Matt Steinglass has responded at length to some of my thoughts on the circumcision debate, in the comments of my posts on the subject. If you’ve read any of my posts on this issue please take the time to digest Steinglass’s rebuttals.

“When David Souter retired, the political class put on an amusing dress rehearsal of the first year of the Obama presidency: Obama did something expected and fairly moderate, and the Republican opposition responded with hysteria and scorched earth campaigning against it. Sonia Sotomayor was the judicial equivalent of a health care proposal of modest insurance reforms and a limited public option. Also she was a racist radical and any health care reform is Nazi Socialism.” – Pareene, Gawker

Forgive me if someone has already coined a superior term for this. rollover- The kind of hangover that comes and goes in a wave-like pattern over the course of the day, lulling you into a false sense that the worst has passed and significantly prolonging the length of the the hangover in question.

Parents consistently rate their child’s education far higher than the country as a whole.

The continuing debate on circumcision and HIV infection is very strange.

Circumcision is tangential to the politics that interest me. While I’m convinced of my position on circumcision for medical gain, and particularly the relative effectiveness of such a procedure in sub-Saharan Africa compare to other parts of the world, the issue just isn’t of great interest or importance to me. It’s not the kind of issue that ordinarily animates me. And yet I find myself increasingly pushed towards emphasizing this issue by the bizarre certitude of people unable to articulate an argument for routine circumcision and by the strange disrespect that many people have towards people who hold my opinion.

I read on and comment on a lot of blogs, and I say with great confidence that the debate about circumcision occurs in a very different way from many other arguments in blog comboxes. We diagree with each other online about many contentious issues, from the trivial (Mac vs. PC) to the deadly serious (Israel and Palestine). Obviously, there are many trolls and disingenuous people who don’t bother to form real arguments or to engage on a substantive level. But more or less, people know to at least try to engage their opponents’ arguments and to keep their objections on a relevant level. They equally tend to understand that beginning from a position of obvious disrespect towards your opponent is not productive and not in keeping with good discourse.

Yet on the issue of circumcision, that is precisely how the conversation proceeds. I have had the weird experience of weighing in on this issue in several different fora, presenting what I see as the statistical and epidemiological case against routine circumcision for medical reasons, and having people both fail to come up with any sound medical reason for supporting circumcision, and yet continuing to insist that everyone should be circumcised. Frequently I receive no rebuttal to my reading of the data and the literature at all, and yet people insist that I am mistaken. I haven’t yet heard a meaningful challenge to my reading of the demographics of the HIV virus in this country, to the limits of circumcision’s potential to slow the spread of HIV, and the vanishingly small odds of American males receiving a meaningful medical benefit to the procedure; and yet despite that paucity of a response, I continue to hear that “everyone knows” that we should be circumcising all of our infant boys. You would be amazed at how many people think that “I don’t see what they big deal is” represents some sort of logically rigorous rebuttal to my position.

I think that some of the louder elements of the anti-circumcision movement argue in a way that does not best represent their position, and to their detriment. I disagree with many of them about funding circumcision procedures and education in sub-Saharan Africa, where this procedure really could have great medical value. And I disagree strongly with a small sliver of them who oppose parent’s rights to circumcise their children as part of religious observation. And yet I find myself increasingly sympathetic to them, and I understand why they radicalize, as they are greeted with such an odd and unfortunate combination of antipathy and a lack of logical rigor from counter argument.

Look, think about it this way.

Say, for the sake of argument, that circumcision is a purely aesthetic change. I don’t think that’s true, and while I find some of the claims about sexual pleasure likely inflated, I also think that such concerns are dismissed with a speed that is embarrassing for the people so dismissing. But let’s say for the sake of argument that a circumcision merely changes the physical look of the penis and nothing else. Let’s further set aside the oddity of preventative surgery, and further let’s leave aside the medical benefit, dubious or no.

