Thursday, December 8, 2016

Trump, Conspiracy Theories, and Mob Mentality

Within the past few days there have been two news stories about right-wing conspiracy theories percolating upward, as such things inevitably do, from the morass of fake news platforms, online chatrooms and posts to actual instances of harassment and violence.   Both conspiracy theories appear to have originated with or, at the very least, been launched into the cybersphere by Alex Jones, a man whom Donald Trump has praised effusively.  Of course, people have a right to believe whatever they want to believe and to say whatever they want to say.  But a line is crossed - as epitomized by the example of screaming "fire" in a crowded movie theatre - when such speech precipitates actual harm.  One of these conspiracy theories, the so-called "pizzagate" conspiracy, which consists essentially in allegations that Hillary Clinton is involved in running a satanic child-sexual-exploitation ring headquartered in a Washington, D.C. pizzeria where the children are being held captive,  has resulted in death threats against and harassment of the owner and employees of this restaurant and culminated earlier this week in a vigilante firing off a semi-automatic weapon on the premises while "investigating."  The other conspiracy theory peddled by Jones is that the massacre by Adam Lanza of twenty 6- and 7-year-old children and six adults in Newtown, Connecticut in 2012 never occurred but was a hoax by the federal government, presumably so that the feds would have their long-coveted pretext for confiscating Americans' guns.  This has now culminated in the arrest of a woman for making death threats against the father of one of the massacre's victims.  

Although the pizzagate myth is manufactured out of whole cloth and the Sandy Hook myth is the opposite - the negation of an event that actually occurred - both of these conspiracy theories are notable for their historical precedents, from the medieval accusations that were made against Jews to the early modern accusations of witchcraft to the contemporary phenomenon of holocaust denial (another of the alt-right's preoccupations).  But even more important than the academic interest that these right-wing conspiracy theories may hold for historians is that, however false they may be, they end up creating real victims or, as with the Sandy Hook massacre, they re-victimize those horrendously victimized already.  Thus, while there were no actual victims until Alex Jones insured that there would be in the persons of the owner and employees of Comet Ping Pong, there were hundreds of actual victims of the Sandy Hook massacre: the 20 children and 6 adults who were gunned down in cold blood as well as the families of the deceased who were left to pick up the pieces of their shattered lives.   Because of Alex Jones, the survivors would be made to suffer the most painful sort of insult-added-to-injury.   That is what is so utterly callous and reprehensible about spreading rumors and conspiracy theories such as these.   Imagine what it must feel like to have been the parent of a 6-year-old who was murdered and to have to listen to some worthless shit claim that your child never existed or that she wasn't really murdered. That is the sort of inhuman, depraved lunacy that right-wing conspiracy theorists such as Alex Jones have peddled and continue to peddle without a shred of concern for the consequences.

Why does this matter now, more than it did one year ago? Because Donald J. Trump has himself traded on these very types of right-wing conspiracy theories. Trump is a fellow traveler of the alt-right who has actively courted its membership and promoted some of its leading figures to the highest echelons of power in the Trump White House. Trump and Jones, meanwhile, have something of a mutual admiration society: NPR reports that Trump has gushed over Jones and that, after the election,  Trump called to thank Jones for his support. It is little wonder that Trump should share in Jones's penchant for fabrication, outright lies and conspiracy theories. Crowds of Muslims in New Jersey cheering as the World Trade Center came crashing down; global warming a hoax perpetrated by the Chinese government; millions of illegal votes for Clinton cast last month by dead people or resulting from other forms of voter fraud: all of these are completely baseless claims without an iota of supporting evidence that serve directly or indirectly only to advance the right-wing agenda.   Each of these claims (and, perhaps, most notoriously, the "birther" lie about President Obama) has been iterated and reiterated by Trump.

