Category Archives: Studies

Jennifer Bossio confirmed: foreskin most sensitive part of penis

Yet she was too biased to admit it!

Bossio, Jennifer, “EXAMINING SEXUAL CORRELATES OF NEONATAL CIRCUMCISION IN ADULT MEN” is a PhD thesis which attempts to “provide a multidimensional perspective of the sexual correlates of circumcision with implications for public policy and individual stakeholders (e.g., medical professionals, parents, men).”

Jennifer Bossio validated Sorrells study and didn't recognize it

Jennifer Bossio validated Sorrells study and didn’t recognize it.

Chapter 3 is dedicated to study penile sensitivity in men who were circumcised as babies, vs. men who were not circumcised (intact). This is evidently a response to the 2007 study “Fine-touch pressure thresholds in the adult penis” by Sorrells et al.

Bossio writes (pg. 69): “we did not obtain sufficient evidence to support the notion that the foreskin of adult intact men is the most sensitive region of the penis to all forms of stimuli; however, the foreskin was significantly more sensitive to touch as compared to all the other genital sites tested, and it was significantly more sensitive to warmth than the glans penis.” She also writes: “our results—and those of Payne et al. (2007)—differ from those of Sorrells and colleagues (2007) who found that the glans penis in circumcised men was less sensitive to touch than in intact men.”

In her conclusions, Bossio writes that “we directly assessed the assumption that circumcision leads to a reduction in penile sensitivity by testing tactile detection, thermal sensation, and pain thresholds at multiple sites on the penis” and offers one conclusion that “this study provides no evidence that neonatal circumcision decreases penile sensitivity, no evidence that the exposed glans penis in circumcised men becomes less sensitive over time, and insufficient evidence to suggest that the foreskin is the most sensitive part of the penis.” and then suggests that “if differences in sexual functioning or sexual dysfunction are related to circumcision status, these differences are not likely the result of changes in penile sensitivity resulting from neonatal circumcision

Finally, she concludes that “findings from this study can be used to inform individual stakeholders, public policy makers, medical health care professionals, and parents regarding the minimal long-term implications of neonatal circumcision on penile sensitivity.”

We have issues with the inclusion and exclusion criteria. Excluding participants over 40 years of age creates a bias. Many individuals restoring their foreskins typically started after their 40s. They also excluded individuals with history of sexual dysfunction.

Reading her paper we found contradictions to her assertions that “this study provides no evidence that neonatal circumcision decreases penile sensitivity [...] and insufficient evidence to suggest that the foreskin is the most sensitive part of the penis“.

We also suggest that Bossio missed a vital point by neglecting to study men who have undergone non-surgical foreskin restoration.

First, the assertion that the foreskin is the most sensitive part of the penis comes directly from the Sorrells study, and it is one assertion that is often misunderstood. Sorrells simply evaluated “fine-touch pressure thresholds” – nothing more, nothing less. So when Sorrells concluded that “circumcision ablates the most sensitive parts of the penis” it should be read that “circumcision ablates the most sensitive parts of the penis [to fine-touch]“. Sorrells did not make any attempt to measure pleasure or satisfaction. Only fine touch, and his findings are consistent with those of Bossio as she said it herself, that “the foreskin was significantly more sensitive to touch as compared to all the other genital sites tested“.

So, if the foreskin is significantly more sensitive to touch, it follows that the circumcised penis, in which the foreskin has been removed, is less sensitive to touch – particularly to fine touch. Which again, contradicts her conclusion that her study “provides no evidence that neonatal circumcision decreases penile sensitivity“.

Now, we partially agree with her assertion that “if differences in sexual functioning or sexual dysfunction are related to circumcision status, these differences are not likely the result of changes in penile sensitivity resulting from neonatal circumcision“, basically because the studies are missing one important point. Static stimulation is not the main method of stimulation during sexual activity. People don’t just lie down being stimulated by touch, warmth, pain, etc. Individuals move during sex. Stimulation is dynamic.

A visual comparison between a typical intact man masturbating, and a circumcised man masturbating, yields important differences – and  this has even been observed by circumcision promoters such as Guy Cox – in a paper published with the pen name of James Badger. While Badger describes it as a difference in preference, the reality is that it is a difference in what is possible to do with the available tissue.

Most intact men masturbate by grasping the mobile penile skin and sliding it up and down the shaft. In most cases this results in the glans being repeatedly covered and uncovered, with the rim of the foreskin stimulating the glans; typically the hand does not touch the glans. In the case of males with particularly long foreskins, the glans may never be uncovered at all, and the hand stimulates the glans only indirectly, through the foreskin.

In circumcised males, the typical technique consists in moving the penile skin what little length it can be moved during erection, or when no mobile skin is available at all, the hand rubs the penile skin, in which case external lubrication (hand lotion or adult lubricant) is needed to avoid chaffing the skin. In many cases direct contact with the glans is avoided unless using lubricant.

What this indicates is that there is a mechanic component of stimulation by using the foreskin as an agent, a mobile part, which interacts with the glans. Obviously, removing the foreskin makes this action impossible, thus altering the mechanism of stimulation for the circumcised male.

We can also consider that during heterosexual penetration, the glans touches the opening of the vagina and goes through its vestibule, but once inside it is not in contact with anything else. The vagina instead is grasping the penile skin, and facilitating its gliding motion during the repeated penetrative motion. For the circumcised male, the vagina simply rubs directly against the penile skin – because there is no movement of the skin, which tends to dry the lubrication of the vagina.

So there is a change that goes deeper than simple passive sensitivity. Circumcision alters the mechanics of the penis and causes stimulation to be different, both for the male and the female.

Bossio’s paper simply moves between two contradictory positions: 1) that the foreskin is more sensitive to touch, and 2) that the circumcised penis is as sensitive as the intact penis – which is simply not possible if a) the foreskin is more sensitive to touch and b) has been removed by circumcision.

It seems to me that given the importance of Sorrells’ study as a starting point to Bossio, she missed the mark. Neither Bossio nor her reviewers understood the meaning of “sensitivity” as used by Sorrells.

Perhaps the real importance of Bossio’s paper was to superficially contradict Sorrells, as an attempt to undermine a common argument used by promoters of genital integrity, and by calling the long-term implications of neonatal circumcision on penile sensitivity “minimal” she gained enough approval from a culturally biased academic community to obtain her PhD.

Misuse of Bossio’s paper:

Annette Fenner published in Nature Reviews Urology a highlight of Bossio’s published study (on The Journal of Urology), which is related to her thesis, with the superficial headline “Circumcision does not affect sensitivity“, and the first sentence, predictably enough, reads “Neonatal circumcision has minimal effects on penile sensitivity“. Fenner misrepresents Bossio’s paper by indicating that “No differences in tactile or pain thresholds, or sensitivity to warmth and heat pain, were observed between circumcised and intact men“. This clearly contradicts Bossio’s assertion that “the foreskin was significantly more sensitive to touch as compared to all the other genital sites tested“.

She then offers an allegedly quoted conclusion that Bossio’s data “do not support the idea that foreskin removal is detrimental to penile sensitivity.” – a quote that is really an inaccurate paraphrase, and we repeat, is deeply flawed based on the non-existent definition of sensitivity.

Fenner then offers her own conclusion, the one that everybody was hoping for, the direct contradiction to Sorrells: “removing the foreskin does not, in fact, remove the most sensitive part of the penis.”

We have already shown above how deeply flawed is this, given that the same assertion is contradicted by Bossio herself.

But that’s what Bossio’s thesis was written for: to allow culturally biased academics to contradict Sorrells’ study by quoting a paper that didn’t understand what Sorrells was writing about, and which is so poor that it contradicts itself without raising the eyebrows of any mindless reviewer.

Misleading headlines

We wrote this review back in January, but we didn’t publish it, silently waiting. Last week, however, the media picked up Jennifer Bossio’s paper, and predictably, as we have often indicated, used misleading headlines to make this look as far more conclusive than it really is. Many of the articles we reviewed, clumsily include Bossio’s contradiction without pointing it out.

Some examples of these disappointing articles:

Science Daily: Neonatal circumcision does not reduce penile sensitivity in men, study finds (New research challenges widely accepted beliefs)

UPI: Study: Circumcision does not reduce penis sensitivity. This article even says “In men with foreskin, it was more sensitive to tactile stimulation than other parts of their penises, however when foreskin sensitivity was compared to other sites intact men had no greater sensitivity than the circumcised men” – the first part obviously contradicts the premise of the headline: if the foreskin is more sensitive to tactile stimulation, removing it has to reduce the penile sensitivity (to tactile stimulation). The second part of the statement simply makes no sense and seems to be a derailing tool.

Tech Times: Getting circumcised does not shrink male organ sensitivity.

Medical Express: Circumcision does not reduce penile sensitivity, research finds.  In this article, Bossio is quoted saying “We found that while the foreskin was more sensitive to fine touch, it was not more sensitive to the other stimuli we used, and those stimuli are likely more important in sexual pleasure“. However, that sentence alone already contradicts the headline – and the whole premise of Bossio’s publication. In fact, the underlined sentence alone shows that Bossio validated Sorrells’ study, the very study that she appears to be trying to contradict.

