Tales of the city

Always something new out of San Francisco: we are pleased to amuse you currently with an initiative to outlaw circumcision of boys under 18.  Circumcision is a millenia-old conventional practice among Jews and Moslems, and widespread otherwise, so there’s a lot of accumulated experience with it.  The science is pretty solid that it doesn’t affect sexual function or pleasure and has (whatever motivated it back in the day) benefits in reducing STD transmission and some other health advantages.

Advocates of this piece of big government meddling have pooched their campaign with propaganda that looks so anti-semitic that fellow-“intactivists” in Santa Monica called off their own program. On a truly loony hour of discussion on our call-in program yesterday, proponents attempted to tie it to female genital mutilation, also sometimes called female circumcision, a millenia-old conventional savagery in some African societies that has the specific purpose  of denying women sexual pleasure and demonstrated serious health consequences.  Callers offered “I knew a guy who did that and he died” anecdotes, all patiently suffered by the host.

The basic argument is that it’s a permanent, invasive physical alteration to the child’s body, and the justification is that voters rather than parents should decide whether to do it. Meanwhile, children all over the city are being fed unhealthy diets condemning them to a lifetime of struggle with obesity, denied vaccinations that protect them and others against disease, and afflicted by second-hand tobacco smoke.  Others, including minors, are allowed to have God’s prescribed natural secondary sex characteristics torn out by the roots with wax, slashed from faces with razor blades, chemically altered in color and form, surgically enlarged with implants, and punctured with hardware. Whole bodies are  reshaped by exercise, diet, and high heels.  And probably more important than any of this, defenseless children’s minds are being permanently and invasively altered one way or another by crib toys, bedtime reading selections and home schooling curricula, preschool choices, Sunday school, church and no church, and parents sharing political views.

Sigh… I myself knew a guy whose parents gave him a stuffed armadillo when he was a baby, and he grew up to be an accordion player.  When are we going to get on top of real threats to our children?

Author: Michael O'Hare

Professor of Public Policy at the Goldman School of Public Policy, University of California, Berkeley, Michael O'Hare was raised in New York City and trained at Harvard as an architect and structural engineer. Diverted from an honest career designing buildings by the offer of a job in which he could think about anything he wanted to and spend his time with very smart and curious young people, he fell among economists and such like, and continues to benefit from their generosity with on-the-job social science training. He has followed the process and principles of design into "nonphysical environments" such as production processes in organizations, regulation, and information management and published a variety of research in environmental policy, government policy towards the arts, and management, with special interests in energy, facility siting, information and perceptions in public choice and work environments, and policy design. His current research is focused on transportation biofuels and their effects on global land use, food security, and international trade; regulatory policy in the face of scientific uncertainty; and, after a three-decade hiatus, on NIMBY conflicts afflicting high speed rail right-of-way and nuclear waste disposal sites. He is also a regular writer on pedagogy, especially teaching in professional education, and co-edited the "Curriculum and Case Notes" section of the Journal of Policy Analysis and Management. Between faculty appointments at the MIT Department of Urban Studies and Planning and the John F. Kennedy School of Government at Harvard, he was director of policy analysis at the Massachusetts Executive Office of Environmental Affairs. He has had visiting appointments at Università Bocconi in Milan and the National University of Singapore and teaches regularly in the Goldman School's executive (mid-career) programs. At GSPP, O'Hare has taught a studio course in Program and Policy Design, Arts and Cultural Policy, Public Management, the pedagogy course for graduate student instructors, Quantitative Methods, Environmental Policy, and the introduction to public policy for its undergraduate minor, which he supervises. Generally, he considers himself the school's resident expert in any subject in which there is no such thing as real expertise (a recent project concerned the governance and design of California county fairs), but is secure in the distinction of being the only faculty member with a metal lathe in his basement and a 4×5 Ebony view camera. At the moment, he would rather be making something with his hands than writing this blurb.

36 thoughts on “Tales of the city”

  1. “the justification is that voters rather than parents should decide whether to do it.”

    If voters rather than parents may decide whether to allow female genital mutilation, or whether to allow the murder of one’s children, for that matter, then voters have a right to decide whether to allow circumcision. And the fact that minors are allowed to mutilate their bodies is ways worse than circumcision is irrelevant.

    The only relevant question is whether, considering the risks of circumcision, its benefits are so great as to override the normal prohibition on parents’ performing permanent, invasive physical alterations to their child’s body. I believe that the question answers itself.

  2. The proposal would not ban circumcision. It would set the minimum age to 18 so that adults could decide for themselves. The fact that some religions require infant circumcision should be of no consequence. If you want your infant circumcised, do it outside San Francisco.