But telling lies, spreading rumors, and promoting "fake news" causes real harm to real people. Today it might be death threats against the grieving father of a Sandy Hook victim, and yesterday it might be a man firing a semi-automatic rifle in a restaurant filled with patrons, but make no mistake: the rumor-mongering and baseless allegations of Alex Jones, Michael Flynn (both the elder and the younger), and Trump himself is precisely the sort of reckless behavior that history shows us inevitably leads to mass hysteria and mob violence. It was just this sort of scurrilous finger-pointing that led to the trials and executions of accused witches in Salem, Massachusetts at the end of the 17th century. It was just this sort of finger-pointing and scapegoating that led to the burning at the stake of tens of thousands (some sources put the figure at between 100,000 and 300,000) mostly (but by no means exclusively) women in Europe during the 15th through the 18th centuries on the basis of nothing more substantial than accusations that they practiced witchcraft.  Yet another notable example of this sort of mob mentality was the periodic rounding up and killing of Jews - usually in mass burnings - in the communities along the Rhine in medieval Europe on the basis of what we would now call conspiracy theories about Jews having caused Bubonic plague by poisoning the wells or their abducting Christian children, killing them, and using their blood to make matzohs (the notorious "blood libel"). 

It is surely no coincidence that there are striking parallels between the wildly false accusations against Clinton in the pizzagate conspiracy theory and the historical accusations of witchcraft in Renaissance Europe and the blood libel against Jews in medieval Europe.  All involve false allegations of organized satanic ritual, sexual exploitation and depravity, and the abuse and murder of children.  Indeed, the Times reports that Alex Jones has actually stated that "Hillary Clinton has personally murdered and chopped up children."  The mentality of all of those who perpetrate and participate in such mass hysteria as is demonstrated in each of these examples is exactly the same: the scapegoating and the demonization on the part of the accusers and the credulousness and complete abandonment of critical thinking on the part of the mobs who listen to them.

And this type of thinking - this mob mentality - is precisely what Donald Trump knowingly and shrewdly exploited in order to get elected.  Trump might not have peddled stories about satanic sex rings but, with his demagoguery and scapegoating of Muslims, Mexicans and other minorities, with his campaign's shameless use of codewords and imagery to appeal to naked anti-Semitism and white nationalism, with his endorsement of the essential canon of right-wing conspiracy theories, with his appointment to his administration of some of the central players in this perverse predilection with gothic horror fantasies and right-wing paranoia and, most obviously, with his unbridled praise for Alex Jones, Trump has bestowed his official imprimatur upon the right-wing conspiracy-theory industry.  And because Trump has used his position to confer legitimacy on these right-wing conspiracy theorists and their fantasies, ultimately, it is now Trump himself who is responsible for them.  

This explains also why Trump has been so reticent on the subject of the support that he has received from the alt-right and why, even now, he has not repudiated it on his own initiative but rather, only when put on the spot, as when he participated in a post-election interview with the editorial- and management staff of the New York Times.  Trump validates right-wing conspiracy theorists and the alt-right and they, in turn, validate Trump.  It is a symbiotic relationship in which one cannot exist without the other.  That is why Trump represents an existential threat to our nation, to its democratic traditions and institutions, and to its social fabric.  

Meanwhile, the larger portion of the pro-Trump electorate and those craven Republicans who supported and continue to support Trump stand by silently and uncritically while the right-wing conspiracy theorists in effect scream "fire" in a crowded movie theatre. 

Monday, October 17, 2016

Billy Bush

Last week, the New York Times reported that Billy Bush, one of the hosts of NBC's morning program "Today," was negotiating his severance package. This follows the release of the now famous and infamous recording in which Donald Trump is heard candidly boasting about his attempts to seduce Bush's former co-host at "Access Hollywood," Nancy O'Dell, and about his propensity for sexually assaulting women in general.  (A tape and transcript of this can be found here:  http://www.bbc.com/news/election-us-2016-37595321).   Bush, throughout much of the exchange, plays the role of fawning sycophant, simultaneously encouraging and savoring Trump's sordid accounts.  In his transparent hero-worship,  Bush's encouragement of Trump's tales of sexual conquest appears to be a facilitation of Trump's further aggrandizement, not unlike rubbing a giant symbolic phallus in order to marvel as it grows to its full turgid magnificence. (I have always been struck by the homoerotic nature of male bonding rituals.  One wonders that the anti-LGBT- and homophobic attitudes of many of the men who engage in such behavior does not outweigh their propensity for engaging in it.)  At the same time, Bush obviously hopes to derive a vicarious sexual thrill from Trump's stories; indeed, to such an extent that, listening to this recording, one is inevitably struck with the truly distasteful realization that one is privy to Bush's act of masturbation, though, of course, the only thing actually being stroked here is Trump's ego. 

