User talk:JakeW/Circumcision debate
From Wikipedia, the free encyclopedia
Contents |
[edit] The Debate
[edit] Conclusions
- Advocate Circumcision significantly reduces the risk of penile cancer.
- Intactivist Under the same point of view, recommending castration as a preventive measure to reduce testicular cancer risk is medically much more sound than recommending circumcision to reduce the penile cancer risk.
[edit] Penile Cancer
- Intactivist Advocates propagate the idea that amputating the foreskin would greatly reduce the chances of penile cancer. I do not dispute this: penile cancer, an exceedingly rare and easily treated condition, is in the majority of cases a form of skin cancer on the foreskin. By the same rationale, you could argue for routine lobotomy because of its expected effect to reduce brain cancer rates.
- I have three comments. Firstly, you describe penile cancer as 'exceedingly rare'. The true rate is between 1 in 1,400 and 1 in 600. Whether this is extremely rare or not is a matter of opinion, but I would like to ask at what point is something rare enough to be ignored? Secondly, you say that it is 'easily treated'. Available information indicates that about 25% (depending upon the source) of sufferers do not survive for 5 years, and those that do often have to endure penectomy. Thus, your description is arguably misleading. Lastly, your comparison with lobotomy is faulty. To my knowledge, there is no evidence that it would in fact reduce brain cancer rates, but if I overlook that for the sake of argument, your comparison depends upon an implicit weighing of risk and benefit. It is only because of the known ill effects of lobotomy that the proposition seems so ridiculous. Jakew 15:25, 17 December 2005 (UTC)
- First, the occurence rate of penile cancer. According to [1] we have 350 new cases each year in the UK. 4/5ths of which are attributed to men over the age of 70. According to the CIA world factbook about the UK, there are about 4 million males over the age of 65, with a life expectancy of 76 years. This means we have (4/5)*350=280 new cases in this demographic, about 3000 in 11 years. That alone means, this highest-risk group has at best a 1 to 1300 chance to get penile cancer in their lifetime. If we calculate the chances for the entire male population, about 30 million individuals, (350*76) we have a chance of about 1 to 1100. This is also the reason why the sufferer often does not survive the next 5 years: Your natural life expectancy is reached and your pecker is no fun anymore. According to the same site, only few cases require penectomy. To quote: Doctors can use various types of surgery to treat cancers of the penis. Surgery removes the abnormal tissue in or near the penis, and may involve circumcision, treatment with lasers or using a chemical called liquid nitrogen to destroy cancer cells. On a side note: A chemical named liquid nitrogen?? So they're just freezing the tumor to cause necrosis in the cancerous tissue.
- Secondly, very obviously, if you remove a part of your brain, your chances to get brain cancer is reduced. Similiarly, if you remove a part of your skin, your chances to get skin cancer is also removed. Remove Lungs: Lung cancer chances reduced. Even you should understand this simple concept.
- The ill effects of lobotomy is a very recent discovery. If you read the respective Wikipedia page, you'll notice that lobotomy, interestingly similiar to circumcision, was claimed to have all sorts of healing powers at the time it was performed. Only later it was found out that turning misaligned people into drooling vegetables is not exactly a benefit. Maybe at some time in the hopefully near future, we'll figure out that removing a vital part of your penis doesn't exactly constitute a benefit either.
- Since your estimates for lifetime risk are in the same range as my figures, I assume we're in agreement there. Unfortunately, you have not answered my question regarding an 'acceptable' threshold for risk. At what point does elimination of a risk cease to be beneficial? 50 percent risk? 10 percent? 1 percent? 0.1 percent (this being roughly what we're talking about)? 0.01 percent?
- The risk of penile cancer is not eliminated, it is probably lessened at best. foreskin cancer, a subgroup of penile cancer, may be eliminated, still leaving a chance to the rest of the penis to develop cancer. Circumcision is, at best, a treatment for foreskin cancer, but as such can not be a preventative measure for penile cancer. Only penectomy could claim this. Do you advocate penectomy as a preventative measure against penile cancer?
- Correct, the risk is reduced, not eliminated. However, circumcision reduces cancers of the glans, so the protective effect is not only due to reduction in available 'target' tissues. The distinction between total protection and significant protection does not seem to be directly relevant to whether it is a benefit. As for whether I'd advocate penectomy, the only thing I advocate is informed choice, and I'd make no exception for that. Jakew 21:22, 17 December 2005 (UTC)
- circumcision reduces cancers of the glans Why on earth would it do that? The glans is now much more exposed to environmental conditions (free radicals). If anything, it would increase the chances of the glans itself developing a cancer, even though the total chance of cancer in the groinal area might be reduced somewhat.
- Nobody knows for certain, but the signs indicate that it is through reduction in risk of smegma, balanitis, phimosis, HPV, and BXO, which are all associated with penile cancer. IMHO, the most probable cause would be tissue damage due to (esp. chronic) balanitis, BXO, and HPV. Jakew 22:05, 17 December 2005 (UTC)
- I do not find this particularly credible. BXO is chronical balanitis, and a balanitis is simply an irritation or infection of the penis. Circumcision does not prevent balanitis, (only foreskin balanitis, of course [2]) and BXO has almost as low a lifetime occurance as penile cancer (1:300), is usually easily treated, and circumcision at best reduces the chance of occurence by a similiar mechanism as with cancer (if there is less material, the chances for it to infect are smaller). Alternatively, smegma, produced much less in circumcised individuals, has a antibiotic effect on germs, may actually prevent balanitis. Smegma's cancerogenous effect has been largely discredited. Further, there is simply no indicator that HPV would infect circumcised men less often, and with an 80% chance of infection in lifetime with various strands of HPV, the only explanation for this would be that circumcised men are less socially active and/or have less physical contact. I would recommend save the topic of STD, HPV, balanitis, and urinary tract infections for a later argument and slowly come to an end with this one.
- You are incorrect. Balanitis is defined as an inflammation of the glans penis specifically, and is 2 to 5 times more common in uncircumcised males. An inflammation of the foreskin is termed posthitis. BXO is identified as a separate condition. The fact that it is relatively uncommon does not count against it having a role in the aetiology of another relatively uncommon condition.
