Skeptics with a K: Episode #049


Cave aliens, the upside down mountain, unnecessary surgery and links to death. Plus twelve vicars, rain dances, Bergerac and washing your cock. Following a 4% decline in our mental ability, it’s Skeptics with a K.

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  1. #1 by Some Dood on July 1, 2011 - 01:59

    So how about the mutilation of earlobes? Ear Piercing, banned as well?
    Like the show BTW. I’m only commenting because you fellas seem way too sure of yourselves on this topic. Also go easy on the straw-men.

  2. #2 by Amber Sherwood K. on July 1, 2011 - 02:43

    Marsh I know we’ve discussed this in the past, but I was really glad to hear you devote a segment to the subject of circumcision. I have no idea why this barbaric practice is still so widespread in the US. I can’t believe how many of my supposedly sensible friends support it. Things are changing however. When my son was born 9 years ago he was probably three days old when our pediatrician said “Oh..did you want to have him circumsized?” almost as an afterthought. I’m sure the looks on our faces were enough. Though I do live in a rather liberal area I think most pediatricians no longer routinely perform circumcisions, generally it’s the OB/GYN (who didn’t even ask us about it). As with homeopathy, accupuncture, MMS and other kinds of medical woo I think it’s important that the skeptical community at large take on this subject to keep moving the trend in the right direction.

  3. #3 by Rupert on July 1, 2011 - 08:38

    Marsh,

    How could you walk so blithely past a pun without realising it?

    On foreskins: “It’s not like the skin on a babybel.”

    Surely that’s exactly what it is?

  4. #4 by G.Shelley on July 1, 2011 - 14:32

    Mostly agree with you that circumcision is a barbaric practice that should be banned, but you were wrong on the penile cancer bit. It is much less common in circumcised men, though it does still occur and the huge disparity between rates in different countries show that many other factors play a role, indeed may account for all of the difference.
    A few points I think you missed
    1) Recently the American Academy of Pediatrics suggested that it might be a good idea to change their rules to allow a “female circumcision nick” – This is essentially a cosmetic process much less damaging and painful than male circumcision. There was a huge outcry, with many people opposing it completely
    2) As you mentioned, one of the main arguments is so that “he looks like his dad”. Unless your baby goes through puberty in the womb, it is very unlikely that his penis will greatly resemble his father’s, whether or not the end is cut off
    3) In my experience, the people who say “it looks better” are American. I have no evidence, but I suspect that Europeans would give an opposite answer and say they look deformed if cut.
    4) The medical justifications are ad hoc reasoning anyway. The evidence is very weak and certainly wasn’t available when the practice first took off
    5) More supposition, but it seems to me that most people defend it because they don’t like the alternative – that their parents did something unacceptable to them, or worse, they did it to their child. Like the cult followers who cling even stronger to their fantasy when judgement day does not appear, it is psychologically easier for them to dismiss counter arguments and accept weak rationalisations than to say “yeah, I was wrong all along, I mutilated my baby’s penis for no good reason”

  5. #5 by Arthwollipot on July 1, 2011 - 15:36

    As a guy who was routinely circumcised as an infant, I’ve found myself at times leaping to defend the practice. I keep finding myself saying things like ‘well, it hasn’t caused me any problems’. I have to stop myself, because I realise that it’s irrational. My sons are not circumcised.

    Oh, and Some Dood? Your comment was an argument that had occurred to me as well, but I dismissed it because sticking a spike through your ear isn’t quite the same as cutting off and discarding a piece of you.

  6. #6 by T J Williams on July 1, 2011 - 15:39

    How do you get 12 priests in a hatchback? 2 in the front, 2 in the back sharing a bag of 8 communion wafers (Jesus would count, wouldn’t he?)

  7. #7 by G.Shelley on July 1, 2011 - 16:08

    Arthwollipot :
    I keep finding myself saying things like ‘well, it hasn’t caused me any problems’. I have to stop myself, because I realise that it’s irrational.

    I forgot that one. It seems to be the reply from every circumcised supporter when someone points out that the foreskin is extremely sensitive and removing it reduces sexual pleasure “Well, it didn’t for me” To which the obvious reply is “how do you know? How are you comparing your current pleasure levels to what they would be if you were intact?”

  8. #8 by Mike on July 1, 2011 - 16:13

    Be interested to hear what Some Dood thinks the straw-men were?

    Also, no-one is advocating routine neo-natal ear piercing. Which ironically makes that a straw-man argument 🙂

  9. #9 by John on July 1, 2011 - 18:42

    Great podcast this week, and I was really glad to hear you taking on circumcision.
    I’ve yet to hear anyone at explain why, even if everyone agreed that it had benefits, it is done to newly born babies, as oppposed to, say, being something that parents might bring up as an option in teenage years.
    It’s disapppointing to see some supposedly skeptical sites putting their own politics ahead of skepticism on this one, and hounding out anyone who suggests that we should leave babies’ penises alone. It should be really clear; speaking out against circumcision is absolutely not condoning other practices done to other people, and choosing to highlight it is a good, and proper thing to do.
    Dulce et decorum est pro prepuce argumentum!

  10. #10 by Some Dood on July 1, 2011 - 18:57

    Mike :
    Be interested to hear what Some Dood thinks the straw-men were?
    Also, no-one is advocating routine neo-natal ear piercing. Which ironically makes that a straw-man argument

    Well if I remember correctly (which I may not): At one point during the show you took the word circumcision out of the argument, setting up a scenario in which we imagine we are aliens or some other creature unfamiliar with human customs. So then we are asked if we should ban a practice where children have a part of their body mutilated (not calling it circumcision). The first thing I thought was that ear-piercing is a similar practice (not the same of course) to circumcision but it doesn’t seem to garner the kind of intense feelings circumcision does. To be clear I’m not “pro-circumcision”, I just think banning it outright is a step to far, not to mention intensely paternalistic as it is a practice that has infinitesimal risks associated but unlike ear-piercing for example actually has some small (but real) benefits. I never claimed that you or anyone else was an advocate of “ear piercing” of babies. Many families do however have their young daughters ears pierced. I very much doubt that if I have children I will be having their ears pierced or have them circumcised, not because I think it’s barbaric but because they will have had no say in the matter. Banning it is a step too far in my opinion.

  11. #11 by Mike on July 1, 2011 - 19:47

    I don’t see how that is a straw-man? It seems a perfectly reasonably analogy to me. If we were being asked to accept the removal of the left earlobe of all boys shortly after birth – I think most would condemn that as barbaric (regardless of the level of risk or discomfort suffered by the child as a result).

