Saturday, December 20, 2014

Centers for Dick Control

In these modern times, it is easy to be under the impression that society has left behind strange, unnecessary, medieval medical procedures and is enveloped in the warm glow of evidence based healthcare.

This assumption is manifest when we come to learn that vaccines are thought by some to be a plot by western governments to control the population.

What utter absurdity! Those that have a respectable science-based outlook on the world know that vaccines are not mind control serums! Enlightened folks know better - smart people understand that what vaccines really do is cause autism. Right?

While not a uniquely an American problem, it is perhaps not an accident that the wealthy nation that seems to have the largest appetite for fantasy (or appetite generally) has made some of the furthest departures from reality when it comes to health and wellness.

The United States does happen to be the nation that did grant Dr Oz a career, for goodness sake.

Another way the United States is exceptional in a bad way is the practice of routine male infant circumcision. Most of the well fed world does not see the purpose in male circumcision. Circumcision is an oddity that is only widespread in the United States and various muslim countries.

On occasion, American health agencies have a moment of clarity to wonder what Americans could possibly be gaining by maintaining their phobia of infant foreskins.

The latest organization to look at the issue is the Centers for Disease Control, which published a document titled "Recommendations for Providers Counseling Male Patients and Parents Regarding Male Circumcision and the Prevention of HIV Infection, STIs, and other Health Outcomes" (accompanied by a backgrounder document)

The American psychosis that is the need to have some medical reason - any medical reason - to cut foreskin is baked right into the paper's title.

Let's circumcise the absurdities in this document.

HIV hysteria 

The document speaks about how studies in Africa showed that cutting off the foreskin of an adult male lowered his chances of contracting HIV by some measurable amount. Of course, this is making the rounds as people that have cut their boys need something to feel happy about.

"Circumcise your infant son now so he will be one of the ones still standing after the HIV pandemic strikes several decades from now!" or so the propaganda goes.

It is stupid, and the CDC document underlines just how silly things really are. In addition to a lengthy discussion of the multitude of HIV prevention techniques that actually work, the CDC instructs:

Although it is biologically plausible that male circumcision could benefit MSM during insertive sex, no definitive data exist. Currently, there are no study results from RCTs including large enough numbers of MSM and results from observational studies are not conclusive among MSM overall or among MSM who practice exclusively insertive anal sex. For example, some epidemiologic data suggest that male circumcision provides partial protection for the insertive partner during penile-anal sex while other studies do not. In contrast, male circumcision provides no biologically plausible HIV risk-reduction benefit for the anal-receptive partner and receptive anal intercourse carries a substantially higher risk for acquisition of HIV than insertive anal sex.

In short - if your son is gay, all bets are off. He'll be in a high risk population and potentially be doing some high risk things. If a parent chooses to circumcise their son for the marginal reduction in HIV transmission risk, they make the choice with the assumption that their son's sex life does not extend beyond repeated insertions of a condomless penis into a vagina.

It cannot be argued that it is ethical to remove a choice from an infant and needlessly perform a surgery early based on silly assumptions about choices later in life.

Reduction of nonexistent risks

Among other things, the document refers to reduction of risk in infant risk of UTIs and penile cancer.

What is an infant male's risk of UTI? 0.07%.

What is a male's risk of penile cancer? 1 in 1,400.

Stop the presses.

Your cut penis might look funny

Hidden within the "risks of circumcision" section for people willing to scroll to the very bottom of the damn document:
For adult male circumcision performed by clinicians, the rate of adverse events is between 2% and 4%, with pain, bleeding, infection and unsatisfactory post-surgical appearance most commonly reported. 
This is saying somewhere between 1 in 40 or 1 in 30 adults that undergo the procedure have some sort of issue with it. Apparently a common problem is that their penis looks unsatisfactory.

Unsatisfactory looking penis. This is where the numbers must come together, as one can imagine that it is difficult to acquire a sexually transmitted infection with an unsatisfactory looking penis.

It is said that infant circumcision has less reported ill effects (0.04%). Maybe the procedure is safer at a younger age. Then again, perhaps infants have less to report about phallus appearance, for some reason...

Money, Money, Money

Under the "positives" of infant circumcision the following is given:

Neonatal male circumcision is, safer, and heals more rapidly than circumcision performed on older boys, adolescent males, and men, and is less expensive

Buy now before the prices go up! It's natural to give the CDC the benefit of the doubt as they are not in the business of selling used cars.