Queens University: NEWS RELEASE – New research finds circumcision does not reduce penile sensitivity. This must be the originating point of all these press releases, as Bossio’s study was the core of her PhD thesis at Queens University. This article, just like the one from Medical Express, quotes Bossio saying “We found that while the foreskin was more sensitive to fine touch, it was not more sensitive to the other stimuli we used, and those stimuli are likely more important in sexual pleasure” – which we are getting tired of repeating, contradicts the headline and the very premise of her study.

Daily Mail: Circumcision does NOT reduce sensitivity of the penis, experts say.  Unfortunately Bossio’s sad excuse of a study made its waves all the way to England. This article is preceded by 3 bullet points, one of which states: “Findings also suggest the foreskin is not the most sensitive part of the penis“. In this article, Bossio herself is quoted saying that her study “provides preliminary evidence to suggest that the foreskin is not the most sensitive part of the penis“. This version of the article avoids saying that “the foreskin was more sensitive to fine touch“, as the Queens University press release and the article on Medical Express did. Perhaps the contradiction would have been too obvious.

Healio, Medical Daily, True Viral News, Australian Networks, The Independent, I Fucking Love Science, GCO News, Renal and Urology News, Today’s Parent and many others also mindlessly reported on this absurd study.

So congratulations Jennifer Bossio. Your nonsense fooled a lot of people. Who knows how many men will be harmed because of your sad thesis.

UPDATE: Additional problems with Bossio’s paper

  • Some readers pointed out that Jennifer Bossio’s measuring point was the outside of the foreskin (see diagram). The foreskin is not a single structure. It has an outer layer of regular penile skin, and an inner layer of mucosa. There is also a transitional area which was pointed by Sorrells as the single most sensitive area to soft touch, and there is the frenulum, joining the ridged band and the inner foreskin to the glans and the meatus. Sorrells measured sensitivity at 8 different points of the foreskin. Bossio did not take measurements on the points indicated by Sorrells as the most sensitive ones to fine-touch sensation, which are the ridged band and the frenulum. Nevertheless, she found that the outer foreskin was significantly more sensitive to touch than the rest of the penis, which is consistent with Sorrells, even if her conclusions fail to indicate that.
    This was the site used by Bossio:
    bossio1
    These are the testing sites used by Sorrellssorrells_sites
  • According to the Queens University press release, Bossio “extended the research methods in her study to include warmth detection and heat pain because these stimuli are more likely to activate the nerve fibres associated with sexual pleasure“.For one, Sorrells did not make any claims regarding fine-touch sensitivity and pleasure.Second, “extending” the method makes the results difficult to compare. For example, Bossio writes “with respect to warmth detection, the foreskin was more sensitive than the glans penis, but not the midline shaft or an area proximal to the midline shaft. Using a different stimulus modality (warmth sensation, as opposed to fine-touch punctate pressure), we partially replicated the findings reported by Sorrells et al. (2007), in that the foreskin was more sensitive than the glans penis, but—unlike Sorrells—not two sites located on the penile shaft.” This makes no sense, because since Sorrells did not take measures of warmth sensitivity, there is no way to compare the data collected to Bossio in this aspect to anything in Sorrells study. It is not correct to say that this data “partially replicates” Sorrells given that they are referring to different types of stimulus.

    Sorrells declared that the foreskin was the most sensitive part (to soft-touch and to soft-touch only). Different parts of the body specialize in different kinds of sensitivity, according to our body’s needs. For example, our eyes are probably the most sensitive part to light. Our ears are probably the most sensitive part to sound. We wouldn’t try to assess sensitivity to sound in our eyes, or sensitivity to light in our ears. If the foreskin is sensitive to soft-touch, it is likely because we need that area to be sensitive to soft-touch, and removing it is going to affect the reasons why we need that sensitivity.

    Think about it this way. Removing one person’s eyes does not make the person deaf. But that is not a reason to justify removing the person’s eyes without necessity, particularly if we don’t know if the person needs to be sensitive to light.

  • Regardless of whether the foreskin is the most sensitive part, or just as sensitive as the rest of the penile skin, or if it was not sensitive at all, removing it would still violate the bodily autonomy and genital integrity of the person. Bossio writes on BJU that her “results are relevant to policy makers, parents of male children and the general public.” This statement misses the point that the most important stakeholder is the person holding the foreskin: the male child, the future male adult, and that no matter to what extent sensitivity is affected, removing the foreskin of the child deprives the child from the freedom to choose and the right to provide informed consent – thus violating his bodily autonomy and genital integrity.

    To be fair, on her thesis, Bossio writes that “Individual stakeholders are also expected to benefit from this research program, such as medical professionals, parents of male infants, and men themselves.” For some reason, “men themselves” were omitted from the conclusion in BJU.

  • Hugh Young pointed out that the graphics on Bossio’s thesis (i.e. figure 3.2) are collapsed across circumcision status. This conceals any existing difference between circumcised and uncircumcised.Figure 3.2 basically shows that the foreskin is more sensitive than the other testing points for tactile, warmth and heat pain (this last one only by a small difference), and that the glans is more sensitive to pain. The collapsed bars fail to show any difference. Young explains: “This makes the inclusion of the bar for the foreskin absurdly different from the others, because the foreskins of the cut men are non-existent. If their measurements were shown, their bars would be infinitely tall, indicating that no amount of pressure, heat etc, would evoke a response.” Sorrells study includes figures that are not collapsed by circumcision status. Two adjacent bars show the results for circumcised and uncircumcised. In the case of the circumcised males, the bar for non-existent measuring sites is simply omitted. If Jennifer Bossio wanted her study to be comparable to Sorrells, she should have considered presenting graphics that were comparable to those by Sorrells.Bossio’s figure 3.2
    bossio_fig

    Sorrells’ figure 3

    sorrells-fig

Bibliography

Bossio, J.A.EXAMINING SEXUAL CORRELATES OF NEONATAL CIRCUMCISION IN ADULT MEN. Thesis (Ph.D, Psychology) — Queen’s University, 2015-09-18 00:15:45.183

http://qspace.library.queensu.ca/handle/1974/13627

 

Bossio, J.A. et al. Examining penile sensitivity in neonatally circumcised and intact men using quantitative sensory testing. J. Urol. http://dx.doi.org/10.1016/j.juro.2015.12.080 (2015)

 

Sorrells ML, Snyder JL, Reiss MD, et al. Fine-touch pressure thresholds in the adult penis. BJU Int 2007;99:864-9.

http://www.cirp.org/library/anatomy/sorrells_2007/

Badger J. A Survey about Masturbation and Circumcision. 2000

http://www.circlist.com/surveys/badger-06.html

 

Fenner, Annette  - Male circumcision: Circumcision does not affect sensitivity – Nat Rev Urol

PY  - 2016/01/20/online

VL  - advance online publication

http://www.nature.com/nrurol/journal/vaop/ncurrent/full/nrurol.2016.3.html

Has Google been hijacked by the pro-circumcision lobby?

A few days ago it had been mentioned that searching for “intactivist” on Google was displaying, before any results, a suggested 2012 text from an odious article by pro-circumcision and misandryst author Charlotte Allen.

Bad as that is, today something far worse and way more dangerous has been reported. Searching for “care of uncircumcised newborn” displays a snippet from a webmed article explaining how to retract the foreskin to clean “under” it. It is problematic, because it is missing a sentence from the beginning of the paragraph, that limits this advice to “[w]hen the foreskin is easy to retract”, and also omits the most important, initial warning: “Do not force the foreskin back over the tip of the penis. At first, a baby’s foreskin can’t be pulled back (retracted) over the head of the penis. After the first few years of life (though it may take somewhat longer), the foreskin will gradually retract more easily“.

12122910_573713709443202_4359581206496907196_n

Naive parents may take the snippet as advice without reading the full article, resulting in pain, bleeding, possible infection and possible scarring which may require surgical care in the future.

Even then, the webmed article isn’t that great. It states that “[b]y the time a boy is 5 years old, his foreskin is usually fully retractable“, and also that “[a] boy as young as 3 can be taught to clean under his foreskin“. Both statements are wrong. It’s long been known that there is wide variation to the age of retraction, with close to 50% of the boys becoming retractable by age 10, and approximately 95% being retractable by age 17. Trying to retract the foreskin of a 3 year old boy or a 5 year old boy (when less than 30% of the boys are capable of retracting) is likely to create trauma and injuries to the child.

McGregor et al (2007, Can Fam Phys) wrote: “if one is patient and does not rush Mother Nature, most foreskins will become retractile by adulthood“. Likewise, Wright (1994, Med J. Aust) wrote “nature will not permit the assignment of a strict timetable to this process.”

Denniston and Hill (2010, Can Fam Phys) explain: “Gairdner’s bar graph [1949!] shows a steep increase in retractility from birth to age 3 years. This does not occur in nature; it is possible that these values were obtained by the use of the probe. In any event, they have been disproved by later research. In actuality, development of retractility tends to be much slower. [...]  Gairdner’s values for the development of foreskin retractility stood alone and unchallenged for decades, during which they were quoted by the authors of numerous textbooks. Unfortunately, thousands of physicians the world over have been trained with these false values.”

