The Scientific Case for Circumcision
Germany, take note!
“Male circumcision is a highly significant, lifetime intervention. It is the gift that keeps on giving. It makes sense to put extraordinary resources into it.”
Who would you guess recently offered this paean to foreskin fleecing? A rabbi? An imam? Nope. Try U.S. AIDS coordinator Eric Goosby at a health convention last month for top officials from 80 countries.
This declaration exposes the shoddy logic of a German regional court that has banned religious circumcision, calling the practice a “serious and irreversible interference in the integrity of the human body.” As the AFP reported at the time, Goosby was reflecting a scientific consensus that has been cemented over the last seven years:
Studies show that circumcision can dramatically reduce HIV infections. One study in South Africa last year found new infections fell by 76 percent after a circumcision programme was launched in a township.
In 2006, trials in Kenya, Uganda and South Africa found foreskin removal more than halved men’s risk of HIV infection. Longer-term analysis has found the benefit to be even greater than thought, with a risk reduction of around 60 percent.
The medical success story here is even more remarkable than the AFP lets on. Those original trials, as the New York Times reported upon their publication, were so effective that they
were stopped early by the National Institutes of Health, which was paying for them, because it was apparent that circumcision reduced a man’s risk of contracting AIDS from heterosexual sex by about half. It would have been unethical to continue without offering circumcision to all 8,000 men in the trials, federal health officials said.
Unethical not to circumcise the men. Since then, study after study has confirmed these initial findings, establishing that while circumcision is far from a silver bullet when it comes to arresting HIV, it is undeniably a potent arrow in the quiver of prevention techniques. In light of this, global health organizations have begun a massive effort to circumcise 20 million African men by 2015. Everyone is getting in on the act: Israeli scientists have started training African physicians to perform the procedure. Supported by non-profits like the Bill and Melinda Gates Foundation, companies are competing to produce more efficient circumcision devices because, as the New York Times notes, “most African countries are desperately short of surgeons, and there is no Mohels Without Borders.” And just yesterday, the Times reported on how “a group of legislators in Zimbabwe had themselves circumcised last week to set a good example for the country, most in an impromptu surgical theater in a tent in Parliament House.”
And the benefits aren’t just for Africans. A peer-reviewed study conducted by Centers for Disease Control researchers found that “circumcision would reduce the lifetime risk of HIV diagnosis for all [American] males by 15.7% in the base case analysis, and the reduction ranged from 7.9% among white males to 20.9% for black males,” resulting in a discounted lifetime HIV health care savings of $427 per male. Other scientists have recently argued in the American Journal of Public Health and Health Affairs that the lack of Medicaid coverage for circumcision in 17 states perpetuates health inequalities among poor and minority populations who make use of the program and are at high risk for HIV. The American Academy of Pediatrics is soon expected to come out with a new policy pushing circumcision, reversing its prior stance.
Given this impressive scientific consensus as to the medical dividends of male circumcision, the German court’s judgment—which permits circumcision for “medical reasons”—is a confused and ignorant muddle. Some have rightly criticized it as an assault on millennia of Jewish tradition and practice (not to mention Islam), something one would have thought a German court would be sensitive enough to avoid. But the ruling itself, as the research above amply demonstrates, is logically incoherent and factually wrong for a simple reason: All circumcisions are medically beneficial. Whether or not the procedure stems from religious motivations, it will have measurable health benefits. So by the court’s own reasoning, all religious circumcisions ought to be permissible as long as the parents also want the medical dividends—which effectively means that circumcision has not been banned at all. Of course, it is very unlikely that this is what the court intended and much more likely that it was entirely unaware of the scientific consensus surrounding circumcision’s advantages.
But that scientific consensus reveals more than just the follies of this German court; it also exposes the deeply problematic aims of American advocacy groups which seek to outlaw circumcision for the entire United States. If, as global health organizations and years of research suggest, circumcision can have major positive health benefits—particularly for poor minorities who often don’t have access to safe sex instruction and are most at-risk for HIV infection—it is absurd to ban the practice. It’s one thing to abstain from a potentially medically beneficial procedure due to personal convictions; it’s quite another to enforce those convictions coercively on others.
Of course, none of the above research means we should start mandating circumcision. There are many reasons a person might legitimately choose to forgo circumcising their child, from wishing to wait for the child to be fully grown and make the decision for themselves, to being swayed by the (quite inconclusive) research on whether the procedure decreases sexual pleasure. Nor do such scientific findings mean we should avoid criticizing and attempting to reform unnecessary and potentially dangerous elements of religious circumcision rites. But they do tell us that safely administered circumcision can be a public good and is an important option that should be open to all parents who wish to grant their child its benefits.
Ultimately, those who seek to ban circumcision as the essential equivalent of child abuse—from this German court to activists who recently attempted to bar the practice in San Francisco—are doing so in the face of tremendous scientific evidence to the contrary. Their claims are at odds with countless studies, not to mention global health policy. The burden of proof, then, is upon these activists to defend their disregard for this science, not on the majority of Americans who choose to circumcise their children and take advantage of its documented benefits.
After all, individuals are free to discount scientific evidence on the basis of value considerations, even dubious ones, and base their life decisions upon that calculus. But such subjective notions should never form the basis for coercive state policy any more than, well, religion.
Your move, Foreskin Man.