- The thing here to understand is that Balanitis is a relatively badly researched inflammation of the penis, and the terminology is often mixed and matched. Some sources differ between posthitis and balanitis, others register inflammation (also BXO) of the glans as well as the foreskin as balanitis. There does not seem to be a consensus between urologists world-wide on the issue. I would like to see a few (well done, credible) studies on the issue however.
- There is no credible evidence that smegma has an antibiotic effect. This myths was started by Paul Fleiss, who failed to read his references. I suggest that you check your sources. Several studies have demonstrated a carcinogenic effect of smegma (see Heins et al for example).
- You are not current. The studies you cite are from around 1950 and discovered lower cervical cancer rates in jewish women (whose men are almost all circumcised), more recent studies come to the conclusion that smegma has no carcinogenic effect. Although the dispute over the association of circumcision and cervical cancer in various populations is still ongoing there seems to be no hard evidence that circumcision prevents its occurrence in Jewish women, and it is no longer considered to play a protective role. (Emphasis in original) and on top of that These findings support the possibility that the low prevalence of the homozygous arginine polymorphism may play a role in determining the low incidence of cervical cancer in Jewish women and may also explain the differences between the ethnic groups. If these observations are confirmed, then the low incidence of cervical cancer in Jewish women is genetically determined, and an explanation for the ethnic incidence pattern of cervical cancer in Jewish women has also finally been found. [4] Interestingly this study does not propose an increased selective pressure on jewish women to develop genetical resistance against cervical cancer, or some of its factors.
- It is evident that you did not read the link I provided. Had you done so, you would have realised that it had nothing to do with Jewish women, but was an experimental study in which mice were subjected to smegma plus a variety of controls. As for your study, it appears to be nothing but an opinion piece. Jakew 16:19, 18 December 2005 (UTC)
- You're talking of this report of Fleiss: [5] Could you provide me with a study where this has been discredited? Or rather, "where he failed to read his references".
- My pleasure. Fleiss bases his claim on the idea that the inner prepuce contains apocrine glands (a type of sweat gland). Had he read his 37th reference, he would have discovered that "the mucosal surface of the prepuce is completely free of lanugo hair follicles, sweat and sebaceous glands." Jakew 16:26, 18 December 2005 (UTC)
- You are really interpreting too much into that text. But lets just save this argument for later.
- No interpretation is required. Either it is 'completely free' of these glands, or it isn't. Jakew 18:42, 18 December 2005 (UTC)
- You are really interpreting too much into that text. But lets just save this argument for later.
- My pleasure. Fleiss bases his claim on the idea that the inner prepuce contains apocrine glands (a type of sweat gland). Had he read his 37th reference, he would have discovered that "the mucosal surface of the prepuce is completely free of lanugo hair follicles, sweat and sebaceous glands." Jakew 16:26, 18 December 2005 (UTC)
- You are not current. The studies you cite are from around 1950 and discovered lower cervical cancer rates in jewish women (whose men are almost all circumcised), more recent studies come to the conclusion that smegma has no carcinogenic effect. Although the dispute over the association of circumcision and cervical cancer in various populations is still ongoing there seems to be no hard evidence that circumcision prevents its occurrence in Jewish women, and it is no longer considered to play a protective role. (Emphasis in original) and on top of that These findings support the possibility that the low prevalence of the homozygous arginine polymorphism may play a role in determining the low incidence of cervical cancer in Jewish women and may also explain the differences between the ethnic groups. If these observations are confirmed, then the low incidence of cervical cancer in Jewish women is genetically determined, and an explanation for the ethnic incidence pattern of cervical cancer in Jewish women has also finally been found. [4] Interestingly this study does not propose an increased selective pressure on jewish women to develop genetical resistance against cervical cancer, or some of its factors.
- You state that there is no indicator that HPV would infect circumcised men less often. This is false. [6] [7] [8] [9] [10] I remind you that many types of HPV are not carcinogenic. Only types 16 and 18 (from memory) are carcinogenic. Jakew 12:15, 18 December 2005 (UTC)
- HPV does not just infect the penis. It can infect all areas of skin of the body that are in direct contact with an infected host or his contaminated body liquids. Explaining reduced HPV in circumcised men's penises is again very simple: The surface of the penis that is inserted into a potentially infectious host may be reduced by 40-70% in circumcised men, and thus may statistically significantly reduce HPV rates in the penis. But: Whereas the foreskin would most likely be inflicted by HPV in intact men, after all, it does have some protective functions, the glans penis is now directly exposed to potentially contaminated body liquids. The only way to avoid HPV is celibate, social isolation, and using condoms.
- That's an interesting theory, but it is clearly speculation only. Jakew 16:19, 18 December 2005 (UTC)
- I would really prefer to save all of these arguments for a later, dedicated debate. We're still talking about penile cancer here, and I'm ready to come to a conclusion.
- Fair enough. You asked why it was protective, so I answered. I'm happy to leave it. Jakew 16:19, 18 December 2005 (UTC)
- HPV does not just infect the penis. It can infect all areas of skin of the body that are in direct contact with an infected host or his contaminated body liquids. Explaining reduced HPV in circumcised men's penises is again very simple: The surface of the penis that is inserted into a potentially infectious host may be reduced by 40-70% in circumcised men, and thus may statistically significantly reduce HPV rates in the penis. But: Whereas the foreskin would most likely be inflicted by HPV in intact men, after all, it does have some protective functions, the glans penis is now directly exposed to potentially contaminated body liquids. The only way to avoid HPV is celibate, social isolation, and using condoms.
- You are incorrect. Balanitis is defined as an inflammation of the glans penis specifically, and is 2 to 5 times more common in uncircumcised males. An inflammation of the foreskin is termed posthitis. BXO is identified as a separate condition. The fact that it is relatively uncommon does not count against it having a role in the aetiology of another relatively uncommon condition.
- I do not find this particularly credible. BXO is chronical balanitis, and a balanitis is simply an irritation or infection of the penis. Circumcision does not prevent balanitis, (only foreskin balanitis, of course [2]) and BXO has almost as low a lifetime occurance as penile cancer (1:300), is usually easily treated, and circumcision at best reduces the chance of occurence by a similiar mechanism as with cancer (if there is less material, the chances for it to infect are smaller). Alternatively, smegma, produced much less in circumcised individuals, has a antibiotic effect on germs, may actually prevent balanitis. Smegma's cancerogenous effect has been largely discredited. Further, there is simply no indicator that HPV would infect circumcised men less often, and with an 80% chance of infection in lifetime with various strands of HPV, the only explanation for this would be that circumcised men are less socially active and/or have less physical contact. I would recommend save the topic of STD, HPV, balanitis, and urinary tract infections for a later argument and slowly come to an end with this one.
