CINCINNATI: Intactivists Protest Circumcision "Experiment" at Good Samaritan Hospital

Last week, intactivists gathered at TriHealth Good Samaritan Hospital in Cincinnati, Ohio, to protest a clinical "trial" they are conducting, which aims to compare two circumcision devices commonly used for neonatal circumcisions. The experiment aims to compare the Gomco and Mogen circumcision clamps to see which one causes "less pain."

Bottom-left: Mogen clamp. Top-right: Gomco clamp

Details of the Circumcision "Study"
The claimed purpose of this study is to see which circumcision method is "less painful." Parents are being solicited to enroll their male infants in a study comparing two clamps used for non-medical circumcision.

In addition, the experiment seeks to see which method causes more bleeding, takes more time, which is followed by the most "parental satisfaction" in follow up visits (never mind the satisfaction of the child, on whom the circumcision is being performed) , which one causes more need for revisions within 6 weeks, and which one is more likely to cause infections.

Bleeding is being measured by weight of blood soaked gauzes after the procedure. Other outcome measures include neonatal pain score and a standarized score, including vital signs and facial expression.

The so-called "researchers" are starting from the hypothesis that the Mogen technique of circumcision is less painful, faster, and associated with less bleeding for newborns when compared to the Gomco technique after a resident circumcision standard teaching curriculum.

The participants are being euphemistically called "volunteers," and they are male babies 4 days old or less, born healthy from pregnancies without complications.

The experiment, entitled "Gomco Versus Mogen: Which is Best?" is currently "recruiting participants," or rather, persuading parents to enroll their healthy newborn baby boys. More than 200 babies have or will become subjects in the experiment, planned to run through April 2014.

More details on this "study" can be seen here.

Glaringly Obvious Problems

Deliberate Pain
The claimed purpose of this "study" is to decide which clamp "causes less pain." While up until recently, circumcision advocates argued that babies felt "no pain," and some continue to insist circumcision is painless still, the researchers here are not pretending the procedure is painless anymore; they are conceding that pain results regardless of used method. (Actually, it's been known for years that newborns feel pain more acutely than adults, and that circumcision is excruciatingly painful.)

In other words, for the purpose this "study," healthy, non-consenting babies are being enrolled, who will be deliberately made to experience pain. This is inescapably necessary to purportedly track which non-medical surgery method causes "less pain."

Non-medical surgery on healthy, non-consenting minors
The babies being circumcised for this experiment are being called "volunteers," which is a horrible stretch. The "researchers" can get by doing this because they've obtained signed consent from parents, placing on them the onus of responsibility, and circumventing the important question of medical necessity.

A big problem with this is the fact that researchers need "volunteers" for their experiment, and for this reason, parents who are being asked to have their children "participate" may not be being told how much pain circumcision actually causes. They CANNOT know; researchers cannot tell them exactly how much pain their child will endure, for measuring pain is the very purpose of the study. How much information are parents being given to obtain their consent to allow their children to participate in this study? Will they be shown a video of each procedure? Would the parents still consent for their children to "participate" in this experiment if they were truly informed?

But more importantly, consent from parents must be asked only after it has been determined that the child is suffering a medical illness for which there is no other alternative. Without medical or clinical indication, can a doctor even be performing surgical procedures on healthy, non-consenting minors? Let alone be eliciting consent from their parents? Let alone be asking them to let their children "participate" in an experiment, where the researchers cannot deny that the children will be experiencing deliberate pain? 

Short Timeframes for Other Factors
The "researchers" state they will be collecting data for other factors, such as bleeding results, "parental satisfaction" results, botched circumcisions, as well as others. The timeframes for many of these seem inappropriately short, such as measuring bleeding only 10 minutes after the surgery; babies have been known to have bleeding complication for hours, if not days. Additionally, some of these complications, particularly botched results and the need for revision, do not present themselves until the parents have gone home, sometimes even months, years down the line, so these babies will be excluded from this "study."

Note that one of the factors measured is "parental satisfaction," as if that had anything to do with the premise of their "study," which is ostensibly to measure and compare the pain of each device. Excluded here is the satisfaction of the person whose penis is in question.

Medical Ethics and Human Rights Consciously Breached
Not only do the "researchers" know that the procedure is painful, they are also aware that there are risks and complications they expect to see. (Infections and bleeding being the most common complication; not mentioned here are adhesions and the need for surgical revision of botched circumcision jobs.)

In other words, they are running a medical experiment on human babies, knowing that they are going to suffer pain, and that some are going to need additional surgeries, and/or may suffer even more severe complications.

The Use of the Mogen Clamp
An important fact that is not being acknowledged, or deliberately omitted here, is the fact that one of the clamps being "compared," the Mogen clamp, has a bad track record and is notorious for circumcision mishaps, even when used by professionals.

The "Manual for early infant male circumcision under local anaesthesia,"published by the World Health organization in 2010, details that both the Mogen clamp and the Gomco clamp have a risk for penile laceration and amputation, but extends to say that "penile amputation can occur even under ideal circumstances" with the Mogen clamp.

In a 2013 study in Botswana, the Mogen clamp and the Plastibell were compared. The adverse events with the Mogen clamp were considered to be more frequent but "minor" (removal of too little skin and development of skin bridges and adhesions). Bleeding was more frequent with the Mogen clamp as well.

Circumcision botches are so common with the Mogen clamp, that its manufacturer has been put out of business by numerous lawsuits involving partial or complete amputations of the glans penis. In a very recent case, a judge approved a $4.6 million settlement on a behalf of a boy who lost the head of his penis in a botched circumcision attempt. In the $11 million dollar lawsuit that finally put the Mogen company out of business, a mohel severed the end of another baby's glans using one of their clamps.

