Debunking David Pakman: "Male Circumcision Is Beneficial!"

 

Thumbnail photos: Angelo Esslinger (whitesession)/Pixabay; Clker-Free-Vector-Images/Pixabay; joffi/Pixabay;

 

Advocates of male circumcision use several key arguments to justify performing this procedure on infants and young children. David Pakman, in particular, is a particularly forceful advocate of circumcision, and while I tend to agree with him on probably 95% of issues, this is one area where I think he gets it completely wrong. It's like the reverse of that common expression, where in this case, even a not broken clock is wrong twice a day.

The argument that circumcision is justified by its medical benefits does not stand up to scrutiny. The commonly-cited CDC and AAP reports are deeply flawed, and the international medical community largely disagrees with their conclusions. The medical conditions pointed to can be treated or prevented by much simpler, more effective and more ethical means. And most of these conditions are only experienced in adulthood—so it doesn't make sense to use them to justify infant circumcision.

UTIs can be treated by antibiotics; HPV can be vaccinated against; and all the other STDs can be avoided by practicing safe sex. Penis cancer is also extremely rare, and the number of complications arising from circumcision far outweigh the number of penile cancer cases that circumcision could prevent. Circumcision can cause horrendous and even deadly complications—and the very worst complications were actually excluded from the cost-benefit analysis that the CDC and AAP performed.

The hygiene argument is ridiculous because cleaning underneath the foreskin is an extremely minor inconvenience, and the alleged aesthetic superiority of a circumcised penis is nothing more than a personal preference. It should left up to the individual to decide, when he's old enough, whether or not he'd prefer to have a mutilated penis. To permanently amputate part of your child's genitals when they're too young to resist is deeply immoral, disrespects their bodily autonomy, and ultimately disagrees with the decision that many of them would've made for themselves.

In a 2012 video of his, David Pakman argued the following:

 

"A pediatricians group, the American Academy of Pediatrics, has announced its first major shift on circumcision in more than a decade, deciding that boys flat-out are better off circumcized than not, and that the benefits clearly outweigh the risks."

 

And in another video, he cites a CDC draft report which reached a similar conclusion:

 

"US health officials yesterday released a draft of long-awaited federal guidelines on circumcision, and the Center For Disease Control And Prevention has come out and said the benefits of male circumcision outweigh the risks. And they went on to say that this is a personal decision that may involve religious or cultural preferences, but that 'the scientific evidence is clear that the benefits outweigh the risks.'

. . . The basis for these guidelines from the CDC, why they've determined that the benefits outweigh the risks, but leave the decision to individual parents, are that circumcision cuts a man's risk of getting HIV from an infected female partner by 50 to 60%, reduces the risk of genital herpes and certain strains of HPV by 30% or more, and lowers the risk of urinary tract infections during infancy and cancer of the penis in adulthood."

 

Clearly I'm not alone in disagreeing with his position here. One of the top comments on this video says:

 

"Looks like the like bar got circumcised."

 

Ouch.

The first thing I would say in response to this is that the international medical community largely disagrees with these American organizations on circumcision. As Svoboda & Van Howe write in a 2013 Journal Of Medical Ethics publication,

 

"The Finnish Union of Medical Doctors is opposed to non-medical circumcision on the grounds that it involves risks, inflicts pain and injury, and violates the child's right to decide about his body, and the Royal Dutch Medical Association (KNMG) has gone so far as to discourage its membership from participating in the procedure as it carries risks without countervailing benefits. The Swedish Paediatric Society has called infant male circumcision an 'assault on boys.' . . . the German [Association Of Pediatricians -- BVKJ] also strongly opposes the procedure."

 

And as Robert Darby points out in a Kennedy Institute Of Ethics Journal paper, other child health organizations that oppose male circumcision include the British Medical Association and The Royal Australasian College Of Physicians.

Where are the videos of David reporting on the positions of these medical organizations? I haven't seem them. Instead what I see is a completely one-sided presentation, where only the findings that support his viewpoints are reported to his audience, whereas those that reject his views on circumcision do not receive the same attention. This is no way to reach a rational conclusion about the subject and it's no way to properly inform your audience.

And if you look into the specific medical claims made by the CDC and AAP about circumcision, you find that they've been widely criticized in the scientific literature. Not only that, but there are many additional flaws and omissions in their analysis that—if corrected—would radically alter their conclusions. Let's go through claim-by-claim and explore what they got wrong here.

One alleged medical benefit of circumcision that Pakman points to is protection against penile cancer. As the AAP writes in their report,

 

"2 case-control studies . . . show an association between circumcision and a decreased likelihood of invasive penile cancer."

 

When you take a closer look at their numbers, however, you find that it's very hard to justify infant circumcision on these grounds. As they continue,

 

". . . It is difficult to establish how many male circumcisions it would take to prevent a case of penile cancer, and at what cost economically and physically. One study with good evidence estimates that based on having to do 909 circumcisions to prevent 1 penile cancer event, 2 complications would be expected for every penile cancer event avoided.

However, another study with fair evidence estimates that more than 322,000 newborn circumcisions are required to prevent 1 penile cancer event per year. This would translate into 644 complications per cancer event, by using the most favorable rate of complications, including rare but significant complications"

 

So even according to their own numbers, it would take anywhere from 900 to 322,000 circumcisions to prevent a single case of penile cancer—and for every 1 case of penile cancer prevented, there'd be anywhere from 2 to 644 complications from those circumcisions!

And this is the number arrived at by using a very low complication rate of 0.2%. Peter Adler points out in a paper of his that a number of at least 1.5% or 2% is much more realistic.

 

"The CDC claims a complication rate of 0.2%, but this is deceptive as the CDC is only referring to risks during the surgery. The CDC states that the median complication rate during and after the surgery is 1.5%; European physicians put the complication rate at 2%; others call 2% to 10% a reasonable estimate; but severe meatal stenosis was found in 20% of boys 5-10 years after circumcision in the neonatal period, often requiring surgical correction. The CDC did not disclose this."