- Nobody knows for certain, but the signs indicate that it is through reduction in risk of smegma, balanitis, phimosis, HPV, and BXO, which are all associated with penile cancer. IMHO, the most probable cause would be tissue damage due to (esp. chronic) balanitis, BXO, and HPV. Jakew 22:05, 17 December 2005 (UTC)
- circumcision reduces cancers of the glans Why on earth would it do that? The glans is now much more exposed to environmental conditions (free radicals). If anything, it would increase the chances of the glans itself developing a cancer, even though the total chance of cancer in the groinal area might be reduced somewhat.
- Correct, the risk is reduced, not eliminated. However, circumcision reduces cancers of the glans, so the protective effect is not only due to reduction in available 'target' tissues. The distinction between total protection and significant protection does not seem to be directly relevant to whether it is a benefit. As for whether I'd advocate penectomy, the only thing I advocate is informed choice, and I'd make no exception for that. Jakew 21:22, 17 December 2005 (UTC)
- The risk of penile cancer is not eliminated, it is probably lessened at best. foreskin cancer, a subgroup of penile cancer, may be eliminated, still leaving a chance to the rest of the penis to develop cancer. Circumcision is, at best, a treatment for foreskin cancer, but as such can not be a preventative measure for penile cancer. Only penectomy could claim this. Do you advocate penectomy as a preventative measure against penile cancer?
- You may care to read up on lobotomy. It doesn't remove tissue. Note the suffix -otomy (division), not -ectomy (excision).
- Well I was speaking of lobotomy in the sense of "Removing part of the brain" rather than the old school method that goes "Stick an ice pick in your nose and whirl it around a bit". Which is certainly going to lead to some necrosis (death) of the tissue, and may have a similiar effect on cancer rates. Lets make a different example. I can absolutely assure you, castration will reduce your chances for testicular cancer (which has a 1 in 250 chance according to Wikipedia, about 4 times more likely than penile cancer then) to zero, and unlike circumcision, is a reliable preventative measure against testicular cancer. Are you advocating routine castration on infants to reduce their testicular cancer risk? Lung cancer is a lot more common still, causing 4 million deaths world wide each year, and by removal of the lung wings, you should be shown to significantly reduce your lung cancer risk. Do you advocate excision of lungs on all newborns or just on smokers as a preventative measure? They have a problem breathing anyway.
- Sorry, I assumed you meant it literally. There are obvious problems with both of your examples. Removal of both lungs would dramatically shorten life, rather than prolong, so it would be pointless. Routine castration might be beneficial for one generation (hormonal problems excepted), but would have dire consequences for the species. I think you need to find a more comparable example. Jakew 21:22, 17 December 2005 (UTC)
- You say routine castration might be beneficial for one generation? I think we have very different opinions on what "beneficial" means! Having the freedom to enjoy oneself sexually, or having the freedom to procreate, does constitute as a benefit in my book that WAY outweighs any benefit castration (except for the context of a cancer treatment) may have!
- I was thinking of the most significant problems caused. You are correct to note that other harms exist. The fact that harms exist, however, does not mean that no benefits can exist. I will make the effort to use the terms 'individual benefit' and 'net benefit' in future, to avoid ambiguity. Jakew 22:05, 17 December 2005 (UTC)
- I understand your reasoning now. In the same spirit, I would like to propose a closing sentence for the argument of penile cancer: proposing circumcision as a means to prevent penile cancer is medically less sound (or sane) than proposing castration as a preventative measure against testicular cancer.
- You're free to hold that view. I disagree. Jakew 12:15, 18 December 2005 (UTC)
- On what grounds? You cannot disagree to the facts! Testicular cancer is at least four times more likely to occur than penile cancer. And castration completely eliminates the risk of testicular cancer, whereas circumcision at best reduces the chances somewhat. In addition, while penile cancer mostly affects people over the age of 70, testicular cancer affects 15-40 year olds most likely. Thus, proposing castration as a preventative measure against testicular cancer is medically much more sound than proposing circumcision as a preventative measure against penile cancer.
- To determine whether a decision is sound, you have to weigh up both benefits and costs. In other words, you have to discover whether there is a net benefit. In the case of castration, yes, the benefit would be greater, but the cost would be vastly increased, and as you commented yourself, this would "WAY outweigh" the benefit. Hence, the decision would not be sound. Jakew 16:19, 18 December 2005 (UTC)
- As you so eloquently noted earlier, there is a difference between net benefit and individual benefit. We have not yet established the net benefits of circumcision, and we could argue for months about the net benefits of castration. The thing is that stating something like "Circumcision is shown to reduce the chances penile cancer", while technically true, might be misleading to parents or men wishing to inform themselves about circumcision. If it is followed up by a statement like "Castration as a preventative measure against testicular cancer, is much more medically sound (as in, it has a much higher individual benefit of preventing testicular cancer) than circumcision as a preventative measure against penile cancer". We can state that people know that castration in that context simply means the removal of the testes - which everyone will understand is going to reduce the chances of testicular cancer. It is very subtle, explains the method by which circumcision can reduce the chances of penile cancer, and at the same time indicates that testicular cancer is a larger threat than penile cancer. In this circumstances, we are only talking about the individual benefit of preventing the respective cancers, which are significantly increased, regardless of the net benefit (or lack thereof) of either castration or circumcision. And since medically, castration IS much more sound as a means to prevent testicular cancer, than circumcision is as a means to prevent penile cancer. And we do not even have to discuss how much exactly circumcision is damaging or castration beneficial in other respects, because in this case, it is very clear the statement is about the individual benefit of preventing cancers only. You may find it polemic, I find it to the point. I suggest we close the issue on penile cancer with this conclusion (intactivist counter-statement) and choose a new subject. Since I picked the first one (and god, did I pick an easy one) you may feel free to chose the next.