In a previous story about this, the Times reported that Billy Bush, who is now 44 years old, issued a statement which reads, in part, "It’s no excuse, but this happened 11 years ago — I was younger, less mature, and acted foolishly in playing along.”  But later in the recording, as the two men are disembarking from the bus in which this conversation took place and being greeted by the actor Arianne Zucker, Bush can be heard pressuring her into hugging Trump and then himself. That is not "playing along," and he's right: the fact that this happened 11 years ago, when he was 33 - a grown man - is no excuse. One does not hug someone one is meeting in one's professional capacity as a reporter or as anything else.

To those fortunate enough not to know from firsthand experience how sexual abuse occurs, it may come as a surprise to learn that it often disguises itself as friendly, supplicating, and innocuous, rather than overtly aggressive or threatening. That is one of the ways in which sexual abuse is at once pernicious and successful.  And that is precisely why victims often feel ashamed and conflicted. People (and I would argue women, more so than men) are socialized to respond welcomingly to overtly friendly overtures and to be on guard more against hurting other people's feelings than against other people's violations of their own personal space and dignity. It is just that sort of socialized vulnerability that sexual abusers exploit and it is this type of unctuous and underhanded approach that Bush used to pressure Zucker into body-to-body physical contact. He first pressures Zucker on behalf of Trump and, in so doing, assumes the role of procurer, again, acting in his role as Trump's lapdog but also, again, so that Bush could experience the thrill of Trump's physical contact with Zucker vicariously.  This, too, takes on the character of a macho bonding ritual, in which the men share in exploiting the vulnerability of a female victim and putting one over on her.  Trump and Bush both knew, from their previous conversation, that the point of the hug was to gain access to Zucker's body when the rules of social and professional etiquette would normally render it off limits.  For her part, Zucker surely was caught unawares and was forced to perform the quick mental calculation that women in this position so often are forced to perform: "Are they just being friendly? Am I being too sensitive and standoffish?"

Not content with acting as Trump's procurer, Bush then goes on to pressure Zucker into hugging him himself so he could experience his own sexual thrill at her expense.  But make no mistake: the thrill for this sort of person is not merely the physical contact with someone who has been pressured into granting it; it is the thrill of knowing that one has used subterfuge and exploited a vulnerability in order to get it.

Sunday, October 2, 2016

Response to Monica Robins, Senior Health Correspondent, WKYC

http://www.wkyc.com/mb/news/local/cleveland/group-of-men-protest-circumcision/328106212#