Data from Attorneys for the Rights of the Child, ARCLaw, show over 80 million dollars paid on settlements over botched circumcisions since 1985. Beyond the economic value (when compared to a billion dollar a year industry), those numbers represent children whose lives will have been impacted for the rest of their lives due to a non-medical elective surgery.

The peculiar thing about Mogen is that until the very end, they claimed that injury was impossible with the use of their clamp, even after other glans amputations were reported. The injury behind a prior lawsuit at Fulton County Superior Court had already put Mogen on notice about the danger of the device. In a different case, at South Fulton Medical Center, another law suit was won in 2009. In that case, a child lost a third of his glans, and the plaintiffs were awarded 2.3 million dollars.

While Mogen is out of business, their clamps have not been recalled, and they continue to be in use, as we observe here. Some doctors continue to market the Mogen technique as "bloodless, painless" and "state of the art."

Given the history of the Mogen clamp, it is beyond me how the "researchers" in this so-called "study" can begin with the hypothesis that the Mogen clamp is "better." It's almost as if the actual purpose of this "study" is to vindicate the Mogen clamp. Perhaps researchers hope that by publishing their study, they could blot out the Mogen clamp's history and clear its record?

So long story short, "researchers" at TriHealth Good Samaritan Hospital in Cincinnati, Ohio, are conducting an experiment on healthy, non-consenting minors, where they will be deliberately made to experience pain, with obsolete and dangerous equipment. Without any medical or clinical indication, they will be eliciting "consent" from parents for surgery, and their permission to include their children for this experiment.


Problems with the Good Samaritan Hospital Statement:
According to WLWT, TriHealth Good Samaritan released the following statement in their defense:

"At Good Samaritan Hospital it is understood that patient care, education and research respect and support the total good of the patient and uphold the sanctity of human life and the principles of Catholic teaching.

The circumcision study compares two medically accepted circumcision processes. Only after the parent or guardian requests and consents to circumcision for their infant, is informed consent sought for this study; they are free to decline their child’s participation in this study. Steps to ensure pain relief are integral to the study protocol.

Male infant circumcision has been practiced for centuries and is not among the procedures prohibited in the Ethical and Religious Directives for Catholic Health Care Services."

The statement is problematic from the get-go; healthy newborn males are not patients. The children on which these "researchers" will be experimenting are not sick. In fact, that the children are in good health is a requirement of this repulsive "study." Nevermind the complete disregard and disrespect for the child's basic human rights, and nevermind the first dictum of medicine "First do no harm," circumcising a healthy, non-consenting minor contradicts the principles of Catholic and Christian teaching.

In the second paragraph, the hospital conveniently fails to mention Mogen's history, and they conveniently circumvent the fact that the children involved will not be suffering any kind of illness for which circumcision is the only method of treatment by placing the onus of responsibility on parents, who, because of the nature of the study (it is to deliberately cause and measure pain), may not be given full information as the truth may discourage them.

At this point it needs to be asked; without medical or clinical indication, can doctors be performing surgery on healthy, non-consenting minors? Let alone be giving parents any kind of "choice?" Let alone be asking parents to "volunteer" their children for an experiment whose stated purpose is to deliberately cause and measure pain? Using a clamp with a negative track record for circumcision mishaps?

The last sentence in the second paragraph is conflicting with the stated purpose of the so-called "study."

 Steps to ensure pain relief are integral to the study protocol.

This seems counter-intuitive to the purpose of the "study," which aims to determine which circumcision method is "less painful," as ensuring pain relief will make it difficult to measure pain adequately.

The last paragraph offers the logical fallacy of appeal to antiquity, and offers a disingenuous reference to the Ethical and Religious Directives for Catholic Health Care Services.

As pointed out by Guggie Daily in her blog, it is true only in that the Ethical and Religious Directives doesn't mention infant circumcision as a separate topic at all in the entire document. The statement made by Trihealth seems to imply it's not prohibited, versus not being mentioned directly.

Furthermore, here is what the Ethical and Religious Directives for Catholic Health Care Services does say, regarding situations where non-consenting minors are being signed up for non-therapeutic experiments with risks:

"31. No one should be the subject of medical or genetic experimentation, even if it is therapeutic, unless the person or surrogate first has given free and informed consent. In instances of nontherapeutic experimentation, the surrogate can give this consent only if the experiment entails no significant risk to the person’s well-being. Moreover, the greater the person’s incompetency and vulnerability, the greater the reasons must be to perform any medical experimentation, especially nontherapeutic."

"51. Nontherapeutic experiments on a living embryo or fetus are not permitted, even with the consent of the parents. Therapeutic experiments are permitted for a proportionate reason with the free and informed consent of the parents or, if the father cannot be contacted, at least of the mother. Medical research that will not harm the life or physical integrity of an unborn child is permitted with parental consent."

The directive doesn't explicitly have a statement on non-therapeutic circumcision of infants, male nor female. In fact, since nothing is said about female infant circumcision, if we are to follow the logic of the above conflicting statement, female circumcision, and perhaps other non-therapeutic surgery is approved as well.

At any rate, the related statements clearly show that non-therapeutic circumcision experimentation on baby boys is prohibited, but Catholic hospitals should already know this. There's certainly no confusion when it comes to Catholic teaching on unnecessary medical procedures, forced medical procedures and amputations.

The U.S. Conference of Catholic Bishops asserts:

"All persons served by Catholic health care have the right and duty to protect and preserve their bodily and functional integrity. The functional integrity of the person may be sacrificed to maintain the health or life of the person when no other morally permissible means is available. (Ethical and Religious Directives for Catholic Health Care Services (Fifth Edition, 2009), n. 29.)