- Stating a benefit is straightforward and accurate. I don't think that an analogy is particularly helpful here, but it would make sense to compare it with a hypothetical, fully effective vaccine against testicular cancer. In such a case, there is no potential for confusion between specific and net benefit. Jakew 18:42, 18 December 2005 (UTC)
- I think the problem that you have agreeing on this is that you would prefer to hide the fact that circumcision is connected to substantial loss of skin and tissue (whatever its function) on the penis. Advocates like to describe circumcision as a very minimal practice that at best removes a few milimeters of skin. The reality is that a large area of skin is removed, and that is just why circumcision does work, why it does have an statistically significant effect on cancer, STD transmission, balanitis etc incidence rates. Naturally, you would prefer to hide this and continue to let people believe that circumcision is a very minimal incision and that all those positive benefits are somehow caused by magic.
- Thank you for your hypothesis. Perhaps you could address my point instead? Jakew 22:20, 18 December 2005 (UTC)
- Unfortunately, then circumcision would have to be replaced by a mediocrely effective vaccine that possibly causes more deaths and implications than the cancer itself. The sentence does not make any assumptions over the net benefit of an operation but quite clearly only deals with the individual benefit of having a cancer risk reduced by a certain measure: reducing the risk of cancer by pre-emptively removing a potentially afflicted organ.
- As I've noted above, the reduction of risk is not simply due to the removal of potentially affected tissue. Also, the risk of death due to circumcision is generally agreed to be about 1 in 500,000. This is approximately one 350th of the risk of penile cancer (assuming a rate of 1/1400). If we make the conservative estimate that one man in 20 will die of penile cancer, the ratio is 17 pen. ca. deaths : 1 circumcision death. This simplistic analysis assumes 100% protection, admittedly, but clearly your implication that circumcision causes more deaths than prevented through this benefit alone is simply false. Jakew 22:45, 18 December 2005 (UTC)
- Unfortunately, then circumcision would have to be replaced by a mediocrely effective vaccine that possibly causes more deaths and implications than the cancer itself. The sentence does not make any assumptions over the net benefit of an operation but quite clearly only deals with the individual benefit of having a cancer risk reduced by a certain measure: reducing the risk of cancer by pre-emptively removing a potentially afflicted organ.
- Thank you for your hypothesis. Perhaps you could address my point instead? Jakew 22:20, 18 December 2005 (UTC)
- I think the problem that you have agreeing on this is that you would prefer to hide the fact that circumcision is connected to substantial loss of skin and tissue (whatever its function) on the penis. Advocates like to describe circumcision as a very minimal practice that at best removes a few milimeters of skin. The reality is that a large area of skin is removed, and that is just why circumcision does work, why it does have an statistically significant effect on cancer, STD transmission, balanitis etc incidence rates. Naturally, you would prefer to hide this and continue to let people believe that circumcision is a very minimal incision and that all those positive benefits are somehow caused by magic.
- Stating a benefit is straightforward and accurate. I don't think that an analogy is particularly helpful here, but it would make sense to compare it with a hypothetical, fully effective vaccine against testicular cancer. In such a case, there is no potential for confusion between specific and net benefit. Jakew 18:42, 18 December 2005 (UTC)
- As you so eloquently noted earlier, there is a difference between net benefit and individual benefit. We have not yet established the net benefits of circumcision, and we could argue for months about the net benefits of castration. The thing is that stating something like "Circumcision is shown to reduce the chances penile cancer", while technically true, might be misleading to parents or men wishing to inform themselves about circumcision. If it is followed up by a statement like "Castration as a preventative measure against testicular cancer, is much more medically sound (as in, it has a much higher individual benefit of preventing testicular cancer) than circumcision as a preventative measure against penile cancer". We can state that people know that castration in that context simply means the removal of the testes - which everyone will understand is going to reduce the chances of testicular cancer. It is very subtle, explains the method by which circumcision can reduce the chances of penile cancer, and at the same time indicates that testicular cancer is a larger threat than penile cancer. In this circumstances, we are only talking about the individual benefit of preventing the respective cancers, which are significantly increased, regardless of the net benefit (or lack thereof) of either castration or circumcision. And since medically, castration IS much more sound as a means to prevent testicular cancer, than circumcision is as a means to prevent penile cancer. And we do not even have to discuss how much exactly circumcision is damaging or castration beneficial in other respects, because in this case, it is very clear the statement is about the individual benefit of preventing cancers only. You may find it polemic, I find it to the point. I suggest we close the issue on penile cancer with this conclusion (intactivist counter-statement) and choose a new subject. Since I picked the first one (and god, did I pick an easy one) you may feel free to chose the next.
- To determine whether a decision is sound, you have to weigh up both benefits and costs. In other words, you have to discover whether there is a net benefit. In the case of castration, yes, the benefit would be greater, but the cost would be vastly increased, and as you commented yourself, this would "WAY outweigh" the benefit. Hence, the decision would not be sound. Jakew 16:19, 18 December 2005 (UTC)
- On what grounds? You cannot disagree to the facts! Testicular cancer is at least four times more likely to occur than penile cancer. And castration completely eliminates the risk of testicular cancer, whereas circumcision at best reduces the chances somewhat. In addition, while penile cancer mostly affects people over the age of 70, testicular cancer affects 15-40 year olds most likely. Thus, proposing castration as a preventative measure against testicular cancer is medically much more sound than proposing circumcision as a preventative measure against penile cancer.
- You're free to hold that view. I disagree. Jakew 12:15, 18 December 2005 (UTC)
- I understand your reasoning now. In the same spirit, I would like to propose a closing sentence for the argument of penile cancer: proposing circumcision as a means to prevent penile cancer is medically less sound (or sane) than proposing castration as a preventative measure against testicular cancer.
- I was thinking of the most significant problems caused. You are correct to note that other harms exist. The fact that harms exist, however, does not mean that no benefits can exist. I will make the effort to use the terms 'individual benefit' and 'net benefit' in future, to avoid ambiguity. Jakew 22:05, 17 December 2005 (UTC)
- You say routine castration might be beneficial for one generation? I think we have very different opinions on what "beneficial" means! Having the freedom to enjoy oneself sexually, or having the freedom to procreate, does constitute as a benefit in my book that WAY outweighs any benefit castration (except for the context of a cancer treatment) may have!
