Friday, June 15, 2012

Motivations of Circumcision Advocates

Most Americans don't think about circumcision much. It is just another standard medical procedure done in the hospital (e.g. like cutting the umbilical cord) that is done to newborn boys and it is not a big deal. There is nebulous and vague talk of "benefits" and hygiene. Most Americans are ignorant on this subject.

Rational open-minded people are nearly always convinced by talk of ethics and accurate information that cutting their children's genitals is wrong.

Some honestly and truly believe that the "medical benefits" outway ethical concerns. Men do not want to admit that something is wrong with their penis. Men want their penis to be better ("male enhancement products" are commonplace in American culture)! It is easier for a man to believe that the foreskin is a useless flap of skin than to believe his penis isn't perfect. These men tend to have their children cut so their sons' penises aren't better than theirs and/or so they don't have to admit something was taken from them.

The most voracious and dangerous circumcision advocates are the circumfetishists. When I first heard this term, I honestly thought it was just a derogatory term that I² advocates used to describe those who support circumcision. Later, when I stumbled across circleaks.org, I began to realize that circumfetishism is real and it is actually is a "fetish" or, more accurately, a form of pedophilia. I read some of the circleaks.org content with my mouth literally hanging open, aghast. I had to stop: the content made me sick to my stomach.

Sex and sexual arousal are powerful human motivators. The sexual motivations of circumfetishists and the thrills that they obtain from thinking about, writing about, watching, or participating in circumcisions results in immutable beliefs.

In looking through the types of disturbing content posted to circlist, it became clear that the circumfetishists enjoy the fact that they are circumcised and some even want to get circumcised again! Now this is looking more like self-harm. The following statement from the Wikipedia article clarifies my point:

The sexual organs may be deliberately hurt as a way to deal with unwanted feelings of sexuality, or as a means of punishing sexual organs that may be perceived as having responded in contravention to the person's wellbeing (e.g., responses to childhood sexual abuse).

It is my belief that the majority, if not all, circumfetishists are victims of sexual abuse. Some of the posts from circlist captured on circleaks.org imply or explicitly state this fact. In order to realize circumfetishism, that abuse, combined with a sociopathic personality, sadism, and masochism results in an individual who enjoys and obtains sexual pleasure from both his own circumcision and that of others.

As abuse victims, I would otherwise pity the circumfetishist—but their vile behavior and actions qualify them as evil. These individuals must be stopped.

P.S. If you do desire to have your son circumcised, you will want to look at the doctor's groin during the circumcision. It is not unheard of for him to get aroused during the procedure. Let's hope this disturbing thought results in reconsideration!

Wednesday, June 13, 2012

Africa HIV Claims

The American medical community and media has bought into the idea that circumcision is a valid tool for HIV prevention. The African studies showing a benefit are dubious; see "Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns".

The WHO, the American NIH, the American CDC, the Bill and Melinda Gates Foundation, and the governments of a few African countries (largely corrupt governments likely receiving kickbacks from American charities and medical device manufacturers) recognize the African HIV studies as valid. Additionally, virtually all of the meta-studies in the medical journals and publications accept the RCTs and they confirm that circumcision has an HIV-reduction benefit. To a casual onlooker, this appears to be a "medical consensus". But is it?

According to "How Well Do Meta-Analyses Disclose Conflicts of Interests in Underlying Research Studies", many meta-studies are not properly vetting the original study.

With any scientific or medical topic, the majority of new research will be funded by those trying to prove or disprove a theory. This is the scientific method. And that's how it should be. In this case, there are endless studies by organizations promoting a pro-circumcision point-of-view. The large volume of studies gives the impression that there is a "consensus" where all studies show the same result. In reality, it's a large number of studies by those trying to prove a point-of-view. This is not the same as consensus.

The question here is: what is the general consensus in the medical community on this issue? I would like to gain clarity. I am aware that numerous national medical organizations outside the US (e.g. Brazil, Australia) have rejected the notion that circumcision is a valid HIV-reduction tool.