    However, if the flap of skin being removed is actually on the penis, suddenly that’s acceptable. And when that is questioned, you get endless amounts of special pleading about why it’s different because it’s their penis.

    If a parent were to arrange the needless removal their child’s earlobe, I strongly suspect they would find themselves on the business end of criminal charges. No such charges are brought if the flap of skin being removed is on the penis instead of the ear. It seems to me that a ban on neo-natal circumcision, except where there is a clear medical justification, is more a case of closing a loophole which otherwise allows parents to mutilate their children with impunity (albeit, they are doing it with the best intentions).

  12. #12 by @rossbalham on July 1, 2011 - 20:22

    Q: How do you get twelve vicars in a hatchback?

    A: Tell them there are twelve prepubescent boys in there.

  13. #13 by Bill on July 2, 2011 - 01:32

    If you do manage to get 12 vicars into a car, would they allowed drive on the Saabath?

  14. #14 by Bill on July 2, 2011 - 01:37

    What would be the first thing the vicars would say once inside the car? Lexus Pray…

  15. #15 by Benjamen Johnson on July 2, 2011 - 15:41

    Sweet! Thanks for reading my Homeopathic Haiku on the show — you made my day. For anybody else that’s interested I have a few more poems over here:

    http://mnskeptics.wordpress.com/2011/06/10/homeopathic-haiku/

    ——
    It’ll be hard to beat @rossbahlham, but here it goes:

    Q: How do you get twelve vicars in a hatchback?
    A: Only put in four vicars, but write a book claiming you fit all twelve.

  16. #16 by Some Dood on July 3, 2011 - 18:19

    Mike :
    I don’t see how that is a straw-man? It seems a perfectly reasonably analogy to me. If we were being asked to accept the removal of the left earlobe of all boys shortly after birth – I think most would condemn that as barbaric (regardless of the level of risk or discomfort suffered by the child as a result).
    However, if the flap of skin being removed is actually on the penis, suddenly that’s acceptable. And when that is questioned, you get endless amounts of special pleading about why it’s different because it’s their penis.
    If a parent were to arrange the needless removal their child’s earlobe, I strongly suspect they would find themselves on the business end of criminal charges. No such charges are brought if the flap of skin being removed is on the penis instead of the ear. It seems to me that a ban on neo-natal circumcision, except where there is a clear medical justification, is more a case of closing a loophole which otherwise allows parents to mutilate their children with impunity (albeit, they are doing it with the best intentions).

    To clarify, I wasn’t addressing your strawman question in my last post.

  17. #17 by Karl on July 4, 2011 - 19:39

    Some Dood :

    Mike :
    I don’t see how that is a straw-man? It seems a perfectly reasonably analogy to me. If we were being asked to accept the removal of the left earlobe of all boys shortly after birth – I think most would condemn that as barbaric (regardless of the level of risk or discomfort suffered by the child as a result).
    However, if the flap of skin being removed is actually on the penis, suddenly that’s acceptable. And when that is questioned, you get endless amounts of special pleading about why it’s different because it’s their penis.
    If a parent were to arrange the needless removal their child’s earlobe, I strongly suspect they would find themselves on the business end of criminal charges. No such charges are brought if the flap of skin being removed is on the penis instead of the ear. It seems to me that a ban on neo-natal circumcision, except where there is a clear medical justification, is more a case of closing a loophole which otherwise allows parents to mutilate their children with impunity (albeit, they are doing it with the best intentions).

    To clarify, I wasn’t addressing your strawman question in my last post.

    As I am not as gifted as you in spotting logical fallacies, I wonder if you could identify the ‘straw-men’ arguments from the show? I have listened to the show again and I couldn’t find a single straw-man. I await your erudite response.

  18. #18 by John on July 5, 2011 - 12:59

    Mr Dood, a straw-man argument is where you mischaracterise yur oppponent’s position, and then argue agains this mis-stated position, not against what they actually believe.

    If I said “creationists believe that dinosaurs and man lived together because it was said to be true on the Simpsons, and the simpsons is a poor source”, then this would be a straw-man argument, as creationists don’t actually use the Simpsons as their proof.*

    You seem to dislike the analogy drawn, and perhaps think that it’s a false analogy (I’d disagree), but you’ve not pointed out any straw man arguments. Where do you think that the pro-circumcision side’s argument was mis-stated?

    *They use the Flintstones as their primary source, not the Simpsons. Maybe the film 1,000BC, too.

  19. #19 by Paul on July 6, 2011 - 02:24

    A couple of points about the circumcision discussion.

    Should a practice be made illegal just because we perceive it as “barbaric”? Marsh makes a good argument that circumcision has no health benefits but I don’t recall any evidence that circumcision causes health problems. If there is evidence of health problems (even if those problems don’t show up until adulthood) then we can make the argument that the infant needs to be protected from those adverse effects.

    Valid health problems might include:
    * Showing circumcised males have less sex than uncircumcised (indicating that there might be discomfort or less pleasure)
    * Showing that sexual dysfunction(s) are correlated with circumcision
    * etc.

    In the absence of strong evidence of health problems or dysfunction we can abhor the practice but I don’t think we can make the practice illegal. Using the law to prohibit practices that are objectionable but harmless is tricky.

    Should parents not be allowed to remove vestigial tails from newborns? What about extra fingers or toes? And (to use one of Marsh’s examples) if parents wanted to cut off a small piece of their baby’s ear (though I can’t imagine why they would) so long as the infant’s hearing is not impaired should we use the law to prohibit it?

    Compare this to legislation that is more easily justified. Using the law to enforce vaccination makes sense because there are health consequences if this is not done. Using the law to force parents to seek modern science-based medical treatment when their baby is ill also makes sense for the same reason.

    There are people who find circumcision abhorrent but there are also people who don’t. In the absence of any objective evidence of harm it does not seem wise to let one group use legislation to force their views on another.

    A good example of this is the 10^23 effort. The goal is not to ban homeopathy (i.e. make selling homeopathy illegal) but rather to (a) make sure it is marketed honestly and (b) make sure that public funds are not spent on this obviously ineffective treatment

    Making an effort to inform people about circumcision in an effort to misinformation is (I think) a noble endeavor. Trying to pass a law that prohibits circumcision in the absence of evidence of harm opens a Pandora’s box of unintended consequences.