 

Using a complication rate of 1.5 and 2%, for every 1 instance of penile cancer prevented, we'd see between 4800 and 6400 complications arising from circumcision. Even if all we do is look at this from a purely medical, cost-benefit analysis standpoint, these numbers do not at all indicate to me the value of circumcision as a preventative measure.

Here's something else to take into consideration. As Morten Frisch et al put it in a 2013 Pediatrics publication,

 

"Penile cancer is one of the rarest forms of cancer in the Western world (∼1 case in 100,000 men per year), almost always occurring at a later age. When diagnosed early, the disease generally has a good survival rate."

 

It doesn't make much sense to me to use a medical condition that almost always occurs at a later age as a justification for circumcizing infants who won't be at risk of contracting this cancer until well into their adult life. Why not allow men, when they're old enough to decide, to make up their own minds about having their foreskin removed, if the vast majority of them at this age will still be able to receive the protective benefits of circumcision against penile cancer given its typical age of onset?

Other data seems to raise doubts about whether or not circumcision even protects against penile cancer. As Frisch et al continue,

 

"It is remarkable that incidence rates of penile cancer in the United States, where ~75% of the non-Jewish, non-Muslim male population is circumcised, are similar to rates in northern Europe, where ≤10% of the male population is circumcised."

 

Now of course, you might say that penile cancer rates in the United States are higher relative to circumcision rates because of other factors—like an unhealthier diet, more obesity and so forth.

I'd be willing to grant that circumcision might indeed reduce one's risk of developing cancer of the penis. If you're removing a significant portion of the penis's skin, it logically follows that there are fewer cells in that area at risk of becoming cancerous. Call me crazy, but I don't think that prophylactically amputating part of the body in all infants is a rational cancer-reduction technique.

I mean we could take this to an extreme and say, chopping your arms off would completely eliminate your risk of getting cancer of the arms. You might think that's a ridiculous analogy, so let's come up with a more serious one: we chop your legs off instead.

No, let's say we started cutting off the pinky fingers of infants. That would probably reduce their risk of contracting cancer of the hand while still leaving their hand functional. Instead of five fingers at risk of becoming cancerous, they would only have four fingers at such risk—and presto!, just like that, we've reduced cancer rates of the hand. Narrowly focusing only on the question of cancer-incidence here is to overlook the much bigger and more obvious question of whether such unconsenting amputation is ethical in the first place—which I would argue, it plainly is not.

Another medical benefit of circumcision that Pakman points to is a reduced risk of urinary tract infections during infancy. Here's what the AAP reports on the subject:

 

"There is fair evidence from 5 observational studies that UTI incidence among boys under age 2 years is reduced in circumcised infant boys, compared with uncircumcised boys . . . The degree of reduction is between threefold and 10-fold in all studies.

. . . There is a biologically plausible explanation for the relationship between an intact foreskin and an increased association of UTI during infancy. Increased periurethral bacterial colonization may be a risk factor for UTI."

 

The first thing to point out is that there's a very simple treatment for urinary tract infections that doesn't involve cutting off part of your penis, and that's antibiotics. As Peter Adler writes,

 

". . . since urinary tract infections in infants can be treated with antibiotics, there is no reason to circumcise any boy to prevent a UTI, let alone 100 boys to prevent one UTI at the risk of 2 or more complications."

 

Especially embarrassing for the circumcision advocate is looking at this issue from a financial perspective, which Svoboda & Van Howe do in their paper:

 

"If 195 circumcisions are needed to prevent one urinary tract infection, and the cost of circumcision is US$200, then US$39,000 will be spent to prevent one urinary tract infection. The cost to diagnose a urinary tract infection is about US$200, and the cost of treatment via antibiotics is about US$18. Already, the senselessness of the pre-emptive surgical course is clear.

But what about the costs related to harm and complications? The cost of a meatotomy (a corrective procedure in which meatal stenosis, or circumcision-induced constriction of the urethral opening, is repaired) is between US$1000 and US$1500. With one case of meatal stenosis occurring as a result of every 5–20 circumcisions performed, the cost of this corrective surgery in a population of 195 males would be between US$9,750 and US$58,500. So, between US$48,750 and US$97,500 would have to be spent to save approximately US$218. Either through incompetence or design, the AAP fails to make these straightforward calculations."

 

That is a pretty damning analysis right there. It seems to me, from these numbers, that we'd be able to save far more lives if we took just a fraction of the money spent on circumcisions and re-invested it more wisely into our healthcare system.

Next we have the data showing that circumcised men are less likely to become infected by several STDs. Citing that AAP report, David says the following:

 

"Also circumcised males, less likely to get infected with a long list of STDs over the course of their life."

 

Svoboda & Van Howe point out that some of this research isn't nearly as clear-cut as the AAP makes it out to be:

 

". . . an association [is] shown in some studies between human papillomavirus (HPV) infection and circumcision status. Embarrassingly, the findings in these highly publicised studies can be completely attributed to sampling bias and lead-time bias. Studies of HPV that have used proper sampling techniques have failed to find an association between these infections and circumcision.

If the AAP had evaluated these trials properly, rather than repeat their results without exploring them for fatal flaws, it would have reached a different conclusion. Of course, if it had bothered to mention the existence of an effective HPV vaccine anywhere in their technical report, it could have skipped the circumcision-prevents-HPV discussion altogether.

The AAP’s discussion of syphilis is likewise myopic. While it notes that the prevalence of syphilis, primarily in Africa, has been found to be lower in circumcised men, they fail to note that two of the African randomised trials found the incidence of syphilis to trend higher in the men randomised to early circumcision. Consequently, the evidence is conflicting.

Likewise, if the AAP had systematically reviewed the medical literature, as it claims to have done, it would have discovered that circumcised males have a significantly greater prevalence of having a sexually transmitted infection in general . . . There is no excuse for this lack of scholastic rigor."

 

Their analysis about HIV transmission also appears to be flawed. Here's the claim that's made in the CDC report:

 

"Male circumcision can dramatically reduce a man's risk of acquiring HIV infection by 50 to 60 percent during sex with HIV infected female partners."