In fact, the advice from the webmed article seems to be using the retraction values of Gairdner (1949) and the erroneous advice of Allan F. Guttmacher (1941) who came with the idea that a baby’s foreskin needed to be retracted and cleaned daily. Both pieces of really dangerous advice.

We call on Google to become more responsible with the snippets presented when they can lead to harming babies.

For a far better article on care of the uncircumcised newborn, read this page of the Paediatric Society of New Zealand

Update: I searched some more keywords on Google. The word “uncircumcised” also brings a biased article, this one from Cosmopolitan: “Although circumcision rates are declining in America, foreskin is still a hotly debated issue“. No Cosmo, foreskin is a part of the body. Circumcision is a debated issue.

And afterwards, a downward arrow offers more related topics: the definition of cicumcision and the definition of mohel.

In the United States, the foreskin is the only part of the body that when named, is followed by the description of the procedure to remove it. Sad and ridiculous.

uncirc

CDC, circumcision and misleading headlines

For anyone following the issue of genital cutting of minors in the United States, yesterday brought a plethora of new and misleading headlines:

The Verge: Benefits of circumcision outweigh the risks, US CDC says

NPR: CDC Considers Counseling Males Of All Ages On Circumcision

webmed: CDC Endorses Circumcision for Health Reasons – WebMD

Salon:  CDC: Circumcision is a very good idea – Salon.com

The Raw Story: CDC to parents: Consider circumcising your sons, because

UPI:  CDC recommends circumcision procedure, says benefits

NYTimes (blog):  Circumcision Guidelines Target Teenagers – NYTimes.com

But are these guidelines really such endorsement?

Or is it that the media is hungry to present benefits and call for a universal endorsement, something that really hasn’t happened?

It is our opinion that these headlines are nothing but a feeble attempt to manipulate the public opinion, under the assumption that everybody is too lazy to go to the source materials.

Anyone wishing to produce objective reporting on the CDC guidelines should start by fully reading and understanding the 8 pages draft document and the 60 pages technical report. It is unlikely that any of the reporters lending their names to the apparently carefully scripted articles, read any of the documents.

But we did, so let’s share our interpretation.

The CDC guidelines refer to counseling. Counseling does not mean immediate and universal endorsement. Counseling means aiding a person through a decision-making process, and that is what the guidelines attempt to do, to counsel patients or parents through a decision-making process.

In this decision making process, the CDC considered 3 main categories of individuals based on the age range: neonates and children, adolescents, and adults.

The CDC also considered the sexual orientation and lifestyle choices as factors to be weighted during this decision making process. And for those willing to go deep enough (as deep as page 39 of the technical report), the CDC also gave consideration to the fact that parents deciding for a newborn raise concerns about autonomy, including the argument that “a man with a foreskin can elect to be circumcised but if circumcised as a newborn, cannot easily reverse the decision“. The PHEC  (Public Health Ethics Committee) subcommittee is, however, of the opinion that “both a decision to circumcise and a decision to not circumcise are legitimate decisions“.  This is one opinion that genital integrity promoters and people for the rights of the child would oppose though.

For those saying that the CDC is fully recommending circumcision, they probably need to read in detail where the technical report indicates that “There are advantages and disadvantages to performing male circumcision at various stages of life” and one of the listed disadvantages of neonatal circumcision is that “the newborn has no ability to participate in the decision“.

The guidelines recognize that in the case of adolescents, both the adolescent and his parents should be involved in the decision-making process.

Let’s make one thing clear. One of the main reasons for the CDC’s discussion of circumcision has to do with the African trials on circumcision and HIV, considered to be evidence that circumcision could help reduce the risk of heterosexual transmission of HIV from infected females to males. The role of the CDC is not to discuss each one of those studies and their validity, strengths and flaws, but to make their recommendations based on currently accepted medical practices and standards. So of course an important premise of these guidelines is the so-mentioned potential benefit of reducing the risk of heterosexual transmission of HIV from infected females to males. As such, it is not within our current scope to discuss the African trials, something that has been already done by others in detail, but to discuss how the CDC interpreted those trials in reference to the U.S. conditions.

When discussing adult circumcision, the CDC recognizes both the documented benefits and limitations of circumcision as part of the prevention of HIV, that is:

  • that circumcision does not replace the need for condoms and safe sex,
  • that circumcision does not reduce the risk of male to female transmission
  • that circumcision does not reduce the risk or male to male transmission,
  • that circumcision does not reduce the risk of transmission through anal or oral sex, or for intravenous drug users.

In other words, that circumcision would only curb the transmission of HIV from females to males during vaginal penetration.

So, with those premises, the guidelines recommend a discussion of the person’s HIV risk behavior, HIV status, sexual preferences and gender of the sexual partner, in order to provide proper guidance depending on individual circumstances.

The PHEC subcommittee concluded that the disadvantages associated with delaying male circumcision would be ethically compensated to some extent by the respect for the integrity and autonomy of the individual.

And what are those “disadvantages”? A slightly increased risk of UTIs during the first year of life (risk of UTIs is low and they are generally easily treatable) and the possibility of the adolescent having a sexual debut prior to counseling and assessment of risks, which could potentially expose the adolescent to the risk of heterosexually transmitted HIV from infected female partners.

The CDC then states that:

The prevalence of HIV infection in the United States is not as high as in sub-Saharan
Africa, and most men do not acquire HIV through penile-vaginal sex. Targeting
recommendations for adult male circumcision to men at elevated risk for heterosexually
acquired HIV infection would be more cost effective than offering routine adult male
circumcision. Men may be targeted according to sexual practices or an elevated
prevalence of HIV within a geographic region or race/ethnicity group.

Also, regarding sexually active individuals:

“All sexually active adolescent and adult males should continue to use other proven HIV and STI risk-reduction strategies such as reducing the number of partners, and correct and consistent use of male latex condoms, and HIV preexposure or postexposure prophylaxis among others.”

So, are these guidelines an immediate and universal recommendation for circumcision? No, as much as biased media and individuals would like it to be, it is not.

The CDC gave slight consideration to sexual effects of circumcision. Again, we need to consider that they are reviewing existing medical standards, practices and publications (and it is noteworthy that proper discussion of the male foreskin is so absent from American health books that even pictorial representations of the foreskin are missing most of the times except in the context of its removal through circumcision). So, the guidelines devote the full length of a single paragraph to the discussion of sexual effects from circumcision:

The foreskin is a highly innervated structure and some authors have expressed concern
that its removal may compromise sexual sensation or function. However, in one survey
of 123 men following medical circumcision in the United States, men reported no change
in sexual activity and improved sexual satisfaction, despite decreased erectile function
and penile sensation. Furthermore, a small survey conducted among 15 men before and
after circumcision found no statistically significant difference in sexual function or sexual
satisfaction. Other studies conducted among men after adult circumcision have found
that relatively few men report that there is a decline in sexual functioning after
circumcision; most report either improvement or no change.”

This paragraph acknowledges the histological studies of John Taylor and Sorrells’ study on fine touch pressure thresholds, but not the European surveys of Bronselaer in Belgium and Frisch in Denmark (both of which showed sexual difficulties among circumcised males), preferring instead to refer to Krieger‘s Kenyan study (which does not show the same difficulties). This begs the question of why African studies are more relevant to the sexual function and satisfaction of American citizens than European studies, but we will leave such discussion for the readers to make their own conclusions.

Finally, missing from the guidelines is any discussion of the role and functioning of the foreskin, something that could be accomplished by simple observational studies of the sexual behavior of uncircumcised males. But one could argue that the role of the CDC is to counsel on control and prevention of diseases, and not on sexuality.

I can’t avoid, however, citing this quote from the late Dr. Paul Fleiss, from his 2002 book:

“Accurate information about the foreskin itself is almost always missing from discussions about circumcision. How can parents make a rational decision about circumcision when they are told nothing about the part that will be cut off?” Fleiss. What your doctor may not tell you about circumcision

Our conclusion is that the CDC draft is far from being the universal recommendation for circumcision that biased media, organizations and individuals may wish for, it is actually more balanced on its ethical aspects than the AAP’s Policy Statement, however it is not unbiased as it still gives more relevance to African studies than European, in spite of the American circumstances being more comparable to those of Europe than to Sub Saharan Africa. The media however latches to key phrases like “benefits from circumcision” ignoring the harms and collateral effects and autonomy concerns, thus distorting the message and manipulating the public opinion.

The Skeptic – Does science support infant circumcision?

We often criticize Brian Morris’ methods and advocacy of circumcision, particularly his underestimating of risks and complications, his denial of the harm, his overestimation of benefits, and his recurrent self-referencing.

It’s good to read others who share our concern. This is a great article by Brian D. Earp and Robert Darby, published on The Skeptic: http://www.skeptic.org.uk/magazine/onlinearticles/articlelist/711-infant-circumcision

It calls attention to an interesting contradiction. Morris argues for circumcision to avoid having to treat urinary tract infections with paracetamol (pain medication) in light of new studies that associate early exposure to paracetamol with an increase in the risk of autism… yet fails to correlate the fact that paracetamol is used after newborn circumcisions.