- Sorry, I assumed you meant it literally. There are obvious problems with both of your examples. Removal of both lungs would dramatically shorten life, rather than prolong, so it would be pointless. Routine castration might be beneficial for one generation (hormonal problems excepted), but would have dire consequences for the species. I think you need to find a more comparable example. Jakew 21:22, 17 December 2005 (UTC)
- Well I was speaking of lobotomy in the sense of "Removing part of the brain" rather than the old school method that goes "Stick an ice pick in your nose and whirl it around a bit". Which is certainly going to lead to some necrosis (death) of the tissue, and may have a similiar effect on cancer rates. Lets make a different example. I can absolutely assure you, castration will reduce your chances for testicular cancer (which has a 1 in 250 chance according to Wikipedia, about 4 times more likely than penile cancer then) to zero, and unlike circumcision, is a reliable preventative measure against testicular cancer. Are you advocating routine castration on infants to reduce their testicular cancer risk? Lung cancer is a lot more common still, causing 4 million deaths world wide each year, and by removal of the lung wings, you should be shown to significantly reduce your lung cancer risk. Do you advocate excision of lungs on all newborns or just on smokers as a preventative measure? They have a problem breathing anyway.
- Since your estimates for lifetime risk are in the same range as my figures, I assume we're in agreement there. Unfortunately, you have not answered my question regarding an 'acceptable' threshold for risk. At what point does elimination of a risk cease to be beneficial? 50 percent risk? 10 percent? 1 percent? 0.1 percent (this being roughly what we're talking about)? 0.01 percent?
- You may have missed the word "Potentially" as well as "implications" which, since death is mentioned explicitely, means non-lethal implications. A circumcision is the (almost) irreparable loss of tissue (whatever its value may be, which we have not yet established). To compare it to a vaccine would simply not be objective. What I can agree on is that the comparison to castration, although medically sound, may not be very objective as it uses castration fear. I would be willing to agree on a sentence like "Suggesting circumcision as a preventive measure to reduce foreskin cancer risk is medically less sound than to recommend removal of both lung wings as a preventive measure to reduce lung cancer risk". You may argue that circumcision is not lethal like the lung removal. 1. There are mechanic lungs. But life quality is certainly decreased. 2. This would just point out the whole absurdity of claiming reduced cancer rates as a benefit of the preventive removal of tissue, and could not be misunderstood. Also you may note I have replaced the word penile cancer with foreskin cancer to further illustrate figuratively, how and why cancer rates are reduced. On a last note, 1950 was the birth rate of males in the UK about 400'000 per year, assuming that every single last one of them was circumcised, 16 deaths per year mean an 1 in 25'000 risk - 20 times more than what you claimed. [11] And still this does not include non-lethal complications. ---- edit: The circumcision rate has been roughly 50% in 1940-1950, making the lethality of the procedure about 1:12500. Also note that the birth rate cited is for the entire UK, while gardner only investigated cases in England and Wales. A more realistic probability may be around 1:10000Dabljuh 01:15, 19 December 2005 (UTC)
- The decreased quality of life is another aspect which makes the analogy poor. The 'absurdity' comes not from a loss of tissue, but from a loss of functional, useful tissue. The fact that you have replaced 'penile' with 'foreskin' actually misrepresents things, because it pretends that there is no preventative effect against cancer elsewhere on the penis.
- Using Gairdner's figures is inappropriate. Gairdner did not specifically address neonatal circumcision, and consequently of the deaths, several ("most") were due to complications of general anaesthesia. Let's look at studies focusing specifically on neonatal circumcision. Wiswell and Geschke reviewed the records of 136,086 boys. 100,157 of these were circumcised. No circumcised boy died, but two uncircumcised boys died of complications of UTIs. They also report that no deaths occur in a larger group of 300,000 boys. Speert reviewed the records of 566,483 circumcised infants, and found one death. Gee and Ansell reviewed the records of 5,521 circumcised infants, and found no deaths. King reported on 500,000 neonatal circumcisions, with no fatalities. Trevino reports that no deaths occurred in 650,000 circumcised boys. Hence, 1 in 500,000 is a reasonable figure. Jakew 11:57, 19 December 2005 (UTC)
- Gairdner's study made the British stop circumcising their kids, just because it turned out to be a 1:10000 risk for death. Lethal complications that were due to anaesthesia and not due to the circumcision itself still mean there is a risk in circumcision. Gairdner made his statistics on circumcisions on under 5 year olds. Newborns exclusively are much more susceptible to anaesthetic mistakes and blood loss, it can thus be expected that circumcision on newborns, using anaesthetics or not, would increase the morbidity logically. The AAP, which I consider a biased, advocating group, reports that there are no good studies on the subject of morbidity of circumcision. Combined with Gairdner established 1:10000 risk of death (and the AAP speaks of a 1:150 to 1:500 risk of complications requiring additional medicinal intervention after the circumcision) I conclude the numbers you are stating are not remotely reliable, and off the true incidence rate by several orders of magnitudes. Personally speaking, I find the carelessness, with which you are throwing all those children's lives away, disgusting.