Dear Ms. Robins,
I am writing to express my disappointment in your coverage of the protest in Cleveland by Bloodstained Men against non-therapeutic genital cutting or circumcision ("Group of Men Protest Circumcision," October 1, 2016, WKYC.com). I realize that you are limited probably to mere seconds or minutes on broadcast TV news, yet the tenor of your coverage (particularly as it reads in transcript form on the station's website) was exceedingly superficial, biased and, at best, dismissive of these protesters. And while I applaud you for at least covering this story, I believe that you missed an opportunity to do what a reporter ought to do, including presenting both sides of the story in an objective and balanced way. Instead, you simply recycled sound bytes and long discredited misinformation on the efficacy and legitimacy of infant circumcision as a prophylaxis against diseases such as urinary tract infections and STIs, all of which can be prevented or treated with non-invasive means. Your viewers and the public deserve far better, especially from a Senior Health Correspondent.
To address the main points of your story:
You stated, "Most circumcisions are performed on newborn boys and have been practiced for religious, cultural, and ethic traditions for thousands of years."
In fact, the majority of the world's male population is intact. The United States is one of the small minority of modern industrialized nations in which infant circumcision is performed routinely. Currently, over half of all newborn males in the United States are subjected to it: over one million annually at a cost of hundreds of millions of dollars to consumers - and to tax-payers, as well, in those states that permit Medicaid funding to be used for this medically unnecessary (by the AAP's own admission) surgery. From a health- and medical standpoint, your statement that circumcision has been practiced as a tradition for thousands of years has absolutely no bearing on this topic, otherwise your station should have sent its religion- or cultural reporter to cover this demonstration. Yet, at the same time, your statement seems intended to confer legitimacy on this practice by virtue of its deep historical roots and longevity. I would remind you, however, that female genital genital mutilation, slavery, and the legal subordination of women - to name only three religious, cultural, and ethnic practices - likewise have been practiced for thousands of years. That does not make these practices valid nor ethical.
As we know, the United States is not thousands of years of old and routine infant circumcision is not in the cultural, religious, or ethnic traditions of the vast majority of people living in the United States. Your viewers might therefore have been better served by a more detailed history - or even any history - of how circumcision came to be commonly practiced here in contrast to most of the rest of the world. That would allow them to judge this surgery in its proper context. To wit:
During the 19th century, circumcision was promoted as an effective remedy for a host of ailments including, but not limited to, rheumatism, epilepsy, asthma, skin cancer, insanity, and venereal disease. However, it was as a remedy for "masturbatory insanity," which was believed to result from masturbation or "self-abuse," that circumcision was most widely promoted by its supporters. Incidentally, one of its most passionate Victorian advocates, none other than John Harvey Kellogg, the co-creator of Corn Flakes, also advocated putting carbolic acid on girls' clitorises for the same purpose: that is, to decrease sexual sensation and thus to inhibit masturbation. Because it was widely pushed by its supporters both outside of and within the medical profession, infant male circumcision increasingly came to be accepted as normal and routine by a credulous public, even as the medical (and sexually-repressive) justifications for circumcision were debunked, one after the other. And because, until about a generation ago, circumcision was seldom questioned, routine infant circumcision metamorphosed from pure pseudoscience to a cultural norm, all while masquerading as a valid medical procedure. It persists to this day as the proverbial cure in search of a disease. These are the historical, pseudo-scientific and cultural roots of routine infant circumcision as it is practiced in the United States.
Added to this are the determined efforts by an entrenched and financially interested pro-circumcision lobby. Circumcision, it should be noted, is a $400 million per year industry for OBGYNs and pediatricians. The stolen foreskins ("stolen," since an infant cannot consent to his own circumcision) are then often used by biotech corporations in the manufacture of everything from replacement skin for burn victims to "beauty cream" products. Circumcision, then, is big business (estimated by some at upwards of a billion dollars) and now generates a huge revenue stream for those who participate in it. This, too, is why circumcision persists in the United States today. Your viewers deserve to have been informed of this, as well.
You stated, "The American Academy of Pediatrics found the health benefits of newborn male circumcision outweigh the risks, but the benefits are not great enough to recommend universal newborn circumcision. The decision should be made by parents."