Anyway, great read. It’s sad that people are still being fooled by Brian Morris’ air of respectability and the scientific community continues playing his game and not exposing his pseudoscientific arguments. Really sad.

NEW CIRCUMCISION “STUDY”: Complication Risks May Increase With Age – Does Medical Necessity?

“Circumcision fails to meet the commonly
accepted criteria for the justification of preventive
medical procedures in children. The cardinal
question should be not whether circumcision can
prevent disease, but how can disease best be
prevented.”
Frisch et al, Cultural Bias in the AAP’s 2012
Technical Report and Policy Statement on
Male Circumcision

Another day, another article. This time, it’s about a study by Charbel El Bcheraoui  published in JAMA Pediatrics, funded by the US Centers for Disease Control and Prevention (CDC). The study claims that “Male circumcision had a low incidence of AEs (adverse events – a euphemism for complications) overall, especially if the procedure was performed during the first year of life, but rose 10-fold to 20-fold when performed after infancy.

The question that El Bcheraoui circumvents is, however, are those circumcisions necessary? Without medical or clinical necessity, are those circumcisions ethical?

Without those considerations, this is nothing more than a sales pitch. “Circumcision! Buy now, or tomorrow it will be 20 times riskier,” El Bcheraoui seems to urge.

But, what are the chances a child will need to be circumcised later on in his lifetime?

What are the reasons a man would have to be circumcised at a later age? Do they increase with time? (Answer: No, they don’t. The majority of men who are left intact, stay that way.)

El Bcheraoui concludes that “Given the current debate about whether MC should be delayed from infancy to adulthood for autonomy reasons, our results are timely and can help physicians counsel parents about circumcising their sons” but this is nothing more than self-interested hogwash. The argument of bodily autonomy is mentioned but not expanded on. In effect, what the author is saying, without daring to say it, is that bodily autonomy can be violated in order to decrease the risk of complications; a risk the author already considers to be low.

If we were to extrapolate the reasoning behind this conclusion, it would be possible to argue that removing the breast buds from baby girls is easier, less traumatic and has less complications than waiting for breast cancer to develop and then perform mastectomies, where breast cancer is the second leading cause of cancer death in women.

The authors did not declare any conflict of interest. But of course it is not surprising that El Bcheroui is affiliated with the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention. Let’s just quickly remember that in 2009 the CDC was considering promoting universal circumcision to prevent the spread of HIV in the United States, despite pre-existing evidence (from the CDC nonetheless) that the high rates of circumcision in the United States had no effect over transmission of HIV.

It seems nowadays no circumcision article or “study” is complete without the obligatory “benefits outweigh the risks” soundbite from the 2012 AAP policy statement on circumcision. Of course, what is never mentioned is that this is only part of the statement, which is rarely ever quoted in its entirety:

“The American Academy of Pediatrics found the health benefits of newborn male circumcision outweigh the risks, but the benefits are not great enough to recommend universal newborn circumcision” - http://www.aap.org/en-us/about-the-aap/aap-press-room/pages/Newborn-Male-Circumcision.aspx

Circumcision advocates love to quote the AAP, but they could not recommend circumcision in their last statement because, in their own words “the benefits were not great enough.” How is it lay parents are expected to analyze the same “benefits” which couldn’t convince an entire body of medical professionals, and somehow come to a more reasonable conclusion? Why are doctors expected to act on it, and why is the public purse expected to pay?

The AAP said in their last statement that “The true incidence of complications after newborn circumcision is unknown, in part due to differing definitions of “complication” and differing standards for determining the timing of when a complication has occurred (ie, early or late)” and catastrophic injuries were excluded from the report because they were reported only as case reports, not as statistics. The statement also indicates that “Financial costs of care, emotional tolls, or the need for future corrective surgery (with the attendant anesthetic risks, family stress, and expense) are unknown.”

In the opening statements of this study, El Bcheraoui estimates that 1.4 million circumcisions are performed in medical settings annually in the United States. This appears to contradict a previous statement by none other than El Bcheraoui himself, claiming a rate of 32.5% in 2009. Perhaps he expects the 2012 AAP Policy Statement to result in the resurgence of circumcision rates.

The study reviewed the medical history of approximately 1.4 million males circumcised between 2001 and 2010, and found that approximately 4,000 infants had suffered complications, leading them to calculate a rate of complications (adverse events) of less than 0.5%

This would mean, using the data they present, that every year, between 5,600 (0.4%) to 7,000 (0.5%) infant males will suffer complications from circumcision; circumcisions that will in all likelihood be medically unnecessary.

This would not include those complications that can be minor or undetected by the parents (skin tags, skin bridges, uneven scarring) or those that will not be detected until much later (pain caused by tight erections, lack of sensitivity).

The researchers note that some complications might not have been picked up because they were reviewing claims data on problems that typically occurred within the first month following the circumcisions.

This would likely exclude meatal stenosis. High prevalence of meatal stenosis has been found in circumcised males (see here and here), possibly as consequence of ischemia (poor blood supply) to the meatus or permanent irritation of the meatus caused by friction with the diaper and resulting in scarring.

A recent ecological analysis by Ann Z. Bauer and David Kriebel found a correlation (but not causation – further studies are needed) between early exposure to paracetamol and other analgesics, and autism spectrum disorders (ASD). This took into consideration that most newborn circumcisions before 1995 used no pain relief at all, but with growing awareness of the pain of circumcision and increasing use of paracetamol, a sudden rise on the rates of male ASD occurred.  According to this analysis a change of 10% in the population circumcision rate was associated with an increase in autism/ASD prevalence of 2.01/1000 persons (95% CI: 1.68 to 2.34) ”

These findings of course would not have been included in El Bcheraoui’s paper, as this would be out of existing billing codes and administrative claims within the first month from the procedure.

So, let’s just think for a moment, if these circumcisions are not necessary, if these circumcisions are “elective,” then what is the tolerance for errors and complications? El Bcheraoui claims that a 0.5% complication rate is low. But how low is it when it means 5,600 to 7,000 babies who will suffer complications annually? And what kind of complications are we talking about?

These low rates fail to explain the increasing rates of circumcision revisions as well.

How many cases like the one of David Reimer can we afford to have before it is ethically wrong, morally wrong? How many more like Jacob Sweet?

How many MRSA infections?

How many partial or full ablations of childrens’ penises, like that baby in Memphis and that other baby in Pittsburgh last year?

How many infections with Herpes?

How many deaths?

Catastrophic complications, rare or not, mean destroyed lives. Not numbers. And to destroy lives of innocent babies in the name of “religious, ethical and cultural beliefs” is simply not right. Because there is no medical indication for surgery in healthy, non-consenting minors, any complications above zero is ethically unconscionable.

CIRCUMCISION: Lies and Fetishism at the University of Sydney

It is generally well-accepted that a researcher or expert that seeks to convince by a claim of authority or by personal observation needs to be objective, impartial and dispassionate; an audience can only evaluate information from such a source if they know about conflicts of interest that may affect its objectivity and credibility. Thus, before  an audience evaluates information from a source, conflicts of interest need to be declared or identified. The personal background and affiliations of researchers can reveal hidden biases and prejudices.

Having eccentric associates does not make one an eccentric, but sometimes friends, coworkers, etc., mutually enable each other by serving as echo chambers to each other. Let’s take a look at Brian Morris, and let’s see how he relates to some friends and fellow researchers, Guy Cox and James Badger. How do they relate?

The characters

Brian Morris

Brian Morris

The University of Sydney staff directory presents Guy Cox as an Honorary Associate Professor, botanist and microscopist, and no mention is made of his interest in circumcision or the role of the foreskin. However some of his interest has managed to creep onto servers at the University of Sydney; one of his papers on circumcision and the foreskin is actually stored in these servers, as will be shown in the next paragraphs.

Guy Cox, University of Sydney honorary associate professor and circumcision advocate

Guy Cox

Brian Morris and Guy Cox are co-authors of chapters 19 and 21 of the book “Surgical Guide to Circumcision” by By David A. Bolnick, Martin Koyle, Assaf Yosha

Text co-authored by Brian Morris and Guy Cox

Text co-authored by Brian Morris and Guy Cox

Guy Cox published an article on Medical Hypothesis called: “De Virginibus Puerisque: The Function of the Human Foreskin Considered from an Evolutionary Perspective” in which he refers to a survey performed by James Badger and thanks Badger for making his data available. A copy of the pdf file is stored on the servers of University of Sydney (url: http://www-personal.usyd.edu.au/~cox/pdfs/dvp.pdf). Is the University of Sydney aware of the existence of this article by Guy Cox stored on their server, outside his particular career path?

Guy Cox's paper

Guy Cox’s paper

Guy Cox thanks James Badger

Guy Cox thanks James Badger

James Badger published a two part circumcision survey on Australian Forum magazine, 1989. Australian Forum is not a peer-reviewed scientific or medical publication.