    One side note: I am aware that the foreskin is very sensitive and contains a multitude of nerve endings. We can’t assume that this means that absence of a foreskin lessens one’s enjoyment of sex. Maybe it does, but I suspect that sexual experiences are influenced mostly by the brain. A brain that matures without benefit of a foreskin foreskin may have no problem producing the same subjective sensations with less nerve endings given that the overall sex organ still exists. Show me evidence to the contrary (not just a study or two but a meta analysis of a number of good studies) and I will happily change my mind.

    One last note. There are known health consequences with many forms of female genital mutilations (FGM). Activists against circumcision (and I agree that “Intactivists” is a horrible term) need to be careful and precise when they claim that circumcision and FGM are the same. Some forms of FGM can be crippling. It seems likely that if any adverse health effects are found for circumcision (maybe they’ve already been found; I’m not up to speed on the topic) the effects will be relatively minor given the astounding number of circumcised males who have full and varied sex lives. Comparing circumcision to FGM is extremely callous (at best). Outlawing FGM practices that have adverse health effects makes perfect sense using the argument above.

    As best I can recall, Marsh did not equate FGM and circumcision. Yet any conversation about the topic should include a condemnation of this brand of extremism. Just as moderate religious sects have a responsibility to condemn their extremist factions, activists against circumcision have a responsibility to be clear that circumcision is not the same as FGM in general.

    OK, those were my points. I really don’t know that much about this topic so feel free to correct whatever impressions I have that are in error. But when you do, please point me to the evidence.

  20. #20 by Paul on July 6, 2011 - 15:43

    Spotted an error in my post.

    “Making an effort to inform people about circumcision in an effort to *combat* misinformation is (I think) a noble endeavor.”

    Sorry for any confusion.

  21. #21 by Charles on July 6, 2011 - 18:17

    BTW, its Bugarach, not Bergerac:

    http://en.wikipedia.org/wiki/Pic_de_Bugarach

    Love the show,

    Charles South of Disneyland, CA USA

  22. #22 by alphaxion on July 9, 2011 - 10:15

    @Paul

    Circumcision of males comes with many risks that involve disfigurement of the penis (even more so than the act of cutting off the foreskin), constant pain in the penis, sexual dysfunction and even death.

    I read an article a while back stating the discovery that the foreskin holds the same number of nerve endings as the clitoris, which would suggest its removal is certain to have a dramatic effect on a persons sexual enjoyment. I’ll have to track that article down.
    I think the same article also had brain activity scans during test subjects sexually pleasuring themselves, the scans showed those who were circumcised in early childhood had activity in different parts of the brain compared to those who were uncircumcised or circumcised as an adult. In all scans, those without circumcision showed much greater activity than the other groups. They made the assumption that the brain was able to rewire itself in childhood to allow some degree of sexual pleasure, which would be about the only excuse for doing it to a newborn but also strengthens the case against it by far more.

    In a wholly unscientific measure, ask how many of your circumcised friends who need to use lube for masturbation. Compare that to the number of uncircumcised friends who use it.

  23. #23 by Scott on July 11, 2011 - 07:18

    About circumcision, of all the hardcore porn videos I’ve come across on the net (purely by accident, I assure you), I don’t think I’ve ever seen a girl giving an uncircumcised male a blowjob. In some way this certainly should be a part of the debate.

    My 4-year-old son has been left physically intact (save for the umbilical cord, which I tyrannically lopped off without a second thought about the right of my son to keep it). I’ll let him make his own decision later on life, but I won’t shield him from the fact that uncircumcised men are far less likely to have online video clips of themselves being serviced.

  24. #24 by Johnny Slick on July 11, 2011 - 22:33

    In fairness to hardcore pornography, most of the time the penises that you see are already erect and therefore the foreskin has already been pulled back. THAT WAS MY FIRST EVER CONTRIBUTION TO SKEPTICS WITH A K THANK YOU

  25. #25 by Scott on July 13, 2011 - 09:01

    Thank you Mr. Slick. I learned something new today. Perhaps there goes the last remaining argument for circumcision.

  26. #26 by Warren on July 13, 2011 - 13:58

    Don’t forget most hardcore porn will be American. I imagine the frequency of uncircumcised men will increase in porn as circumcision rates decrease. After a quick Google search there are apparently some big uncircumcised names out there, many seem Latino so I don’t imagine there is a strong cultural aversion in porn.

  27. #27 by YourDirtymind1 on August 2, 2011 - 04:45

    There were quite a few solid arguments made in the podcast (and in these comments) about the circumcision debate. However, I was a bit surprised and disappointed to see Marsh, et al take such a non-skeptical approach to the argument. It seemed mostly like the tactics of a debater trying to win an argument than a skeptic trying to thoroughly discuss the facts at hand.

    Let me state that I am at this point neither pro- or anti-circumcision. I am simply in favor of looking at all the facts in the argument. Assuming that the religious, social and other arguments in favor of the procedure are fairly weak (and arguably not the domain of the skeptic or scientist), the issue I have is with the podcast was the discussion of the medical/health side of things. Specifically, there were a errors of omission, a misinterpretation of the risks of disease transmission, and a lack of understanding of why (at the cellular level) the foreskin affects the likelihood of contraction of various diseases.

    The fact that a condom is quite effective against the transmission of HIV is only a partial argument against the benefit of circumcision in this area. While it’s true that the preventative effects of the two items aren’t additive (or you’d have a roughly 155% effectiveness rate), it is inaccurate to say that the circumcision adds no additional protection. The reasons for circumcision’s effectiveness are still in place even when a condom fails, and it does add an additional level of protection as it will provide its benefits at it’s typical percentage in the remaining cases if a condom fails. While the argument presented suggested that this eventuality was extremely rare, that’s not an accurate assessment. Saying “just use a condom” or “all you need is a condom” is a poor argument for multiple reasons. If the same argument were made for why birth control pills, IUD’s, vasectomies and other birth control procedures should be abandoned, it would seem silly. Despite their relative effectiveness, condoms are seen as relatively poor means of birth control, and the mechanism they provide for it is essentially the same as for disease prevention.

    The main issues with condoms are compliance, correctness of use and availability. And those still apply when considering the relative benefit of circumcision. In the real world, condoms have an birth control effectiveness rate considerably poorer than they do in theory. This holds (even more) true for disease transmission as well. People simply don’t use them every time, and don’t always use them properly. Sometimes they begin sex and put the condom on midway. Other times, they don’t have one, but continue anyway. And so on. So the numbers cited on the podcast were (intentionally?) grossly inaccurate. Having a circumcision will provide a significant additional protection against HIV (and other venereal disease) transmission. Whether or not that is reason enough to advocate circumcision is another matter, but it is disingenuous to say that a condom is all you need. If it were, then there would be no unwanted pregnancies ever. And we know that isn’t the case. Advocating the same methodology to prevent disease transmission makes you look more like a religious fanatic arguing with an abortion-rights supporter than a real skeptic.

