Meta: I think we should have more posts like this in that I want to see more discussion of different cause areas. However, I spent a lot of time in a research rabbit hole after reading this, and I wound up being disappointed with the execution of the post. So: while the concept of the post was good, and I think the authorās intentions were good, Iām going to be honest in my criticism.
I appreciate the breakdown of importance, tractability, and crowdedness here, but I donāt think this post uses scout mindset; itās written to persuade, and leaves out a lot of contradictory evidence while overstating the strength of other evidence.
In the end, I decided to downvote; once Iād spent ~90 minutes reading evidence from both sides, I found that this post linked to weaker resources than most others I found, and with a strong bias that made it hard to trust anything I was reading.
*****
Most things have pros and cons. There will occasionally be cases where every argument and consideration lines up on one side of a question, but they are rare, while confirmation bias is common and produces the same impression. (See also āsurprising and suspicious convergenceā.)
I checked a couple of links, and quickly found a few misleading statements:
The linked study refers to the circumcision of adult males, which seems extremely rare and isnāt the target of intactivism. I was expecting to see a comparison of men who were circumcised as babies and men who werenāt; the use of this study makes me wonder whether the study I āexpectedā actually exists, and if so, what the results were. (I then found this literature review, which seems like reasonably strong evidence of weak-to-nonexistent differences in pleasure.)
In the 20th century alone, over 120 million circumcisions were performed in the United States, most of which on non-consenting infants, with a circumcision happening every 17 seconds.
11 million men in this dataset chose to become circumcised, leaving 110 million infants. There are 3.15 billion seconds in a century, so an infant circumcision happened roughly every 29 seconds. This is still very bad if circumcision is bad, but the division mistake leaves me questioning everything else just a bit more.
Meanwhile, the discussion of HIV differences between the U.S. and Europe left me cold. There are many, many differences between those two parts of the world ā sexual mores, sex education, demographics, access to preventative care, prevalence of high-risk clustersā¦ even if circumcision did reduce HIV transmission rates (I acknowledge that the positive evidence there has sometimes been overstated), those other factors could easily overwhelm that single protective element.
*****
Iām disinclined to force permanent surgery on infants without strong evidence of benefit, and Iām dubious that current evidence is strong enough. Iām also curious about the difference between American and European medical norms. Overall, Iām open to the idea that male circumcision is net-negative and that reducing rates around the world is a reasonable ānormalā charitable cause. And I respect the views of people who donāt want their tax dollars to pay for a nonconsensual surgery with uncertain benefits.
But the quality of intactivist argumentation that Iāve seen (linked from this post and elsewhere) isā¦ mixed. And given that circumcision has clear health benefits (UTI risk, penile cancer risk) and remains the subject of active debate, I find it hard to imagine this cause area stacking up against something like malaria prevention.
I appreciate the breakdown of importance, tractability, and crowdedness here, but I donāt think this post uses scout mindset; itās written to persuade, and leaves out a lot of contradictory evidence while overstating the strength of other evidence.
I did link to a number of resources that address the arguments from circumcision proponents though, such as Eric Clopperās lecture. I also mentioned the possibility of infants not being sentient, which would weaken the case for it as a cause area.
In the end, I decided to downvote; once Iād spent ~90 minutes reading evidence from both sides, I found that this post linked to weaker resources than most others I found, and with a strong bias that made it hard to trust anything I was reading.
Most things have pros and cons. There will occasionally be cases where every argument and consideration lines up on one side of a question, but they are rare, while confirmation bias is common and produces the same impression. (See also āsurprising and suspicious convergenceā.)
Keep in mind that the circumcision proponents may also have confirmation bias. Since circumcision is a highly profitable industry for hospitals, there may be economic incentives for medical/āacademic institutions to be biased in favor of it. For example, the AAP Circumcision Task Force 2012 operated as a way of preserving third party payment. The task force also apparently did not have a single member with an intact foreskin, and thus did not have informed opinions on the foreskin and its functions. Some circumcised men may also be emotionally invested in defending circumcision for cultural reasons, or since they may be uncomfortable with the possibility that they are missing out on the increased sexual satisfaction they may have had if their foreskins had remained intact.
The linked study refers to the circumcision of adult males, which seems extremely rare and isnāt the target of intactivism. I was expecting to see a comparison of men who were circumcised as babies and men who werenāt; the use of this study makes me wonder whether the study I āexpectedā actually exists, and if so, what the results were. (I then found this literature review, which seems like reasonably strong evidence of weak-to-nonexistent differences in pleasure.)