 

Sounds pretty compelling, right? I about circumcised myself when I read this!

One major drawback in this analysis is that these statistics are largely based upon studies conducted in sub-Saharan Africa on adult men. There's very little medical basis for extrapolating these results to the circumcising of infantsin the United States—where the prevalence of HIV as well as the common transmission mechanisms are completely different. As Frisch et al put it:

 

"Three RCTs in Kenya, Uganda, and South Africa suggest that circumcision in adulthood may lead to a noticeable reduction in risk of heterosexual HIV acquisition in areas with extremely high HIV prevalence.

. . . However, there is no evidence that circumcision, whether in infancy, childhood, or adulthood, is effective in preventing heterosexual transmission in countries where HIV prevalence is much lower and routes of transmission are different, such as Europe and the United States. Sexually transmitted HIV infections in the West occur predominantly among men who have sex with men, and there is no evidence that circumcision offers any protection against HIV acquisition in this group."

 

Svoboda & Van Howe elaborate on this point:

 

"The epidemiological differences are in fact vast; in Africa, one of the 'best' places to become infected with HIV is at a health clinic through iatrogenic exposure, whereas in the developed world, HIV is primarily transmitted by injecting drug users and by gay men. The dramatic differences between the African and American medical and epidemiological settings could hardly be more stark."

 

There's another glaring problem with using the reduced risk of contracting STDs to justify infant circumcision, and that's there's exactly zero newborn infants having sex without condoms.

Even if it was the case that circumcision had all of these protective effects against sexually transmitted diseases, the only people at risk of contracting these STDs are people who are sexually active—and thus old enough to be capable of deciding for themselves whether they want to be circumcised or not.

The average American male loses his virginity at the age of 17 years old—and if you're an A Skeptical Human viewer, it's probably more like 28. I'm joking...you're probably all a bunch of virgins. "Hey, you know what, man? Go fuck yourself." Yeah, unfortunately that's the plan!

So if the average American man first has sex at 17 years old, and circumcision only offers these protective effects against STDs when a man is old enough to be having sex, why not allow men to make up their own mind about whether or not they want to be circumcised? What's the rush?

It's like someone says, "Holy shit! There's gonna be a hurricane that hits 17 years from now. We need to start boarding up windows and stockpiling food today." No, actually, we really don't.

There's another major reason that this argument fails to justify child circumcision, and that's that there are other, much more effective ways to protect against STDs that don't involve amputating parts of the penis. Frisch et al write the following on this point:

 

"The African findings are also not in line with the fact that the United States combines a high prevalence of STDs and HIV infections with a high percentage of routine circumcisions. The situation in most European countries is precisely the reverse: low circumcision rates combined with low HIV and STD rates.

Therefore, other factors seem to play a more important role in the spread of HIV than circumcision status. This finding also suggests that there are alternative, less intrusive, and more effective ways of preventing HIV than circumcision, such as consistent use of condoms, safe-sex programs, easy access to antiretroviral drugs, and clean needle programs."

 

Circumcision reduces the likelihood of contracting certain STDs? That's interesting. Have you ever heard of these things called "condoms" before? They do the same thing, except they're dramatically more effective. How about people just educate their children about the danger of STDs and the importance of practicing safe sex?

"Hmm, should I teach them about condoms, or should I cut off part of their penis when they're a baby? That is a tough one right there!" I don't know what to call this, but I certainly wouldn't call it good parenting.

There's a comment on one of David's circumcision videos that says:

 

"Oh Americans... Cutting into their kids' genitals to lower their bareback-risks."

 

Seriously, dude. STD prevention is not rocket science. If you want to avoid STDs, there's a very simple way to do so: wear condoms; carefully choose your partners; get tested regularly and insist that your partners do the same. Even better, be a loser like me who gets laid like every 39 years. Fuckin' foolproof!

"Ooh, another self-deprecating joke, Anton. Good one!"

No, if I'm being completely honest, women can't keep their hands off me—and that's usually 'cause they're pushing me away and saying "Get away from me, you pervert!"

And I have to underscore the point that implementing these safe sex precautions provides you with a virtual guarantee of never getting STDs, whereas all circumcision does is slightly reduce your risk of contracting some STDs. Circumcised men still get STDs all the time—and according to some data, they even get them at higher rates than uncircumcised men.

This is one of several reasons why the comparison between infant circumcision and vaccination is hilariously invalid. Here's an example of David making this analogy in a video of his:

 

"And this is what gets us into the argument #2, which is, David, the children don't get the chance to decide. The parents are making a decision for them, and it's a decision that is not reversible. Well, if you're making that argument about circumcision, why aren't you making that argument about all other medical decisions that are not reversible that parents make about kids, at the top of the list being vaccines? There is huge controversy over vaccination, you can't undo the fact that you vaccinated your child. As they age, they could decide they want no more vaccines, but we don't see that parallel drawn!

And this idea that it's OK for parents to make other medical decisions, which have an impact which can not be reversed, but this one decision on which there is medical data, it's not OK for parents to make for kids."

 

What an incredibly silly comparison this is. For one, vaccination actually effectively and consistently protects people against illnesses; all circumcision appears to do is slightly reduce your risk of contracting these illnesses. It's not like, you get the polio vaccine, and your chances of getting polio only drop by 20% or something; no, something like 85% to 95% of people who get the polio vaccine are at zero risk of ever getting polio even if they get a job working at the polio factory.

Here's another reason why the vaccine comparison is absurd: vaccines don't permanently and irreversibly deform a key part of your body. You just get a little injection from a needle, they put a Spongebob band-aid over it, and it's completely healed in three days. Maybe if vaccines permanently deformed your ballsack or something, then we'd begin to approach a serious analogy.

A third flaw in this analogy is that there is no condom analog to vaccines. Let's make this an accurate analogy and see where it gets us. Let's say that vaccinations permanently deformed a person's genitals in some way, and rather than completely protecting about 90% of people against illnesses, they only slightly reduced their risk of contracting these illnesses.