    But the problems go much further. The risk of penile cancer was laughed at in the podcast due to its low prevalence. However, there was absolutely no discussion of the general transmission of HPV (the virus that causes penile cancer), which happens to be a serious public health issue because it also causes cervical cancer in women, genital warts in both sexes and a host of other undesirable effects. The problem is that well more than 50% of the adult population can expect to become carriers of HPV at some point in their lives, and therefore part of the cervical cancer and STD problem, not just the penile cancer problem. It’s pretty crass to dismiss that concern just because you probably won’t get cancer in your own penis.

    HPV is the single most prevalent vector for STD’s in the world. Because the circumcision is thought to have a significant effect on the transmission of this virus, it is a very important touchpoint in any discussion of the medical benefits of circumcision. To say that you don’t care about it because you, the owner of the penis, probably won’t get penile cancer, is a self-centered and epidemiologically bankrupt argument. And not even discussing circumcision’s role in the potential prevention of spreading HPV is morally equivalent to refusing vaccination unless you’re the one who might get sick. As we all know, one of the reasons we vaccinate is to prevent others from contracting the disease in question, and to prevent the spread of a given vector. Vaccination protects those who may not be able to fight the contraction of a disease and those who can’t get vaccinated for various reasons as well as the vaccine receiver. As the most prevalent STD in the world, I’d say HPV prevention is worthy of discussion, not derisive laughter due to the low rate of penile cancer. Again, it’s not an outright reason to circumcise, but it should certainly be part of the discussion. Furthermore, condoms are much less effective in stopping the transmission of HPV than HIV, as any genital area skin contact, even outside the areas covered by a condom, is a potential risk. Its transmission is similar to Herpes in that respect, rather than HIV.

    Lastly, the assertion that we can simply wait until the age of majority and then allow the owner of the foreskin to decide whether to be circumcised is another problematic argument once we consider the entire health discussion described. Aside from the additional pain, expense, risk, recovery time, and reduced likelihood due to fear, there is a much bigger issue. The age at which someone can legally make this decision for himself (let alone afford to pay for the procedure himself) is quite a few years after the typical male becomes sexually active. This window makes that argument a bit like advocating the closing of the barn door after the horses have already run out. And I assume the riposte isn’t “They don’t have to have sex…they can just wait until they’re old enough”. That may work for making religious decisions, but if there are public health issues in the interim, then it is meritless.

    Once again, I’d like to reiterate that I’m not advocating routine pre-natal circumcision. In fact, I haven’t decided where I stand on the issue. But I do feel that if it’s going to be discussed, we should do so with full factual disclosure and a practical understanding of the issues at hand, rather than just providing a dismissive anti-circumcision rant. The latter is quite a bit more entertaining on a podcast, but it does the skeptical thinking process a disservice.

    NOTE: (Any discussion of additional washing as an effective disease preventer misunderstands the way that circumcision helps prevent STDs. This wasn’t a part of the podcast, but is often brought up when the disease question is raised. While washing is a perfectly reasonable way to keep bacterial infections at bay, washing has actually been shown to increase the chances of transmission of some STDs. The reason the circumcision works in blocking disease transmission is believed to be related to the cell types contained in the foreskin rather than the trapping of vectors in the foreskin itself. In effect, the viruses can enter the body more easily via the cells of the foreskin than those in other parts of the penis.)

  28. #28 by sam on August 5, 2011 - 07:55

    FYI – ‘Foreskin Man’ – causing controversy in the states. The legislation has been removed from the ballot though…. http://motherjones.com/mixed-media/2011/08/sf-circumcision-ban-matthew-hess-foreskin-man-comic

  29. #29 by Marsh on August 26, 2011 - 12:53

    Hi @YourDirtymind1

    Sorry for the long delay, it’s been a busy few weeks, but I did want to give your points some attention so waited until I’d had a chance to consider them a little more.

    YourDirtymind1 :

    The fact that a condom is quite effective against the transmission of HIV is only a partial argument against the benefit of circumcision in this area. While it’s true that the preventative effects of the two items aren’t additive (or you’d have a roughly 155% effectiveness rate), it is inaccurate to say that the circumcision adds no additional protection. The reasons for circumcision’s effectiveness are still in place even when a condom fails, and it does add an additional level of protection as it will provide its benefits at it’s typical percentage in the remaining cases if a condom fails. While the argument presented suggested that this eventuality was extremely rare, that’s not an accurate assessment. Saying “just use a condom” or “all you need is a condom” is a poor argument for multiple reasons. If the same argument were made for why birth control pills, IUD’s, vasectomies and other birth control procedures should be abandoned, it would seem silly. Despite their relative effectiveness, condoms are seen as relatively poor means of birth control, and the mechanism they provide for it is essentially the same as for disease prevention.

    Perhaps I wasn’t entirely clear when I described this aloud (I’ve not gone back and listened for a while), but I was primarily referring to areas where the relative incidence of HIV is already low, and thus the use of a condom combined with the already-low chances of becoming infected is enough to protect against the disease, and the protection of circumcision added to those other two elements adds nothing significant. While I don’t know the numbers, if the chance of HIV infection was 1 in 100 000, and with condom use it became 1 in 10 000 000, then perhaps with circumcision you can increase that to 1 in 10 050 000 (numbers invented for demonstration, and are not accurate by any means). In that case, the circumcision intervention offers relatively insignificant benefit.

    But the problems go much further. The risk of penile cancer was laughed at in the podcast due to its low prevalence. However, there was absolutely no discussion of the general transmission of HPV (the virus that causes penile cancer), which happens to be a serious public health issue because it also causes cervical cancer in women, genital warts in both sexes and a host of other undesirable effects. The problem is that well more than 50% of the adult population can expect to become carriers of HPV at some point in their lives, and therefore part of the cervical cancer and STD problem, not just the penile cancer problem. It’s pretty crass to dismiss that concern just because you probably won’t get cancer in your own penis.