However maybe someone should take up a career in car sales, for the background analysis of expense they used is quite absurd:

In a cost-effectiveness study of male circumcision at different ages in Rwanda, an African country with an adult HIV prevalence of 3%, infant male circumcision was found to be less expensive than adolescent and adult male circumcision (US$15 instead of US$59 per procedure) and cost-saving despite a delay in realization of savings from infant circumcision. 

Let's be clear - the United States is not Rwanda.

While this is obvious, in bizarre way we do not even need to look at recent history or any unrelated comparison to make this argument. We already know what circumcision cost is in the United States - NPR, another source of concern and worry, has already lost its mind about circumcision cost.

The NPR article spoke about infant male circumcision costing about a thousand dollars in the state of Alaska. As shown by its geography, Alaska is an outlier - in Alaska, presumably every procedure is cheaper when deferred to adolescence as older people would find it cheaper to seek care in other states.

However let's assume infant boy exists in an "average" state and assume the procedure costs around $500. To conclude that the procedure will be more expensive later, one needs to make the following assumptions:

  • The return on investment on the $500 will not result in an amount higher than the circumcision price 10-14 years from now (early adolescence)
  • Technology will not force the cost of the procedure to go down
  • No other factors will impact total cost (e.g. more than a decade later, the young male will still not be able to arrange his own transportation to the medical practitioner)
  • No other deflationary pressures exist (e.g. absolutely no positive health care reforms)
For many reasons, it's natural for medical practitioners to want to do stuff sooner rather than later, but there is not an economic argument to be made when a patient will not need substantially more work done later. It turns out adolescent males do not have considerably more foreskin to deal with.

The economics of infant circumcision is a clear win only for the person performing the surgery. Left entirely unaddressed in the CDC literature is the open secret that no right-minded sober adolescent male is going to sign up to be circumcised. Circumcision as it exists today is a money maker, and it relies on undermining consent in the most reprehensible ways.

To round out a tale of marginal improvements to embellished risks with a half-assed analysis of what routine infant male circumcision actually costs the nation is incredibly negligent. 

Like many other discussions of circumcision, the most troubling pieces of this "evidenced" counsel is what is not actually on the pages. Each new review of male circumcision is lengthy, but uninspired. Proofread, but not serious. Evidenced, but not logical. Clinical, but not honest.

Luckily, you have an opportunity to tell "the man" your thoughts by submitting a formal comment about the CDC notice.

January 15, 2015 is the cut off date.

Get typing - for if we know anything it is that these people love to cut things off early.

Tuesday, December 9, 2014

Second-rate Feminism failed Jackie

If one has not read the news in some time, one may have missed the ongoing discussion surrounding a poorly executed article about an alleged gang rape at the University of Virginia. The story consists primarily of the experiences of a woman named Jackie.

Several details of the story were challenged, and Rolling Stone (and Sabrina Erderly) provided woefully unsatisfactory responses and revealed that story development was rather slipshod in a number of ways.

The result is that Rolling Stone gave Jackie's story a platform without bothering to fix several things that may have been simple errors of memory. Now readers are left wondering if Jackie can be at all credible. Several believe it could all be a hoax.

If it were not a hoax and Jackie's story (or something similarly terrible) was true, then Jackie is twofold a victim. Once having been subject to horrific sexual assault, then again when being subjected to a nation thinking she is a compulsive liar that is unbalanced enough to falsely accuse someone of rape.

The ongoing argument on Twitter is one of good versus evil - presumably those that believe Jackie are strong proud feminists, while those that think there is no way that most of a fraternity is guilty of rape are victim blaming misogynists that further abuse survivors with their cold disbelief.

The thing is, bad feminism is what created skepticism.

Let's go over some cases:

These are some examples people point out as hoaxes. The details of some of the cases were so alarming that it's easy to suggest that they were obvious fantasy - and then use this methodology to dismiss the allegations that appeared in Rolling Stone.

But let's add two cases - that of the Central Park Five and the Norfolk Four - to the list. In these cases, it is undeniable that a crime occurred, but the persons put in prison were either proven to be or likely to be innocent.

What is interesting is that modern "feminism" discusses all of these plausible scenarios in precisely the same way - condemnation of the crime, public shaming of the suspects, and prolific discussion about violence against women and factors in our culture that allows such violence to propagate.

This is all well and good - until it comes time that just a handful of high profile cases turn out to be hoaxes. The world turns inside out - suddenly it is the men that were abused by the allegation. "Feminism" loses its words, incapable of making a display of sympathy that does not seem contrived. Artists of activist opinion even go as far as to reinforce their previous support of the accuser-now-perpetrator, citing belief in "victims" without question is what will bring more reports forward. 