Here’s my question: how many of the people intent on ridiculing opponents of routine circumcision would recoil at the idea of a parent tattooing their child? I think very many would. Tattooing an infant just seems wrong, to most of us. Should a parent be allowed to do it? I have to say yes. That doesn’t mean that I give up the right to argue that they shouldn’t. Part of being a responsible parent is preparing children for their adulthood, and in part that means preserving for them the choices that they will make as an adult. That’s why we recoil at arranged marriages for children, after all. So even if a circumcision involves only an aesthetic change, I must ask, how is that materially different from tattooing your child? Both are permanent changes to a child’s body, and both are undertaken without their consent at a time when they are too young to understand what is happening to them. A permanent choice is being made about their body.

And that’s the point; it’s their body. As I said above, it’s incredible the number of people who seem to think that saying “what’s the big deal” constitutes some sort of a meaningful rebuttal. It doesn’t matter if you think it’s a big deal or not. It’s not even a matter of you ever becoming convinced that it’s a big deal. It’s a matter of recognizing and respecting that at some point, the child will become an adult, and that it may be a big dealt to them. It is their body, after all, and as much as I think parents have the right to determine medical treatment for their children I equally think that parents should respect boundaries to that authority in the interest of self-determination for their children, who will eventually become adults.

I find this debate to resemble nothing more than the abortion debate, where many on the pro-life side can’t understand why women who want abortions can’t just have the baby and give it up for adoption. And there, too, you often here people wonder “what’s the big deal” with carrying a baby to term. What pro-choice people like myself have said is that whether or not it is a big deal to an individual or any number of people is immaterial in the face of the fact that it is the pregnant woman’s body, and it is her right to make decisions about her own body. This is similar to the argument about circumcision, where whether or not any great number of us see what the big deal is about circumcision is immaterial to the question of whether we respect the autonomy of a person to make up his own mind about the value of the procedure. It’s his body, and this debate takes place in the context of a medical benefit which even many of those who support routine circumcision admit is dubious for the average American man. People like to say that if men got pregnant, abortion would be a sacrament. I think if women had penises, circumcision would be anathema.

What I have asked, and continue to ask, is why parents who don’t have religious convictions pushing them to circumcise their sons don’t wait until those sons are adults and let them choose for themselves. Or, if they prefer, wait until adolescence, when a 12 or 14 or 16 year old boy can hear about the benefits and drawbacks from supportive parents and make a decision about his own body. I have not heard anything approaching a coherent objection to this. Yet people persist in opposing it. Why? Why do people feel so strongly in favor of a medical procedure of dubious medical value, performed on infants who cannot yet understand what is happening to them? The only reason I can think of is the only one that really matters to most people: in the United States, circumcision is the norm. And people, despite all of their liberal, tolerant self-identification, like enforcing norms. They just don’t like admitting that this is what they’re doing. So they dress it up in this slight medical justification, and they use ridicule and exclusion to do their arguing for them.

Whenever people feel strongly about an issue without being able to articulate why, it usually tells us more about them than about the issue. I think there are a lot of primal emotions about what is “weird” and what is normal going on under the scenes with this issue. By all means, let’s have a debate, but let’s please have one with less marginalization of one side and less assertion about what is and isn’t a big deal.

Who Goes with Fergus?
by William Butler Yeats

WHO will go drive with Fergus now,
And pierce the deep wood’s woven shade,
And dance upon the level shore?
Young man, lift up your russet brow,
And lift your tender eyelids, maid,
And brood on hopes and fear no more.

And no more turn aside and brood
Upon love’s bitter mystery;
For Fergus rules the brazen cars,
And rules the shadows of the wood,
And the white breast of the dim sea
And all dishevelled wandering stars.

For all the people defending bringing a gun to a political protest: if we go beyond merely saying, “you have the right to,”– and just saying that, you aren’t saying much– what is the practical purpose of bringing a gun to a town hall meeting?

Let your eyes rest on this argument for while, and be amazed.