    I believe you have the wrong end of the stick here, and it’s not what we said. The risk of penile cancer directly is low (single-figure deaths in years/decades iirc), and the prevalence of it is reduced somewhat by circumcision. However, your point is that the transmission of HPV is also reduced in circumcised men – this is absolutely incorrect. Circumcision leaves men MORE open to infection with HPV. So my point absolutely was that circumcision can lead to increased HPV infection, leading not only to penile cancer but cervical cancer – I think if you listen back you’ll hear that bit clearer? I’ve transcribed here (http://www.merseysideskeptics.org.uk/2011/07/circumcision-genitial-mutilation-under-another-name/) and said:

    There were other more telling flaws in his research – later studies have shown that while penile cancer is only slightly more prevalent in the uncircumcised than the circumcised (not enough to justify de facto intervention on all men) the human papilloma virus (HPV) is the most important risk factor for cancer of the penis. HPV is the virus which causes genital warts, and as it turns out HPV is more easily contracted by circumcised men. So you may have a small, disputed level of protection against cancer, but you’re more likely to contract a virus which cause cancer. Great.

    I hope that clears that up, and will also point out why the ire you show in the next section is misdirected (I’m happy to accept this was genuinely misdirected via misunderstanding – had I said what you’re saying I did, you’d be right to be filled with ire!):

    HPV is the single most prevalent vector for STD’s in the world. Because the circumcision is thought to have a significant effect on the transmission of this virus, it is a very important touchpoint in any discussion of the medical benefits of circumcision. To say that you don’t care about it because you, the owner of the penis, probably won’t get penile cancer, is a self-centered and epidemiologically bankrupt argument. And not even discussing circumcision’s role in the potential prevention of spreading HPV is morally equivalent to refusing vaccination unless you’re the one who might get sick. As we all know, one of the reasons we vaccinate is to prevent others from contracting the disease in question, and to prevent the spread of a given vector. Vaccination protects those who may not be able to fight the contraction of a disease and those who can’t get vaccinated for various reasons as well as the vaccine receiver. As the most prevalent STD in the world, I’d say HPV prevention is worthy of discussion, not derisive laughter due to the low rate of penile cancer. Again, it’s not an outright reason to circumcise, but it should certainly be part of the discussion. Furthermore, condoms are much less effective in stopping the transmission of HPV than HIV, as any genital area skin contact, even outside the areas covered by a condom, is a potential risk. Its transmission is similar to Herpes in that respect, rather than HIV.

    I hope my answers clear things up a little, and I really appreciate you taking the time to comment.

    Best
    Marsh

  30. #30 by Soren on September 8, 2011 - 07:37

    I’ll just carry some more weed to this fire.

    A Danish study of circumcised men was recently published. It was as questionnaire of about 5000 women and men on the effect of circumcision on sexual health. Their conclusion was:
    “Circumcision was associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in women, notably orgasm difficulties, dyspareunia and a sense of incomplete sexual needs fulfilment. Thorough examination of these matters in areas where male circumcision is more common is warranted.”

    Int. J. Epidemiol. (2011)
    doi: 10.1093/ije/dyr104

    The abstract is here:
    http://ije.oxfordjournals.org/content/early/2011/06/13/ije.dyr104.abstract?sid=bd160f1a-5b42-44da-af1b-62882c9021a2

  31. #31 by YourDirtymind1 on December 2, 2011 - 13:16

    Hi @Marsh,

    Thanks for your response. I didn’t even realize you had made it until now, so I apologize for the even slower response to your response. I’m pretty much crap at manipulating the features of the site, and have no idea how to quote and reply as you did, so will try to refer to your post with a bit of cut and paste where appropriate.

    I appreciate the idea that your reference to the HIV issue pertained to areas where the transmission is very low. That’s a fair point. However, within any community, there are specific areas where the concentration goes WAY up, such as among drug users and the gay population. Since we don’t know early on which people are likely to end up in those groups, there is still a fairly reasonable chance that circumcision could prevent quite a bit of HIV spread from an epidemiological viewpoint. Further, your math on the relative benefits was erroneous, as it would be expressed as a much larger percentage of the whole considering the condom’s effectiveness. Your point was made in principle, but the numbers may have made it a bit misleading. The addition of the condom to this already small chance would actually make it infinitesimal, not just slightly smaller. It’s multiplicative. I agree that it’s still a very small number in most of Europe compared to some other areas, and I wouldn’t necessarily support the practice if this were the only justification, but I don’t think it can be discounted when taken into consideration with the other subjects discussed.

    Which brings me to the HPV issue. You said above:

    <>

    I’m not sure which research you’re basing that assertion on, but it contradicts almost all of the primary source published research I’ve seen on the subject. Dozens of publications, (including the Lancet in January, among many others) have specifically associated early male circumcision with notably reduced transmission of HPV from male to female sexual partners. Were it true that circumcision reduced the likelihood of penile cancer while increasing the likelihood of HPV transmission, I’d agree with your assessment of it being a “devil’s bargain”, but I’m unaware of anything solid in the medical literature to back that up. I consulted with a few of my former colleagues at Johns Hopkins who specialize in contagious diseases and epidemiology and they confirmed my original impression that the current position of those practicing in that field is that circumcision makes a significant difference in male/female HPV transmission. If they and I are under a misapprehension about this, I’d be very interested to see the source work.

    My own writing probably seemed more filled with “ire” than was actually the case…probably because of my own longwindedness and blowhard style. Tone is a little tough to get the nuances of in print, after all. As someone who isn’t strongly pro- or anti-circumcision, I thought a little balance ought to be added to the discussion if we wanted to treat it in properly skeptical manner, rather than simply rant at the pro-cutters. I wasn’t angry with you or the show, I was simply trying to balance the discussion in the spirit of skepticism. I’m a big fan of the show in general, and really enjoy listening. I also think what you guys do is very important as well as entertaining.

  32. #32 by YourDirtymind1 on December 2, 2011 - 13:18

    Wow, very odd, I definitely cut and pasted the quote into my post, but it disappeared when posted. The quote I was referring to where the little appear is:

    “However, your point is that the transmission of HPV is also reduced in circumcised men – this is absolutely incorrect. Circumcision leaves men MORE open to infection with HPV. So my point absolutely was that circumcision can lead to increased HPV infection, leading not only to penile cancer but cervical cancer…”

    Cheers,
    YDM1

  33. #33 by Paul on June 9, 2013 - 13:06

    It seems like the circumcision debate is predominantly populated on one side by insecure uncircumcised men vehemently against the practice, and on the other side by insecure circumsised men vehemently defending the practice.

