The Next Health-Care Debate

Circumcision? Lord love a duck.

From Hannah Rosin at Daily Dish:

But the procedure is only "controversial" because people have emotional, psychological and religious reactions to it. Scientifically speaking, it's not remotely controversial. The anti-circumcision sites always refer to the American Academy of Pediatrics' 1999 policy statement on circumcision, which declined to recommend the procedure. But that statement was issued before the most compelling studies emerged about the role circumcision plays in reducing the risk for transmission of HIV and other STD's. This is a good overview from medical writer Arthur Allen.

Three trials in which Kenyan and Ugandan men were randomly selected to receive circumcision were halted when it became clear that circumcision helped prevent transmission of HIV. Men who got it were about half as likely to get infected. “A 50% reduction is about the same as some vaccines,” says [Edgar Schoen, MD, who was chief of pediatrics at Kaiser-Permanente Healthcare.]

Yes, conditions in Africa are different. The trials showed results mostly in heterosexual transmission. But the evidence is still pretty strong, and even stronger for STD's. The problem with all this "controversy" is that Medicaid now doesn't pay for the procedure, which costs all of $300 in most hospitals. Rates of circumcision for the poor, particularly African Americans and Latinos, have plummeted in the last ten years.

Here's a statement of the policy -- and please note that there is a comment at the top that the poicy was reaffirmed in 2005. And here's the article that Rosin lifted her quote from. Frankly, it's long on assertion and personal opinion, short on data, and completely lacking in direct citations.

I don't doubt that the studies exist or that they conclude what the reports say they conclude, but I'm not swayed. There's something missing here: what impact does circumcision have on disease transmission for those who habitually use condoms or practice other forms of safe sex? Yeah, I thought so.

Update:

Before you run out to get your hood whacked off, read this, of particular interest to at least some readers here:

Circumcision, which has helped prevent AIDS among heterosexual men in Africa, doesn’t help protect gay men from the virus, according to the largest U.S. study to look at the question.

The research, presented at a conference Tuesday, is expected to influence the government’s first guidance on circumcision.

Circumcision “is not considered beneficial” in stopping the spread of HIV through gay sex, said Dr. Peter Kilmarx, of the U.S. Centers for Disease Control and Prevention.

There's also the fact that about 80% of American men are already circumcised. (By the way, this study also specifies that transmission rates for circumcised and uncircumcised men who engage in anal sex are about the same. I suspect that the sex of the person on the receiving end is not going to make much difference.)

Can you say "agenda"? On the parts of both Rosin and Allen, it would seem. (I won't make reference to the implicit heterosexism in both writers' comments -- but then, I probably don't have to.)

I don't know that I need to concern myself with the feminist take on circumcision, but I will say that for American feminists -- or American anything -- to take the results of a study of African men who do not use condoms and demand that American men all trot off obediently to get cut strikes me as a little specious, not to mention downright dangerous: circumcision doesn't eliminate the risk of infection with STDs, including HIV, it only moderates it in those who do not use condoms for penetrative sex. Sure, every little bit helps, but you will note that neither writer mentions practicing safe sex, and regrettably, that is still not something that can be taken for granted, particularly among younger men. (And I'm not just talking about young gay men -- teenage pregnancy rates have risen in the past few years, and the girls aren't doing it with turkey basters, you can bet on that. Concomitantly, of course, there has been an increase in the incidence of STDs among teenage girls.) (It reminds me in a way of that horrible woman who went on a campaign to ban pornography because it demeaned women. Well, sometimes, maybe. And of course, she had no response when asked about gay pornography. But she still wanted to ban it all. Same attitude.)

So here we have the Daily Dish lending itself to another half-baked opinion without much backing from complete research, or even much in the way of careful thought. My objection, I guess, is that for most responsible men, the message here is irrelevant. And those for whom the message might be relevant are not being provided with useful information. That pisses me off.

And in case you were wondering, none of your business -- if you're someone who needs to know, you'll have direct evidence. My own attitude is a cock is a cock, and each has its good points and its less than good points. It's the man attached to the cock who's the most important part of the whole thing.

(I thought about including a picture or two, but this is not that kind of blog.)