- It is simply ludicrous to cling to Gairdner's figures while rejecting those from numerous sources as unreliable solely because they differ from rates mixed up with those from dangerous (general) anaesthesia. In essence, you reject these rates because you don't like them. If you're not able to take part in an honest debate, perhaps we'd better stop there. Jakew 17:09, 19 December 2005 (UTC)
- So, what you are saying is that anesthesia increases the lethality of circumcision by a factor of 50!? Or more, considering the appliance of anaethstetics may have been lower than 100%. Lets assess the facts again: Considering the birth and circumcision rate, and the death rate by circumcision in Gairdners report, the lethality of the procedure in children under 5 years is about 1:10000 - purely neonatal circumcision can be expected to have a higher rate of morbidity. To quote Gairdner on the causes: In most of the fatalities which have come to my notice death has occurred for no apparent reason under anaesthesia, but haemorrhage and infection have sometimes proved fatal. The american association of pediatrics reports there are no reliable figures on complications in neonatal circumcision, but that the rate of complications requiring additional medicinal intervention is between 1:150 to 1:500. The Canadian Pediatric society states: Circumcision may lead to complications, which range from minor to severe. They include easily controllable bleeding, amputation of the glans, acute renal failure, life-threatening sepsis and, rarely, death. The evidence of postoperative complications is unknown. The rates of complications reported in several large case series are low, from 0.2% to 0.6%. However, published rates range as widely as 0.06%88 to 55%. Williams and Kapila have suggested that a realistic rate is between 2% and 10%. and continues Therefore, the incidence of complications of circumcision, according to some reports, approaches or exceeds the incidence of UTI among uncircumcised male infants. Although some of the complications are less severe than a UTI, the incidence and cost of complications need to be included in any assessment of the cost-effectiveness of routine circumcision. Now you come along and announce the lethality of the procedure is around 1:500'000. Where do you get those figures? Your ass does not qualify as a respectable source. Your figures are very clearly bogus, and your reluctance to revise them once again shows off your inability to remain an objective view on the subject. Currently I will admit I have problems remaining objective myself, as the thought of thousands of children dying is quite irritating to me. Clearly you have no interest in informing people about the true risks of neonatal circumcision while overemphasizing the medical benefits like a "decreased penile cancer rate". A honest debate? It was me who asked you for one. I was willing to let myself be convinced by your arguments if they would prove to be convincing, but the more I learn about the issue the more I am convinced of my initial opinion. I am disgusted and outraged at your irresponsible and unjustifiable behavior. Dabljuh 19:12, 19 December 2005 (UTC)
- I have already explained where I obtained my figures. This rate is quoted by the AAFP[12] and even Paul Fleiss.[13] Neonatal circumcision is known to have a lower complication rate than circumcision of older males. General anesthesia is known to be hazardous. It should not be surprising that a study that grouped together circumcisions of any male under 5 years of age and using general anaesthesia should give artificially high death rates. Jakew 20:16, 19 December 2005 (UTC)
- You may have noted that the figure of 1:500000 is merely an estimate according to the AAFP, and the (grossly biased) source for this figure does in fact not state any death rate, but instead claims all deaths were due to sepsis (infection) and thus preventable. I can definitely agree on the preventability, of course. Fleiss, arguably a biased intactivist authority, seems to again have failed to read his sources for this figure. One figure is the ridiculously low rate of approximately 1:25,000,000 (4 neonates died of circumcision in the last 45 years.), and the other states Death as a complication from newborn circumcision has been estimated to occur in from 1 in 24,000 to 1 in approximately 500,000.. I repeat the argument of the AAP: "The true incidence of complications after newborn circumcision is unknown". While arguably, the lethality of neonatal circumcision without anaesthesia may be different from the lethality of circumcision in <5 year olds with anaesthesia, in either direction, stating a figure of 1:500000 as a realistic odds ratio, is objectively just wishful thinking from circumcision advocates. A rate of about 1:10000 in 1950 England in anaesthesized under five year olds however is neutral, verifiable, and realistic, plain cold hard fact. Wouldn't you agree that hard numbers are better than estimates? On a sidenote, could you source the claim on the argument that circumcision on neonates has a lower fatality rate than circumcision on older males? And if you could organize some figures on general risk of death and complications of surgery in general (maybe listed by invasiveness) would also help to put things into perspective.Dabljuh 21:27, 19 December 2005 (UTC)
- This figure was not obtained by someone pulling a figure out of the air, Dabljuh, they are based upon actual numbers of deaths in large series of patients. Speert, for example, estimated a rate of 1 in 500,000, because when he examined the records of (slightly over) 500,000 patients, he found that one had actually died. The same is true of Wiswell, King, and Trevino - all factual data. The deaths (and hence the estimates) are no more and no less than Gairdner's - the difference is in the circumstances.
- There are several issues with this: Examining 500'000 records and finding 1 death due to circumcision does not automatically warrant a ratio of 1:500000 - It would be required to examine a much larger sample to find a statistically meaningful odds ratio. Secondly, Gairdner states the most common cause of death was 'death for no apparent reason under general anesthesia'. Which means the heart or the brain apruptly stopped functioning during the circumcision, not that anesthesia has been overdosed. You may argue that this sudden death may not have any causal relationship with the circumcision being performed, but wouldn't that indicate that the same type of death (under anesthesia or not) is not being attributed to the circumcisions in the Wiswell et al analysis? I repeat the AAP statement: "The true incidence of complications after newborn circumcision is unknown". Your figures are all estimates. The figure of an average of 16 dead infants due to circumcision in England 1949 however was hard enough to make the british stop circumcising neonates as a routine procedure. To put things in perspective, the American Society of Astaethic Plastic Surgery found that The rate of serious complications was less than half of 1 percent. and The mortality rate was extremely low – only one in 57,000 cases. [14]. And these are plastic surgeries done on healthy adults, not newborns. I must ask you to reconsider your view objectively and neutral for once.
- You are correct - you would indeed require a larger sample to be able to accurately predict such a rate. All you can do is find a reasonable estimate of a ceiling. Concerning your question about cause of death, most of these authors (I haven't read Speert in full) recorded deaths for any reason, so if anything they would overestimate deaths due to circumcision.
- Obviously the true complication rate is unknown, since nobody agrees on what, precisely, is a complication, and furthermore some are not recorded. There is, however, a legal requirement that deaths are reported, so it is reasonable to expect to see a clearer picture.
- There may be several factors that make this scenario unlikely, given that there is no reliable data on complications and lethality in the US.
- True, but deaths are recorded, even if the cause is not guaranteed to be. Thus, given a large sample of infant boys who were known to be circumcised, it is possible to know whether they died or not. This gives an upper bound for the death rate due to circumcision. Jakew 23:42, 19 December 2005 (UTC)
- There may be several factors that make this scenario unlikely, given that there is no reliable data on complications and lethality in the US.
- Given the fact that this is an extremely common procedure, that it is semi-automated with bloodless clamps, and that general anaesthesia is not used, it would be reasonable to expect a significantly lower mortality rate than cosmetic surgery in general.
- Not necessarily. Adults can be checked for weeks and months prior to the operation, and will generally tolerate blood loss and anesthesia better, simply due to increased mass and due to the lack of birth stress.
- Lastly, the influence of Gairdner's paper is unknown. It came along at the same time as the formation of the notoriously cash-strapped NHS. It is unreasonable to suppose that a major change in funding model would not affect non-essential surgeries, and so your confident assertion that his data was 'hard enough' to cause the change is questionable at best. Jakew 22:52, 19 December 2005 (UTC)
- IIRC, The NHS was formed in 1948, and before its formation, the parents generally paid for the infant's circumcision themselves. It originally was part of the NHS' service but as a result of gairdners study (data from 1941 to 1947) was removed from the services catalogue 1950. It is not unreasonable to believe that Gairdners paper, even if most parents didn't read it, it may have influenced british doctors to generally avoid recommending unnecessary circumcision on newborns.
