Both the CDC and the WHO have produced recommendations for circumcision. While there isn’t enough information to create a full plan of action, recommending universal circumcision, the science is fairly solid when it comes to counting the claims of anti-circs. I use that term because in many cases, the kind of science denial seen among anti-cutters is no better than that seen among anti-vaxxers. And because of the degree of science denial, and other political issues, I’ve decided to finally write a public health article on the topic.
Why do we know that circumcision is useful? While there’s no absolute in science, there are degrees of justification. The weakest form of justification is personal experience, while the gold standard of scientific research is the double-blind, randomized, placebo-controlled trial. But such trials aren’t always possible. Moreover, in many ways there’s a higher standard. Call it the “platinum standard” if you will: in order to look at efficacy and safety of a treatment, when possible, a systematic review of all available literature should be conducted. This study is essentially a way to test the theory of whether or not there’s enough scientific information to justify a position on a research question. It is a comprehensive, and hopefully largely unbiased analysis of the entire state of the field.
Such a study has been conducted for male circumcision. Two studies of note are Singh-Grewal et al. 2005 and Morris et al. 2017. the researchers found justification for significant efficacy and limited side effects. The first paper looked only at urinary tract infections. Using a simple assumption of equal utility of benefit from treatment and harm from complication, the paper’s findings suggest that circumcision would best be limited to those at high risk of UTI, but indeed that in that sub-population, a significant benefit exists.
Morris et al. takes a broader look at the issue. The 140 journal articles that were analyzed in their systematic review indicated both immediate and long term benefits through the prevention of UTIs, phimosis, diseases caused by poor hygeine, and various STIs. The study looked at the impact of STIs among both sexes, and indicated that females too benefit from male circumcision, through the reduction in transmission of STIs. The study also conducted a risk vs benefit analysis and indicated high benefit and low risk.
One argument against the second paper is that it was written by Morris, who is a vocal supporter of circumcision. But this argument is a genetic fallacy. A paper stands on its own, regardless of who wrote it. What matters is if there is any evidence that the method of the paper itself is flawed. If we are to reject the findings of the study, simply because it was written by a staunch supporter of circumcision, then we should reject pretty much every climate change study and vaccine study, as the authors in these cases are very often associated with organizations that promote various policies related to the two. Indeed, one of the main arguments, used by anti-vaxxers, against a lot of the findings in studies is that the studies were conducted by vaccine supporters, or by or on behalf of the pharmaceutical industry or health organizations that strongly support vaccines.
From an anthropological point of view, it also doesn’t make sense that circumcision would have a net harmful effect, at least not on overall population heath and evolutionary fitness. I’ve pointed out why this condition holds, in some of my other anthropology articles. Natural selection occurs on both the biological and cultural levels. A cultural phenomenon which negatively affects the overall evolutionary fitness of a population in which it exists, tends to die out over time.
A practice which has persisted for 4,000 years is therefore unlikely to have a net negative socioeconomic effect. Indeed, while from the perspective of the people who practiced circumcision, the reason for doing it was because “god said so,” the anthropologist would say that it’s likely that groups that began the practice outperformed those who did not, and thus the practice survived and spread.
American isn’t comparable to Europe. But that won’t stop a lot of people from using the argument that Europe, with its relatively low circumcision rate, also has a relatively low rate of HIV and some other sexually transmitted diseases. The problem with making a direct comparison between these two regions is that they are simply too dissimilar. There are so many other variables that efficacy of the treatment doesn’t necessarily override other factors. For instance, the United States has poor sex education. The war on drugs and refusal to decriminalize drugs also leads to a lot of needle sharing, which spreads HIV and other STIs. Moreover, England has been transitioning to acceptance of homosexuality for a longer period of time than the United States, which allows for better treatment of HIV transmitted through homosexual activities.
Bodily autonomy is another topic of interest for this discussion. I have to admit that bodily autonomy is one of the most basic rights that we have, so violating or circumventing it should be done with caution. We need to look at a number of factors, including net benefit of the treatment, and impact on one’s life going forward. MC seems to have a limited negative impact on quality of life, with a significant benefit to personal and public health. And the argument that bodily autonomy should only be violated, when there is an immediate medical need to treat a current medical issue, also constitutes an argument against childhood vaccination. I’m honestly still a little unsure of how well I can accept any violation of bodily autonomy, but I can at least say that the argument against MC generally constitutes an argument against childhood vaccination as well. And it most certainly constitutes an argument against mandatory vaccination.
Female circumcision, often known as FGM, is the final topic that I’d like to address, as it’s often used as a straw man in my discussions on MC. It might be argued that if my argument holds for MC, it should hold for FC. And maybe it does. If systematic review of scientific literature shows limited negative impact on quality of life, with significant positive impact on personal and public health then it might be possible to argue that FC should be recommended. But FC is far less studied. A couple of studies, most of which are over a decade old, are all we have. Compare that data set to the literally hundreds of studies and multiple systematic reviews on the safety and efficacy of MC.