If this was the only known medical method of reducing the spread and contraction of this illness, perhaps we could have a real conversation about whether it's justified from a cost-benefit perspective. But not only is there an alternative treatment method that doesn't permanently deform their genitals, but this alternative method is dramatically more effective at protecting against the illness! Who in their right mind, under such circumstances, would still argue that we should provide infants with this penis-deforming vaccine despite its lack of efficacy and despite the easy access to a more effective, non-deforming alternative treatment? This is a complete no-brainer.

The only way I can see the circumcision advocate trying to wriggle out of this would be to say that these two options aren't mutually exclusive; we could circumcise children and teach them about safe sex practices, thus adding together these two protective benefits and even further reducing STD transmission. The reason I reject this is because safe sex practices are virtually 100% effective at preventing STDs. Imagine that we're summing up the numbers here, with the highest possible effectiveness being 100. Properly adopting safe sex practices already gets you to the maximum of 100/100, so further adding penis mutilation into this equation is not necessary considering that safe sex is already maximally effective.

"Oh, come on, Anton! You know most people slip up and don't practice safe sex 100% of the time! What am I gonna do, pick up a chick at the bar and be like 'So, what do you say we get out of here and get tested for STDs together?' Ooh, man, those are the magic words right there!"

Look, I get it: Many people won't practice safe sex 100% of the time. But that is their decision to make, and I don't think it's ethical or wise to prophylactically amputate part of their penis without their consent because you suspect that they might act irresponsibly in the future.

Another important point about STDs is that circumcision could actually have the reverse of the intended effect. Because of all the pro-circumcision propaganda lauding the fact that it reduces your risk of contracting STDs, this could actually have the net effect of discouraging safe-sex practices because it leads men to have a false sense of security. It may sound silly, but there's actually data to back this up. As Peter Adler puts it,

 

". . . according to the CDC, 17% of circumcised men mistakenly believe that if they are circumcised, they do not need to practice safe sex. Not disclosed by the CDC, circumcised men engage more frequently in anal sex, which the federal government states is the highest high risk factor for HIV infection. Thus, even if circumcision would otherwise reduce HIV by 1.3% in Africa . . . and even if it reduced HIV by the same percentage in the U.S. . . . after taking into consideration these risk factors, and lower condom use by circumcised men, circumcision may cause a net increase in HIV among men in the U.S."

 

So things are clearly not as simple as the circumcision advocate makes them out to be.

Something else you might argue is that waiting until they're old enough to decide for themselves isn't a good idea because the risk of complications from circumcision increases as you get older—as does the cost of the procedure. This is something a caller into the David Pakman Show implied when he tells a story about a neighbor of his who got circumcised as an adult and had some rather unpleasant complications. David's former producer Louis then goes on to agree with the point he was making:

 

Louis: "Because of this, it is much, I think, much less painful to get it done when you're very young, because you do get involuntary erections. And like he said, if later in life you decide that you do want—"

David: "The idea of letting the 13-year old choose or something, yeah."

Louis: "It can be a serious, painful problem when it comes to healing."

 

Here's what the AAP writes about the subject in their report:

 

"Newborn males who are not circumcised at birth are much less likely to elect circumcision in adolescence or early adulthood. Parents who are considering deferring circumcision should be explicitly informed that circumcision performed later in life has increased risks and costs. Furthermore, deferral of the procedure also requires longer healing time than if performed during the newborn period and requires sexual abstinence during healing."

 

First off, I wouldn't be so quick to concede that all of these things are true. As Brian Earp writes in a 2015 paper:

 

"First, as Svoboda and Van Howe have argued: 'complications may certainly be better documented for adults, who have the knowledge and wherewithal to complain if something goes wrong; but there is no consistent evidence that properly performed adult circumcision is actually riskier.' Second, 'It is true that it can be more costly, but only if proper pain control is used: general anesthesia is contra-indicated in infants, meaning that the surgery is performed either with no pain control or with sub-optimal pain control, driving down costs at the expense of humane treatment.'"

 

And then he goes on to make the point that—even if they were supported by the evidence—arguments of this sort overlook the key question at hand:

 

". . . consider the hypothesis that any number of surgeries might be (statistically) 'safer' if carried out in the neonatal period. The prior question, however, is whether the surgery itself is ethically sound. For example, imagine that it could be shown that removing a child's earlobes for non-therapeutic reasons was 'less risky' if it were done to an infant. Nevertheless, from a moral perspective, such an intervention would be seen as clearly impermissible."

 

And there's a very telling piece of information in this quote from the AAP report:

 

"Newborn males who are not circumcised at birth are much less likely to elect circumcision in adolescence or early adulthood."

 

Thank you for proving my point. They bring this information up as if it's a point in favor of infant circumcision when I would argue that precisely the opposite is the case: If a significant portion of these people don't voluntarily get themselves circumcised, it logically follows that a significant portion of these people don't want to be circumcised—and by doing so without their consent, you're violating their wishes and you're disregarding their bodily autonomy.

I couldn't find any polling data on what percentage of men who were circumcised as children are unhappy with the procedure and wish it never happened, but the fact that men old enough to think for themselves are "much less likely to elect circumcision" proves that doing it when they're too young to resist goes against the decision that they would have ultimately made for themselves.

There is no reverse point you can make that has the same force behind it: "Man, I really wish that my parents did circumcise me, but unfortunately it's too late for that and their decision is permanent!" Nonsense; if an uncut man wants to be circumcised, they can schedule an appointment and get it done.

"Oh yeah? Well I'm glad that my parents circumcised me!"

Ok, and what about all the people who aren't glad that their parents circumcised them? Just because you personally happen to be happy with the removal of part of your penis doesn't mean that everybody else who had this done to them is equally as satisfied.

Go online and you can read story after story of circumcised men who are angry at their parents, unhappy with the way their penis looks, desperately trying to find ways to regrow their foreskin, and so on. There are entire online communities of such men. Yes, I know anecdotes like these are no substitute for hard scientific data on this question—or even flaccid scientific data—but these anecdotes certainly do prove that many who have had this done to them are deeply unhappy about it.