Regarding your literature review, I found this article written in direct response to it. Itās virtually impossible to study the differences in subjective sexual pleasure between men who were circumcised as infants compared to those who remain intact as adults, simply because two individuals cannot access each otherās memories and subjective experiences in order to make an accurate comparison. Itās far easier to study men who were circumcised as adults, simply because they remember being intact and can more easily make a comparison. Eric Clopper also talks extensively about many of the methodological flaws in many of the studies used to defend circumcision in his lecture. Regarding the author of your meta-analysis, Brian J. Morris, IntactiWiki has quite a lot to say about him.
If you believe that there is no significant difference in sexual pleasure between intact men and men who were circumcised as infants, that would seem to imply that there is some mechanism by which the penis/ābrain compensates for the lost nerve endings and keratinization of the glans. Since thousands of nerve endings are physically removed, that would seem to imply that either the remaining nerve endings somehow become more sensitive, or that new nerve endings regrow to make up for those that are lost. Do you have any strong evidence that this happens? Alternatively, what could happen is that the nerves simply atrophy, or that the severed nerve endings could grow into amputation neuromas instead of new pleasurable nerve endings.
11 million men in this dataset chose to become circumcised, leaving 110 million infants. There are 3.15 billion seconds in a century, so an infant circumcision happened roughly every 29 seconds. This is still very bad if circumcision is bad, but the division mistake leaves me questioning everything else just a bit more.
I probably could have worded that better, I apologize. I edited the post to state it a bit more clearly. The statistic I cited was the circumcision rate at its peak, not the average circumcision rate throughout the entire century. Hereās the direct quote from the article I linked:
During 20th century, more than 120 million foreskins were severed from American penises, more than in any other country in the world. At the height of the circumcision frenzy, a foreskin was being sundered, and a penis crippled, every 17 seconds.
The peak in the number of circumcisions performed per year according to the article was during 1955-1965. Hereās also some data on the number of births per year in the US, apparently peaking during 1957.
From the article: The annual number of circumcisions was highest between 1955 and 1965. During that decade, 1.8 million males were circumcised every yearāalmost 5,000 every day.
Meanwhile, the discussion of HIV differences between the U.S. and Europe left me cold. There are many, many differences between those two parts of the world ā sexual mores, sex education, demographics, access to preventative care, prevalence of high-risk clustersā¦ even if circumcision did reduce HIV transmission rates (I acknowledge that the positive evidence there has sometimes been overstated), those other factors could easily overwhelm that single protective element.
You could make the same argument about Africa. One argument Iāve heard from circumcision proponents is that northern/ācentral Africa (which has higher circumcision rates) has lower HIV rates than southern Africa, and this is evidence that circumcision reduces HIV transmission. Yet there are also many, many cultural differences between different parts of Africa. For example, the Sahel is predominantly Muslim whereas southern Africa is predominantly Christian. Lesotho and Eswatini, the 2 African countries with the highest HIV rates in the world, have cultures with a high rate of multiple concurrent partnerships. In Lesotho, there is a practice known as bonyatsi, which involves people of both genders maintaining many sexual partners, even after marriage. In Eswatini, there is also a traditional culture that discourages safe sexual practices.
There are also other parts of the world besides Europe that donāt circumcise and have low rates of HIV. Latin America, India, and East Asia all have fairly low rates of HIV infection despite having populations that are mostly intact. India, for example, has an adult HIV prevalence rate of only 0.2%, despite being far poorer than the US or Europe. The US, by comparison, has an HIV prevalence rate of 0.3%. China is even lower, at 0.09%.
Iām disinclined to force permanent surgery on infants without strong evidence of benefit, and Iām dubious that current evidence is strong enough. Iām also curious about the difference between American and European medical norms. Overall, Iām open to the idea that male circumcision is net-negative and that reducing rates around the world is a reasonable ānormalā charitable cause. And I respect the views of people who donāt want their tax dollars to pay for a nonconsensual surgery with uncertain benefits.
But the quality of intactivist argumentation that Iāve seen (linked from this post and elsewhere) isā¦ mixed. And given that circumcision has clear health benefits (UTI risk, penile cancer risk) and remains the subject of active debate, I find it hard to imagine this cause area stacking up against something like malaria prevention.
If you believe that circumcision has significant health benefits, you still have to explain why the foreskin evolved in the first place. If the foreskin was net harmful, evolution probably would have gotten rid of the foreskin long ago. Yet almost every species of mammal has some form of foreskin or penile sheath. Aposthia exists at a low rate within the population, but any genetic predisposition towards it has evidently not undergone any degree of positive selection pressure. If you accept evolution, this seems to imply that the foreskin has historically been a net evolutionary benefit, and any health effects resulting from it are insignificant.
