Wednesday, February 5, 2014

The Failure of Intactivism

The purpose of this blog post is to highlight both my own failings and what I see as some of the areas where the intactivist community could use improvement. The intention is to bring increased awareness to some important issues and to bring attention to aspects of our cause that need more attention.

This Blog

When I first learned of the i2 hashtag, I saw it defined as standing for genital integrity and intactivism. So I thought I was being clever and named this blog an equation with the product of those terms equaling i2. Recently, I have seen i2 defined as integrity (i) for both genders (2). Well I guess I butchered that. Not only do I have an insanely awkward and nerdy name for this blog, but it is incorrect. I fail.

I started this blog to try to give some perspective and insight that I hadn't been seeing. I didn't want to replicate the types of blogs that were already out there—who wants to read the same old thing. I write about topics that are interesting to me or that I think haven't been addressed by other intactivist bloggers.

With exception of Genital integrity advocates: Can't we all just get along?, My Intactivist Journey, and maybe E-mail to Dr. Laura Schlessinger, virtually nobody reads this blog. I'm pretty sure that "My Intactivist Journey" is only popular because I admit to having only one testicle. I get more referrer spam than honest page views. My blog has been a failure. Or should that be fail blog?

Ghost Orchid Pseudonym

I decided to switch to a pseudonym to avoid alienating non-intactivist followers on my real name account and to prevent an issue where this type of creepy, perverted, and weird activism could affect future employment opportunities. My ability to provide for my family comes first. There are some who call this cowardly, but I call it smart and pragmatic. I can't change American culture by myself and I certainly won't be taken down by it's ignorance on this issue.

I chose this name because I like orchids; my wife and I used to be collectors. It turns out that there is an anti-FGM group called The Orchid Project so I guess it fits. I also enjoyed Susan Orlean's book The Orchid Thief whose story centers around the Florida ghost orchid (Dendrophylax lindenii or the shorthand D. lindenii) which is where my Twitter username is derived. My Twitter username is hard to spell, hard to remember, and too similar to an anti-FGM group. Fail again.

The Kooks

The things I've seen, you people wouldn't believe... fires on attack ships off the belt of Orion —Roy Batty (as played by Rutger Hauer), Blade Runner

I feel like Roy Batty when describing my social networking experiences to others in real life.

It's pretty silly to be against science since science is nothing more than a systematic study of the world around us through empirical observation and experiment. As with any other field, there are good and bad scientists. Some scientists and researchers produce studies that are not scientific. Medicine is an applied science that, in general, incorporates methods and practices that work and rejects those that don't. As with any endeavor, there are good medical practitioners and bad ones. There are good researchers who follow scientific methods in their research, and there are bad ones that produce non-scientific research to support a pre-determined outcome.

Medicine is not perfect, but there is no doubt that medicine has, overall, improved quality of life and health outcomes. Profiteering and agendas occasionally taint medicine with non-scientific methods. A focus on symptoms rather than root causes often results in non-ideal outcomes as well: for example, it's easier for a doctor to prescribe a diet pill than to convince a patient that he needs to use self control to cut down on calories. Patients come to expect the easy solution and doctors are often all to eager to prescribe it. But there is no reason to "throw the baby out with the bath water".

The intactivist community is full of kooks. Intactivism has to do with human rights and genital integrity. Let's not pollute the waters by confounding intactivism with pseudoscientific beliefs, conspiracy theories, and other nonsense. The kooks make intactivists look bad and make our job that much harder by unintentionally harming the credibility of the movement as a whole.

Medicalization of Male Circumcision

The reason why male circumcision (i.e. routine infant circumcision (RIC)) is hard to stop is because of medicalization. Well-meaning parents trust their doctors who have spent many years studying the human body. If their doctor says that cutting the genitals of their son is healthy, they will do it. After all, if leaving this vile, diseased, filthy foreskin on a child will harm him, by all means, remove it.

The human rights and ethics argument carries very little weight with the average American. I've seen this myself among friends, family, and countless people on Twitter. As long as there is a "health benefit", whether it is real or perceived, cutting genitals will be considered the most ethical option: after all, it would be unethical to deprive a child of health benefits. Many intactivists have trouble grasping this concept: they fail to understand that as long as male circumcision is medicalized, the human rights argument will carry very little weight.

Because intactivists fixate on the human rights and ethical arguments against RIC, the medical arguments are sorely neglected. Don't get me wrong, the human rights and ethical arguments against RIC should be enough. But they aren't. We're trying to change culture here, not win debate club.

In order to fight medicalization, we have to play the game. The circumfetishists are experts at this. We fail completely. We don't understand how medical research works. We don't fund studies that will convince the medical community. We continue to place human rights up against medicine and we lose time and time again.

Medical research starts with primary studies. These are the ones where researchers analyze data, conduct surveys, and perform experiments. There are lots of primary studies in our favor. Primary studies, however, do not represent the beginning and end of scientific knowledge on a subject. Researchers can make mistakes. Sometimes, results aren't reproducible. Sometimes researchers introduce various types of bias either intentionally or unintentionally. So in comes secondary studies in the form of reviews and meta-analysis. Secondary studies look at a number of primary studies, based on selection criteria, and reach a broader conclusion. Secondary studies do form the basis of scientific fact because their analysis of large data sets allows more concrete conclusions to be drawn from the data. Primary and secondary studies are generally subject to peer review where the researcher's peers review the study for errors before publication; reputable journals have a more stringent peer review process.