    Im just disapointed to see the hosts of this show, usually impeccable in their objectivity in analysis, resorting to “FUCK OFF” as a standalone rebuttal three or four times.

    Additionally to dismiss a scientific paper by stating the lead author was “good friends” with someone you say is a crank? What I love about this show is how quack papers are deconstructed to SHOW why the results are flawed. Simply stating “well he is friends with so n so, CLEARLY he has a vested interest in a certain result” does not mean jack shit, and the hosts know this.

    Also, the conclusion that if circumcision has protective value X and condoms have protective value Y, I don’t see how the conclusion that having both doesn’t give benefit X plus Y. It seems to me that any potential lack of protection from condoms would result from the condom breaking or being used improperly. In the case of the condom breaking, then effectively there is no condom being worn. At this point, it seems that the prior circumcised vs uncircumcised levels protection would go into effect. I don’t know if this is for sure correct, but it seems logical to me. At the very least, the out-of-hand rejection of this is one more indication of the pink elephant lingering about throughout the segment…

    Everyone has their sacred cows, even the best of us. In this particular case, the sacred cow of the hosts is even quite likely is on the “correct” side of things. All in all, the benefits probably do outweigh the risks of circumcision, although it seems like both risk and benefit are negligible anyway, if done right after birth similarly to vestigial tails.

    Really I just found it disconcerting to hear so many false analogies (comparing circumcision to dual leg amputation? Please), ad homonem attacks towards research paper authors, switching back and forth between adolescent circumcision and infant circumcision as if they were the same thing, and argumentum ad fuckoffium type fallacies coming from marsh and friends instead of rational analysis. This segment could really use a redo on a newer episode, because I know if the guys would just leave their penis architecture at the door and analyzed the arguments theyve made here, they would agree that it’s just not up to snuff.

  34. #34 by Paul on June 9, 2013 - 13:13

    Second to last paragraph I meant to say “the risks probably do outweigh the benefits, although it seems both are negligible” Not the other way around.

  35. #35 by Steve660 on July 13, 2013 - 22:19

    This is what Marsh says:
    “However, your point is that the transmission of HPV is also reduced in circumcised men – this is absolutely incorrect. Circumcision leaves men MORE open to infection with HPV. So my point absolutely was that circumcision can lead to increased HPV infection, leading not only to penile cancer but cervical cancer”.

    This is what the EVIDENCE says:

    Three randomized controlled trials as part of the HIV-prevention trials in Africa, all found a significant protective effect following circumcision:
    B. Auvert, J. Sobngwi-Tambekou, E. Cutler et al., (2009). “Effect of male circumcision on the prevalence of high-risk human papillomavirus in young men: results of a randomized controlled trial conducted in orange farm, South Africa,” The Journal of Infectious Diseases, vol. 199, no. 1, pp. 14–19.

    A. A. R. Tobian, D. Serwadda, T. C. Quinn et al., (2009). “Male circumcision for the prevention of HSV-2 and HPV infections and syphilis” The New England Journal of Medicine, vol. 360, no.13, pp. 1298–1309.

    D. M. Backes, M. C. G. Bleeker, Meijer CJLM et al., (2012). “Male circumcision is associated with a lower prevalence of human papillomavirus-associated penile lesions among Kenyan men,” International Journal of Cancer, vol. 130, pp. 1888–1897.

    And also in women whose partners were circumcised:
    M. J. Wawer, A. A. R. Tobian, X. Kong et al., (2011). “Effect of circumcision of HIV-negative men on transmission of human papillomavirus to HIV-negative women: a randomised trial in Rakai, Uganda,” The Lancet, vol. 377, no. 9761, pp. 209–218.

    Less HPV in circ’d men, and less cervical cancer in their female partners:
    X. Castellsagu´e, F. X. Bosch, N. Mu˜noz et al., (2002). “Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners,” The New England Journal of Medicine, vol. 346, no. 15, pp. 1105–1112.
    NB. When this study was published by researchers at the Catalan Institute of Oncology, circumcision opponents launched a cyber-attack against the institute and succeeded in wiping the hard drive of the lead author.

    This study, of Washington students, found no difference in acquisition, but did find that uncirc’d men had HPV at a greater number of sites:
    K. VanBuskirk, R. L. Winer, J. P. Hughes et al., (2011). “Circumcision and the acquisition of human papillomavirus infection in young men,” Sex. Transmitted Disease, vol. 38, pp. 1074–1081, 2011.

    This one found no difference between circ’d and uncirc’d men, but it only looked at visible lesions, rather than swabbing, which is better at picking up HPV:
    O. Aynaud, D. Piron, G. Bijaoui, and J. M. Casanova, (1999). “Developmental factors of urethral human papillomavirus lesions: correlation with circumcision,” BJU International, vol. 84, no. 1, pp. 57–60, 1999.

    Reduced incidence of HPV around the coronal sulcus and shaft of circ’d men:
    A. A. R. Tobian, X. Kong, P. E. Gravitt et al., (2011). “Male circumcision and anatomic sites of penile high-risk human papillomavirus in Rakai, Uganda,” International Journal of Cancer, vol. 129, no. 12, pp. 2970–2975, 2011.

    These studies found, variously, same or lower acquisition of HPV in circ’d men, but all found that in circ’d men the virus clears more quickly:

    Same acquisition rate, but faster clearance:
    B. Y. Hernandez, Y. B. Shvetsov, M. T. Goodman et al., (2010). “Reduced clearance of penile human papillomavirus infection in uncircumcised men,” The Journal of Infectious Diseases, vol. 201, no. 9, pp. 1340–1343.

    Much faster clearance of oncogenic HPV, but no difference for non-oncogenic HPV in circ’d men:
    B. Lu, Y. Wu, C. M. Nielson et al., (2009). “Factors associated with acquisition and clearance of human papillomavirus infection in a cohort of US men: a prospective study,” The Journal of Infectious Diseases, vol. 199, no. 3, pp. 362–371.

    A large randomized controlled trial found lower HPV acquisition AND faster clearance in circ’d men:
    R. H. Gray, D. Serwadda, X. Kong et al., (2010). “Male circumcision decreases acquisition and increases clearance of high-risk human papillomavirus in HIV-negative men: a randomized trial in Rakai, Uganda,” The Journal of Infectious Diseases, vol. 201, pp. 1455–1462.