The Catechism of the Catholic Church states:

"Except when performed for strictly therapeutic medical reasons, directly intended amputations, mutilations and sterilizations performed on innocent persons are against moral law." (CCC, n. 2297)

What is infant circumcision?

Or, more appropriately, what is the foreskin?

The foreskin is not a birth defect. Neither is it a congenital deformity or genetic anomaly akin to a 6th finger or a cleft. Neither is it a medical condition like a ruptured appendix or diseased gall bladder. Neither is it a dead part of the body, like the umbilical cord, hair, or fingernails.

The foreskin is not "extra skin." The foreskin is normal, natural, healthy, functioning tissue, with which all boys are born; it is as intrinsic to male genitalia as labia are to female genitalia.

Circumcision is the surgical removal of the foreskin from the penis, which leaves the glans, or head of the penis, permanently exposed. After circumcision, the head of the penis, and surrounding mucosal tissue, dries out and becomes tough and calloused in a process called "keratinization." The appearance and mechanics of the penis are changed for the rest of a man's life.

What is the medical definition of amputation?

The Free Dictionary by Farlex gives the following definition:

"Amputation is the intentional surgical removal of a limb or body part. It is performed to remove diseased tissue or relieve pain."

Even the medical definition of amputation clearly states that removal of a body part is done to address disease and relieve pain, neither of which are present in a healthy newborns. As the very premise of this so-called "study" concedes, circumcision causes pain, which the "researchers" no longer deny, and which they are set to measure by deliberately causing it.

Unless there is a medical or clinical indication, the circumcision of a healthy, non-consenting individual is a deliberate wound; it is the destruction of normal, healthy tissue, the permanent disfigurement of normal, healthy organs, and by very definition, infant genital mutilation, and a violation of the most basic of human rights.

For any surgical procedure, including surgery to modify the genitals, medical ethics requires both necessity and informed consent, both of which cannot be present in healthy, non-consenting newborns. Without medical or clinical indication, doctors have absolutely no business performing surgery in healthy, non-consenting individual, much less be eliciting any kind of "decision" or "participation" from parents.

This "experiment" on human babies in in direct violation of Catholic teaching and ethical health care directives. Trihealth's statement is complete hogwash. 

Closing Statements

Imagine if you will, a "study" that sets out to see what the "least painful" method of female circumcision. Which one causes the least bleeding. Which one causes "less complications." Which one results in less need for revisional surgery later on. Imagine a "study" whose stated purpose implies causing deliberate pain in baby girls. Imagine one of the factors the "study" sets out to measure is whether or not the parents have been satisfied. Would it ever fly?

Would it be called "progress" if so-called "researchers" found a way to perform infant female circumcision in a way that was "bloodless?" "Painless?" "With little to no risk?"

I'm reminded of a 1959 American researcher, W. G. Rathmann MD, who invented a clamp for female circumcision, as a cure for frigidity. At the least he wasn't targeting infants.

Rathmann Clamp for female circumcision

Rathmann clamp in action - clamping the clitoral hood, the female equivalent of the male foreskin

The trend of opinion on routine male circumcision is overwhelmingly negative in industrialized nations. No respected medical board recommends circumcision for infants. All of them, including the AAP in their last statement, say that the "benefits" are not sufficient.

It must be asked how it is that parents are being asked to consider the self-same "benefits" that couldn't convince a single respected medical organization, and somehow come up with a more reasonable conclusion, and how it is doctors are expected to comply a "decision" that goes against the best medical authorities in the West.

It must be asked, WHY are "researchers" conducting "experiments" on a procedure no medical organization recommends, on healthy, non-consenting minors?

Without medical or clinical indication, how is it doctors are performing surgery on healthy, non-consenting minors? How it they're even letting parents make any kind of "choice?" Let alone "volunteer" their children for an experiment to "measure the pain" of a non-therapeutic, non-medical surgical procedure no respected medical organization can bring itself to recommend?

Is it conscionable that an "experiment" involving a procedure that no medical organization in the world can bring itself to recommend in healthy, non-consenting minors is being conducted?

Is it conscionable that "researchers" are conducting an experiment whose very premise admits that the newborns will be deliberately made to experience pain?

And, can it be conscionable that a device that is known for circumcision mishaps (its manufacturer was put out of business by countless lawsuits raised against them) is being tested?

Who in the world approved this experiment? What was running through their minds?

Would an experiment to see "what is the least painful method of female circumcision" ever be aproved in this way?

The only good that can come out of this "research study" is that nobody will be able to pretend that infants cannot feel pain anymore. They say that they are trying to determine which method results in LESS pain and LESS blood loss, in other words, admitting that there is pain and blood loss involved no matter how it's done.

Further Details:
The study itself can be viewed here, and here.

Principal Investigator: Mounira Habli, MD
http://www.cincinnatichildrens.org/bio/h/mounira-habli/        
mounira_habli@trihealth.com

(The principal investigator appears to be wearing a Muslim head covering. No conflict of interest there...)

