BOYLE AND HILL'S CIRCUMCISION ‘PHALLUSIES’

Authors


Sir,

In a recent Letter, Boyle and Hill [1] provide a raft of emotive and fallacious statements denigrating a scholarly editorial in JAMA that explained why current medical evidence favours infant male circumcision (MC) [2].

Their Letter starts with a selective appeal to authority, namely two anonymous, non-evidence-based, non-peer-reviewed Internet policy statements by the Dutch Medical Association and the Royal Australasian College of Physicians (RACP), which contradict affirmative, evidence-based, reports published in peer-reviewed journals by the Circumcision Foundation of Australia [3], the Centers for Disease Control and Prevention [4], and others.

Boyle and Hill then go on to deride the findings from three large, well-conducted randomised controlled trials in sub-Saharan Africa [5] that have shown MC protects against female-to-male HIV infection. They do so by repeating arguments that have been exposed previously as fallacious [6–8]. This includes their selective citation of an outlier study in Uganda that noted non-significantly higher male-to-female HIV transmission in HIV-positive men who resumed sex before their circumcision wound had healed, while ignoring a large meta-analysis that included that study with other studies, showing overall that male-to-female HIV transmission was 20% lower [9].

They then make various speculative claims about the function and sexual role of the foreskin, none of which is supported by hard scientific evidence (see reviews [3,4]). As pointed out previously, MC opponents, such as Boyle and Hill, consider it sufficient to simply assert a contrary position rather than evaluate the credible research literature published in good journals after peer review [10]. Moreover, in support of their claim that MC results in ‘possible long-term psychosexual difficulties’ they cite four opinion pieces.

In contrast to their claim that ‘MC invokes an abundance of human rights and ethical issues’, ethicists have argued that denying MC may violate ethical principles and human rights [10,11].

Rather than Boyle and Hill's claim of ‘certain inherent injury’, MC is a low-risk procedure with no long-term harm, and for which, just as childhood immunisation, benefits exceed risks by a large margin, death being exceedingly rare (see reviews: [3,12], where Morris et al[3] exposes the fallacious nature of the MC death statistics used by MC opponents). Calling MC ‘mutilation’ is illogical, as ‘in the context of circumcision, a morally value-laden definition of “mutilation” cannot be used as a reference to circumcision unless one has already established that circumcision is wrong. To establish that circumcision is wrong, one cannot simply describe circumcision as mutilation (which would be circular)’[10]. The same charge can be levelled at their claim that MC presents ‘intractable moral, child abuse, human rights, and ethical problems’.

They end their Letter with an elaborate form of argumentum ad hominem: they speculate that Tobian and Gray are circumcised, speculate that they are ‘psychosexually wounded’ as a result, and then offer this as an explanation for their article, completely ignoring the actual arguments.

Finally, it would seem unreasonable to present Tobian and Gray's recent editorial in JAMA and the RACP infant MC policy statement as polar opposites, considering:

  • • The editorial states ‘Parents should be provided with information derived from evidence-based medicine about the risks and benefits of male circumcision so that they can make an informed choice for their children. It would be ethically questionable to deprive them of this choice’.
  • • The RACP policy states ‘When parents request a circumcision for their child the medical attendant is obliged to provide accurate unbiased and up-to-date information on the risks and benefits of the procedure. Parental choice should be respected’.

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