Matt Steinglass has weighed in on the circumcision argument. (Judging from his picture, he also apparently chose the “Alpine” background on school picture day. I always preferred Laser.) I’ve enjoyed some of Steinglass’s stuff in the past, even when I disagree with him, so I’m a little confused: this is genuinely one of the five worst blog posts I’ve ever read, and I have read at least 40 a day for three years. It’s that bad. Let us count the ways.

1. Present information utterly shorn of context or importance.
Steinglass: “the CDC may recommend circumcision because it helps prevent AIDS” and “In the case of circumcision, the evidence shows that it prevents the transmission of HIV and other STDs.”

Well! We’re off to a fast start. As my posts on this issue have taken pains to point out, all of these studies have demonstrated that only certain demographics receive a reduced risk of infection through circumcision, and that the composition of these demographics is an essential element to understanding the public health policy ramifications of the studies. You’d never know that from Steinglass’s post, though, and indeed, there’s no evidence that Steinglass has read a single one of the studies or even a substantial recap in the popular press. It would be rather hard to miss the constant caveats that these results were observed only in sub-Saharan Africa, and that the benefits were seen only in female to male infection of heterosexual men. And, indeed, saying “prevents the transmission of HIV” is, well, a terribly incorrect way to parse the data. But hey, who needs to actually read the study you are basing your aggrieved ramblings on, am I right?

2. Pick the absolute weakest arguments for the other side you can find. Profit.
Steinglass quotes: “It’s my dick. It’s my dick. It’s my dick. It is no one else’s dick but my dick.  And I should have the choice to circumcise it when I am old enough to make that decision.”

Sounds like the kind of guy you should be refuting! Why look around for someone making a sound argument? After all, you’ve got your mind made up! Nevermind that there are many places to find rational, statistical evidence-based arguments against your position, including in the archives of the blog that started this conversation in the first place. Clearly, “my dick” guy is the unquestioned spokesman for one side of a contentious issue.

3. Dispute empirical claims without really disputing them.
Steinglass: “There is some disputed evidence, on the other hand, that it reduces sexual pleasure;”

Uh, ok. What evidence? From whom? In what context? Who disputes it? What is the nature of the dispute? Why would a functioning intelligence not assume that these are maybe important questions?

4. Forget about what exactly people are objecting to, or don’t bother to find out in the first place. Steinglass: “Parents have the right to decide on medical treatment for their children, presuming such medical treatment is not actively harmful. And parents have the right to include their children in cultural rites and practices, again presuming no harm is done.”

They sure do. Luckily, no one is arguing that we should take away the parents rights to determine the medical treatment of their children, nor or they arguing that we should prevent people from taking part in religious practices. What we are arguing about, as Steinglass would know had he bothered to actually consider the content of the argument, is whether the CDC should be recommending as routine a surgical procedure with dubious health benefits for an entire gender, and at infancy.

5. Veer wildly from one argument to the next; act like they’re the same argument.
Steinglass: “Children are born into families. Those families have cultures and beliefs, and are entitled to make decisions about how their children will be treated, shaped, and raised.”

Well, yes, indeed. Again, dude– the CDC? Their recommendations? The medical side of a medical issue? Look, a lot of people are uncomfortable with forcible surgical alteration of newborns. As an atheist, I am not a big fan of religious practices being forced on children of any sort; it’s just that, as I don’t believe baptism, etc., actually do anything, I’m not all that ginned up about them. The point is that I don’t know anyone who literally believes that parents should not have the legal right to have their children circumcised. I do know that a lot more parents will do so out of an appeal to medical benefits if the CDC recommends it, even though, as I have argued the medical benefits appear negligible outside of sub-Saharan Africa. No one is forcing anything on parents. We are participating in a conversation and attempting to bring issues to light that parents without religious impetus to circumcise their children might want to consider. Confusing and conflating recommendations with enforcement, and culture with medicine, is unhelpful and unfair.