The argument about penile cancer is just grasping at straws. Eric Clopper actually mentioned penile cancer risk and UTIs in his lecture. Penile cancer is a rare cancer in the first place, and almost entirely affects old men. Even if you believe reduced risk of penile cause area is a significant benefit of circumcision, it involves performing tens of thousands of circumcisions to prevent a single case of penile cancer. If you still believe that reducing the rate of an already rare cancer is a legitimate reason for amputating a body part, you should also advocate for removing many other body parts if you want to be consistent, such as removing girlsā breast buds to prevent breast cancer, amputating the toes to prevent toe cancer, etc.
On the topic of UTI risk, UTIs can sometimes result from forced retraction of the foreskin. This can easily be prevented by not retracting the foreskin before the balano-preputial lamina has dissolved. The lifetime UTI risk for intact men appears to be only very slightly higher compared to circumcised men, with the risks being 1.29% and 1.27%, respectively.
For other potential EA causes like malaria prevention, these causes may also have significant drawbacks and unintended consequences. For example, Nassim Taleb believes that the Gates Foundation is repeating the errors of Mao Zedong. Malaria nets may also often go unused, or could also cause local net manufacturers to go out of business. Africans may also view malaria as a minor ailment, similar to how we view the cold of flu.
Meta: I think we should have more posts like this in that I want to see more discussion of different cause areas. However, I spent a lot of time in a research rabbit hole after reading this, and I wound up being disappointed with the execution of the post. So: while the concept of the post was good, and I think the authorās intentions were good, Iām going to be honest in my criticism.
I appreciate the breakdown of importance, tractability, and crowdedness here, but I donāt think this post uses scout mindset; itās written to persuade, and leaves out a lot of contradictory evidence while overstating the strength of other evidence.
In the end, I decided to downvote; once Iād spent ~90 minutes reading evidence from both sides, I found that this post linked to weaker resources than most others I found, and with a strong bias that made it hard to trust anything I was reading.
*****
Most things have pros and cons. There will occasionally be cases where every argument and consideration lines up on one side of a question, but they are rare, while confirmation bias is common and produces the same impression. (See also āsurprising and suspicious convergenceā.)
I checked a couple of links, and quickly found a few misleading statements:
The linked study refers to the circumcision of adult males, which seems extremely rare and isnāt the target of intactivism. I was expecting to see a comparison of men who were circumcised as babies and men who werenāt; the use of this study makes me wonder whether the study I āexpectedā actually exists, and if so, what the results were. (I then found this literature review, which seems like reasonably strong evidence of weak-to-nonexistent differences in pleasure.)
11 million men in this dataset chose to become circumcised, leaving 110 million infants. There are 3.15 billion seconds in a century, so an infant circumcision happened roughly every 29 seconds. This is still very bad if circumcision is bad, but the division mistake leaves me questioning everything else just a bit more.
Meanwhile, the discussion of HIV differences between the U.S. and Europe left me cold. There are many, many differences between those two parts of the world ā sexual mores, sex education, demographics, access to preventative care, prevalence of high-risk clustersā¦ even if circumcision did reduce HIV transmission rates (I acknowledge that the positive evidence there has sometimes been overstated), those other factors could easily overwhelm that single protective element.
*****
Iām disinclined to force permanent surgery on infants without strong evidence of benefit, and Iām dubious that current evidence is strong enough. Iām also curious about the difference between American and European medical norms. Overall, Iām open to the idea that male circumcision is net-negative and that reducing rates around the world is a reasonable ānormalā charitable cause. And I respect the views of people who donāt want their tax dollars to pay for a nonconsensual surgery with uncertain benefits.
But the quality of intactivist argumentation that Iāve seen (linked from this post and elsewhere) isā¦ mixed. And given that circumcision has clear health benefits (UTI risk, penile cancer risk) and remains the subject of active debate, I find it hard to imagine this cause area stacking up against something like malaria prevention.
I did link to a number of resources that address the arguments from circumcision proponents though, such as Eric Clopperās lecture. I also mentioned the possibility of infants not being sentient, which would weaken the case for it as a cause area.
Keep in mind that the circumcision proponents may also have confirmation bias. Since circumcision is a highly profitable industry for hospitals, there may be economic incentives for medical/āacademic institutions to be biased in favor of it. For example, the AAP Circumcision Task Force 2012 operated as a way of preserving third party payment. The task force also apparently did not have a single member with an intact foreskin, and thus did not have informed opinions on the foreskin and its functions. Some circumcised men may also be emotionally invested in defending circumcision for cultural reasons, or since they may be uncomfortable with the possibility that they are missing out on the increased sexual satisfaction they may have had if their foreskins had remained intact.