Contact: Michaela Eschenbacher, MPH
http://www.linkedin.com/in/michaelaeschenbacher   
michaela_eschenbacher@trihealth.com  


Contact: Rachel Sinkey, MD
http://www.trihealth.com/discover-trihealth/education/trihealth-obstetrics-and-gynecology-residency/list-of-current-residents/      
rachel_sinkey@trihealth.com

Sponsors and Collaborators
TriHealth Inc.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01726036


Related Posts:

Circumcision Botches and the Elephant in the Room

The Ghost of Mogen

AAP: Around the Bush and Closer to Nowhere

The Circumcision Blame Game

Politically Correct Research: When Science, Morals and Political Agendas Collide

Other takes on the matter:
Guggie Daly

Related Links:

Intact America Press Release

WLWT Coverage

WCPO Coverage

CNN: Circumcision study halted due to trauma

"I Did My Research" - The Quest for Scientific Vindication

The battle for genital integrity and basic human rights for boys has come a long way. Advocates of circumcision have come to realize that appeals to antiquity, tradition and religion simply aren't enough to justify the forced genital mutilation of healthy, non-consenting minors. They now call and plead with the gods of science and research to vindicate male infant circumcision, and to placate human rights activists, such as myself, as if science and research could be used to make an ethically repugnant practice morally acceptable.

While in the past, most parents confronted about the issue made appeals to their religion, or the fact that "this is what's been done in our family for generations," today, no circumcision apology is complete without appeals to knowledge and scientific research.

"Don't you insult us by posting links to studies and papers," retorts many a parent defensively; "We've done our research."

There are a few things wrong with this type of reasoning, beginning with the notion that an ethically repugnant practice can be made justifiable with "the right amount of research."

The second thing I find wrong with this kind of reasoning is the delusion that parents can demand procedures for their children as long as they can dig up the "research" that suits them, and that doctors are obliged to comply, like servants at their beck and call. For any other medical treatment and procedure, it is usually the doctor's professional responsibility to "do the research," and determine the medical validity of a procedure. Only after a doctor has issued a diagnosis and prescribed treatment can a parent be asked to consent to treatment. Circumcision seems to be the only instance in American medicine where it is lay parents, not doctors, who are expected to determine the medical validity of a surgical procedure, and then doctors are expected to act on this judgement, whether it be consistent or inconsistent with the medical trends of the time.

But thirdly, what I find particularly disconcerting about about "we've done our research" is the fact that, if current position statements from the most respected medical authorities in the world are correct, this is simply not possible.

The fact is that the trend of opinion on routine male circumcision is overwhelmingly negative in industrialized nations. No respected medical board in the world, not even the AAP, recommends circumcision for infants. All of them, including the AAP in their latest statement, state that there isn't sufficient evidence to warrant this endorsement, much to the chagrin of circumcision advocates.

It is simply not possible, then, that parents who defend their decision to have their male children circumcised "did their research."

Parents who claim having "done their research" and choose in favor of circumcision take an unfounded position against the best medical authorities of the West.

"We've done our research" is, then, a poor attempt at sounding intelligent, that human rights activists in the know will see through rather quickly.

Let it be clear...
No respected medical organization endorses male infant circumcision, not even the AAP. The most respected medical organizations in the West have weighed the current body of evidence, and have found it to be insufficient to recommend the circumcision of infants.

It is simply not possible, then, that parents who choose in favor of circumcision "did their research."

It is fallacious to expect lay parents to examine the same body of evidence, and come up with a more reasonable conclusion than that of entire organizations of medical professionals.


It is medically fraudulent that parents are being allowed to make a "choice" that is inconsistent with the conclusions of entire organizations of medical professionals, that doctors pretend that they can comply with such a "choice," and that public coffers are expected to reimburse them.

Without medical or clinical indication doctors have no business performing surgery on healthy, non-consenting minors, let alone be giving parents any kind of a “choice.”

Genital mutilation, whether it be wrapped in culture, religion or “research” is still genital mutilation.

It is mistaken, the belief that the right amount of “science” can be used to legitimize the deliberate violation of basic human rights.

Related Posts:
Politically Correct Research: When Science, Morals and Political Agendas Collide

AAP: Around the Bush and Closer to Nowhere
 

OUT OF LINE: AAP Circumcision Policy Statement Formally Rejected

TU QUOQUE: The AAP Fends Off Accusations of Bias

The Circumcision Blame Game

Politically Correct Research: When Science, Morals and Political Agendas Collide

What happens when a researcher is bold enough to publish findings that contradict popular, long-held beliefs, and shake core foundations?

Emotions run high, fallacious arguments are made, conclusions are jumped to, and logic and reason fly out the window.

Popular Beliefs Regarding Female Genital Cutting
Activists involved in trying to bring an end to the practice of female genital cutting purport that female genital cutting, or "mutilation" in their words, has all kinds of negative side effects.

One of the most popular claims of activists in the anti-FGM movement is that female genital cutting eliminates in a woman her ability to experience orgasm, leaving her to be a sexual cripple for the rest of her life.

Never actually making attempts to substantiate this claim, it is enough to say that the intent of female circumcision is to diminish a woman's sexuality.

This is a core belief in the anti-FGM movement, which is often used to parry any suggestion that the practice of male circumcision could be compared to female circumcision (and therefore equally appalling and worthy of eradicating), which is always, under any circumstance, "mutilation." (Even though the "intent" to curb male sexuality was the reason circumcision was introduced in Western countries.)

"Female circumcision removes the clitoris, which is equivalent to the removal of the entire penile shaft," the argument goes.

"Male and female circumcision can't be compared."

Putting the Lie to anti-FGM Claims
In my experience, people making claims that sensationalize female genital cutting, but that trivialize male genital cutting, often go unchallenged.

The delusion that female circumcision is one and the same in every case, that all women have their external genitalia removed, and have their vaginal opening sewn shut is put forth, and the claim that female circumcision destroys a woman's ability to orgasm, is readily believed.

The myth that female circumcision is the same across the board is demonstrably false, and one only need to compare female genital cutting practices around the world to realize that there is a broad spectrum in regards to female genital cutting.