Circumcising children is also unethical for the simple reason that it's a very painful procedure—oftentimes even when attempts are made to control the pain. As we read earlier from that Brian Earp paper:

 

". . . general anesthesia is contra-indicated in infants, meaning that the surgery is performed either with no pain control or with sub-optimal pain control."

 

The AAP's own report concedes the painful nature of the procedure when they write that:

 

"Analgesia is safe and effective in reducing the procedural pain associated with newborn circumcision,"

 

with the key word being "reducing" procedural pain—not eliminating.

Note also that this is a fourth reason why the vaccination analogy falls flat: when you get vaccinated, you experience only a brief moment of very minor pain from a tiny needle; when you get circumcised, richly innervated skin from one of the most sensitive regions of the body is cut deeply into and removed. There's just no comparison between the two.

You'll sometimes hear circumcision advocates argue that the pain felt during the procedure doesn't matter because they're not gonna remember the pain when they grow up, anyway. Oh, ok, by that logic, I can get you blacked out drunk and torture you, because you're not gonna remember the pain the next morning, so what does it matter?

I also find it strange that Louis expresses his concern about the pain that an adult might feel while recovering from a circumcision, but he doesn't seem bothered by the pain that children feel after being circumcised. Yes, you could argue that men who are old enough to have erections could experience more pain during recovery, but if avoiding the pain from circumcision is the goal here, how about people just don't get circumcised unless it's medically necessary?

And while pain during recovery might be more severe for adults, pain during the procedure itself is undoubtedly more severe for infants, because as we've already seen, sub-optimal pain control is used during infant circumcisions whereas anesthesia is commonly used for adult circumcisions.

At the end of the day, whether they want to subject themselves to this procedure, as well as whatever pain or complications might result during recovery, is a decision that adult men are perfectly capable of making for themselves. You can't say the same for infants who are forcibly circumcised.

I also find it a bit odd that it's perfectly acceptable for parents to sign off on having doctors do this to their own kids—or even to have untrained members of their religious community do it despite having no medical background—but if I were to snatch some woman's baby, take it home, and start painfully cutting away at its genitals, the only question that people would have is: How many years should we throw this piece of shit into prison to rot for?

How likely would I be to evade punishment if, during my trial, I pointed to the medical and hygienic benefits of the genital mutilation that I subjected her child to? Not very likely, I would imagine. What if I was a well-trained surgeon who knew exactly what I was doing? Again, I still highly doubt that this would keep me out of prison. So why are parents allowed to subject their own children to such a procedure?

I get that parents have the right to make many decisions for their children, but this is one that I maintain should not fall into that category. This is something that Louis disagrees with—even going so far as to say that parents should be allowed to override the wishes of a kid who's old enough to decide for himself that he doesn't want to be circumcised:

 

David: "The last thing I wanna get to is Brad from Tarzana(?), sent me a kind of hypothetical morality . . . type question, which is this: I think it would be a perfect time to propose to Louis, since he's so dismissive of the brutality, and thinks people who compare circumcision to female circumcision are idiots—I would agree that there is a difference between the two. For this scenario, we'll assume, all health benefits from the study we cited are true, for this example. Here's the example:

A 12 year old orphan is adopted by a family who decide that they wanna have him circumcised for the medical benefits. The boy's adamant that he doesn't want the procedure done, but his parents are resolute in their decision. Is this child abuse?"

Louis: "Nah."

David: "Why not?"

Louis: "A 12 year old does not know what's best for him. And he's still a minor."

David: "Up until what age do the parents get to decide whether the kid has a circumcision or not?"

Louis: "Well, I'd say when you're legally an adult. But, at the same time, I might say something like 16, 15."

David: "So you're 16 years old, your parents say, it's time to be circumcised. You have no say because you're not a legal adult."

Louis: "It's tough. I mean, there are different maturity levels here, too. It's hard to draw that line."

 

"Mom, Dad, I don't want my penis mutilated."

"Too bad, son; it's gonna happen anyway."

How do you not see what's ethically wrong with this? Do you really think 12-year-olds are so naive as to not understand what a terrific idea it is to cut off part of their penis?

I am not asking for much here. All I ask is that you don't permanently amputate parts of your children's genitals without their consent. It should be up to me to voluntarily have this done to myself it that's what I want—and if there really are so many spectacular benefits to circumcision, presumably I would be falling over myself while running to the doctor to get it done. It happens to be the case that I'm not doing that, I never plan to, and I would be outraged if somebody did this to me against my will.

If you want to have your penis mutilated, Louis, by all means, schedule an appointment with your doctor and have it done. I can assure you that nobody would try to stop you. It's your penis, your decision. That's exactly the point, though: It's not: Your penis, somebody else's decision. It should be yours and yours alone.

This is like the simplest ethical question that it's possible to ask—and yet so many people still manage to get it wrong. I don't just think circumcision should be frowned upon; I would go so far as to argue that, unless there's a specific and unique medical reason that motivates your doctor to recommend circumcision, removing part of your child's penis without their consent should be against the law.

"Oh, well I circumcised my child, so are you saying I should be in jail?"

Obviously I don't think a law like this should be applied retroactively; I would just argue that, once the law is put in place, if you violate it from that point on, yeah, you should be punished.

Another argument you'll sometimes hear is the hygienic as well as the aesthetic argument. David provides an example of this when he discusses an e-mail from a listener:

 

"Then I got a e-mail from Pamela saying, listen, I have a female perspective on this. Circumcision should be mandatory. It's cleaner. It's more hygenic. And let's face it, it's more attractive. So Pamela, as a female, taking the aesthetic point of view on circumcision."

 

I think the hygiene argument is actually a very good one, because let's all remember that we live in the 14th century where we have no reliable methods of cleaning ourselves. Please. Get serious! As somebody who's not circumcised, I can tell you that it takes me a grand total of five seconds to pull back my foreskin in the shower and clean that area. It's about as inconvenient as scratching the back of your head.