Regarding your literature review, I found this article written in direct response to it. Itās virtually impossible to study the differences in subjective sexual pleasure between men who were circumcised as infants compared to those who remain intact as adults, simply because two individuals cannot access each otherās memories and subjective experiences in order to make an accurate comparison. Itās far easier to study men who were circumcised as adults, simply because they remember being intact and can more easily make a comparison. Eric Clopper also talks extensively about many of the methodological flaws in many of the studies used to defend circumcision in his lecture. Regarding the author of your meta-analysis, Brian J. Morris, IntactiWiki has quite a lot to say about him.
If you believe that there is no significant difference in sexual pleasure between intact men and men who were circumcised as infants, that would seem to imply that there is some mechanism by which the penis/ābrain compensates for the lost nerve endings and keratinization of the glans. Since thousands of nerve endings are physically removed, that would seem to imply that either the remaining nerve endings somehow become more sensitive, or that new nerve endings regrow to make up for those that are lost. Do you have any strong evidence that this happens? Alternatively, what could happen is that the nerves simply atrophy, or that the severed nerve endings could grow into amputation neuromas instead of new pleasurable nerve endings.
I probably could have worded that better, I apologize. I edited the post to state it a bit more clearly. The statistic I cited was the circumcision rate at its peak, not the average circumcision rate throughout the entire century. Hereās the direct quote from the article I linked:
During 20th century, more than 120 million foreskins were severed from American penises, more than in any other country in the world. At the height of the circumcision frenzy, a foreskin was being sundered, and a penis crippled, every 17 seconds.
The peak in the number of circumcisions performed per year according to the article was during 1955-1965. Hereās also some data on the number of births per year in the US, apparently peaking during 1957.
From the article: The annual number of circumcisions was highest between 1955 and 1965. During that decade, 1.8 million males were circumcised every yearāalmost 5,000 every day.
You could make the same argument about Africa. One argument Iāve heard from circumcision proponents is that northern/ācentral Africa (which has higher circumcision rates) has lower HIV rates than southern Africa, and this is evidence that circumcision reduces HIV transmission. Yet there are also many, many cultural differences between different parts of Africa. For example, the Sahel is predominantly Muslim whereas southern Africa is predominantly Christian. Lesotho and Eswatini, the 2 African countries with the highest HIV rates in the world, have cultures with a high rate of multiple concurrent partnerships. In Lesotho, there is a practice known as bonyatsi, which involves people of both genders maintaining many sexual partners, even after marriage. In Eswatini, there is also a traditional culture that discourages safe sexual practices.
There are also other parts of the world besides Europe that donāt circumcise and have low rates of HIV. Latin America, India, and East Asia all have fairly low rates of HIV infection despite having populations that are mostly intact. India, for example, has an adult HIV prevalence rate of only 0.2%, despite being far poorer than the US or Europe. The US, by comparison, has an HIV prevalence rate of 0.3%. China is even lower, at 0.09%.
If you believe that circumcision has significant health benefits, you still have to explain why the foreskin evolved in the first place. If the foreskin was net harmful, evolution probably would have gotten rid of the foreskin long ago. Yet almost every species of mammal has some form of foreskin or penile sheath. Aposthia exists at a low rate within the population, but any genetic predisposition towards it has evidently not undergone any degree of positive selection pressure. If you accept evolution, this seems to imply that the foreskin has historically been a net evolutionary benefit, and any health effects resulting from it are insignificant.
The argument about penile cancer is just grasping at straws. Eric Clopper actually mentioned penile cancer risk and UTIs in his lecture. Penile cancer is a rare cancer in the first place, and almost entirely affects old men. Even if you believe reduced risk of penile cause area is a significant benefit of circumcision, it involves performing tens of thousands of circumcisions to prevent a single case of penile cancer. If you still believe that reducing the rate of an already rare cancer is a legitimate reason for amputating a body part, you should also advocate for removing many other body parts if you want to be consistent, such as removing girlsā breast buds to prevent breast cancer, amputating the toes to prevent toe cancer, etc.
On the topic of UTI risk, UTIs can sometimes result from forced retraction of the foreskin. This can easily be prevented by not retracting the foreskin before the balano-preputial lamina has dissolved. The lifetime UTI risk for intact men appears to be only very slightly higher compared to circumcised men, with the risks being 1.29% and 1.27%, respectively.
For other potential EA causes like malaria prevention, these causes may also have significant drawbacks and unintended consequences. For example, Nassim Taleb believes that the Gates Foundation is repeating the errors of Mao Zedong. Malaria nets may also often go unused, or could also cause local net manufacturers to go out of business. Africans may also view malaria as a minor ailment, similar to how we view the cold of flu.