    Large randomized controlled trial, found faster HPV clearance in circ’d men:
    A. A. Tobian, G. Kigozi, P. E. Gravitt et al., (2012). “Human papillomavirus incidence and clearance among HIV-positive and HIV negative men in Rakai, Uganda,” AIDS, vol. 26, pp. 1555–1565.

    So we have multiple, high-quality studies, including large randomized trials. Not a single one supports Marsh’s statement that circumcision increases HPV risk. Not one!
    A few of these studies (not the randomized trials, which are considered the “gold standard” for clinical trials) found no difference (but not Marsh’s alleged increased risk from being circ’d). The rest all found, variously, lower acquisition and/or faster clearance of HPV, particularly oncogenic HPV in circumcised men. Two trials also found protection in their female partners.

    In short, circumcision DOES protect against HPV, and also protects against cervical cancer in the female partners of circ’d men. Marsh is spectacularly wrong. His is an epic fail. Please Marsh, if you are reading this, do tell us where you got your claim from? And what happened to your critical thinking skills? Was your claim from an anti-circumcision (“intactivist”) website? If so, here’s a tip: you will learn as much about circumcision from one of those sites as you will about evolution from answersingenesis.org

    I will hazard a guess he’s been reading “intactivist” websites, and not the medical literature. I learned long ago that circ opponents cherry-pick, misrepresent and exaggerate in their quest to make circumcised guys feel we are damaged goods (no we f*cking aren’t – and I was circ’d as an adult so I can compare), and to undermine public health initiatives against HIV, and other diseases, which is just plain irresponsible.

    I know it is tedious but the only way to see through their crap is to go straight to the medical literature and read it for oneself. It took me several hours a day, for about ten day’s solid, to get through the stuff above – and a load of other material I am holding in reserve lest Marsh comes back with the standard counter-argument intactivists try with respect to HPV. I’m not saying what it is. If he does, without first checking it out, it will show that even skeptics can sometimes be suckered.

    See you in the Head of Steam Marsh!

  36. #36 by Marsh on July 25, 2013 - 15:52

    Steve

    There’s a lot to get through in your comment, so please excuse me if I’m somewhat briefer.

    As the post was written over two years ago, I’m afraid the detail of the evidence I was citing is lost to me now. However, I’ve been wrong plenty of times in the past, and if the data suggest I’m wrong in this case and that circumcision offers either a neutral (as per the RCTs you mention) or beneficial (as per the other forms of studies you cited) effect in preventing HPV, I’m happy to accept that.

    Yet, the issue is more complicated than that: circumcision does not represent our best defence against HPV, indeed from your own reading of the data it can’t be confidently said to be better than neutral, but let’s accept for a moment that it is unequivocally positive. It still isn’t as effective as a condom, and it isn’t close to being as effective as a vaccine, despite having attendant risks far higher than either intervention (a point I’m sure you’d equally concede).

    However, let’s for a moment set aside both alternative interventions and imagine for a moment that we live in a universe (or even a country) where neither a vaccine nor a condom is an option – there still isn’t a case to be made to circumcise infants specifically. Setting aside the attendant risks of operating on someone as vulnerable as a new born, and the risks of having an open wound in the nappy of an individual who hasn’t yet developed self-awareness – let alone a sense of hygiene – even with all that aside, the ethics are dubious. I don’t believe it to be ethical to perform an irreversible operation on an infant, unable to consent, when they’re unable to see any benefits until (let’s take a low bar to express your argument in a strong form) perhaps 13 years. Far better, surely, to have the conversation in an open and transparent way, at the age of (say) 13, when the child is in a better place to understand what’s happening and why.

    To sum up my position, on the matter of HPV even a marginal benefit is outweighed by the harm when there are alternatives with far more effectiveness and far less risk.

    In response to some of your points that are less around the evidence and are more around my reasoning and ‘epic fail’, I think you’ve missed a point somewhat. You mention HIV, and I believe that was covered in my original piece – there is no compelling evidence for circumcision as prophelactic against HIV in countries where HIV incidence is low. That, as with the rest of my comment, comes not from intactivist propoganda any more than from pro-circumcision propoganda – it’s based on my own weighing of ethics and issue of consent.

    However, from your comment, you mention that you’re circumcised, and you know it’s not that bad because you elected to have it done as an adult. Presumably you did so having weighed up the options and implications, or (if it were a medical need) with awareness and consent? Which is entirely my argument. I believe everyone should be able to be given the same level of choice and opportunity to consent as you had.

    Best,
    Marsh

  37. #37 by Steve660 on July 26, 2013 - 12:18

    Hi Marsh,
    Thanks for replying. Firstly, apologies if my tone seems combative at times. It’s just my style, nothing personal. On all other issues except circumcision, I think you are a skeptical superhero, and I have tremendous respect and admiration for you. You truly are a mighty nerd, and absolutely awesome, keep it up! Glad you also admit to being wrong sometimes, many have not the courage or honesty to say that. I sometimes quip that I am never wrong, just mistaken.

    I made another post a while back on the other thread on this topic: http://www.merseysideskeptics.org.uk/2011/07/circumcision-genitial-mutilation-under-another-name/
    I would add that I am surprised you dredged a 1932 study up about penile cancer when there are so many more recent ones. If you want to update yourself, then maybe Larke’s 2011 review would be a good starting point “Male circumcision and penile cancer: a systematic review and meta-analysis” (Google the title, and it’s free). Note also that the 1 in 100,000 figure is actually a per annum figure and downplays the frequency of the disease. Multiply by an average life span (say 80 years) to get a lifetime risk (1 in 1250). In fact it is higher still. Roughly 450 cases per year in the UK, out of ca. 30,000,000 males, with lifespan of ca. 80 years works out at about 1 in 900 British men doomed to get this hideous disease in their lives. It doesn’t seem so rare now, does it? Penile cancer is quite common in parts of Africa, SE Asia and Latin America. In Uganda it is the most common cancer in men. In these countries it is even turning up in guys in their 20s, and the problem is growing. Risk factors include HPV, but also phimosis and inflammatory conditions. All reduced, or entirely prevented, by infant circumcision. Infant, but NOT adult, circ provides excellent protection against penile cancer.

    Having mentioned infant circ, I should clarify my position to avoid straw men. I do NOT advocate for routine infant circ. In fact I’m somewhat ambivalent about trimming babies outside of high HIV countries, but will point out that there is a case to be made for it, and that there are strong counter-arguments to the ethical ones you cite. I go into this in more detail in an article I have submitted to “The Skeptic” and am waiting to learn if they’ve accepted it.