Badger's survey on circlist

Badger’s survey on circlist

Brian Morris’ website identifies James Badger as a “University of Sydney biomedical scientist” who “used to regard himself as neutral on the issue of circumcision, but would now appear swayed by the evidence into adopting a ‘pro’ stance”.

Morris cites Badger

Morris cites Badger

Circlist (a website and discussion group for men who sexually fantasize about performing and receiving circumcisions) identifies James Badger as one of its members and has 6 surveys by Badger on different aspects of circumcision, such as masturbation, urination, emotions, attitudes, etc.

Circlist identifies Badger as a member

Circlist identifies Badger as a member

A PowerPoint presentation by Brian Morris on the topic of circumcision, which can still be found on the server of University of Sydney, makes reference to the “first ever survey by a USyd academic in 1989″ (slide 35) – the survey by James Badger.

Slide 35 of Brian Morris' PowerPoint presentation

Slide 35 of Brian Morris’ PowerPoint presentation

A curious fact, slide 6 of the same PowerPoint file shows a picture of Morris with a small group of Sub-Saharan boys during the preparation for their circumcisions, with emphasis on the close up of an old razor hanging from the necklace of one of the boys, a razor that will be used to remove his foreskin. Traditional circumcisions in Africa account for many yearly deaths, mutilations (loss of the penis), life threatening infections and other complications, as denounced on the Ulwaluko website.

Slide 6

Slide 6 – Notice the razor

But the existence of James Badger poses a new mystery.

James Badger

James Badger

Morris’ book “In Favour of Circumcision” reveals that James Badger is a pen-name for the purposes of the Forum survey and debate in general. See note 168 on page 93.

Morris identifies Badger as a pen-name

Morris identifies Badger as a pen-name

Searches on the University of Sydney’s staff directory for James Badger return empty. Further searches for a Sydney scientist named James Badger also return empty.

So now that we know something about our characters, let’s develop the story.

Lies and fetishism

Brian Morris’ original website was hosted on the servers of the University of Sydney, where he and Guy Cox were professors. The old url, now inactive, was http://www-personal.usyd.edu.au/~bmorris/circumcision.shtml (archive)

Old Morris site on the server of University of Sydney

Old Morris site on the server of University of Sydney

Brian Morris’ website has a page of links and resources. On 2007, the second link listed was aboutcirc.org, and, as revealed on the Wayback Machine  (a tool that saves snapshots of websites at different times), between parenthesis it used to read “Dr. Guy Cox, Australia” (see archive).

In 2007 Morris identified aboutcirc as authored by Guy Cox

In 2007 Morris identified aboutcirc as authored by Guy Cox

On December of 2011, the University of Sydney asked Morris to remove his website from their servers.

Message from Chris Coffey announcing the decision to have Brian Morris remove his website from the University of Sydney servers

Message from Chris Coffey announcing the decision to have Brian Morris remove his website from the University of Sydney servers

Morris found a new hosting service, a company called Lemonred, and moved his website there. (Before Lemonred, Morris’ site moved temporarily to Trinidad and Tobago).

Currently, the first link on the page of links and resources remains aboutcirc.org. However the parenthesis now read “James Badger, Australia”.

Currently Morris attributes aboutcirc to James Badger

Currently Morris attributes aboutcirc to James Badger

According to Robert Darby, historian interested on the topic of circumcision, James Badger is really Guy Cox. This seems to be supported by Morris’ diverging attribution of the author of the aboutcirc.org website. It seems ironic then, that Guy Cox, on his paper about the function of the foreskin, would quote James Badger’s survey and thank him for authorizing the use of his data. If they are really the same person, this would be disrespectful of the general public.

Robert Darby discusses James Badger

Robert Darby discusses James Badger

Brian Morris is known for self-referencing openly in third person: “researchers have demonstrated”, “experts criticized”, etc. A good example of this is his recent article, coauthored with Tomas Wiswell and Stefan Bailis and published by Mayo Clinic Proceedings, which is said to be a literature review: out of 80 references, 12 are articles and studies co-authored by Brian Morris himself.

Self-referencing Morris

Self-referencing Morris

So now let’s go back to the University of Sydney on December of 2011 asking Morris to remove his website, and Morris finding a new hosting service, Lemonred.

Lemonred

Lemonred

Internet records show that Lemonred’s domain is owned by Cassian Cox, who happens to be the son of Guy Cox.

Further investigation reveals that Lemonred also hosts:

  • Guy Cox’s personal website (Guy Cox Software). In a web design section, this site lists two websites as examples of their work: Male Circumcision (aboutcirc.info) and Claude Cox Old and Rare Books (claudecox.co.uk) – notice the last name.
Guy Cox Website

Guy Cox Website

guycoxpage2

Aboutcirc.com has a section for book reviews, and one of the books is called “airport encounter” by James Badger, described as “a light-hearted story about an Australian choirboy and his friends, this books follows the life and loves of a group of boys and girls as they grow from children into teenagers. Circumcision is a major theme as, naturally, is music. It is quite sexually explicit at times“. The contact to buy this book happens to be, surprise! Claude Cox, the British librarian.

Reviews on Aboutcirc

Reviews on Aboutcirc

Would it also be a surprise that James Badger’s website would make a review of one erotic fiction book which includes circumcision, whose author is also James Badger, who is a “University of Sydney biomedical scientist” and “used to regard himself as neutral on the issue of circumcision” but is also “a circumcision pen-name“? (all italics are literal words by Brian Morris)

The other book reviewed is “The surgical guide to circumcision”, which, as we mentioned earlier, includes two chapters written in collaboration by Brian Morris and Guy Cox!

  • There is another website hosted by lemonred (and most likely owned by Guy Cox himself) which deserves particular attention. The website is called boyguard.com and offers a product for boy chastity. The purpose of the website seems to be to promote this product to control children’s sexuality, aided by “high and tight” circumcisions.

    boyguard website

    boyguard website

The site states: “We are strongly in favour of circumcision for all boys. (…) If you are considering circumcision for your boy, make sure it is done properly, with the foreskin completely removed. The glans (knob) should be completely uncovered and there should be no surplus skin on the shaft of the penis. Otherwise the hygiene benefits may not be fully realized. (…) So the skin will stretch to allow for the firmest erection, and this is the desired outcome – the skin should be stretched tight when the penis is erect.

While we do not subscribe to the 19th century notion that circumcision prevents masturbation, there is no doubt that this type of circumcision makes it more difficult, and so if a boy does get access to his penis in an unguarded moment he is less able to succumb to temptation. In particular, if he has seen an uncircumcised or partly-circumcised boy abusing himself, he will be quite unable to mimic what he has seen.

boyguard - in favour of circumcision

boyguard – in favour of circumcision

(The first sentence almost seems as a direct reference to the title of Brian Morris’ book: “In favour of circumcision”).

It is worthy of note that James Badger (AKA Guy Cox)’s survey includes observations about the difference in masturbation techniques between circumcised and uncircumcised males.

It was also “James Badger” who on April of 2013 announced to the inter-circ Yahoo Group to the existence of the Boyguard website, while pretending not to have any relation to it.

Badger announces Boyguard to the inter-circ Yahoo group

Badger announces Boyguard to the inter-circ Yahoo group

Incidentally, the Inter-circ group is, in its own words, “a global male circumcision appreciation group encouraging discussion of the pros and cons of circumcision as an adult. The group is also for those who feel that male circumcision is a perfectly acceptable parental decision resulting from religious, cultural, or medical considerations. WE ARE PRO-RIC.” (RIC = Routine Infant Circumcision)

Inter-Circ Group

Inter-Circ Group

Recapping, the administrator for lemonred is Cassian Cox.

lemonred-whois

lemonred-whois

The admin for circinfo.net is private, but it doesn’t matter because it’s recognized as Brian Morris’ website

The registrant for James Badger’s websites (aboutcirc.info, .org and .com) is Guy Cox, with Cassian (his son) being the administrator.

aboutcirc-whois

aboutcirc-whois

The administrator for claudecox.co.uk is Claude Cox.

The registrant for Guy Cox’s personal website, guycox.com, is Guy Cox, with Cassian Cox as administrator.

guycox-whois

guycox-whois

The registrant for boyguard.com is private, however the contact us page has a P.O. Box which corresponds to the P.O. Box of Guy Cox Software (see previous screenshot).

boyguard-contact info

boyguard-contact info

Conclusions

Considering that James Badger appears to be a fictitious character, identified as a scientist at University of Sydney (but impossible to find through the staff directory), who owns three websites, who really published a survey on an Australian magazine in 1989, who is said to be neutral on the topic of circumcision, who is a member of circlist -a mailing list that accepts circumfetish-, who authored one erotic fiction book that includes the topic of circumcision, who then used his website to publish a review of said book speaking in third person, whose surveys have been used as reference by Brian Morris and Guy Cox, and who comments on internet articles about circumcision… We have to say, quite a talented and busy fictitious character!

If James Badger is a fictitious character, Brian Morris is lying by currently identifying him as the owner/author of aboutcirc.com and a scientist at University of Sydney, and by using his surveys as references; but if James Badger is not fictitious, then Brian Morris lied on his book by identifying him as a pen-name, and by attributing the aboutcirc.com website to Guy Cox back in 2007.