The AAP's latest position statement (from 2012) has been roundly criticized by numerous professional medical organization both in the United States and in Europe, and specifically because of the manifest cultural bias which led the AAP task-force members to come to their conclusion. Indeed, one of the lead authors of the AAP's revised policy statement, Andrew Freedman, MD, FAAP, has recently conceded in a published statement that when the AAP task force on circumcision alluded to its "benefits," it was referring not strictly to "health benefits" but to the cultural and "aesthetic" "benefits" of circumcision as well. It is not surprising, therefore, that the AAP's 2012 statement on infant circumcision was criticized for its cultural bias. In a commentary signed by about 40 physicians and published in the Journal Pediatrics (the journal of the American Academy of Pediatrics, March 18th, 2013), entitled "Cultural Bias in the AAP's 2012 Technical Report and Policy Statement on Male Circumcision," the authors write: "Seen from the outside, cultural bias reflecting the normality of nontherapeutic male circumcision in the United States seems obvious, and the report's conclusions are different from those reached by physicians in other parts of the Western world, including Europe, Canada and Australia." The authors of this commentary conclude, "There is a growing consensus among physicians, including those in the United States, that physicians should discourage parents from circumcising their healthy infant boys because nontherapeutic circumcision of underage boys in Western societies has no compelling health benefits, causes postoperative pain, can have serious long-term consequences, constitutes a violation of the United Nations' Declaration of the Rights of the Child, and conflicts with the Hippocratic oath: primum non nocere: First, do no harm."
The AAP's conclusion that the "benefits" of infant circumcision "outweigh the risks" has also been criticized by a group of psychologists who wrote to the CDC, after the latter issued a draft of updated recommendations in support of circumcision based on the AAP's position statement. The authors of this letter noted not only the numerous methodological errors behind the AAP's position statement, but "the troubling fact . . . that the CDC completely ignored the psychological effects of genital cutting on male children." Among the conclusions of these psychologists was that "circumcision causes significant psychological harm in children and adolescents" and that "by encouraging circumcision, medical professionals are shaming [intact] boys' bodies."
So, aside from the AAP, whose members have a financial interest in perpetuating infant circumcision, where does the rest of the medical community actually stand on this question? Your viewers deserve to know. This is what the Royal Dutch Medical Association (KNMG) has to say: "[N]on-therapeutic circumcision of male minors is a violation of children's rights to autonomy and physical integrity. Contrary to popular belief, circumcision can cause complications - bleeding, infection, urethral stricture, and panic attacks are particularly common. KNMG is therefore urging a strong policy of deterrence." This is what the Canadian Paediatric Society has to say about it: "The overall evidence of the benefits and harms of circumcision is so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns." Here's what the Royal Australasian College of Physicians has to say: "After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand." In fact, there is not a single professional medical organization on Earth that recommends routine infant circumcision. Every research arm of every major medical organization ever tasked with assessing infant circumcision has found insufficient evidence to warrant recommending it. That holds even for its most ardent defender in the U.S. - the American Academy of Pediatrics. As you have noted, The AAP's own position statement on circumcision is that ". . . existing scientific evidence is not sufficient to recommend routine circumcision [my emphasis]." The AAP's position statement goes on to say that "because the procedure is not essential to a child's current well-being, we recommend that the decision to circumcise is one best made by parents in consultation with their pediatrician taking into account what is in the best interests of the child, including medical, religious, cultural, and ethnic traditions [my emphasis]." As is obvious, the AAP's position statement professes to represent not exclusively medical best practices but instead adopts a position in support of what it concedes is not a medically necessary but rather is essentially a cultural practice. Again, I would remind you that to argue on behalf of circumcision on the basis of "religious, cultural, and ethnic traditions" not only is not appropriate on the part of a medical organization but these are the very same justifications that have been used and continue to be used to defend the practice of female genital mutilation.
Nary a mention of the significant and growing opposition to circumcision within the medical community itself, as opposed merely to the opposition among human rights groups such as Bloodstained Men, was made by you in your report. Yet this, too, is information with which your viewers should have been provided. Indeed, when reporting on this topic, the countervailing weight of the medical opinion in opposition to the AAP's tepid but unmistakable endorsement of infant circumcision is information that is required of any legitimate news outlet by the principle of fair and balanced reporting. Your failure to include it thus conveyed the erroneous impression that Bloodstained Men is out of step with medical opinion and, therefore, a "fringe" group. It is not. Its tactics may be "fringe," but on the question of the ethics and validity of nonconsensual infant circumcision, Bloodstained Men stands foursquare within the majority of world opinion.
I observed above that your story merely recycled long discredited sound bytes and misinformation regarding the risks and efficacy of infant circumcision when you stated, "Risks include bleeding, swelling, and botched procedures. Benefits include prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted diseases including HIV." Let's look into the purported benefits of circumcision a little more deeply.