  3. It won’t pass. Lots of measures make it to the ballot here, many don’t get beyond it. Like the measure to rename a sewage treatment plant with GWB’s name – failed.

  4. Having decided against circumcision at birth, and then having had to deal with not one but two boys in the 2-3 year age range with repeated infections and the ultimate need for the surgery at age 3 (when it is a LOT less pleasant than at birth), I have a hard time controlling my anger at these people. If they want to make certain decisions in what they believe is the best interest of their children, fine. But what exactly is their right to make decisions about the children of others, and what justifies their blatant ignoring of all evidence that contradicts their personal beliefs?

    Cranky

  5. “But what exactly is their right to make decisions about the children of others, and what justifies their blatant ignoring of all evidence that contradicts their personal beliefs?”

    Cranky, my opening comment answered your first question: the state has a duty to prevent parents from harming their children. The relevant question, as I said, is whether the harm in this case is justified by a greater good. Your personal experience constitutes evidence on one side of the question, but is not sufficient to answer the question.

  6. Henry at 10:22: “The relevant question, as I said, is whether the harm in this case is justified by a greater good. Your personal experience constitutes evidence on one side of the question, but is not sufficient to answer the question.”

    Henry at 8:49: “I believe that the question answers itself.”

    Well, sure: if you ignore all evidence and arguments that contradict your preferred course of action, the “question answers itself”. Not so clear to others those who disagree with you, however.

    Cranky

  7. Cranky, you caught me in an inconsistency. I acknowledge that the question does not answer itself, and that I lack the knowledge to answer it. I suspect that you do too, unless you have evidence that your experience with your boys is quite common and that the risks of circumcision are significantly less common and less severe. In addition, whereas I am taking a utilitarian approach, others might believe that infant boys have a right not to be mutilated, regardless of the consequences.

  8. I don’t know – even as a circumsized man, I find it a somewhat creepy cultural practice. If it really is a health issue, I suppose that’s an argument for it. But it seems more an aesthetic or religious one. To which I say… that’s creepy.

    So, regarding health – how much is it simply an issue of improper hygiene practices?

  9. Henry, does the circumcision ban have a clause allowing it in cases in which the health or life of the child is in danger? Your dismissal of Cranky’s actual life experience implies that it doesn’t. Doesn’t that make your view comparable to right-wing attacks on abortion in which they want to remove the “health or life of the mother” exception?

  10. Sean, I don’t know; I have been expressing my support for a ban in the abstract. If circumcision constituted a treatment for a particular condition, then of course that would be different from circumcision for aesthetic or religious reasons (to borrow Eli’s words), or to avoid speculative future health problems that any male might suffer. I do not believe that the government should ban any medical treatment that a doctor recommends, whether it be smoking marijuana, abortion, or circumcision.

  11. @ Eli

    Oh, it’s definitely an aesthetic issue in some cases. I’m old enough that I fall in the group that was routinely circumcised. I’d learned enough about it to decide that I didn’t want my sons (if any) to be circumcised. I communicated that desire to my then-wife, who decided that because I’m circumcised our sons should be, too. Less explaining to do that way was how it was justified for Number 1 son; making Number 2 son look like Number 1 son and his father was the justification for that circumcision. Our pediatrician when Number 2 was born was militantly against circumcision and told her to her face that was a stupid reason to mutilate a baby. (Female pediatrician, by the way.)

    On the other hand, it IS a health issue in some cases. A friend of mine has a thinking wife, and they’d thought it through and decided no circumcision, although he is also circ’d. Three years after their son was born, they had to have him circumcised because he was experiencing phimosis (shrinking of the foreskin) which created a lot of pain for the kid. Not that the circumcision was any fun, either. He told me afterward he wished (after the fact) that they’d had it done as a neonate.

    You pays your money and takes your chances.

  12. @Henry: The relevant question, as I said, is whether the harm in this case is justified by a greater good.

    What harm? Calling it mutilation doesn’t make it so. “Mutilation” implies violence and disfigurement; yet circumcision is only as violent as any other surgical procedure, and disfiguring only to the eyes of those who hate the sight of a circumcised penis.

    I actually agree that there is no strong justification for neonatal circumcision, but I am amazed at the disproportionate passion the circumcision argument always brings, relevant to the actual stakes.

    The only downside of neonatal circumcision I can think of is the real but extremely small risk of a botched job that affects sexual function in adulthood. That’s a real downside, but should be evaluated for what it is: an extremely low risk of a catastrophic outcome. We enounter a number of those kind of risk/benefit evaluations in life. On the other hand, the only downside I can imagine for forgoing neonatal circumcision is the risk that because of infection, phimosis, or whatever, a circumcision will be required later in life when it will be experienced more painfully and will be (at least temporariily) disruptive to sexual function. This is also a low-probability event, but still much more probable than a botched circumcision.