    I’ll return briefly to this at the end of this essay with a thought experiment (you like those), but first to clear up some points about HPV. You have misread my post. Only ONE study of the 12 listed was neutral overall (the 1999 one which looked only at visible lesions). The rest found, variously, lower incidence/faster clearance/fewer infection sites in circ’d men. ALL the RCTs found strong protective effects. Odds ratios (OR) of about 0.65 are reported from some of the African trials (even lower in the Kenyan one looking at visible lesions over the entire penis). That’s good! It is not marginal. It’s good. Circ is unequivocally protective against HPV in both genders. But intactivists are stuck in denial and use a “sampling bias” argument to attack the data, whilst ignoring the multiple debunkings of that argument. Glad you didn’t dredge it up.

    You correctly say there is a vaccine. Actually there are two, but they only protect against 2 of the 15 known oncogenic strains of HPV, albeit the most common ones. It is uncertain how long they remain effective for (circ is for life). Uptake is not 100 % (indeed much less in some countries). And some people cannot take them due to counter-indications, like allergies.

    Condoms are good but are surprisingly short of 100 % effective. (Adjusted OR = 0.3, better than circ, but well short of OR = 0, source: http://www.nejm.org/doi/pdf/10.1056/NEJMoa053284). They are nowhere near as good as they are for HIV (ORs of around 0.05 for male to female transmission, i.e. 95 % effective, still not 100 %, according to: http://www.ncbi.nlm.nih.gov/pubmed/9141163 but a 2007 Cochrane review found only 80 % effectiveness, perhaps due to issues of condom type and how they are used – they are NOT 100 %). And these figures are for CONSISTENT use, and therein lies the Achilles heel of condoms. You can lecture people all you like about condoms, and dish them out like sweeties, but you are up against human nature. I am a realist, not an idealist. I am all for vigorously promoting condoms (and fuck the Catholic Church) but am not naïve enough to imagine that everyone will use them, or use them every time. Circ provides back-up, should a condom fail, or be overlooked in the heat of passion (or the confusion of alcohol). It is there all the time should a horny young lad, slightly pissed and a little reckless, get chatted up by an 18 year old, blond, svelte, Swedish nymphomaniac with firm, pink-nippled breasts massaged in oil, a pert, goose-pimpled bottom, and shaved naughty bits, and discovers he’s not got a condom, but thinks with his cock and gets stuck in anyway. Get real Marsh. You will NEVER get everyone to use condoms, or use them all the time. Condoms will never achieve the optimistic figures cited above for consistent use, simply because they will never get used consistently by everyone.

    Yes there are risks with circ (as with any medical procedure, including vaccines). Whether the benefits in low HIV countries are greater than the risks is debatable. The AAP thinks so (their recent statement to that effect has set the cat amongst the pigeons) and I’ve heard “on the grapevine” that their Canadian counterparts are about to follow suit. And there is evidence that even in low HIV countries, circ has a protective effect against the virus, it’s just that in absolute terms, it is low and so much less cost-effective. (I guess a cynic would argue that we could just sit and wait until HIV reaches African levels, then it will be cost-effective.)

    This debate, the finely-balanced ratio of cost/benefit, and lack of medical consensus (there is a lot of bitching and hissy fits going on now, amongst medics, following the AAP’s change of heart) is one of the reasons I keep out of advocating for routinely trimming babies, especially outside of high-HIV countries. But at the same time I acknowledge there are significant benefits, and it is possible they might be enough to win a cost-benefit analysis. And the evidence I’m getting off PubMed is slowly edging that way. So I won’t stand in the way of parents seeking a circ for their baby, provided it is done medically. But won’t stand on the rooftops and promote it either.

    My main complaints about the anti-circ movement (which I target in my “Skeptic” article) are two-fold. Firstly they cause tremendous psychological distress to circ’d men by telling them bullshit about loss of function (it really makes no difference – see the 2013 meta-analysis by Tian et al (“Effects of circumcision on male sexual functions: a systematic review and meta-analysis” – I’ve got the full eCopy ahead of print, very interesting). It makes my blood boil every time I see them telling some impressionable lad on a forum that he is missing out on all this wonderful gliding, sensitivity, erogenous tissue etc. etc. It is bollocks. Absolute bollocks. But it causes real angst to those who fall for it, and leaves previously happily circ’d males mentally fucked up. And my complaint is valid regardless of the rights or wrongs of them being circ’d in the first place.

    And secondly, they are still in denial about HIV and circ. They still keep publishing articles attacking the African RCTs. And it’s the same old canards they keep trotting out (lead time bias, lack of equipoise, trials stopped early, USA has more HIV than Europe, blah, blah, blah) even though these have all been debunked ad nauseam. Worryingly they are publishing some of their crap in the African press, just where circ is needed most. In this regard they are like anti-vaxers and HIV/AIDS deniers, and are endangering lives. A prime target for a little scepticism, don’t you think?

    Finally (sorry this has got so long, but as you can see it’s a topic I have thoroughly looked into) I said I’d suggest a thought experiment, so here goes. Imagine you live in Swaziland. Around 40 % of women are HIV +ve. I don’t have data for other diseases but quite likely HPV, HSV, penile cancer, chancroid etc. etc. (all part prevented by circ) are probably rampant too. You have availed yourself of the WHO-sponsored government adult circumcision program and found to your great relief that sex and wanking are just as good as before (in fact slightly better, and your dear HIV –ve wife is also delighted with the result, and can hardly keep your knob out of her mouth having now discovered that lollipops are way better unwrapped). But it was a pain (literally) and nuisance, waiting 6 weeks to recover, and you now have a prominent scar around your dick. But you’ve seen men done as infants (am not asking how you’ve come to see them) and they have just a faint join mark, if anything. You are aware of the many reasons why infant circ is better than adult, and of research that indicates that the protective effect against HIV is even greater for infant circs (http://www.ncbi.nlm.nih.gov/pubmed/10199231). You have seen the reckless way your peers behave when they’ve had a bit to drink, or don’t have condoms to hand, or that sexy whore down the road is coming on strong to them. Your first son has just been born and your local clinic offers a free medical circumcision with local anaesthetic for the infant as part of the government program to achieve 80 % neonatal circumcision. What would you do?

    If I see you at the Head of Steam I’ll introduce myself. I only attend once or twice a year though, and am currently grounded by injury. I’m the guy with the NCSE Steve’s T-shirt at QED.

    Stephen

    PS. Have you got the latest “Skeptic” (issue 24/3)? Still not got mine.

(will not be published)