A reduction in the risk of penile cancer is one oft-cited benefit, and one you mentioned yourself. Yet the American Cancer Society itself has written that "circumcision is not of value in preventing cancer of the penis." In fact, penile cancer is so rare that a male is more likely to develop breast cancer than penile cancer yet, curiously, infant boys' breast buds are not routinely amputated along with their foreskins. Another claim is that circumcision can reduce the risk of the adult male or his sexual partner's contracting an STD or the human papilloma virus (HPV). But not only are there far more effective measures that can be taken to prevent these, such as the use of condoms and the administration of the HPV vaccine, but these measures do not sacrifice a functionally important part of the male genitalia. (It is also unethical and irresponsible to imply that one need not use a condom simply because one has been circumcised.) Still another medical justification for circumcision is that it reduces the risk of an infant's getting a urinary tract infection (UTI), but girls are ten times as likely as boys to develop UTIs and, when they do, girls are routinely administered antibiotics as a remedy. Why is genital surgery indicated prophylactically in boys to lessen the risk of developing a UTI while the far less invasive and far less risky intervention of administering antibiotics is employed to treat UTIs in girls? Given that UTIs are far more common among females than males, the "cost-benfit" justification for male circumcision becomes even weaker. As for its role in reducing the risks of contracting HIV, this medical myth comes primarily from two African studies that purported to demonstrate the efficacy of prophylactic circumcision. Yet these studies have been roundly criticized for their methodological errors as well as for their hyperbolic claims as to the reduction in HIV transmission rates. What these studies reported as a 60% reduction was in fact a relative reduction as opposed to an absolute reduction. The actual reduction in the rate of transmission was found to be in the neighborhood of one and a half percent.
In sum, there is a veritable mountain of peer-reviewed research and authoritative medical opinion that not only does not support infant circumcision but positively condemns it. Yet you chose in your coverage to omit this fact entirely and that is why I say that your reporting here was biased and superficial and that your viewers were not well served by it.
I commend you for encouraging parents to do their "homework" and to seek information from "reputable sources" but I am bewildered by your own failure to do the same in preparing this story. I would also urge your viewers, if they seek information from their OBGYN or pediatrician about infant circumcision, to ask them why men in Europe, where circumcision is rare, have lower rates of STIs, including HIV, than men in the United States, where circumcision is common. They should also ask their OBGYN or pediatrician to describe and explain both the anatomical and histological structures of the male prepuce. Likewise, parents should ask their OBGYN or pediatrician to explain the centrality of the male prepuce to male sexual sensation and response, as well its functional role during intercourse. And they should ask about the fact that women partners of men who have undergone circumcision (either volitionally, or who have been subjected to it without their consent, as most of us have) frequently report problems with intercourse including painful intercourse. In this regard, parents may also wish to ask their OBGYN or pediatrician why the AAP did not look at a single study on the long-term effects of circumcision on male genital function and sensation when it revised its position on circumcision. Finally, parents should ask their OBGYN or pediatrician about the normal development of the penis and at what age the prepuce (or foreskin) naturally detaches from the glans (to which it is fused at birth) and at what age it is appropriate to retract the prepuce in the course of performing normal hygiene. If their OBGYN or pediatrician cannot answer any and all of these questions to their satisfaction, they may wish to take their medical consumer business elsewhere. At the very least, if their OBGYN or pediatrician cannot demonstrate a basic knowledge of the structure and function of the male prepuce, parents should be deeply skeptical about the wisdom of allowing her or him to amputate it from their child's body.
A final word. In your report on this demonstration and the position of Bloodstained Men, you made no mention whatsoever of the ethics of this invasive, traumatizing, painful, medically unnecessary, controversial and increasingly discredited surgery. Your only oblique references to this aspect of the subject were the observation that Bloodstained Men considers male genital cutting "cruel" and your quotation by Mr. Guiremand of Bloodstained Men that nonconsensual circumcision "violates the right of someone to have control over [his] own body." I find it troubling that you did not pursue this line of inquiry in your report. After all, it is precisely the ethical dimension of nonconsensual circumcision that is at the very heart of the movement to eradicate it. In this respect, the movement to end non-therapeutic male genital cutting is no different than its sister movement to end non-therapeutic female genital cutting. Thus, not only from the standpoint of balanced medical reportage but from the standpoint of serving the public interest by highlighting the ethical dimension of a medically unnecessary and nonconsensual yet routine amputation, you missed an important opportunity. I would urge you, therefore, to look into this topic further and see what medical ethicists such as Brian Earp, physicians such as Morten Frisch and Adrienne Carmack, and legal scholars such as Peter Adler have to say about it. I hope that you will follow up with more detailed, more balanced, and more enlightening coverage of this topic for your viewers in the near future.
Sincerely,
David Balashinsky