Never once have I been like: "Jeez, this is so burdersome that I should just surgically remove this part of my penis!" This would be the thought of an insane person. Seriously, I can imagine myself walking through a mental asylum, then I put my ear up to the door of a padded cell and the guy inside is like: "I need to cut this part of my penis off 'cause it's dirty." You'd be like: "Hoooly shit! Keep the straitjacket on that one!"

"Well, listen, son: I cut part of your penis off when you were a baby because I didn't want you to inconvenience yourself in the shower for 5 seconds." I'm sorry, this is just not a serious argument. The extremely trivial burden of having to clean a body part doesn't justify the unconsenting amputation of that body part.

Pamela also thinks that circumcised penises are more attractive. Ok, and some women think the opposite, so I guess it's a wash, then.

What if I were to say to you that I think circumcised vaginas are more attractive? "Ew, you didn't have your clitoris cut off when you were a child? That's disgusting." I could even back it up with the hygiene argument: I'm like, "Look, when you remove some of the vaginal skin, it makes it easier to clean the vagina, there are fewer skin folds that bacteria can grow in—it's an all-around more hygienic decision! Plus it's just more aesthetically appealing to me! Uncut vaginas are gross!"

What would be your reaction if I went around publicly saying these things? Could you stand to listen to me gleefully describe how much more attracted I am to mutilated vaginas? People who heard this would be revolted at my lack of respect for female sexuality as well as their bodily autonomy—but when the conversation turns to male circumcision, this, for some reason, becomes a perfectly acceptable argument.

The comparison between male and female genital mutilation is something that David and Louis wholeheartedly reject.

 

David: “Now, what do the critics say? Critics, of course, are unconvinced. They say male baby circumcision is the same as female genital mutilation.”

Louis: “I've never heard anything that stupid in my life.”

David: “A lot of people make that comparison.”

Louis: “They're all idiots.”

David: “Wow! Louis taking a big stand on this!"

 

You know what? I think Louis is right about this: Cutting off part of your child's genitals is just not comparable to cutting off part of your child's genitals. Night and day. Two completely different things.

Rather than simply calling people idiots like Louis does here without any elaboration, in another clip, David at least tries to explain why the comparison is invalid.

 

David: "So, let's go through some of the reactions I've already received on Twitter. Number one, David, this is exactly the same as female genital mutilation, where entire parts of the woman's vagina are sometimes removed. Of course, the one main difference is that all of these versions of female genital mutilation serve no medical purpose, and they have a more significant risk of inflicting serious harm, both physically and psychologically.

And while we will hear from the anti-circumcision group, Louis, that we don't know for sure that there isn't huge psychological trauma inflicted by infant circumcision, and we have anecdotal stories of circumcisions going bad, that is not the same as a procedure that serves no medical purpose, that has been verified by the medical community—regardless of what those doing FGM might say—we don't have an independent medical community saying, yes, this serves a medical purpose."

Louis: ". . . And as far as FGM goes, I think it's important to talk about motivations: When it comes to FGM, certainly, the motivations are not medical, they are not to help the women."

 

Look, I'm gonna take a very bold position here and say that mutilating the penis is similar to mutilating the vagina. I know! Outrageous! How dare I. You say that to some people and they look at you like they just saw a Martian or something—a Martian who just flashed you with his uncircumcised penis, that is.

You're like, "Wow, this is simultaneously the weirdest and coolest thing that's ever happened to me. Nobody is ever going to believe this story."

He's like: "Wanna take a ride in my spaceship? I've got some shiny probes I could show you. This little baby right here? I call 'The Bermuda Triangle.'"

You're like: "Ehh, I'm gonna have to pass on that. Thank you, though."

David is correct about the current evidence indicating that male circumcision has more medical benefits than female circumcision. But if you listen to the proponents of female circumcision, you find that they make some of the exact same arguments that we hear from male circumcision advocates. As Robert Darby points out, there's a rich history of its proponents pointing to the alleged medical benefits:

 

"An assumption behind our differing attitudes to male and female circumcision is that the former offers 'medical benefits' while the latter does not. In truth, we do not know whether some forms of female genital cutting might reduce the risk of certain diseases, such as HIV, because Western abhorrence of the practice precludes research into this interesting question.

Clitoridectomy was practiced for a short time in mid-nineteenth century Britain as a therapy for certain female ailments, and various forms of female genital cutting were advocated as a health precaution by respectable American doctors until well into the twentieth century. The real reason Western societies reject female while accepting male circumcision is that the latter is comfortably familiar while the [former] seems outlandishly strange."

 

And as Brian Earp puts it,

 

". . . in countries in which female 'circumcision' is culturally normative, it is often said to confer a range of such benefits, including 'a lower risk of vaginal cancer … less nervous anxiety, fewer infections from microbes gathering under the hood of the clitoris, and protection against herpes and genital ulcers'. In addition, female 'circumcision' in such countries is often described as 'more hygienic' as well as more esthetically pleasing."

 

It's like a line-for-line replication of the arguments made by male circumcision advocates.

So as we can see, it's completely untrue when Louis says:

 

"When it comes to FGM, certainly, the motivations are not medical, they are not to help the women."

 

Even if such medical data was valid about female circumcision, it seems to me that few people would hesitate to nonetheless condemn the procedure as a violation of female human rights.

Or maybe I'm wrong about this. According to David's logic, if we discovered that there were comparable medical benefits to female genital mutilation, to be consistent, wouldn't he then have to support FGM—or at least certain types of it? This is a serious, non-rhetorical question for supporters of male circumcision: If removing the clitoris or labia from a vagina had similar medical benefits, would you then support infant, female circumcision?

The only reason I can see people saying no is because they'd argue that female circumcision sharply reduces sexual pleasure. I would point out that in the case of male circumcision, while the data definitely is mixed on the subject, there certainly is at least some evidence supporting the idea that it reduces male sexual pleasure.

I just don't think the research is complete enough on this subject. What we need to do is conduct a rigorous scientific experiment where beautiful women come over to my house and touch my penis, and I'll report what I feel. (We run the experiment and they're like: "Anton, we think your conclusion was very premature.")