    In my view, the issues of consent and “mutilation” are distractions from the essence of the decision to circumcise or not: is it better to accept an infinitessimal risk of a catastrophic outcome, or a very small risk of a bad outcome?

  13. “disfiguring only to the eyes of those who hate the sight of a circumcised penis”

    Is lopping off the bottom of one’s ear, a la Van Gogh, disfiguring only to the eyes of those who hate the sight of a lopped-off ear? In any case, if “mutilation” is not the appropriate word for it, we can use Michael O’Hare’s description: “a permanent, invasive physical alteration to the child’s body.”

  14. “Is lopping off the bottom of one’s ear, a la Van Gogh, disfiguring only to the eyes of those who hate the sight of a lopped-off ear?”

    How ’bout pierced ears? Are those obvious signs of mutilation?

  15. There is too much cost-benefit analysis in this thread. There are two other issues: the autonomy of the family* and religious freedom. Both of these are conditional, but both are important. Even if male circumcision is harmful, the harm is pretty small. As Michael pointed out using snark, we tolerate much greater potential harms in the name of family autonomy and religious freedom, without the state allowing itself to intervene. There are limits to both family autonomy and religious freedom. But these limits only kick in with harms far greater than those alleged for male circumcision.

    *(And yes, I know that “family autonomy” means a near-dictatorial power of parents over their children. When my three-year-old wants to play in traffic, I snatch him back by main force. What, sir, do you do?)

  16. Sean, that’s a good question. I think it wrong for parents to pierce their children’s ears, because they do it for themselves, not for their children, and because pierced ears often become infected. But it is not comparable to circumcision because the holes can grow over by themselves or at worst require minor plastic surgery.

  17. Is lopping off the bottom of one’s ear, a la Van Gogh, disfiguring only to the eyes of those who hate the sight of a lopped-off ear?

    Yes. Which is most people.
    Actually, I don’t think this is a bad analogy. If it had, somewhere in the ancient mists of time, become standard practice to cut off the majority of a person’s earlobes right after birth, then there’d be a cultural aesthetic preference for earlobelessness. And if everybody preferred the earlobeless look, it would take a stronger argument than curling your lip and calling it mutilation to talk people out of the practice. Circumcision obviously isn’t as universal as this hypothetical, but outside of sincere religious belief, aesthetic preference is probably always the driving factor behind the choice to circumcise. What makes circumcision more complicated than earlobectomy is that there are real benefits and drawbacks to circumcision that allow us to justify our preference without invoking aesthetics.

    a permanent, invasive physical alteration to the child’s body

    So, like vaccination, then?

  18. Ebeneezer, you make good points on family/religious autonomy.

    I once commented to a female friend that if circumcision resulted in less sensation for men, that would be a negative. She responded wryly that she didn’t think men needed any extra sensation down there!

  19. This is the sort of thing that gets the We-ligious White all riled up with conspiracy theories about the evil gay liberal atheists always attacking their religious rights. That it’s happening in SF doesn’t help.

    Sweetly ironic, isn’t it? Aren’t they usually the ones seeking to legislate the behavior of others?

  20. “Sweetly ironic, isn’t it? Aren’t they usually the ones seeking to legislate the behavior of others?”

    Not conspicuously more than liberals, just in different areas. For example, who’s been trying for years to pry the guns loose from all those “bitter clingers”? Was it the “We-ligious White”? I don’t think so…

  21. Note that the political polarity would be reversed if some buffoon in the Bible Belt had offered a circumcision ban as part of an attack on Islam.

  22. I’m surprized how animated so many posters are on this issue. ‘Course I don’t have occasion to examine too many pee-pees so I don’t realy know or care about foreskins too much.

    I knew a gay guy who was really proud of his and wouldn’t shut up about it. Called it a “pull back”. Conversation with him was pretty boring.

    Mine is shorn and I guess I should be angry with my parents for visiting such an offense on my poor innocent willie but some how I never let it drive me to a psychiatrist’s couch. Must be something wrong with me.

  23. Eli: No, guns don’t kill. People do… But most of the people liberals attempt to disarm don’t kill, you’re not trying to disarm them because of a tiny chance they might kill somebody. You’re doing it because you find gun ownership offensive, even if it doesn’t hurt anybody.

  24. Brett Bellmore–“You’re not trying to disarm them because of a tiny chance they might kill somebody. You’re doing it because you find gun ownership offensive, even if it doesn’t hurt anybody”

    Mr. Bellmore, you don’t read my mind worth a damn. I strongly favor making handguns, automatic weapons, etc. unlawful and enforcing the law rigorously. It has nothing to do with finding them “offensive”. I find them dangerous … to me, to my family and friends, to my neighbors, to the poor devils who get shot up whenever somebody goes postal, or Columbine, or whatever.