Monday, August 29, 2016

Meatless Mondays, Oprah Winfrey, and the Humane Society of the United States

by David Balashinsky

Wayne Pacelle, the CEO of the Humane Society of the United States, recently announced on his organization's Facebook page that Oprah Winfrey has endorsed the Meatless Mondays movement.  In a post that also links to his appearance with Winfry on SuperSoul Sunday, Pacelle writes, "The big news coming out of my appearance with Oprah Winfrey onSuperSoul Sunday today is that she took the “Meatless Mondays” pledge and asked her 33.5 million Twitter followers to follow suit. Incredible, high impact, game-changing stuff. On today’s show, she showed such facility for the cause and a great shared passion for fighting for animals, in ways large and small. It’s great to have this amazing woman on our side."  

I write as a long-time and proud monthly financial supporter of the HSUS when I say that I am deeply disappointed to see the HSUS sully its reputation by associating itself with Oprah Winfrey.  Yes, Winfrey - to her credit -  now endorses the Meatless Mondays movement.  Good for her.  But this is the same Oprah Winfrey who has gone on national television and shilled for SkinMedica, a company that manufactures anti-wrinkle face cream which is made from the stolen prepuces of helpless infants who have been subjected to nontherapeutic circumcision - a totally unnecessary genital modification surgery that causes infants excruciating pain, violates their right of bodily integrity, permanently removes a normal, sensitive, and functional body part, kills over 100 infants and leaves over one million more scarred for life in the United States every year. How can one oppose an industry that exploits animals and causes them needless suffering while at the same time supporting an industry that exploits human infants and causes them needless suffering?  It strikes me as morally inconsistent and exceedingly hypocritical to refrain from meat consumption on ethical grounds while smearing "beauty cream" made from stolen human body parts on one's face.  Yet this is exactly what Oprah Winfrey is now doing.  
  
The HSUS, as well as many other animal-welfare and animal-rights organizations, has long deplored the use of animals in cosmetics testing, not merely because the animals subjected to these tests experience horrific pain while the tests themselves are absolutely unnecessary but because, as unethical as such testing is to begin with, such mechanized and routine exploitation of animals becomes even more conspicuously unethical when it is done for no more noble a purpose than to gratify human vanity.  Yet how is tearing off part of an infant's penis without a shred of medical justification, without his consent, and with insufficient or no anesthesia morally any better than vivisection?  How is manufacturing a "beauty cream" (or any other product) that is made from these stolen body parts morally any different from subjecting animals to painful cosmetics testing?  

As Pacelle himself has written, "As harsh as nature is for animals, cruelty comes only from human hands.  We are the creature of conscience, aware of the wrongs we do and fully capable of making things right.  Our best instincts will always tend in that direction. . . ." ("The Bond: Our Kinship With Animals, Our Call to Defend Them" by Wayne Pacelle; published by William-Morrow/Harper-Collins; 2011; the quotations included here are all taken from excerpts from Pacelle's book that appear on the HSUS website.)  As I understand him, Pacelle is arguing here from the unassailable and morally unambiguous position that, because human beings have the capacity to entertain the notion of ethics, we have not merely a duty but even an innate impulse to act ethically.  The focus of Pacelle's mission is to call humanity to a better version of itself and to apply the standards of integrity, rectitude and compassion to animals that we would like to believe we apply to ourselves - or, as Pacelle puts it, to uphold "the decent and honorable code that makes us care for creatures who are entirely at our mercy."  