On this particular question, David makes the exact same mistake that we saw earlier: Only reporting on the data that supports his views. Here's an example of this from a 2016 video he posted:

 

"There is a new study that has come back with some findings that really have the anti-circumcision crowd in a tizzy. New research reported in the Journal of Urology indicates that there are no differences in penile sensitivity for a variety of stimulus types and penile sites between circumcised and uncircumcised men."

 

There's a comment on this video by Patch Peterson noting that, even if this was true, it's overlooking the crux of the issue:

 

"Why the heck does it matter!? If I was engaged in a practice of cutting off babies' ear lobes, would 'there's a study that shows it doesn't affect hearing' justify it? It's child abuse. Period."

 

And the scientific data on this question isn't nearly as one-sided as David makes it out to be. As Peter Adler writes,

 

"The CDC's background materials . . . do not mention that the foreskin is erogenous. They devote only one paragraph to sexuality, citing a survey finding that '[a]dult men who undergo circumcision generally report minimal or no change in sexual satisfaction' or an improvement.

. . . The CDC then contradicts itself by citing in its background materials a survey that found 'decreased erectile function and penile sensation', by acknowledging that the foreskin is 'highly innervated', and by expressly acknowledging that circumcision risks 'the possibility of adverse effects on sexual sensation and function'.

. . . The prevailing opinion worldwide is that circumcision also impairs sexual sensation and satisfaction. An oft-cited 2007 study suggests that circumcision desensitizes and removes the most sensitive part of the penis. Bossio et al. stated in a 2014 review, 'Adverse self-reported outcomes associated with foreskin removal in adulthood include impaired erectile functioning, orgasm difficulties, decreased masturbatory functioning (loss in pleasure and increase in difficulty), an increase in penile pain, a loss of penile sensitivity with age, and lower subjective ratings of penile sensitivity'."

 

And it just makes intuitive sense that circumcision would reduce sexual pleasure: you're cutting off a richly innervated, erogenous part of the penis. What would you expect the result to be?

So if both male and female circumcision reduced sexual pleasure, and if there were medical benefits to both procedures, it seems to follow that a supporter of one would have to be a supporter of the other—and an opponent of one should therefore be an opponent of the other.

I also want to briefly point out that describing this practice as "circumcision" is pure euphemism. Circumcision is genital mutilation—plain and simple. To refuse to ever call it that is to sanitize your language and cover up the hideous nature of this procedure.

Some take issue with the term "genital mutilation", but a simple glance at the dictionary should correct their unease. It always used to piss me off in school, by the way, when you'd have the straight-A students who'd start their essays by saying something like: "Webster's dictionary defines liberty as follows"—like, "Fuck you, dude, we all know what liberty means"—but in this case, I really do think a look at the dictionary is appropriate because there's contention over the term being used.

Dictionary.com defines "mutilate" as:

 

"Mutilate - to injure, disfigure, or make imperfect by removing or irreparably damaging parts."

 

Removing the foreskin from the penis is a textbook example of this, and I don't think the very minor medical benefits that can sometimes come from this procedure change the fact that it's an act of mutilation.

Notice also the linguistic double standard that David is operating with. When you cut part of the male genitals off, it's "circumcision." When you cut part of the female genitals off, it's "genital mutilation."

David and Louis also mock the alleged inhumanity of circumcision:

 

David: "I get a lot of e-mails from people saying that they want me to talk about the brutality of . . . circumcision."

Louis, sarcastically: "Yeah, so brutal"

 

"Oh, cutting part of your child's penis off when they're incapable of resisting. Big whoop!"

Yeah, big whoop! It's a huge whoop.

How would you like it, Louis, if somebody strapped you down and cut part of your penis off without your approval using only mediocre analgesics?

"No, I don't want you to do that!"

"Oh, don't be such a baby, Louis. All we're going to do is cut part of your dick off. You're being such a drama queen. Look, we've even got the rabbi here to suck your penis afterwards."—yes, that's actually something that people do.

If this wasn't a religious ritual and it was just one guy that did this, even the violent psychopaths in a maximum security prison would be sickened by him.

"What are you in for?"

"Stabbed a guy during a robbery. What about you?"

"Eh, I cut part of a baby's penis off and then I stuck it in my mouth and sucked it."

That's like the most vile thing I could imagine doing. Ted Bundy would hear this and he'd be like: "What the fuck, man? You have issues."

 

David: "I get a lot of e-mails from people saying that they want me to talk about the brutality of . . . circumcision."

Louis, sarcastically: "Yeah, so brutal"

 

This kind of eye-rolling over such a serious matter seems extremely heartless to me. I mean how much more callous could a person be?

It reminds me of a debate that Christopher Hitchens had against a rabbi who tried to downplay the severity of circumcision while also having a laugh about it.

 

Rabbi: "Christopher, I've gotta call you down on referring to circumcision as genital mutilation. My son cried more at his first haircut than he did at his bris."

Christopher: "You weren't doing it right, then."

Rabbi: "And statistically, the only long-term effect that it seems to have on people is it increases their chances of winning a Nobel Prize."

Christopher: "I can't find the compulsory mutilation of the genitals of children a subject for humor in that way, or flippancy in that way. Maimonides says very plainly that it's designed to repress the sexual urges, to deprive the male child as far as possible of the opportunity of that.

The full excision—not just the snip; the full, mandatory covenant—is fantastically painful, leads to trauma, leads to the dulling of the sexual relationship, and can be, in itself, life-threatening at that moment. We have the records, I can show them to you, of hundreds and hundreds and hundreds—in the United States—of boy babies who've died or had life-threatening infections as a result of this disgusting practice.

That a person as humane as yourself can sit here and think of that as a fit subject for humor shows what I mean: Religion makes morally normal people say and do wicked and disgusting things. You've just proved my point for me. Shame on you for saying what you've just said! Shame on you for saying it about your own son, my God.

. . . What next? Cutting the labia of little girls. At least Judaism doesn't do that. What if a Muslim was to say to you just now, 'My little girl cried more at her first haircut than when I cut off her clitoris.' What would you think of me if I was to say such a disgusting thing? . . . Genital mutilation is no joke."