If James Badger is a fictitious character, Guy Cox lies by using his survey as reference and thanking him for allowing him to use the data; particularly if James Badger and Guy Cox are the same person.

If James Badger is a fictitious character, then it is incredibly ironic that Brian Morris, circlist, Guy Cox, and Badger himself behave as if James Badger really existed.

But if James Badger does exist, we would love to see more information on his work: publications, work story, bio, or at least one photo!

Implications

The association between Brian Morris and Lemonred is not as casual as looking for hosting companies in the yellow pages and shopping for prices and hosting packages. The owner of Lemonred, Guy Cox, happened to be a co-worker of Brian Morris at Sydney University, and also happens to be an independent researcher/author on topics of circumcision, outside his career path. Both of them have referenced each other on their papers and publications and coauthored at least one publication. Both have been known to participate on circumcision related mailing lists such as circlist and the Gilgal Society, funded by now convicted pedophile Vernon Quaintance.

Our investigation reveals that Cox also happens to be interested in interference in the sexual lives of children through chastity devices and circumcision . As our readers may remember, the very beginning of “medical” circumcision during the late 19th century was caused by a desire to prevent children from masturbating, and included chastity devices, infibulation of the penis (sewing the foreskin shut with a silver thread), circumcision without anesthesia and other similar barbarities, and included genital mutilation as a way of dealing with female masturbation (clitoridectomy, rubbing carbolic acid on the clitoris, removal of the labia, etc). The dynamic of power involved in controlling children’s sexuality opens the door for potential child abuse.

Both Morris and Cox are now retired professors but continue to participate in the debate over circumcision, with Morris particularly having a very active role in the public eye.

The media in general and particularly medical journals such as Mayo Clinic Proceedings; the University of Sydney, and the general public should be informed that Brian Morris lacks medical credentials to be speaking on the matter of circumcision; he is not a pediatrician, urologist, sexologist or physician in any capacity; Brian Morris is known to interact with individuals who openly practice circumfetishism or identify as “circumsexuals” and his website links to at least one circumfetish website. While he may outwardly portray an interest in child well-being and public health, this conflicts with the perverted interest in the forced circumcision of minors and/or sexual control and chastity of minors.

Acknowledgments

Thanks to all the anonymous individuals who in one way or another collaborated with this investigation from different corners of the world.

On The Stream: To Cut or Not To Cut – Brian Morris, Richard Wamai on circumcision

Spotting contradictions between circumcision promoters on Al Jazeera’s “On The Stream: To Cut or Not To Cut”

If you are outside the U.S., you can watch the video here: https://www.youtube.com/watch?v=GitOnW-nzck&sns=fb

If you are in the U.S., this link may work: http://bc19.ajnm.me/864352181001/201404/3132/864352181001_3492775214001_FULL-to-BC-AJE-0421.mp4

Richard Wamai

Richard Wamai

At 8:25 Richard Wamai denies risk compensation

Richard Wamai: There is no evidence out of Sub Saharan Africa where male circumcision is being promoted to prevent millions of men from getting infected with HIV that somehow there is disinformation and that men get circumcised and reduce using condoms or change behavior, we don’t have that evidence, it simply does not exist.

At 20:21, after a YouTube blogger argues that we don’t need to amputate every tissue that becomes infected, and calls for “our bodies, our choice”,  Richard Wamai responds:

Richard Wamai: I totally disagree with that. First off all, if we talk about human rights, adult men can determine whether they want to keep their foreskin or not. If I know the benefits of circumcision, then I have the right to make the decision. For somebody to say that it is amputation, that is not quite accurate at all.

[Richard Wamai is co-author of "A snip in time: what is the best age to circumcise?" where he, along with Brian Morris and other circumcision advocates, argues that infancy presents a "window of opportunity" for circumcision. Infants cannot provide informed consent.]

Richard Wamai

Richard Wamai

At 22:25 approximately:

Moderator: I don’t understand if you are circumcised as a man, you are still putting a condom on. Why don’t you put a condom on in the first place?

Richard Wamai: Well, why, you don’t, because, you know what the rate of condom use is in South Saharan Africa?

Moderator: But you have to use it to have protection

Richard Wamai: You know what it is? Very few people ever use a condom consistently so we need to do something, that’s why we are doing studies, that’s why we are doing studies  to test whether there could be a microbicide, a vaginal stuff, gel that women can use…

Moderator: Because men don’t like to wear condoms?

Richard Wamai: Well, that too, but I mean, we know that condom use is very low…

At 23:22 Brian Morris tries to interrupt, I have not been able to figure out what he says. The show goes to a commercial break. Upon return, John Geisheker from Doctors Opposing Circumcision presents his critique of the African circumcision trials.

Brian Morris and John Geisheker

Brian Morris and John Geisheker

John Geisheker: (…)For one thing, the figure of 60% does not rise to the level of immunization, which must, by standard of bioethics, be in the high nineties. A 60% protection of anything is merely a roll of the dice. All that a person is doing who is circumcised and then not bothering to use the usual protection of ABC [abstinence, be faithful, condoms] is playing bio-roulette, Russian roulette. (Continues explaining the real meaning of the 60% figure)

Brian Morris: John is a lawyer, he is not a scientist, he is not a doctor [never mind that Brian Morris is not a medical doctor either], trials are not about following people for ever and ever, trials follow people until they find a statistical difference and in this case the statistical difference happened so soon that the monitoring body stepped in and stopped the trials because it would be unethical to continue them since the evidence showed such a strong protective effect

Moderator interrupts for a back story. Then Brian Morris continues

Brian Morris: I also completely dispute John’s misunderstanding of immunology and vaccines. Vaccines some are quite effective, but look at one of the more common vaccines, the flu vax, the effectiveness of that in the population is about 80%, which is also about the effectiveness of condoms, and with the long, long term follow up of HIV trials and roll out, the protective effect of circumcision has risen over the years, so it’s now approaching that 80% mark, and in public health we advocate [I keep missing this word, sorry] interventions, not just condoms, not just circumcision, but also a behavioral practice, anything else that we can show does work. We don’t say oh let’s just go this way because we like it. We use all of the effective methods and circumcision is one of THE MOST effective [vocal emphasis], and as Richard pointed out condoms cannot be used but once a man is circumcised he is circumcised for life and that is significant. Condoms have to be put on the penis before any sexual contact…

…..

So, let’s point some issues here. In Richard Wamai’s view, condom use rate cannot be increased significantly, so it seems better to go on a crusade to circumcise millions of men, even though men are not running to take the offer. And while Wamai denies risk compensation, he also denies that condom use rate can be increased (which is a risk compensation behavior on its own). And yet he seems to put hopes on hypothetical future gels for women to use, when men cannot (in his mind) be expected to use condoms.

Brian Morris on his end appears to be doing what he usually does: inflating the benefits and overlooking the risks. In his mind the protective effect has been increasing and is close to the 80% mark.

About this increasing protective effect, I’m reminded of this text by Des Spence (BMJ 2010;341:c6368) (we highlighted some keywords):

Study design—Study populations are biased by design. Only high risk, unrepresentative populations are studied because they are the most likely to show an effect. These data are then extrapolated to low risk populations of people who never benefit—statins are studied in Scotland and prescribed in Surbiton. The inverse care effect also means that people at low risk are more likely to seek treatment and comply with it.

The same article indicates:

Statistical trickery—There is systematic and cynical use of statistics to manipulate results [see following paragraph]. This dishonesty—the dark magic of surrogate and composite end points, “validated” questionnaires, the premature ending of studies, the reporting only of relative risks , and the lack of long term follow-up—is just cheating.

The famous 60% figure is a relative risk, a comparison between two very small percentages, as John explained in the debate until Brian Morris interrupted.

One fact often overlooked about the African trials is that the number of individuals lost to follow up was 3 times more than the total number of sero-converted individuals. This alone casts serious doubts over the “statistical significance” of the results.

Trying to listen to Brian Morris and Richard Wamai, we are reminded of the technique known as Gish Gallop: “The Gish Gallop is the debating technique of drowning the opponent in such a torrent of small arguments that their opponent cannot possibly answer or address each one in real time. More often than not, these myriad arguments are full of half-truthslies, and straw-man arguments - the only condition is that there be many of them, not that they be particularly compelling on their own. They may be escape hatches or “gotcha” arguments that are specifically designed to be brief, but take a long time to unravel.

Another important detail, Richard Wamai argued that to call circumcision amputation is wrong because every adult man has the right to decide over his body. John Geishener made clear that he and his organization (Doctors Opposing Circumcision) agree that every adult man has the right to do anything to his own body, and that their opposition is to forceful circumcision of infants and children, and to using the African trials as rationale to push for infant circumcision in the United States (extrapolation).  Brian Morris and Richard Wamai are, however, coauthors of a paper called “A snip in time: what is the best age to circumcise?” where they argue that infancy presents a “window of opportunity” for circumcision. So how would Richard Wamai defend his argument that circumcision is not amputation, after arguing in writing for circumcision during infancy?

But please dear readers, don’t take our word; watch the video, do your best research, evaluate the evidence, evaluate the advocates one way or another, and formulate your own conclusions.

