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Health

Fair & balanced on circumsion

Gene ExpressionBy Razib KhanApril 4, 2011 8:48 PM

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When Michelle mentioned on Twitter that she was going to write about circumcision, I told her to expect some angry people to come out of the wood-work. Today she has a post up at Scientific American, What's the deal with male circumcision and female cervical cancer? She concludes:

In addition, while it is true that women with circumcised partners are less likely to get cervical cancer, they are not immune. Women with circumcised partners still contract HPV and develop cervical cancer! They just do it at a reduced rate. There are other methods that are much more likely to reduce a woman's chance of contracting HPV and developing cervical cancer, such as vaccination and condom use. Therefore, from a public health standpoint in the United States, it may not be necessary to circumcise male babies solely for the purpose of reducing the risk of cervical cancer in his future sexual partners (of course, this doesn't take into account the possibility that the child might not be heterosexual).

On the whole I think that Michelle's take is reasonable and fair-minded. But, I think numbers are of the essence here. What is the expected reduction in rate of risk? This was the major bone I had to pick with Jesse Bering's post on this topic last year at Scientific American. Bering closes on a pro-circumcision note on public health grounds:

I started this piece with an open mind but I’ll close by putting my cards clearly on the table. For me, if one fully appreciates the scientific findings reported by these landmark studies with sub-Saharan African men, circumcision is the more humane decision. Some minor bloodletting today could spare that child unthinkable degrees of suffering tomorrow. Nobody knows where your child will live as an adult (perhaps Africa), or how rampant HIV will be there, or whether he’ll wear a condom every time he has sex with a stranger, or whether an infected, beautiful woman will cross his path on the day he forgets to tuck a condom into his wallet. Admittedly, my own “son” is a border terrier, but this issue is still a no-brainer to me. However, I’m well aware that male circumcision is a contentious topic for many people, some of whom, aghast, will make their opinions known to me in the coming days.

If I'm not being generous, I'd have to say that circumcising your son because he might live in Africa which might still have a rampant HIV epidemic 20-30 years from now, is kind of a stupid decision if grounded on probabilistic logic. After all the probabilities of the various outcomes contingent upon your priors matter. My future children will be raised in the United States of America. If male, they will likely be straight. They will probably middle to upper-middle-class. HIV rates vary a great deal by demographic category. I know I won't allow my sons to be circumcised as infants. I don't see the need, and I am familiar with the literature on the efficacy of mass circumcision in preventing the spread of sexually transmitted diseases in some environments. But, if I lived in South Africa I might make a different decision based on the probabilities of my different environment. This is why I would dissent a bit from Michelle's note that even women with circumcised partners can develop cervical cancer. Risk assessment, by its nature, should not be viewed dichotomously. To make proper decisions based on probabilities you need to take into account the magnitudes of all the risks.

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