Female genital cutting can range from making a small incision to draw a symbolic drop of blood, to a "ritual nick" as described by the AAP, to just the removal of the clitoral hood, to the removal of the labia, to the removal of the clitoris itself, to the removal of the external labia, to sewing up the vaginal opening to leave a small hole. Female circumcision may or may not include all of these. The worst kind of female genital cutting which does, also known as "infibulation," or "pharaonic circumcision," is actually the rarest kind of female genital cutting, at 15% globally.

Not too long ago, Swedish professor Sara Johnsdotter published findings that shook the core belief that female genital cutting, particularly the removal of the clitoris, destroys a woman's capacity to experience orgasm.

Johnsdotter discovered not only that women who had undergone some sort of genital cutting were still able to orgasm, but also that women who had undergone infibulation, which is the worst documented type of female cutting, removing the clitoris and having the vaginal opening sewn shut, were still able to orgasm and have fulfilling sexual lives.

Science, Moral Values and Political Agendas
At least ideally, science is supposed to be fundamentally value-free and amoral. Researchers are supposed to be neutral, impartial, unbiased and dispassionate, and they are supposed to publish their findings as they found them. Something is either true, or not. At least in theory, findings are simply that, findings, and are not supposed to be "good," or "bad."

Ideology and reality, however, do not always coincide, and research, especially research involving male and female genital cutting, is plagued with political agenda, activism and moral judgement.

Having presented her findings at the World Congress for Sexual Health, Johnsdotter was criticized, being told that her research "only encourages female genital mutilation."

Italian researcher Lucrezia Catania, also presented at the same congress. According to her findings,  the little bump most people think of as the clitoris is actually only the tip. In fact the clitoris carries on deep inside the body, so even if the tip is cut off, there's plenty left for stimulation.

This image was taken from the Wikipedia article on the clitoris.

Even still, either mishearing or completely ignoring what the Italian researcher had just said, Egyptian sexology professor Hussein Ghanem insisted that "[T]he clitoris is the female equivalent of the penis... Let's cut off your penis and see how well you do!"

Further dismissing Johnsdotter, Ghanem insists "We must be very firm and clear that [female circumcision] is harmful, and that the majority of Egyptian and African women do not experience orgasm."

But contrary to Ghanem's assertions, Johnsdotter found, to her surprise, having studied Somali women living in Sweden, that they had a very positive view of sex, and had lots of sexual pleasure, including orgasms, even having undergone the most severe form of female genital cutting (or "mutilation," as Ghanem, and other anti-FGM activists, insist).

Johnsdotter found that it was the Somali women who were more integrated into Swedish society, and more aware of campaigns stressing that genital cutting ruins women's sex lives, who had a negative view about sex and their genital cutting.

Hussein Ghanem argues that the Swedish and Italian researchers are "playing right into the hands of people who defend genital cutting." He claims a colleague of his, who is a member of the Muslim Brotherhood, is now  using the Italian findings show the practice isn't so bad after all.

"Help the victims, but condemn the practice," says Hussein Ghanem.

But Johnsdotter's approach is different: "You have real victims, women who suffer all their lives, but you also have many women who live very well with it. A respectful treatment would talk to both kinds of women, with all kinds of experiences. Don't start by telling people they're barbarous and that they torture their own daughters, focus on bodily integrity and human rights, a woman's right to keep her genitals in one piece."

So here we observe that researchers are presenting what they found, and even though the researchers themselves are morally opposed to the practice of forced genital cutting in women, we have others who are morally opposed to publishing findings, as true and valid as they are, that contrast with the with their activist slogans that female circumcision is sexually crippling.

We are witnessing what happens when researchers publish findings that aren't politically correct, conflict with popular belief and that challenge the status quo.

Findings vs. Politically Correct Research
I recently ran across some writings by Johnsdotter on TierneyLab. It was written in response to a post by WHO researchers, who were discussing the hazards of female genital cutting.

I'm going to cut and paste some excerpts from the writing that I think are very relevant to this blog, research concerning male and female circumcision, and research in general. I will pause between each excerpt and talk about how it is relevant to the discussion of "research" and male circumcision.

"One of the hazards for science is when politically correct results are uncritically welcomed, readily published and repeatedly cited; while politically embarrassing results are ignored or marginalized. Perhaps nowhere is this more obvious than in the study of “female genital mutilation,” where the roles of researchers and political activists often seem to be confused."

The same is true for the "study" of "male medical circumcision," except the situations between male and female circumcision are inverse.

While with female circumcision, publishing "research" that shows female circumcision is harmful, sexually debilitating, etc. are uncritically welcomed, readily published, repeatedly cited, and politically embarrassing findings (for example, research that shows female circumcision may actually beneficial, and may not affect sexuality) are ignored or marginalized, with *male* circumcision, it's the opposite.

With male circumcision, it is "research" that shows male circumcision is "beneficial," that it "does not cause sexual dysfunction" (perhaps even enhancing male sexual performance), that it "prevents disease" etc. which is uncritically welcomed, readily published, repeatedly cited etc. It is findings that show male circumcision is harmful, puts children in danger, causes sexual dysfunction etc. which are ignored, marginalized, etc.

"Other publications in leading medical journals suggest that the boundary between scientific research and activism has become blurred, to the detriment of scientific standards. The WHO study is one example of the uncritical rush to convey politically correct results.

One is left worrying that publication standards might have been compromised for the sake of making medical claims in support of the ongoing eradication campaigns."

Another example is how readily the WHO accepted the latest circumcision/HIV "research" in Africa, and used it immediately to initiate so-called "mass circumcision campaigns" across the continent.