Steinglass: “In any case, this doesn’t have much to do with anything, because we’re talking about a medical recommendation.”

But… you just said… I… you were just arguing… he….

6. Assert! Assert as if your life depended on it!
Steinglass: “But the main point is that if the guy who wrote the email were circumcised, he wouldn’t have written the email.”

Oh! Well then! You’re right, nothing to see here. I’m sure “my dick” guy will be pleased to know that. If he asks what evidence you offer for that wild claim, I’ll tell him to put a sock in it.

Steinglass: “There may be some vanishingly small number of guys who are upset about the fact that their parents circumcised them.”

I’m gonna go ahead and guess that Matt Steinglass has not been out in the field taking some sort of foreskin census.

7. Beg the question as if that shit is going out of style.
Steinglass: “It’s a weird thing to be upset about. The whole issue of treating this as some kind of mutilation of a rights-endowed human being who should be allowed to decide for himself seems to me like an insane metastasis of the American fixation with individual rights-based ideology.”

You see, folks, it’s a weird thing to be upset about, so no one should be upset about it.

8. Pick an abusive, provoking title.
Steinglass: “The Foreskin Police”

Yes, that’s right; a couple of emails to Andrew Sullivan and a few respectfully questioning blog posts represent “the foreskin police”. Lord knows, there’s no lobby more powerful or pernicious than the vast anti-circumcision network who secretly pull the strings of the world’s political and medical apparatus. Why, they’re so successful, they’ve reduced the portion of American men who have been circumcised to only three quarters of American men! Truly, this juggernaut must be stopped.

9. Let your sense of grievance and certitude be in inverse proportion to your knowledge on the issue.
Steinglass: “the most amusing and hysterical reaction to the news that the CDC may recommend circumcision”, etc.

Look, this dude clearly hasn’t read the studies he briefly alludes to; he clearly hasn’t attempted to put them in an international or statistical context; he clearly hasn’t engaged the more powerful counter-arguments; he’s done no homework. I imagine that he read the post on the Daily Dish and let fly. This, sadly, is the Internet. I’m no expert and I have tried not to make myself out to be one. You can read my two posts on the issue and decide for yourself. What I have done is to read as much of the studies in question as I have had available to me online; read synopses when I can’t; looked at as much statistical information as I can; read a book by an eminently credentialed epidemiologist on the issue of HIV prevalence and risk factors; considered the best arguments I can find, pro or con; and presented all of my data and links to readers so they can evaluate my arguments for themselves. I’m sure I haven’t done a particularly great job. But I think I’ve made a structurally sound argument. And seriously, this is the weakest brew I’ve come across in some time.

Young bloggers, Matt Steinglass has done you a service, and you must not allow his efforts to go to waste. Print out his post, display it prominently, and learn.

The Daily Dish’s guest bloggers continue to post on circumcision. Yet they continue to ignore what to me is the central issue regarding these studies, the vastly different rates of infection between sub-Saharan Africa, and the unique logistical and cultural factors that make sub-Saharan Africa an international outlier in both HIV infection and the types of people who contract HIV. Sub-Saharan Africa, when it comes to HIV and AIDS, is a unique place, with rates of infection and methods of transmission that simply aren’t seen in other parts of the world.

Which is why I think that circumcision is an enormously powerful tool for fighting HIV and AIDS in sub-Saharan Africa. It’s worth pointing out that none of the studies of circumcision as a tool for fighting HIV transmission took place in the developed world. These studies are demonstrating a clear advantage in fighting a terrible disease, but it is a clear advantage in one part of the world with a disease that is largely regional. And, again, it is a disease that, in the developed world, afflicts two kinds of people, men who have sex with men, and people who abuse intravenous drugs. And, again, the only method of infection that has shown any benefit in terms of reducing risk is female to male infection from vaginal sex. All of these studies have shown no reduced incidence of infection in homosexual sex. In the developed world– in America– HIV is not transmitted through heterosexual sex in any kind of statistically relevant way. Statistically, we know that it is almost always the case that HIV infections in America are the product of sex between men, the sharing of needles, passage from mother to child in utero, and the (happily, now much rarer) through blood transfusion. Deductively, we can understand that without the cultural practice of dry sex as practiced in sub-Saharan Africa, and without the incidence of untreated, open sores from other STIs, there isn’t the possibility of blood-to-blood contact that is the only reliable way that HIV is transmitted. And the risk of infection is only one half of the question when considering the public health risks of infection; the other half is the pool of infected, and again, outside of sub-Saharan Africa and particularly in America, the pool of non-intravenous drug using heterosexuals who have HIV is effectively zero.