So now here's the heart of the issue: I want to remove the Africa HIV claims from the lead of the Wikipedia circumcision article. Ultimately, I'd like to remove those claims entirely, but the lead is a good start. In the lead, these Africa HIV claims are front-and-center: someone skimming the article may see these claims and decide circumcision is good without reading rest of the article. That's why the pro-circumcision advocates want these claims in the lead! I can remove these claims if I can show that these claims don't represent consensus in the medical community.

What I am asking for is feedback either here or on Twitter for any references, sources, or ideas regarding whether or not there is medical consensus on this issue—and what it is.

Friday, June 1, 2012

Wikipedia and I2

1.0 Current State


It is worthwhile to take a look at the Wikipedia article on Circumcision as well as the Female Genital Mutilation article. The article on circumcision describes the medical benefits of the procedure. The FGM article, on the other hand, approaches the topic from a human rights point-of-view and connotes a negative view of FGM.

The differences between these two articles reflects commonly-held American/Western viewpoint that circumcision is not harmful and may have significant benefits while FGM is a violation of human rights and must be stopped. The circumcision article at Wikipedia and all articles relating to this topic are watched over by a single editor whose seniority grants him virtually complete control over the article: he acts as a gatekeeper. This editor is supported by a few administrators who tend to back up his decisions.

There are many incorrect claims, inaccuracies, and biases in the Wikipedia Circumcision article. The following sections highlight two issues.

1.1 Africa HIV-Circumcision Claims


One of the most disturbing claims of the Wikipedia Circumcision article is the following claim in the article lead:

One analysis of studies done in Africa indicates that circumcision reduces the risk of HIV infection in heterosexual men by 38-66%,[15][16] and studies have concluded it is cost effective in sub-Saharan Africa.[17] The WHO currently recommends circumcision be part of a comprehensive program for prevention of HIV transmission in areas with high endemic rates of HIV.[18] Some organizations have discussed under what circumstances circumcision is ethical.[19][20]

Wikipedia editors are insistent that this claim is consistent with medical consensus.

At the time of this writing, the Wikipedia circumcision article is protected from editing due to disputes. One of the current disputes is over the inclusion of the Boyle-Hill study finding serious flaws in the African HIV-Circumcision research. The current discussion of the circumcision article can be found on the Circumcision Talk page.

1.2 Sexual Function


The Wikipedia Circumcision article makes dubious claims about the loss of sexual function in circumcised individuals:

A 2010 review reported that "...despite conflicting results in some of the historical observational studies, most recent articles do not show evidence of adverse effects on sexual function."[59] A review which analysed the data from eight clinical trials concluded that the "evidence suggests that adult circumcision does not affect sexual satisfaction and function."[12]

2.0 Challenges


2.1 Research Reliability


Wikipedia prefers reliable secondary sources to back up claims made in articles. Although the definition of a reliable secondary source is well defined, editors have been known to reject certain sources as fringe if the editor doesn't agree with the study's conclusions.

2.2 Quantity of Research and Medical Consensus


As with many controversial issues, it can be difficult to determine medical or scientific consensus. Although Wikipedia gives some guidance as to what defines medical consensus, editors tend to "count up articles supporting a point of view" in medical journals to determine consensus. This is clearly an inaccurate approach since the advocates of a point-of-view—especially when well-funded—tend to conduct more research while the status quo point-of-view tends to have fewer research papers supporting it.

2.3 Conflict of Interest


The type of conflict-of-interest that Wikipedia is primarily concerned with is when an organization directly edits a page making the content biased. For example, it would not be allowed for the Romney or Obama campaigns had editors change the "Barack Obama" or "Mitt Romney" articles to introduce negative, un-sourced, and/or inaccurate information about their opponents.

The African HIV-Circumcision studies have issues cannot be rejected from the Circumcision article without Boyle-Hill due to the following statement regarding assessment of evidence quality:

Do not reject a high-quality type of study due to personal objections to the study's inclusion criteria, references, funding sources, or conclusions.

Because the African HIV-Circumcision studies are of a high-quality type (RCT), they meet Wikipedia's guidelines for supporting article content. The Boyle-Hill study shows that these studies are not true RCTs. The Boyle-Hill study (and any other studies drawing similar conclusions) is critical to support the removal of the African HIV-Circumcision claims from the article.