"We do not necessarily question the statistical correlation that was found in this Lancet study. But we do call for a broader and more rigorous discussion of all published findings on FGM, including those published in prestigious medical journals. When it comes to publications on the topic of “FGM” we don’t see the usual critical scientific discussion regarding possible bias, possible confounders, or weak links in the causal hypotheses used or in study design."

And the same applies to male circumcision "research." 

"We suggest that this silence has to do with prevalent Western ideology concerning “female genital mutilation” and ongoing political projects. Activists, governmental bodies, funders and even editors of medical journals systematically welcome research results that can be used in preventive work while muting or hesitating to publish results that go against the grain of mainstream thinking regarding this issue."

The Western ideology concerning "male medical circumcision" is that it "causes no harm," that it is "not sexually debilitating," and that it may even be "beneficial" in preventing disease. It is also a practice that has taken hold in the United States (and previously in the British Commonwealth), and is a cherished tradition for Jews, Muslims and many African peoples. Activists, governmental bodies, donors and even editors of medical journals systematically welcome research and results that can be used in the promotion of male circumcision, while muting, or hesitating to publish results that go against the grain of mainstream thinking regarding male circumcision, if not their own core beliefs and values.

"This blurring of the distinction between science and activism is so endemic that researchers often present their 'hard facts' with explicit reference to their political agenda. The abstract of the article by Almroth et al. ends with a blunt comment: 'The association between FGM and primary infertility is highly relevant for preventive work against this ancient practice.'"

If one examines "research" regarding male circumcision, one will find similar comments along the lines of: "The association between male medical circumcision and a decreased rate of HIV transmission is highly relevant for the promotion of male circumcision as a method of HIV prevention." 

So in the end, does the research that finds itself in scientific journals convey neutral and dispassionate findings? Or does it convey politically correct results intended for the furthering of an agenda?

Attempts to Block Research from Publication
At the World Congress for Sexual Health, Hussein Ghanem criticized Sara Johnsdotter for presenting findings that went against his moral position that female genital cutting is "mutilation" and ought to be stopped. Ghanem's criticism goes as far to suggest that Johnsdotter's research "only encourages female genital mutilation." He continues with saying "We must be very firm and clear that [female circumcision] is harmful, and that the majority of Egyptian and African women do not experience orgasm," despite the fact that evidence that contradicts this belief was presented.

This is just one example of findings being criticized, with suggestions that they ought not to be published (and that mainstream beliefs be repeated) based on moral objections. (This despite the fact that Johnsdotter holds the same moral objections as Ghanem.)

(It must be pointed out: While academics who oppose FGM can get away with dismissing information that doesn't jive with them using the "moral" argument, those against MGM who challenge "research" being used to instate "mass circumcision campaigns" are called "emotional, science deniers.")

The following is but one documented example of similar behavior surrounding the publication of politically incorrect findings.

In 2011, Morten Frisch, an MD, PhD and Doctor of Medicine, a professor of sexual health epidemiology at Statens Serum Institut in Copenhagen and at Aalborg University in Denmark, published a study, which showed an excess of orgasm difficulties in circumcised men, as well as significantly increased frequencies of orgasm difficulties, pain during intercource and a sense of incomplete sexual needs fulfillment in women with circumcised spouses.

This study was preceded by three other publications based on the same data set, dealing with sexual dysfunctions in Danish men and women in relation to socioeconomic factors, health factors and lifestyle factors, respectively, which were swimmingly published without serious criticisms from peer reviewers in the two most prestigious US journals of sexual health, the Journal of Sexual Medicine and Archives of Sexual Behavior. After adding the variable of male circumcision status to the analysis, however, the study was met with extremely critical reviews of everything about the entire data set.

In particular, Brian Morris, made extensive, obstructive peer-review comments in a review which included serious insinuations of racism and amateurism. (Brian Morris is quite possibly the most vocal circumcision advocate in Australia.) According to a letter of appreciation written by Morten Frisch to the editors of the International Journal of Epidemiology for the publication of his study, Frisch was informed by a colleague that Morris used his mailing list to enact a campaign to write critical letters to the editors of the International Journal of Epidemiology.

"I would like to thank the IJE editors for withstanding the pressure from one particularly discourteous and bullying reviewer who went to extremes to prevent our study from being published. After the paper's online publication, I have received emails from colleagues around the world who felt our contribution was useful and potentially important. One colleague informed me that the angry reviewer was the first author of the above letter to the editor. In an email, Morris had called people on his mailing list to arms against our study, openly admitting that he was the reviewer and that he had tried to get the paper rejected. To inspire his followers, Morris had attached his two exceedingly long and aggressive reviews of our paper (12858 words and 5291 words, respectively), calling for critical letters in abundance to the IJE editors. Breaking unwritten confidentiality and courtesy rules of the peer-review process, Morris distributed his slandering criticism of our study to people working for the same cause."
--Morten Frisch. Author's Response to: Does sexual function survey in Denmark offer any support for male circumcision having an adverse effect?

The Study of Adverse Effects of Circumcision Strictly Prohibited
At least in one case, scientific observers are severely reprimanded for attempting to document the adverse effects of circumcision, and they are told that any attempt to study them was "strictly prohibited by ethical regulations."

The following letter was sent out some time ago, by one Dr. Paul D. Tinari, Ph.D.

Two of my physics professors at Queen's University (Dr. Stewart & Dr. McKee) were the original developers of Positron Emission Tomography (PET) for medical applications. They and a number of other Queen's physicists also worked on improving the accuracy of fMRI for observing metabolic activity within the human body.