If I was an anti-circumcision zealot, I would not recommend circumcision for men living in sub-Saharan Africa. And I would likely not want parents to circumcise their children on religious grounds. But I do think circumcision is a very important tool for preventing the spread of HIV and AIDS in sub-Saharan Africa; I think men should be encouraged in those cultures to be circumcised; and I think we should provide funding and education for them to do so in clean, sterile conditions. I additionally, of course, believe that ultimately parents are empowered to make the decision, whether for religious observation or whatever else. What I ask, however, is that a procedure with almost no proven medical benefit whatsoever for Americans not be recommended as a universal procedure for an entire sex based on a reduced risk of a disease when the people who are protected from that disease by the procedure don’t get the disease in the first place. And I want those arguing for routine circumcision to be more honest about who, exactly, is being zealous. Shouting “Lose the foreskin!,” as Rosin’s first post did, demonstrates that she is taking exactly the wrong kind of attitude towards the issue, and reveling in a lack of sensitivity or regard for the concerns of people who don’t think routine surgical procedures for negligible medical benefit make sense.

The only reason I can think of that Chris Bodenner and Hanna Rosin are not being honest about the number of people infected in the United States, and the essentially mythical nature of HIV infection from heterosexual sex in the United States, is out of some dedication to political correctness. In a very well-intentioned but ultimately harmful way, those pushing for AIDS awareness in the early and mid-90s ended up developing many myths about HIV and AIDS, particularly the size of the disease here in America (HIV is most certainly not a pandemic in the Western world) and of who catches the disease. Outside of our dedication to political correctness, the simple fact is that HIV and AIDS, outside of sub-Saharan Africa, afflict two groups of people, gay men and those who use intravenous drugs. That we have elided respect and love for the people who have the disease, and a dedication to fighting it, with the sympathetic lie that everyone has to fear HIV and AIDS, tells you something about our culture.

And Bodenner and Rosin’s reticence, I think, tells you something about the clarity of their thoughts on this issue. Whatever else you think of Andrew Sullivan, one thing he most certainly is not is someone who allows pleasant fictions to control his thinking on contentious issues. I put it to you that Andrew would be exactly the first person to admit to politically incorrect truths. It’s especially disheartening to read such muddled thinking about HIV and AIDS on the Daily Dish, where open and critical thinking on the virus and disorder is usually found. I hope one of the guest bloggers will consider the gaping statistical differences between sub-Saharan Africa and the United States, when it comes to HIV, in a post soon.

If you’re not one to travel in feminist blogs, you may not have heard that there was some controversy over this post in Double X by Katie Roiphe, in which she talks about how ecstatic and intense her feelings are regarding having her first child (no problem), and attacks feminism as somehow hostile to mother-infant love (problem). This has resulted in a lot of critical comments, and this sharp rebuttal from Shapely Prose. I won’t try to come up with a new argument about Roiphe’s piece. I just want to underscore what’s a bit understated in the post from Shapely Prose: it’s irresponsible, and more, just kind of weird, for Roiphe to claim that feminism “won’t admit the pleasure of infants” without quoting a single feminist or naming a single feminist work that makes such a claim. I don’t like it, as a matter of principle, that she made a claim about feminism generally without naming any specifics. But more I just find it kind of strange.