3.0 Plan of Action


3.1 Make Efforts to Change Policy


3.1.1 Scientific and Medical Organizations


Wikipedia medical policy states the following regarding medical and scientific organizations:

Statements and information from reputable major medical and scientific bodies may be valuable encyclopedic sources. These bodies include the U.S. National Academies (including the Institute of Medicine and the National Academy of Sciences), the British National Health Service, the U.S. National Institutes of Health and Centers for Disease Control and Prevention, and the World Health Organization. The reliability of these sources range from formal scientific reports, which can be the equal of the best reviews published in medical journals, through public guides and service announcements, which have the advantage of being freely readable, but are generally less authoritative than the underlying medical literature.

David R. Tomlinson, founder of the circumcision device maker AccuCirc is a medical adviser to the WHO. Thomlinson, who admits he is the mad scientist type, represents a conflict of interest in his association with the WHO and the WHO's conclusions regarding circumcision and HIV. Removing the WHO as a "reliable source" would help to improve the quality of the circumcision article.

3.1.2 Reliability of "Reliable Sources"


Many pro-circumcision studies are published by the Cochrane Collaboration. The Cochrane Collaboration receives funding from the WHO. The WHO receives funding from the Bill and Melinda Gates Foundation.

It is doubtful that the Cochrane Collaboration is conducting itself properly. Based on a study published in JAMA, the Cochrane Collaboration does not properly conduct peer review of the articles it publishes failing to disclose conflict of interest the majority of the time:

However, very rarely was this information reflected in the meta-analyses. Only two (7%) reported RCT funding sources and none reported RCT author-industry ties. The authors conclude "without acknowledgment of COI due to industry funding or author industry financial ties from RCTs included in meta-analyses, readers’ understanding and appraisal of the evidence from the meta-analysis may be compromised."

If conflict of interest were properly disclosed, many pro-circumcision research studies could be eliminated from the article due to compromised reliability.

3.2 Editor Conflict of Interest


Although Wikipedia doesn't ban editors with a conflict of interest from editing articles, it does present specific criteria for these edits. At least one editor's conflict of interest is front-and-center. The following is an excerpt from the circumcision article:

Promotion
.
Circs.org maintained by <editor name removed>.

Due to the editor's seniority, he is believed to edit from a neutral point-of-view. His point-of-view and his edits to the circumcision article over the past eight years have been not been neutral overall. Change to Wikipedia policy to further highlight and address conflict of interest would be beneficial both to Wikipedia as a whole and the circumcision article.

3.3 Discussion on the FGM Page


There have been battles on the FGM Talk page similar to (though to a lesser extent) those on the circumcision page. At least one editor is trolling from a pro-FGM point-of-view to highlight the gross disparity between FGM and circumcision articles. These are generally analogous procedures of male and female genital mutilation but with completely different treatment in Wikipedia. It is noteworthy that an editor of the circumcision article has made some pro-FGM statements on the FGM talk page.

3.4 Collect & Analyze Research


I am in the process of collecting research and links from I2 advocates on Twitter, pro-I2 websites, news stories, and research papers. It will take me some time to sort through this information. Please contact me via Twitter (using the same username as this blog) if you are willing or able to help out with sources.

3.5 Edit the Circumcision Article


Editing the Wikipedia circumcision article is easy. Getting those changes to stick is the hard part. Addressing Wikipedia policy, challenging invalid research, and using reliable secondary sources can work towards making a positive change in the circumcision article. Tangentially, it may also be useful to approach editor conflict of interest issues. An effort to use a similar approach for both FGM and circumcision articles to eliminate cultural bias (e.g. circumcision is accepted in American culture while FGM isn't) might be a useful tactic as well.

4.0 Next Step


My next step is to write another blog entry summarizing a possible edit to the Wikipedia circumcision article. Once arguments for the change seem airtight, I'll make the edit. I have no doubt that it will be a significant battle—even with airtight arguments for the change.

I welcome any thoughts, ideas, or other feedback regarding this blog entry.