 

Spot on. Imagine a Muslim man right now making the same type of dismissive comment:

"I get a lot of e-mails from people telling me they want to talk about the brutality of removing a woman's clitoris without her approval."

"Oh, yeah, so brutal!"

Yeah, Louis, that's actually exactly what it is. If you've never had the misfortune, go look at some pictures or videos of male circumcisions being conducted. I'm not going to include any uncensored such images in this video because I'm not sure that the YouTube policy would allow it, but do a Google search, see circumcision actually being performed, and try not to cringe with revulsion at what you're seeing. It is nothing short of sickening.

We also need to talk about some more drawbacks in these CDC and AAP reports that David cites. One is their flawed cost-benefit assessment of circumcision. It's flawed because the only downside of the procedure they consider are short-term surgical complications. Not only that, but the most consequential short-term complications are largely excluded from their analysis.

As we read on DoctorsOpposingCircumcision.org,

 

"[The AAP report] dismisses major complications and death from circumcision as 'anecdotal.' Case reports were excluded from the AAP’s review, so individual reports of deaths and catastrophic outcomes of circumcision were simply ignored."

 

The number of deaths from circumcision each year certainly are not negligible. CIRP.org informs us that:

 

"Douglas Gairdner reported 16-19 actual deaths a year in England and Wales from neonatal circumcisions in the 1940s. . . . Robert Baker estimated 229 deaths per year from circumcision in the United States. Bollinger estimated that approximately 119 infant boys die from circumcision-related [complications] each year in the U.S. (1.3% of all male neonatal deaths from all causes)."

 

If 1 out of every 100 male baby deaths in the United States were the result of complications caused by prenatal vitamins or something, they would be pulled off the shelves tomorrow.

Svoboda & Van Howe describe more complications that went ignored in the AAP report, including:

 

". . . partial and complete amputation of the glans of the penis, which are typically described in (virtually innumerable) case reports and case series."

 

They go on to explain the folly of conducting a risk assessment without even taking into consideration the most serious risks of the procedure:

 

"The AAP admits that 'the true incidence of complications after newborn circumcision is unknown,' stating also, 'Based on the data reviewed, it is difficult, if not impossible, to adequately assess the total impact of complications, because the data are scant and inconsistent regarding the severity of complications.' Yet despite the purported lack of complication data the AAP somehow manages to conclude that '... current evidence indicates that the health benefits of newborn male circumcision outweigh the risks'. Since they concede that they are missing the denominator to their equation, one wonders how they performed this calculation."

 

Robert Darby points out another flaw in their risk assessment, arguing that there are other key factors that went completely ignored by the AAP:

 

". . . the AAP means risk of surgical or other complications (i.e. adverse outcomes additional to foreskin loss, such as bleeding, infection, meatal stenosis, etc.) arising from the circumcision procedure.

. . . Since the foreskin is an integral part of an organ with profound sexual, psychological, and social significance, the harm of losing it should be factored into the equation. Failure to do so loads the dice to an unacceptable degree: it is akin to arguing that the risks of amputating a leg or arm are nothing more than complications arising from the surgery (bleeding, infection, etc.) and ignoring the usefulness and value of the limb to the individual.

. . . [Consider] the possibility that it is the loss of the foreskin itself and the denial of choice—quite apart from any 'complications'—that in themselves constitute the principal harms."

 

These reports also appeared to be biased in at least two ways, in terms of their selection and omission of research, as well as the viewpoints of the people that worked on the reports. Svoboda & Van Howe write the following:

 

"Studies that suggest benefits for circumcision appear in the technical report, while at least 100 studies that fail to support a benefit, or that find detrimental effects of circumcision are omitted."

 

And Peter Adler quotes Van Howe as saying:

 

"'The list of participants [at the CDC in 2007] reads like a Who's Who of Circumcision Advocates. No group opposing circumcision was allowed any input.'"

 

They also presented some of their data in a manner that was misleading in favor of circumcision. Brian Earp explains in his paper:

 

". . . the CDC . . . describes the 'benefits of male circumcision [in terms of] relative-risk reductions (e.g., a 50% reduction from a 2% risk of an STI to a 1% risk), whereas any associated harm is expressed as an absolute risk (e.g., a 2–4% risk of adverse events).'

. . . This may have the effect of inflating the perceived likelihood and/or magnitude of the potential benefits of circumcision, and – by contrast – deflating the perceived drawbacks and harms, especially in the minds of those who are unversed in interpreting medical statistics."

 

The final point I'll make is that circumcision originated as a purely religious ritual that's continued on to this day. People didn't start circumcising their children because they looked at the scientific data and saw the wonderful medical benefits; it was a religious tradition, plain and simple, and many of the contemporary arguments used to justify circumcision seem to be little more than attempts to provide post hoc rationalizations for something that never had a rational basis to begin with.

So let's review the key points made in this video. The international medical community largely disagrees with the assessment put forth by the CDC and AAP. Their reports on circumcision point to medical benefits that mostly apply to adult men—and thus don't make sense as a justification for infant circumcision. The only medical condition cited that applies to young children are urinary tract infections—which can be treated with basic antibiotics in a much safer and more cost-efficient manner. STDs can be avoiding by simply practicing safe sex.

Other drawbacks that these reports suffered from include omitting contradictory studies, failing to take into consideration other key areas of the circumcision debate, and excluding the most serious complications of circumcision in their cost-benefit analysis. Comparisons between circumcision and vaccination fall flat, whereas comparing male and female circumcision is much more valid than some make it out to be. The hygiene argument is completely ludicrous because the trivial burden of quickly cleaning a body part doesn't justify forcibly amputating it, nor do purely aesthetic preferences.

Taking into consideration the serious complications of circumcision, the potential reduction in sexual pleasure, the extreme pain that it causes, and finally, its irreversible, consequential and completely unnecessary nature, it doesn't make ethical sense to forcibly subject your children to this procedure. Men should be left to make up their own minds about whether they'd prefer a circumcised penis—taking into consideration the possible benefits and harms and deciding if it's the right decision for them.