Hanna Rosin continues to polish her trophy as the least thoughtful person, and worst reader, to ever blog in any capacity for the Atlantic.

In a post as hectoring as its title, Rosin writes,

But the procedure is only “controversial” because people have emotional, psychological and religious reactions to it. Scientifically speaking, it’s not remotely controversial.

Not only is this nonsense, it’s insulting nonsense. The first thing to say is that, in fact, there are very many rational reasons to oppose routine circumcision. The first is to point out the simply bizarre notion of recommending preventative surgery to all Americans to prevent a condition that afflicts a tiny minority of Americans. Something along the lines of a third of a percentage point of our population has HIV. (All stats courtesy of the CDC.) I know that the efforts to raise AIDS awareness is undertaken in good faith, but the simple fact, obscured by people with good intentions, is that AIDS and HIV are extremely rare in the United States, and theaverage American has very little to fear contracting HIV. That’s just the numbers.

Appendicitis, meanwhile, afflicts some 680,000 Americans a year; for comparison, the CDC estimates that there are a total of 1,168,000 people living with HIV in the United States.  Yet no one proposes routine appendectomies to prevent appendicitis. Obviously, appendectomy is a far more invasive procedure, although it is entirely routine and extraordinarily safe. The point is that there is something bizarre about preventative surgery, and particularly when the disease in question is so rare. Remember, too, what we take for granted with every other category of medicine but circumcision, that medical science needs to demonstrate a compelling, repeatable benefit that is likely to be needed by a particular patient in order to recommend a treatment, particularly one that is surgical and permanently changes the patient’s body. “First do no harm” also means “leave well enough alone” unless there is a compelling medical benefit. Circumcision is still a surgical procedure; it’s permanently altering to those with no capacity to choose or ability to prevent the surgery; and it is changing the natural human form in the service of pursuing health gains that benefit a statistically tiny portion of the American population.

Rosin speaks, meanwhile, as all circumcision boosters do, as though the studies demonstrating a benefit for HIV transmission prevention from circumcision aren’t subject to further review and future study. To take less than a half dozen studies, released in the last five years, as permanently dispositive is a joke to anyone with even a cursory understanding of medical research. Medical studies are notorious for being released to great fanfare and subsequently being discredited or mitigated by new research. Even those who advocate the use of circumcision in sub-Saharan Africa caution that circumcision is not a magic bullet for solving the spread of HIV in the Third World. A 50% reduction in the infection rate, meanwhile, does not come close to matching the efficacy of using condoms and spermicidal lubricant, still the best solution in America and the rest of the developed world.

Even if we take all of the findings of these new studies at face value, they don’t, actually, make it clear that the United States should recommend circumcision for all male babies. Why? Because the studies all deal with sub-Saharan Africa, where unique sexual practices increase the risk of infection, and, crucially, because they deal with the HIV infection rates of the American demographic among the least likely to become infected, heterosexual men. Circumcision does not improve the risk of infection for a female partner, and as the very New York Times story that Rosin links takes pains to point out– and Rosin, revealing her fundamental dishonesty on the topic, does not– gay men do not enjoy any benefit in rates of infection from circumcision.

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I’m happy to say that a favorite of mine, Rortybomb– aka Mike Konczal (whose real name I didn’t know until I saw this)– has made his Bloggingheads debut, and alongside the always brilliant Reihan, to boot. Rortybomb writes with a real clarity about very complicated subjects, and used to comment at my old digs.

In the above excerpt, Mike and Reihan talk about something that, frankly, haunts me, the specter of permanent high American unemployment. I really do think that at least minimally compensating employment is an absolutely essential element of the American social contract, and I deeply worry about the kind of political consequences of a European-style permanent high unemployment rate without the attendant European social programs. Something about basic economics that I’ve never understood is why it’s necessarily the case that increased innovation won’t simply erode the necessary number of jobs in society. I’m not smart enough to know what’s going to happen, so it’s nice to listen to two smarter people consider the issue.