one’s own body for one’s own good. If the concern is that waiting until a child is a legal adult to have a circumcision might mean that he will already have had sex, why not wait until a child is still too young to likely be sexually active but old enough to make an informed choice? Say 12 years old, or so, when the child can, with the help of an engaged and sympathetic adult, come to understand the odds of infection and who is protected by circumcision and make a choice about his own body. I think the only reason those who enforce circumcision norms would object is because they are aware that a child might decide that, in fact, he doesn’t want to have a piece of his penis cut off, in order to lower the risk of infection of a disease he is very unlikely to be exposed to and even less likely to be exposed to in the kind of sexual practice circumcision provides a benefit for. Maybe the fact that such a person as that 12 year old, someone in charge of his own body and able to make his own choices about what exactly is in his best interest, might very well not choose circumcision, will give the enforcers of circumcision norms some pause. But if it does, it will require more thought, integrity and open-mindedness than the Hanna Rosins of the world are willing to give.