Related News:

ZIMBABWE: Men are not buying circumcision…

ZIMBABWE: …so they’re doing it to babies

UGANDA: Myths about circumcision help spread HIV

ZIMBABWE: Circumcised men abandoning condoms

Evidence that “simply does not exist” – according to Wamai:

Botswana – There is an upsurge of cases of people who got infected with HIV following circumcision.

Zimbabwe – Circumcised men indulge in risky sexual behaviour

Nyanza – Push for male circumcision in Nyanza fails to reduce infections

Did a Mayo clinic study confirm health benefits on circumcision? Or Brian Morris, and how to manipulate public opinion on circumcision using clever headlines

Recently, circumcision has resurfaced as a hot topic in the media. All last week, numerous articles with misleading titles were published by big name media outlets,  promoting the latest “study,” which supposedly “confirms” the so-called “benefits” of circumcision.

Here are some of the titles:

Infant circumcision is the healthiest choice, new study claims
Researcher says circumcision should be offered like childhood shots
Circumcision should be offered ‘like vaccines’ to parents of boys
Study determines circumcision comparable to vaccination” (Israel and Stuff)
Call for circumcision gets a boost from experts
Circumcision rates declining in US infants, raising health risks later in life
Circumcision should be seen ‘in same light as childhood vaccination’: study
Circumcision benefits far outweigh the risks, finds study IN MAYO CLINIC PROCEEDINGS (elsevier connect)
MAYO ON MILAH – Mayo clinic study confirms health benefits on circumcision” (The Jewish Press)
New Journal argues circumcision should be mandatory
The benefits of circumcision outweigh the risks 100 to 1
To snip or not to snip – academic claims circumcision should be treated like vaccination

But, is it true? Did the Mayo Clinic perform a new study on circumcision? And, was the study published legitimate?

To the casual observer, these headlines appear to say all they need to know. When they approach a conversation about circumcision, they will remember one of these headlines and quote it or paraphrase it without any real knowledge of what it means or what really happened. And this is exactly what some sectors want.

Now, let’s go step by step:

First off, the Mayo Clinic did not perform a study on circumcision.

The study being discussed is not new, original research, but a literature review of select articles.

The article was not written by unbiased researchers. The three authors have been known to promote circumcision for many years.

To call this article a “Mayo Clinic study” is misleading and manipulative. Independent authors submitted the article to the journal of Mayo Clinic, Mayo Clinic Proceedings. The Editorial Board procured peer reviewers, who then approved the article for publication. This is very different from having actual staff researchers or commissioned experts performing a study at the Clinic’s request. The article was not written at Mayo Clinic’s request or by Mayo Clinic personnel.

Related: Problems with Peer Review

Related: Is peer review broken?

This article (or literature review) was written by Australian retired professor and molecular biologist Brian Morris, and co-authored by Dr. Thomas Wiswell  and psychologist Stefan A. Bailis, both of whom had already co-written other publications promoting infant circumcision with Brian Morris.

Some articles referred to Brian Morris as Dr. Morris. While the fact that Brian Morris has a PhD makes this reference technically correct, it is misleading because it makes it sound like he is a qualified medical physician, when he does not hold a medical degree of any kind. Brian Morris is not a physician or a medical doctor in any way, and the public should know that. He is a professor of molecular science, and does not hold a degree in urology, surgery, pediatrics or epidemiology.

In their last Policy Statement on circumcision (2012), the American Academy of Pediatrics tries desperately to push the soundbite that “The benefits of circumcision outweigh the risks.” Be that as it may, the AAP stops short of the recommendation that circumcision advocates like Brian Morris were hoping for.  In this new review, Brian Morris takes a position far more extrem, going as far as comparing circumcision with vaccines; yet, the implied goal of both papers is to get Medicaid and insurance companies to re-establish coverage for neonatal circumcisions in those U.S. states where they no longer cover it.

This review makes claims that are manipulative and hard to prove, for example that the  “benefits exceed risks by at least 100 to 1” and that “over their lifetime, half of uncircumcised males will require treatment for a medical condition associated with retention of the foreskin”.

Because awareness that circumcision of minors violates human rights has been moving from the “anti-circumcision lobby groups” (as Brian Morris refers to pro-genital integrity organizations on his website) to mainstream organizations such as the Royal Dutch Medical Association, the Parliamentary Assembly of Council of Europe, the International NGO Council on Violence against Children and many others, professor Morris now is trying to manipulate the language to suggest that  “not circumcising a baby boy may be unethical because it diminishes his right to good health“, again a claim hard to substantiate.

Morris’ desired conclusion is that “as with vaccination, circumcision of newborn boys should be part of public health policies” particularly on “population subgroups with lower circumcision prevalence“.

Unsurprisingly,  the same authors, in cahoots with some of the promoters of circumcision in Africa, presented a paper called “a snip in time” two years ago, arguing that infancy is the best time to circumcise and that “by making MC (male circumcision) normative in a community, [...] the prospect of [psychological problems] would be largely eliminated“.

As usual, in this new article Morris references his own previous publications numerous times. Out of 80 references, he is author or co-author of at least 12 of them. On the contrary, the American Academy of Pediatrics in their 2012 Policy Statement did not quote a single publication by Brian Morris.

So this is the problem:

In the eyes of the casual observer (and reporter), the fact that this article is being published by Mayo Clinic Proceedings (a publication of the Mayo Clinic) is almost equivalent to saying that the Mayo Clinic performed an original study and/or agrees with it. While this is certainly not true, it is an easy assumption for people to make or believe.

Media headlines are used to manipulate the general opinion by using the more dramatic claims from the abstract to embed them in the collective consciousness. Most people will not read past the headlines, and will reach their conclusions based on this limited information.

Few reporters and authors dare to criticize peer reviewed publications. In this case, one notable exception is Wellington Professor, Dr. Kevin Pringle, who perfectly summarized: “Vaccination is a low-risk intervention to prevent a problem with significant adverse outcomes. Circumcision is an intervention with significant risks (ignored or minimised by the authors of this paper) to prevent problems that will not develop in the vast majority of males; most of which can be simply addressed if and when the need arises.

For those wishing to seriously challenge Brian Morris’ new article, the following is a response from the Editor-in chief of the Mayo Clinic Proceedings journal:

April 4, 2014 at 2:46 am

The article, “Circumcision Rates in the United States: Rising or Falling? What Effect Might the New Affirmative Pediatric Policy Statement Have?” was authored by 3 experts in the subject matter. All 3 have previously authored numerous scientific articles on this topic, and their combined credentials are far more than adequate to allow them to authoritatively address the topic.

Once submitted to Mayo Clinic Proceedings, the aforementioned manuscript was rigorously peer reviewed by other experts in the field, revised, and later accepted for publication. The Journal’s Editorial Board oversaw this process. All of these are typical processes for the review and acceptance of a manuscript. As a result of these processes, the approved manuscript was deemed to provide solid scientific information and appropriate speculative synthesis on the subject matter.

Formal comments regarding this article and other materials published in Mayo Clinic Proceedings should be directed to the journal, in the form of a Letter to the Editor. That communication should be submitted through the journal’s manuscript management portal, http://mc.manuscriptcentral.com/mayoclinproc . There, those wishing to comment will find instructions on the allowable content and other guidelines for formulating a Letter to the Editor. The comments within the Letters must be restricted to the scientific matter under investigation, and will be evaluated by a peer-review process to determine their educational and clinical value to the general/internal medicine readership of the Proceedings. In general, only 15% to 20% of all submissions to the journal are eventually accepted for publication. Ad hominem attacks on the authors, the Journal, or its sponsoring institution, Mayo Clinic, will not be permitted in any published Letters. Further, any letters eventually accepted for publication will be accompanied by a published response from the authors.

William L. Lanier, MD
Editor-in-Chief
Mayo Clinic Proceedings

Response to IBT “Brian Morris (author of circumcision study) denies link to Gilgal Society”

Dear Editor,
I see your apology and remarks that Brian Morris denies involvement with the Gilgal Society. I would like to point that the Publications page of the Gilgal Society, url: http://www.gilgalsoc.org/pubs.html
Has a link to the Reference Centre, url: http://www.circinfo.com/index.html which at the bottom specifies “Sponsored by The Gilgal Society“. This page includes a document, “Circumcision, a guide to the parents“, url: http://www.circinfo.com/parents_guide/gfp.html
At the bottom of this document you can clearly see: Copyright © 2006 Brian Morris and The Gilgal Society
I also want to point that Brian Morris website has a page on testimonials, url: http://www.circinfo.net/circumcision_testimonials_from_men.html, at the bottom of this page there is a link to a Next Section: Humor, which currently produces a page not found error. This page, however, can be found in the Internet Archive, at this url:
Points to notice:
  • Photo of a nude infant with a flip phone grasping the tip of his foreskin. Why did Mr. Morris ever consider this worth of publishing on his website, we can only guess.