    Strongly suggest that you stop drawing cartoon “liberals” in your head.

  25. Michael, you lead off with, “The science is pretty solid that it doesn’t affect sexual function or pleasure”.

    The Wikipedia summary (http://en.wikipedia.org/wiki/Sexual_effects_of_circumcision) indicates a profound ambivalence within the medical community. There definitely are studies that indicate that it has a negative impact on sexual pleasure, as well as studies that are neutral, and, I believe, a few that indicate that it has a positive impact.

    I personally consider infant circumcision to be mutilation sanctified by habit, and in the absence of an overwhelming demonstrable need for it (the medical exception), I can’t see it as any more justifiable than cutting off a toe.

  26. 2 points that rarely come up in this debate:

    1) Men who are circumcised as adults and men who are circumcised as infants are not equivalent groups for the purposes of scientific studies. An infant’s nervous system is an unfinished piece of work and everything else known about early postnatal development supports the assumption that the circumcised baby’s brain wires itself to optimise sexual function with the penis it has to work with. This would not be the case with men who are circumcised as adults or adolescents (although there may be a similar but less significant difference between the results of circumcision before and after puberty). Therefore, studies that compare uncircumcised men with neonatally circumcised men should be considered separately from “before/after” studies of men circumcised as adults.

    2) “Sensitivity” in general is very commonly conflated with sensitivity to sexually-exciting stimuli, but they aren’t the same thing. There’s no argument that nerve endings are lost, but there’s no clear significance for those nerve endings in sexual response. For example, in the Wikipedia article Keven links to above, a study is cited describing a high density of Meissner’s corpuscles (a type of somatosensory nerve ending) in the foreskin. I’m happy to believe this is true, but there is also a high density of Meissner’s corpuscles in my fingertips, yet I cannot elicit a sexual reponse by stimulating my fingertips. The sensory system that drives sexual response is specific to sexual reponse, is preserved after circumcision, and doesn’t require a penis that can feel a pea under 20 mattresses to work. In fact, sexual response is robust to changes in sensitivity during adulthood brought on by behavioral/environmental factors. Consider Dan Savage’s advice to men who have become so accustomed to vigorous stimulation in their masturbatory habits that they are insensitive to stimulation during intercourse: quit masturbating and allow orgasm to occur only in the context of intercourse, effectively re-setting the *sexual* sensitivity of the penis to allow for normal sexual function in the desired context.

    Kevin, when I read that wikipedia article, I don’t see a profound ambivalence in the medical community; what I see is a lot of studies producing precious little evidence for any difference in sexual sensitivity.

  27. I would never vote for one of these laws, but I do wonder a bit if there are any lasting psychological effects on the baby. I would think one could at least ask a question about whether waiting until the child is older would be better, if that allowed him to rationalize the experience in some better way, and also be able to use painkillers. But I’ve no idea what studies have been done on it. Piminnowcheez’s point about brain rewiring raises many questions.

    On the other hand, I assume that if this were doing massive harm to baby boys, parents would have noticed by now?

  28. @Eli – I should copyright that shit, huh?

    @NCG – one of the rationales for performing circumcision on neonates is that it reduces/eliminates the chance of psychological trauma because babies aren’t retaining autobiographical memories at that point. The sensorium of a newborn is an inchoate mess – they can’t see well, can’t locate stimuli in space, can’t control their muscles, don’t respond normally to stretch and startle reflex stimuli, etc. I have no doubt that circumcision hurts newborn boys (although how they experience pain is subject to question) but that pain is one among many confusing, aversive sensory experiences a newborn is going through that his brain is unequipped to contextualize. At that age, the baby’s brain is learning about how to work the body and sensory receptors rather than learning associations about individual events, so it’s hard to imagine a scenario in which a painful event a so early an age would produce a maladaptive learned association (i.e., psychological trauma).

    I always end up sounding like a circumcision advocate in these arguments, but I’m really not. I just hate watching passionate arguments driven by misinformation/misunderstanding.

  29. Pminnowcheez- well, I hope you’re right. From the little I know, our subconscious is basically one big mess. I would think it might be better to lessen traumatic events in early childhood as much as possible, though I agree we don’t and maybe can’t know what circumcision is like to a baby. For all I know, getting put down to sleep in a separate room may be just as scary. Yet I’m not sure autobiographical memories are the only kind to worry about.

    All in all, I’m comfortable letting parents make this decision. I don’t think it’s an easy one though. Maybe older + painkillers would do the trick just as well. Oh, also, I don’t own a penis, so there’s that too.

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