In the scientific community, secondary studies are considered the "gold standard" for knowledge on a subject. The problem comes in for topics like circumcision where there are a number of motives (e.g. profit, sexual fetish, culture, jealousy) that overwhelms the truth. The truth becomes distorted. Secondary studies uses selection criteria that typically results in about 10% of the available studies on a subject to be selected. Poor quality studies are omitted. In the case of studies on male circumcision and its effects, unethical researchers such as Brian Morris, carefully choose selection criteria ostensibly to remove poor quality studies from consideration. The reality is that his selection criteria is carefully chosen to remove studies that would disprove his point of view. Morris publishes in respectable peer-reviewed journals. He finds peer reviewers who agree with his point of view and he gets published. Unfortunately, Morris studies are part of the body of scientific evidence.

Intactivists generally publish in fringe journals with lax peer review that aren't indexed in Medline or Pubmed. Many of these are primary studies or poor-quality secondary studies. These studies do not become part of the body of scientific evidence.

It has been fifty years or so since the majority of Americans had foreskins. Americans do not know what is lost to circumcision. Older studies showing the benefits of foreskin and circumcision harm are generally overlooked in favor of newer studies by profiteers, ignorant researchers, and circumfetishists showing no harm from circumcision. These newer studies render the older studies obsolete: knowledge is lost and the circumcised researcher, doctor, and patient are all in the dark.

I have been told by at least one intactivist that there is a wide body of evidence on our side and we can easily defeat the medical argument. I've been involved in the intactivist community for about two years now and I have been searching for quality secondary studies showing circumcision harm and benefits of foreskin. They don't exist. Sure, we can ask questions like "if FGM had benefits, would you support it?" But that doesn't get us anywhere because that would require logic and intelligence. Our detractors generally possess neither so we must bring the battle to them. Although we are losing the medical battle, we can make a comeback. We must play the game and fund some quality studies. This is essential if we are to defeat medicalized RIC in the United States.


The Problem

When I started this blog, one of my goals was to hone my sources and arguments before editing the circumcision article on Wikipedia. I thought I had a solid case for some changes with Wikipedia and I2. It didn't work. I tried again with Africa HIV Claims. Shot down again. Although it's a violation of Wikipedia policy to recruit others to bolster an argument, I would have liked other intactivists to have joined me in the discussions.

There are some intactivists that tell me that Wikipedia is not important. This is wrong. Wikipedia is one of the top sites on the Internet. It has been shown to be as reliable as Encyclopedia Britannica. It may have its problems, but people do trust it. It is the first link that comes up when you search for circumcision. It is important even if it has huge problems.

I did do some good over there. I got some ridiculous uncited claims removed, and I helped in removing some inaccurate information. Overall, it was a huge waste of time and caused me lots of stress.

Nowadays, the circumcision article at Wikipedia article is getting worse. It is really bad. For example:

  • Claim that circumcision is "elective". For most, it is not.
  • Disproven Africa-HIV claims are featured prominently
  • Claim that male circumcision does not harm male sexuality or affect it in any way
  • Claims of health benefits
  • Consistent de-emphasizing of harm, physiological, or psychological affects

The problem is that, with the exception of the first bullet above, all of these claims and statements are backed up by "reliable" secondary sources. Their favorite trick is college textbooks (which are generally reliable, but, in this case, make claims based on poor quality studies). There really isn't a good way to challenge reliable sources on Wikipedia. The only way to correct the Wikipedia article is to change the game from medical to human rights as is the case with the FGM article. There is very little chance of this happening with the largely pro-circumcision editors and admins running the show.

On Reliability

The following is a quote from an editor who supports intactivism. I replaced his name with "XXX YYY", but his words speak volumes.

(ec) Once more in different words: "Reliable source" is a technical term that is merely meant to exclude forum posts, random blogs, pamphlets distributed by lunatics and self-published books. Being a reliable source does not imply that everything is correct, let alone unbiased. Fox News, for example, is obviously totally biased, yet it's a reliable source. The same is true for the Socialist Worker. If you don't believe me, go to WP:RS/N and ask.

The AAP document is used inappropriately on this article, but you are not going to change this by making unrealistic claims about its (non-)reliability. It's technically reliable but at the same time overused and inappropriately used for questions of weight (i.e. what to include and what not). There is no contradiction between these two statements. XXX YYY

Wikipedia reflects "reliable" information which is not necessarily the truth. See The 'Undue Weight' of Truth on Wikipedia which gives a far better overview of the problem than I ever could. There is no accounting for whether a source is credible and not just "reliable". Another fantastic read is The Decline of Wikipedia.

Next Steps

We need to move beyond rhetoric. We need to make factual claims instead of dubious ones. I firmly believe that the only way we can change the game to a human rights discussion is to compare male circumcision to FGM:

  • Would FGM be OK if it had medical benefits?
  • Would FGM be OK if it didn't harm sexuality?
  • Why is a "ritual nick" that causes virtually no harm FGM but far more invasive male circumcision not harm?

It is imperative that we force our detractors to answer these questions. In my experience on Twitter, I get handwaving and insults. I've never had a single person provide an answer to these questions.

We also must focus on doing quality research. We need someone with a medical background, time, and money to sort through the primary studies and produce quality secondary studies that can disprove Morris and his ilk. It shouldn't be that hard. We have the truth on our side. Morris has to lie and manipulate. We must codify the truth in a way that is accepted by the medical community to un-medicalize male circumcision and restore it to its rightful place as a human rights issue.