  • Immediately following, a poem called “Decision“ 

Decision
Some people claim that foreskins are fun
And keep the ‘muzzle’ on the gun.
But many doctors do declare:
‘It’s healthier with the glans laid bare’
So, mum & dad, we say to you,
You must decide what’s best to do,
Your son will benefit throughout his life,
As, incidentally, will his wife;
If you make the choice that’s always wise
and do decide to circumcise.
Written
by Vernon Quantance


This poem is attributed to Vernon Quantance, the founder of the Gilgal Society (currently a convicted pedophile).
In internet comments, Mr. Morris has confirmed having previous contact with Mr. Quantance and having texts published under the Gilgal Society, which fell out of his favor with Quantance’s arrest last year. And while Mr. Morris objects to the Gilgal Society’s religious name, the Gilgal Society does not pretend to be a religious entity, but according to their home page “THE GILGAL SOCIETY is a not-for-profit publisher of medical educational material for the general public.” http://www.gilgalsoc.org/
While it is sad that Mr. Morris would feel offended by your article, truth is he has association to this group and previous cooperation that he has been quick to try to erase in face of Quantance’s misfortune.

hodgekiss

It’s official: Brian Morris is desperate

Back in August, the “Daily Telegraph” in Australia, reported on a new study by Morris and Krieger published on the “Journal of Sexual Medicine” called “Does Male Circumcision Affect Sexual Function, Sensitivity, or Satisfaction?-A Systematic Review.“. Back then, we replied: “No Morris, it doesn’t work that way

Anna Hodgekiss


For some reason, the Daily Mail in England has, just today, published a review of the same study, called: “It’s official: Circumcision DOESN’T affect sexual pleasure, according to biggest ever study of the issue“, authored by Anna Hodgekiss. This is interesting to the vigilant reader, as just in February 15th of this year the same newspaper published another article, this one by Claire Bates, titled: “Circumcision DOES reduce sexual pleasure by making manhood less sensitive

Have the male genitals adapted so much in a few months, that early this year circumcision reduced sexual pleasure, but now by December it doesn’t anymore?

No, of course not. But stay with us reader, so you can see through the words of Emeritus Professor Brian Morris, who -we never get tired of repeating it- is not a medical doctor, a sexologist, an epidemiologist, a pediatrician, an urologist or anything similar, but a molecular biologist and a circumcision enthusiast, one who, apparently, manages to convince naïve or biased reporters every few months.

The one concern I have is, why is a newspaper now in December reporting about a study that was published in August? Is it just that Mrs. Hodgekiss suddenly stumbled upon it and decided to talk about it? Or is Morris trying to get his study to do a second round, perhaps frustrated about recent developments regarding his beloved mutilating surgery?

Brian Morris


Because, unlike what Mr. Morris would like you to believe dear reader, circumcision is a multidimensional problem that can’t be simply resolved with an “evidence based appraisal”.

Circumcision, when performed for non-therapeutic reasons on non-consenting patients, becomes a human rights issue. Morris would like to cover this truth with his finger, but truth outshines him. Even the World Health Organization in its Manual for early infant male circumcision under local anaesthesia“, an extremely pro-circ document related to the intent of circumcising 20 million African males, recognizes that:


A concern about early infant male circumcision is that the child cannot give informed consent for the procedure. Moreover, some of the health benefits, including reducing the risk of HIV infection, will not be realized until many years later when the person becomes sexually active. If circumcision is postponed until an older age the patient can evaluate the risks and benefits and consent to the procedure himself.


More important, just two months ago (October 1st) the Parliamentary Assembly of the Council of Europe voted on and approved a resolution that declares that:


Despite the committed legislative and policy measures which have been taken by Council of Europe member States to protect children from physical, sexual and mental violence, they continue to be harmed in many different contexts. One category is particularly worrisome, namely violations of the physical integrity of children which supporters tend to present as beneficial to the children themselves despite evidently negative life-long consequences in many cases: female genital mutilation, the circumcision of young boys for religious reasons, medical interventions during the early childhood of intersex children …


Where this resolution reads “religious reasons” we need to read “non-therapeutic reasons”, in other words, not with the intent of treating a condition or disease. A social or religious surgery.

A few days later, October 10th, the Nordic Association for Clinical Sexology expressed its support to the Council of Europe, and declared that:


The penile foreskin is a natural and integral part of the normal male genitalia. The foreskin has a number of important protective and sexual functions. It protects the penile glans against trauma and contributes to the natural functioning of the penis during sexual activity. Ancient historic accounts and recent scientific evidence leave little doubt that during sexual activity the foreskin is a functional and highly sensitive, erogenous structure, capable of providing pleasure to its owner and his potential partners.

As clinical sexologists, we are concerned about the human rights aspects associated with the practice of non-therapeutic circumcision of young boys. To cut off the penile foreskin in a boy with normal, healthy genitalia deprives him of his right to grow up and make his own informed decision.

Unless there are compelling medical reasons to operate before a boy reaches an age and a level of maturity at which he is capable of providing informed consent, the decision to alter the appearance, sensitivity and functionality of the penis should be left to its owner, thus upholding his fundamental rights to protection and bodily integrity.

Every person’s right to bodily integrity goes hand in hand with his or her sexual autonomy.

This statement involves two aspects: human rights, and bodily integrity. It doesn’t matter if a doctor, a researcher, or even a parent, is convinced that a part of the body of a child, a) has no function, and b) is of no value to the child. While that part is healthy and does not represent an immediate threat to the life or health of the child, it’s the child’s right to discover, explore such part, and make a determination when his mental maturity allows for it.

Overriding this right to bodily integrity and self-ownership, is very problematic. That is why circumcision promoters try to blur this line and dismiss it with statistics of potential benefits.


We mentioned back in August that Morris must have been feeling desperate with the 2011 publication of Frisch’s “Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark” in 2011 and Bronselaer’s “Male circumcision decreases penile sensitivity as measured in a large cohort” early in 2013, so maybe he decided to play professor (maybe he had not retired yet at the time) and “grade” those previously published studies. Given that his coauthor, Krieger, is the author of one of such studies, it’s not surprise that Krieger’s study was the second highest graded study. We could suspect some bias.

But of course, given the recent developments in Europe, Morris and Krieger’s meta-analysis pretty much lost its momentum, so perhaps Morris found a new reporter, strategically located in Europe, with the hopes of bringing attention back to his paper and try to counter the effect of these European changes.

According to Anna Hodgekiss, the “lead author of the study, Professor Brian Morris of the University of Sydney, told MailOnline: ‘This is a ground-breaking article’“. Of course Morris would say that, given that he wrote it. One thing we know is that Morris loves to toot his own horn.

Hodgekiss writes:

The professors found that the very high quality studies reported circumcision ‘had no overall adverse effect on penile sensitivity, sexual arousal, sexual sensation, erectile function, premature ejaculation, duration of intercourse, orgasm difficulties, sexual satisfaction, pleasure, or pain during penetration.’

In contrast, the studies which find negative effects were poor quality, Dr Morris said.

This begs the question of if the high quality studies did in fact report one way, and poor quality ones reported in a different way, or if the quality was assigned by the professors depending on what the studies reported. Furthermore, the title of “Dr” is not the appropriate one for a molecular biologist.

She continues: “He added: ‘The methodology was impeccable’” (he would say that, of course, the advantages of ranking one’s own work)

Hodgekiss provides as example the discussion of “One high-quality trial of nearly 3,000 sexually experienced men in Kenya” (surprise surprise, Krieger’s study!).

One quick observation of Krieger’s study shows three suspicious elements: 

  • The age range of the participants was 18 to 24 years. At this age, males are very sexually active, and even those circumcised in early infancy have not suffered the long term desensitization. Not only that, but all the participants already wanted to become circumcised, which would be a prejudice factor. This is selection bias
  • The length of the study is of only 24 months. The gradual desensitization of the glans takes much longer, which makes long term follow up almost impossible.
  • One of the most surprising elements is that “For the circumcision and control groups, respectively, rates of any reported sexual dysfunction decreased from 23.6% and 25.9% at baseline to 6.2% and 5.8% at month 24“. In other words, by participating in the study, even if assigned to the control group (no treatment), the final result was a decrease of dysfunction. Exactly how is this possible?
In his study Morris spends considerable space trying to debunk those “poor quality” studies. We might go over them later. Morris also promises to review histological information in a future article, a hint at an upcoming attempt to discredit Taylor’s “The prepuce: specialized mucosa of the penis and its loss to circumcision“. 

As usual, it is amusing to check his references and see Morris’ last name repeated several times. He often refers to his own studies in third person. For example he writes: “In the Danish study that found more frequent orgasm difficulties in circumcised men, a number of flaws have been identified [58]“, and subsequent evaluation of reference 58 reveals Morris BJ,Waskett JH, Gray RH as the authors.

In the end, the authors report no conflicts of interest. Considering that Morris is author of a book called “In favour of circumcision” and a website called “circinfo”, and co-founder of the “Circumcision Foundation Australia” -an entity created to present a Policy Statement when the RACP disowned him, and that Krieger is the author of one of the highest quality studies referred, as ranked by Morris and Krieger, this lack of conflicts does not appear sincere.

Oh Morris, it’s official. You should retire from this debate too. You are getting too repetitive.