Forget the lives of all the other people involved, what is important is some grandiose realization of a culture where women feel unafraid to bring a perpetrator to court. Apparently what is going to bring victims to the police station is knowing that an online cabal of unconditional belief will be immediately created to ruin the perpetrator on social media.

The problem is that "feminism" has scuttled its credibility. It rests at zero. One simply cannot bet on the wrong horse several times and then pretend it never happened - or more perversely, that it did not matter anyways. Duke lacrosse players did not get a grovelling apology from all the bloggers that thought they were gang rapists. Those that put forward that Conor Oberst was guilty have not bought his newest album as recompense. Even basic elements of justice are out of reach - people that are entirely innocent of charges rarely receive something as simple as the title of "victim" when the subject is discussed.

Put simply, nobody believes a rape allegation lifted by "feminism" as it's now taken for granted that it is propaganda that ignores the humanity of the accused. People assume that feminist activism is blindly supporting Jackie as that is the role that this "feminism" has created for itself.

In the case of the UVA allegations, the damaging nature of this brand of feminism is the reason the Rolling Stone article exists in the first place. Sabrina Erderly essentially wrote the Rolling Stone equivalent of a Tumblr post - a long credulous narrative from one perspective of questionable veracity.

Blind faith both published the article and had already created the legion of skeptics (and trolls) ready to take it down. 

Terrible "feminist" rhetoric failed Jackie.

It need not be this way.

Saturday, December 6, 2014

Are you co-opting Ferguson?

On August 9, 2014, a white police officer shot and killed a young black man named Michael Brown in Ferguson, Missouri, a suburb of St Louis. The shooting, as can be expected, has led to a great deal of protest and controversy.

A number of people have brought their own perspectives to the discussion -

Several young women involved in organizing the Ferguson protests have described similar encounters with a gender barrier: men bowling them over at meetings or not inviting them to help make decisions. The media, they said, also tended to focus on the guys, who sometimes delivered more inflammatory sound bites — about, say, the likelihood of a riot.
Other women similarly refused to back down after early skirmishes with their male counterparts. They organized their own demonstrations, contributing to the complicated mesh of establishment and start-up activist groups that took to the streets in the chaotic, early weeks after the shooting.
“There are some who still think God only speaks in baritone, and that leaders only speak in baritone,” said Traci Blackmon, a pastor in the Ferguson-adjoining city of Florissant, who said that her fellow clergy tend to be men. “We still teach our males to be dominant, domineering.”
Meanwhile, girls are taught to be nurturing and collaborative, said Blackmon, one of six women who have been appointed to Missouri Gov. Jay Nixon’s 16-member Ferguson Commission to examine the aftermath of the shooting. “There is a socialization that creates certain forms of leadership.”
Over the months, he said, the protests have become a “women-led movement. ... They're stronger, smarter, sober. A lot of guys are saying, 'I can't be up there [on the front lines], because I've got warrants.' The women don't make excuses.”
“When it comes to being a black woman, you deal with the oppression of both race and gender,” Richardson said. “You can't turn one off. I will always be black and a woman. ... Black lives matter, trans lives matter, women's lives matter. I'm standing for all of black lives.”

Then there is "Why Ferguson Should Matter to Asian-Americans":
Michael Brown’s death has several parallels in Asian-American history. The first to come to mind may be the story of Vincent Chin, a Chinese-American killed in 1982 by a Chrysler plant superintendent and his stepson, both white, both uncharged in a racially-motivated murder; like Brown, Chin unified his community to demand protection under the law. However, most direct parallels have often had one distinct dissimilarity to Ferguson: they have not spurred widespread resistance, nor have they engraved a visible legacy.
There is the story of Kuanchang Kao, an intoxicated Chinese-American fatally shot in 1997 by police threatened by his “martial arts” moves. There is Cau Bich Tran, a Vietnamese-American killed in 2003 after holding a vegetable peeler, which police thought was a cleaver. There is Fong Lee, a Hmong-American shot to death in 2006 by police who believed he was carrying a gun. None of the three cases resulted in criminal charges against the police or in public campaigns that turned the victim’s memory into a commitment to seek justice. One op-ed even declared how little America learned from Tran’s slaying.
As with Ferguson, it’s easy to say the Civil Rights movement was entirely black and white, when in reality there were many moments of interplay between African-American and Asian-American activism. Japanese-American activist Yuri Kochiyama worked alongside Malcolm X until he was assassinated in front of her.
And Asian writers again:

[...] We are outraged by the state violence against young black and brown men and the less noticed but equally distressing state violence against black and brown women. We are dissatisfied with an unjust system and dominant culture that continues to craft false narratives around our African American, Latino, and Native American brothers and sisters – similar to the construction of false narratives about Asian Americans.
The myth of the model minority, for example, has sought to pit us against each other, even though some of us have a long history of mutual support and collaboration across racial lines. We can’t overstate this: the rich, productive, complicated relationships across boundaries among Asian, Latino, and African-American people are too often poorly represented or entirely erased. It may not appear in the official record, but we squabble and we love. The evidence of this suppressed history very often finds its way into the poems, novels, talk-stories, plays, kitchen gossip, and movies that we are making – works of art that are often ignored or dismissed.

And how the situation connects with muslims: (Note: a search did not find any evidence that Michael Brown was muslim)
It’s never been exactly cozy between American Muslims and African Americans. But with Ferguson—and Gaza—that’s changing. [...] The Muslim-American community of which I’m part hasn’t been great in standing up with and for African Americans. [...] Other Palestinians, including a doctor, even offered advice via Twitter to the protesters in Ferguson on how to deal with the tear gas being fired at them based on their own experiences with Israeli security forces.

There are plenty of reasons to be quite happy with this diverse discussion. Different groups coming together in solidarity so that none is left fighting battles alone. A large army to solve large problems.

On the other hand, perhaps this is just a bunch of barnacles attaching themselves to an issue and derailing conversations that need to take place. Or merely a capitalist response to any tragedy, as anyone paid for their analysis or opinions would be leaving money on the table if they found themselves unable to write a piece with "Ferguson" in the title.

As everyone adds their own idea of how Ferguson fits into issues close to their heart, what is drown out is in-depth analysis of specifics of the situation. Breadth, not depth. Attention scatters. But that could be the point.

A simple truth is that young black men do not form a demographic that collects much sympathy. Concern and attention are abound - but this may be sourced more often from fear than caring. There are plenty of reasons to believe that the death in Ferguson is illustrative of what is primarily an issue African American men are dealing with. In adding "voices", perhaps some groups in some sense see themselves as lending their legitimacy to black men and humanizing them.

It's just a shame that the writing could not lend a little more light to the issues faced black men.

We can speak about Gaza - and absolutely should, as the conflict rages on. But let's not allow anyone to think that African Americans are somehow the junior when it comes dealing with complex social problems.

And the extension into contemporary "religious discrimination" in America may also not be desirable. It may be a cynical assessment of intentions, but getting dirty looks at the airport, being mocked as a Mormon or being ignored as an atheist does not mean that one is granted special insight into what life in St Louis is like.

As an example of the sort of thing that may be unhelpful, let's reread the piece that appeared in the Los Angeles Times:

Several young women involved in organizing the Ferguson protests have described similar encounters with a gender barrier: men bowling them over at meetings or not inviting them to help make decisions. The media, they said, also tended to focus on the guys, who sometimes delivered more inflammatory sound bites — about, say, the likelihood of a riot. [...] “We still teach our males to be dominant, domineering.”

While it's admirable that the paragraph has the familiar essential qualifier of not all men, the injury is dealt. It spells it out - having women speak is better as black men are more prone to dramatic allusions to violence.

And this is coming from the team said to be in support of black men.

Maybe it is true. Perhaps black men are not fantastic ambassadors of their cause. Maybe this even fits the protest narrative - it's difficult to expect absolute civility from a group that is hassled by police and subject to extremely low expectations from society.

This possibility is left unmentioned by the article however, as it thanks women for their bravery, level-headedness and good nature. Women are a gem in a world in which men are simply brought up wrong.

Sugar and spice and everything nice.

If one finds nothing much lacking in how the dialogue speaks of black men or deflects from them, then one should at least find much lacking in this text. For this article is co-opting Ferguson, using it as a springboard to address what one opinionated armchair activist feels about other opinionated armchair activists.

This article does not discuss:

  • Voter engagement
  • Police hiring practices
  • Economic problems
  • The drug war
  • Urban planning
  • Education funding
  • Family norms
  • Overemphasis on incarceration 
  • ... and so on ...

Trying to piece a lot of possible factors together in a meaningful and evidenced manner takes work. Creating a hypothesis about what has happened and back it up with facts. What could be more boring and exhausting?

Tell a story, share sympathies flavored with your own worldview, get those page views and move on.

Anything more would be effort.