- Certainly it may have influenced doctors, but it is unlikely that it was the sole cause of any change. Jakew 23:42, 19 December 2005 (UTC)
- IIRC, The NHS was formed in 1948, and before its formation, the parents generally paid for the infant's circumcision themselves. It originally was part of the NHS' service but as a result of gairdners study (data from 1941 to 1947) was removed from the services catalogue 1950. It is not unreasonable to believe that Gairdners paper, even if most parents didn't read it, it may have influenced british doctors to generally avoid recommending unnecessary circumcision on newborns.
- There are several issues with this: Examining 500'000 records and finding 1 death due to circumcision does not automatically warrant a ratio of 1:500000 - It would be required to examine a much larger sample to find a statistically meaningful odds ratio. Secondly, Gairdner states the most common cause of death was 'death for no apparent reason under general anesthesia'. Which means the heart or the brain apruptly stopped functioning during the circumcision, not that anesthesia has been overdosed. You may argue that this sudden death may not have any causal relationship with the circumcision being performed, but wouldn't that indicate that the same type of death (under anesthesia or not) is not being attributed to the circumcisions in the Wiswell et al analysis? I repeat the AAP statement: "The true incidence of complications after newborn circumcision is unknown". Your figures are all estimates. The figure of an average of 16 dead infants due to circumcision in England 1949 however was hard enough to make the british stop circumcising neonates as a routine procedure. To put things in perspective, the American Society of Astaethic Plastic Surgery found that The rate of serious complications was less than half of 1 percent. and The mortality rate was extremely low – only one in 57,000 cases. [14]. And these are plastic surgeries done on healthy adults, not newborns. I must ask you to reconsider your view objectively and neutral for once.
- Several authors have investigated complications in neonatal circumcision vs later. For example, see: Horowitz M, Gershbein AB. Gomco circumcision: When is it safe? J Pediatr Surg. 2001 Jul;36(7):1047-9 and Wiswell TE, Tencer HL, Welch CA, Chamberlain JL. Circumcision in children beyond the neonatal period. Pediatrics. 1993 Dec;92(6):791-3.
- These reports are mostly anectdotal and neither are statistically meaningful.
- Will you please take the time to read the evidence I offer before dismissing it? Had you done so, you would realise that they are not anecdotal, but are based upon empirical, statistical evidence. Jakew 22:52, 19 December 2005 (UTC)
- I have indeed read the reports. One is a single doctor, performing about 100 circumcisions on newborns, and about 50 on older children, and notes a 0% complication rate with the newborns and a higher than that complication rate on the older children. The other is analysis of the medical records of about 500 individual children whose medical records "happened" to be available. Neither are statistically meaningful whatsoever.
- You have a strange idea of what is meant by statistically meaningful. Jakew 23:42, 19 December 2005 (UTC)
- I have indeed read the reports. One is a single doctor, performing about 100 circumcisions on newborns, and about 50 on older children, and notes a 0% complication rate with the newborns and a higher than that complication rate on the older children. The other is analysis of the medical records of about 500 individual children whose medical records "happened" to be available. Neither are statistically meaningful whatsoever.
- Will you please take the time to read the evidence I offer before dismissing it? Had you done so, you would realise that they are not anecdotal, but are based upon empirical, statistical evidence. Jakew 22:52, 19 December 2005 (UTC)
- These reports are mostly anectdotal and neither are statistically meaningful.
- This figure was not obtained by someone pulling a figure out of the air, Dabljuh, they are based upon actual numbers of deaths in large series of patients. Speert, for example, estimated a rate of 1 in 500,000, because when he examined the records of (slightly over) 500,000 patients, he found that one had actually died. The same is true of Wiswell, King, and Trevino - all factual data. The deaths (and hence the estimates) are no more and no less than Gairdner's - the difference is in the circumstances.
- You may have noted that the figure of 1:500000 is merely an estimate according to the AAFP, and the (grossly biased) source for this figure does in fact not state any death rate, but instead claims all deaths were due to sepsis (infection) and thus preventable. I can definitely agree on the preventability, of course. Fleiss, arguably a biased intactivist authority, seems to again have failed to read his sources for this figure. One figure is the ridiculously low rate of approximately 1:25,000,000 (4 neonates died of circumcision in the last 45 years.), and the other states Death as a complication from newborn circumcision has been estimated to occur in from 1 in 24,000 to 1 in approximately 500,000.. I repeat the argument of the AAP: "The true incidence of complications after newborn circumcision is unknown". While arguably, the lethality of neonatal circumcision without anaesthesia may be different from the lethality of circumcision in <5 year olds with anaesthesia, in either direction, stating a figure of 1:500000 as a realistic odds ratio, is objectively just wishful thinking from circumcision advocates. A rate of about 1:10000 in 1950 England in anaesthesized under five year olds however is neutral, verifiable, and realistic, plain cold hard fact. Wouldn't you agree that hard numbers are better than estimates? On a sidenote, could you source the claim on the argument that circumcision on neonates has a lower fatality rate than circumcision on older males? And if you could organize some figures on general risk of death and complications of surgery in general (maybe listed by invasiveness) would also help to put things into perspective.Dabljuh 21:27, 19 December 2005 (UTC)
- It is simply ludicrous to cling to Gairdner's figures while rejecting those from numerous sources as unreliable solely because they differ from rates mixed up with those from dangerous (general) anaesthesia. In essence, you reject these rates because you don't like them. If you're not able to take part in an honest debate, perhaps we'd better stop there. Jakew 17:09, 19 December 2005 (UTC)
- Finally, your speculative argument that some future discovery of an unspecified harm of circumcision is weak at best. Jakew 18:31, 17 December 2005 (UTC)
- Gairdner's study made the British stop circumcising their kids, just because it turned out to be a 1:10000 risk for death. Lethal complications that were due to anaesthesia and not due to the circumcision itself still mean there is a risk in circumcision. Gairdner made his statistics on circumcisions on under 5 year olds. Newborns exclusively are much more susceptible to anaesthetic mistakes and blood loss, it can thus be expected that circumcision on newborns, using anaesthetics or not, would increase the morbidity logically. The AAP, which I consider a biased, advocating group, reports that there are no good studies on the subject of morbidity of circumcision. Combined with Gairdner established 1:10000 risk of death (and the AAP speaks of a 1:150 to 1:500 risk of complications requiring additional medicinal intervention after the circumcision) I conclude the numbers you are stating are not remotely reliable, and off the true incidence rate by several orders of magnitudes. Personally speaking, I find the carelessness, with which you are throwing all those children's lives away, disgusting.