As a graduate student working in the Dept. of Epidemiology, I was approached by a group of nurses who were attempting to organize a protest against male infant circumcision in Kinston General Hospital. They said that their observations indicated that babies undergoing the procedure were subjected to significant and inhumane levels of pain that subsequently adversely affected their behaviours. They said that they needed some scientific support for their position. It was my idea to use fMRI and/or PET scanning to directly observe the effects of circumcision on the infant brain.

The operator of the MRI machine in the hospital was a friend of mine and he agreed to allow us to use the machine for research after normal operational hours. We also found a nurse who was under intense pressure by her husband to have her newborn son circumcised and she was willing to have her son to be the subject of the study. Her goal was to provide scientific information that would eventually be used to ban male infant circumcision. Since no permission of the ethics committee was required to perform any routine male infant circumcision, we did not feel it was necessary to seek any permission to carry out this study.

We tightly strapped an infant to a traditional plastic "circumrestraint" using Velcro restraints. We also completely immobilized the infant's head using standard surgical tape. The entire apparatus was then introduced into the MRI chamber. Since no metal objects could be used because of the high magnetic fields, the doctor who performed the surgery used a plastic bell ("Plastibell") with a sterilized obsidian bade to cut the foreskin. No anaesthetic was used.

The baby was kept in the machine for several minutes to generate baseline data of the normal metabolic activity in the brain. This was used to compare to the data gathered during and after the surgery. Analysis of the MRI data indicated that the surgery subjected the infant to significant trauma. The greatest changes occurred in the limbic system concentrating in the amygdala and in the frontal and temporal lobes.

A neurologist who saw the results postulated that the data indicated that circumcision affected most intensely the portions of the victim's brain associated with reasoning, perception and emotions. Follow up tests on the infant one day, one week and one month after the surgery indicated that the child's brain never returned to its baseline configuration. In other words, the evidence generated by this research indicated that the brain of the circumcised infant was permanently changed by the surgery.

Our problems began when we attempted to publish our findings in the open medical literature. All of the participants in the research including myself were called before the hospital discipline committee and were severely reprimanded. We were told that while male circumcision was legal under all circumstances in Canada, any attempt to study the adverse effects of circumcision was strictly prohibited by the ethical regulations. Not only could we not publish the results of our research, but we also had to destroy all of our results. If we refused to comply, we were all threatened with immediate dismissal and legal action.

I would encourage anyone with access to fMRI and /or PET scanning machines to repeat our research as described above, confirm our results, and then publish the results in the open literature.

Dr. Paul D. Tinari, Ph.D.
Director,
Pacific Institute for Advanced Study

One can already make the observation that this research would be biased from the very beginning, but not any more biased than research conducted by activists against female genital cutting.

Usually, findings are published, and are either validated or dismissed after other scientists have analyzed the data, methodology etc. But here we observe strict prohibition of observation, and the destruction of inconvenient findings by so-called "ethical regulations." Whose ethics dictate that the negative effects of a commonly performed surgical procedure are not to be documented is beyond me.

We also observe two contrasting sets of standards for the publishing of scientific observations of the genital cutting of each sex:

For female circumcision, observations of the adverse effects are readily and uncritically published, while observations that it may not be as harmful as thought, perhaps that it may even be beneficial, face skepticism, criticism and scrutiny. Some even go as far as saying that the latter should not be published, as it plays "right into the hands of people who defend genital cutting."

For male circumcision, it is observations of its adverse effects which are met with opposition, if not outright prohibition, while observations that circumcision is "not harmful," and may have "medical benefits" that are readily and uncritically published. There seems to be no concern that the latter may be used to justify the forced genital cutting of healthy, non-consenting minors.

"Studies show..." - How findings and their publication are tainted
An idea that has come to dominate both sides of the genital cutting debate is the dubious premise that, whether a practice is morally justified or morally reprehensible is determined by the outcome of some "study."

The reasoning goes as follows:

"If the practice is scientifically proven to be "harmless," even "beneficial," then it is morally justified, perhaps even a social imperative.

If it is shown to be "harmful" and have bad side effects," then it is morally reprehensible and must be condemned."

"Science" and "research" command respect, prestige and authority. Scientists and researchers are, at least in theory, supposed to be impartial, dispassionate and unbiased bearers of scientific fact, as opposed to mere opinion.

It is no surprise, then, that advocates of genital cutting, and opponents alike, seek to support their moral stance with the respect and authority of scientific research.

Morals are relative and subjective, but science is authoritative and final.

The argument is, then, no longer about moral values, but about "disease prevention" and "public health," which are assumed to be, not only morally justified, but also an indispensable and even a necessary social imperative.

A stance is now no-longer "opinion-based," but "evidence-based."

No longer "right," or "wrong," because that would sound like the imposition of values.

Instead, it is now either "beneficial," or "it has devastating consequences."

But using science and research to support a moral position is problematic; and Johnsdotter presents a clear example.

The problem of activists and politicians depending on scientific research to explain the merits of their principles leaves the door open to all kinds of abuse:

• "Researchers" with an agenda taking liberties with what is supposed to be scientific data
• Editors and reviewers using their positions to publish results that support their own personal views, and refusing to publish results which do not, in what are supposed to be scientific journals
• Flawed research making farfetched associations between a practice and benefit/harm
• Bad methodology that grossly overstates human costs and/or "net benefit" of a practice
• The justification of actions that are actually morally repugnant under the guise of "disease prevention" and "public health"
• Failure to cross-examine politically favorable "research," or subject it to critical scrutiny
• The corruption of the scientific virtues of impartiality and balance in the assessment of evidence, and critical skepticism with regard to proposed hypotheses, and vigilance against value-driven confirmation bias in the conduct of research
• Overall, political activism overwhelming science and research

Medicine becomes value-based, as opposed to "evidence-based."

"Science" and "research" is all good until findings begin to contradict chosen moral values.

Solution
Political activism, moral values and deeply held beliefs are factors that can permeate both sides of an issue. Activists on all sides of the genital cutting debate can be seen trying to wield the respect and authority of scientific research.

Genital cutting is but one example; search the literature for other controversial issues such as marijuana, abortion, or firearms, and you will find much more of the same; so-called "research" being used to shore up a chosen social policy.

So what is the solution?

What can be done to weed out politically correct "research" from actual dispassionate scientific findings?

To quote Johnsdotter again:

"We do not necessarily question the statistical correlation that was found in this Lancet study. But we do call for a broader and more rigorous discussion of all published findings on FGM, including those published in prestigious medical journals. When it comes to publications on the topic of “FGM” we don’t see the usual critical scientific discussion regarding possible bias, possible confounders, or weak links in the causal hypotheses used or in study design."

Usually, findings are published, and are either validated or dismissed after other scientists have analyzed the data, methodology etc. This is supposed to be the whole point of "peer review."

But personal convictions and moral values gum up this process.

As is seen in Johnsdotter's case, if Hussein Ghanem had his way, her findings would not be published because it doesn't jive with his personal a priori beliefs.

If Brian Morris had any say in the matter, only colleagues of his who are in complete agreement with his interpretations, analyses, and conclusions would be heard and all others, such as Danish researcher Morten Frisch, would be silenced.

In Paul Tinari's case, he was told that any attempt to study the adverse effects of male circumcision was strictly prohibited. He was forbidden from publish the results of his team's research, as well as commanded to destroy the results under the threat of immediate dismissal and legal action.

So for one thing, scientists ought to have the freedom to publish what is found, as they found it. Findings need to be published regardless of whom it pisses off.

But most of all, as Johnsdotter suggests, there needs to be a broader and more rigorous discussion of all published findings, including those published in prestigious medical journals.

The same critical scientific discussion regarding possible bias, possible confounders, weak links in in the causal hypotheses and/or in the study design, needs to be applied to research across the board, not just the research which doesn't support a particular moral stance or political agenda.

But scientific research can only undergo this scrutiny when it is published, an there may be self-interested individuals trying to keep this from happening.

Therefore, possible conflicts of interest, such as political agendas, activism, and cultural and religious bias, must be declared by scholars and scientists in every part of the peer review process, from the scientists and researchers, to editors and reviewers for scientific journals.

If not declared, then others need to have the courage to point them out. 

We must remember, when all is said and done...
Johnsdotter is to be commended for having the integrity to publish findings that do not support her own stance against female genital cutting. She sends the very important message that it is a mistake to use science and research to support a moral stance. It corrupts science (findings and their publication), and it distorts the definition of moral values.

Johnsdotter is warning of the danger of relying on findings to determine the moral justification or reprehension of a practice. Findings are beginning to show that female genital cutting practices aren't as catastrophic as anti-FGM activists would like others to believe. Some findings show that female genital cutting may actually enhance the sexual experience for both partners, and may even confer protection against disease. (See here and here.)

Scientific findings may actually be used to justify what may in fact be morally reprehensible.

The same warning applies to us intactivists.

There is not a doubt in my mind that the "scientific research" regarding circumcision has been hijacked by people with a pro-circumcision agenda. It is my personal view that scientific scrutiny would reveal that most of what is out there is grossly exaggerated and/or completely fabricated by circumcision advocates to support their own view that all males should be circumcised.

But Johnsdotter's warning applies to intactivists as well. It is a mistake for us to rely on scientific "research" to support our cause. It could very well be that male circumcision is not as harmful as we say, and that it does genuinely offer some kind of "benefit," to men.

It's an important part of any strategy to keep the truth, truth. If it doesn't cause serious problems, then this is what needs to be reported, and intactivists have to have the courage and integrity to acknowledge and recognize findings that don't support our cause. Johnsdotter sets a very good example.

We must remember that, after all is said and done, moral principles stand on their own.

The forced genital cutting of healthy, non-consenting individuals of any sex is morally reprehensible regardless of what "studies" say.

Genital mutilation, whether it be wrapped in culture, religion or “research” is still genital mutilation.

It is mistaken, the belief that the right amount of “science” can be used to legitimize the deliberate violation of basic human rights.

Not even if it could be made "painless," not even if it offered "medical benefits," not even if sexual experience would remain unscathed would forced genital cutting ever be justified in girls and women.

The same applies to boys and men.

Afterthoughts...
Johnsdotter says: "You have real victims, women who suffer all their lives, but you also have many women who live very well with it. A respectful treatment would talk to both kinds of women, with all kinds of experiences. Don't start by telling people they're barbarous and that they torture their own daughters, focus on bodily integrity and human rights, a woman's right to keep her genitals in one piece."

Perhaps both activists against FGM and MGM can learn from this.

Many people I've encountered who are both against FGM, but pro MGM, often say that parents who circumcise their boys love their children, and only do it because they believe it is what is best for them. Does this same consideration apply to parents who circumcised their daughters? Parents who circumcise their sons are "loving parents with good intentions," while parents who circumcise their daughters are thoughtless monsters?

Intactivists, while there are real victims of male genital mutilation, the fact is that that most circumcised males have a very positive view of sex, and have lots of sexual pleasure as well. Perhaps it would be better for our movement to talk about both kinds of men with all kinds of experiences. It would probably serve our movement better if we didn't start by telling people they're barbarous and that they torture their own sons. We should focus on genital integrity and human rights, and a man's right to keep his genitals in one piece.