- I have three comments. Firstly, you describe penile cancer as 'exceedingly rare'. The true rate is between 1 in 1,400 and 1 in 600. Whether this is extremely rare or not is a matter of opinion, but I would like to ask at what point is something rare enough to be ignored? Secondly, you say that it is 'easily treated'. Available information indicates that about 25% (depending upon the source) of sufferers do not survive for 5 years, and those that do often have to endure penectomy. Thus, your description is arguably misleading. Lastly, your comparison with lobotomy is faulty. To my knowledge, there is no evidence that it would in fact reduce brain cancer rates, but if I overlook that for the sake of argument, your comparison depends upon an implicit weighing of risk and benefit. It is only because of the known ill effects of lobotomy that the proposition seems so ridiculous. Jakew 15:25, 17 December 2005 (UTC)
- From an ethical point of view using cancer of the penis as a justification for cutting off a boy's foreskin is equivalent to using cancer of the vulva as a justification for cutting off a girl's labia. More than twice as many women in the USA die each year from cancer of the vulva than men die from cancer of the penis. -- DanBlackham 07:48, 19 December 2005 (UTC)
- What evidence is there that doing so would be effective, Dan? Jakew 11:57, 19 December 2005 (UTC)
- If you cut off a girl's labia, she will never have cancer of the labia. -- DanBlackham 14:21, 19 December 2005 (UTC)
- True, but you said cancer of the vulva. Jakew 14:58, 19 December 2005 (UTC)
- The vulva is the external, visible part of the female genital organs, my gay friend, and the labia are directly part of it. The more you cut off of the vulva, the more decreased are the chances for a cancer to develop on the vulva as a whole. This is rational and a valid argument, and directly compares to the reduced penile cancer rates due to circumcision.
- True, but you said cancer of the vulva. Jakew 14:58, 19 December 2005 (UTC)
- If you cut off a girl's labia, she will never have cancer of the labia. -- DanBlackham 14:21, 19 December 2005 (UTC)
- What evidence is there that doing so would be effective, Dan? Jakew 11:57, 19 December 2005 (UTC)
[edit] Risks of Infant Circumcision
- Intactivists: Gairdner's study of circumcisions in the 1940's would imply a mortality rate of the procedure around 1:10'000, when performed on <5 year olds with anaesthetics. The most common cause was "for no apparent reason", followed by bleeding to death. No good data on the rate of complications requiring additional medicinal attention in the US is available, estimates range from 0.06% to 55%, but the canadian pedriatic society [15] suggests that a complication rate of 2-10% is most likely. Complications may include but are not limited to: easily controllable bleeding, amputation of the glans, acute renal failure, life-threatening sepsis and, rarely, death.
- Are you going to move the relevant section of the above debate in here, then? I really don't see the point in repetition. I really don't see the point in repetition. ;) Jakew 00:11, 20 December 2005 (UTC)
- We have already established many things in the first debate. For better organization, and to avoid all too painful bulleting, I recommend we start a new section for this. I have taken the liberty of adding two more sections for future use. It is a goal (for me at least) to make this debate not just productive and fruitful, but also readable. I hope we can work out a consensus on each issue, if we encounter a sub-issue that we cannot work out otherwise, I recommend we establish the policy of dedicating them their own section. If you agree, you may move these two 'out of character' bullets somewhere else, maybe to the rules section, and make a (convincing) counter argument. Or, feel free to add an initial STD or Foreskin argument, otherwise I may do so in time. Dabljuh 00:25, 20 December 2005 (UTC)
- Are you going to move the relevant section of the above debate in here, then? I really don't see the point in repetition. I really don't see the point in repetition. ;) Jakew 00:11, 20 December 2005 (UTC)
- The issue I'm having is that you (and other advocates) are carelessly using numbers on complication and death rates that are just quite demonstrably devoid of any relation with reality. You should have double-checked those figures, been objective and sceptical, you must not carelessly play a numbers game with children's lifes without at least double checking them. Doing so is just evidence of an appalling bias, and the recommendation of circumcision based on this careless risk assessment is... I cannot find the words. I hope I have made myself clear, I want to apologize for my emotional outbreak earlier, I try to collaberate with you in a civil, yet hot debate, but learning things like this just break my heart. Dabljuh 04:57, 20 December 2005 (UTC)
Okay, um, I'm new to Wikipedia but I'm not sure how to edit this or where you get your names and all. Excuse me if this is in the wrong place.
I'm against circumcision of infants. It is a tradition here to circumcise children at the age of 13 - since I grew up amongst Europeans (I was lucky enough to be born among a well off family and many of my friends came from Europe and were uncircumcised), naturally when the time came I was opposed to it. But it was still done, without my permission. I even talked to my guidance councelor at school, and she said my parents knew what was best for me.
First off - I had no medical condition requiring circumcision. My foreskin was perfectly fine. I have never had a Urinary Tract Infection. It was done because it was a tradition. Not for anything about health.
After the circumcision, I noticed a distinct drop in sensitivity (Most of my frenulem was removed, aswell). Since then, my glans have also...kind of, dried up? I don't know how to describe it, but they're not as sensitive as before. I'm 15 now - if my penis was more sensitive when I was 13 something is definitly wrong. I can't even believe what was done was legal, either. I mean, it's my body, not theirs, right?
From my own research, I seem to remember that the foreskin contains special nerves of some sort, which are more sensitive than the regular nerves on the shaft of the penis? From my own experience I know this is correct at least in some for, therefore there has to be at least some (if not a substantial) reduction in sensitivity.
Onto the benefits thing. I thought condoms already reduced the chances of HIV to like, 5% or something? And if your partner doesn't have HIV you won't get it either. And a Urinary Tract Infection isn't going to kill you (I don't think), and Penile Cancer, if it is indeed as uncommon as it is, doesn't seem to be a problem. Actually, using circumcision as a preventive measure when there isn't cancer doesn't really make sense to me. Wouldn't that be like cutting of the breasts of a female to stop her from getting Breast Cancer? Or, DanBlackham's example about the labia.
I ask that you take my post seriously, disregarding my age.
Sincerely, Michael