But isn't it axiomatic that we have no less a duty to apply these same standards to our fellow human beings?  Doesn't "the decent and honorable code that makes us care for creatures who are entirely at our mercy" apply no less to infant boys than to our fellow living creatures?  Pacelle continues: "Especially within the last 200 years, we've come to apply an industrial mindset to the use of animals, too often viewing them as if they were nothing but articles of commerce, the raw material of science, or mere obstacles in the path of our own progress.  Here, as in other pursuits, human ingenuity has a way of outrunning human conscience, and some things we do only because we can - forgetting to ask whether we should."  Exactly these observations, criticisms, and questions are at the very heart of the genital rights movement: a movement that has arisen in response to the medically unwarranted but culturally normalized practice of routine infant circumcision. Indeed, I can think of no more fitting a description of routine infant circumcision and the unethical use of the human tissue obtained thereby than Pacelle's trenchant observation that "as in other pursuits, human ingenuity has a way of outrunning human conscience, and some things we do only because we can - forgetting to ask whether we should." 

Subjecting an infant to a medically unnecessary and irreversible amputation of part of his body is unethical.  To then use that infant's excised body part in the manufacture of "beauty cream" as SkinMedica does is by orders of magnitude even more unethical: it is a moral abomination.   Oprah Winfrey has enthusiastically promoted this practice and this product.  I cannot think of a poorer choice as a spokesperson for the Meatless Mondays movement, much less everything else that the HSUS stands for, than Oprah Winfrey.


http://www.supersoul.tv/supersoul-full-episodes/wayne-pacelle-full-episode

Sunday, August 28, 2016

Where They Stand: Straddling the Great Divide Between Non-Therapeutic Circumcision and Pain-Prevention in Neonates

by David Balashinsky

Earlier this year, the AAP published a revised policy statement regarding procedural pain in neonates.  The very first recommendation, as it appears in the Abstract section of the new policy statement (AAP Gateway, Pediatrics; February 2016, Volume 137 / Issue 2) is that "The prevention of pain in neonates should be the goal of all pediatricians and health care professionals who work with neonates. . . ."  In the Background section, the revised policy also states, in part, "The prevention and alleviation of pain in neonates . . . is important not only because it is ethical but also because exposure to repeated painful stimuli early in life is known to have short- and long-term adverse sequelae."  The AAP's policy also states (again, returning to the Abstract): "every health care facility caring for neonates should implement . . . a pain-prevention program that includes strategies for minimizing the number of painful procedures performed. . . ."  

I take it as axiomatic that the starting point for "preventing or minimizing pain" is avoiding unnecessary pain in the first place.  That being the case, one wonders how the AAP reconciles these humane and common-sense recommendations with its continued support for  nontherapeutic infant circumcision.

Nontherapeutic infant circumcision, which is still routinely practiced in the United Sates, in contrast to most of the developed world, and which is overwhelmingly practiced here for reasons of custom or cosmesis, is a medically unnecessary surgery that violates the four most basic and important principles of medical ethics.  First, not to do harm.  Second, not to provide a treatment in the absence of a medical problem (such as a disease or harmful congenital deformity). Third, to opt for the least invasive or aggressive treatment available when there is a disease or other medical problem.  And, fourth, to obtain consent from the patient before rendering care unless the patient is incapable of providing consent and the treatment is required urgently to save life or limb. Nontherapeutic infant circumcision violates every one of these principles.  Every one of the "health benefits" on the basis of which  infant circumcision is rationalized can be achieved through the use of non-painful and non-invasive means, such as the practice  of basic hygiene, the administration of the HPV vaccine, the use of a condom in order to prevent the spread of STIs, or the use of antibiotics or other non-painful and minimally invasive treatments when a pathological condition, such as a UTI for example, does occur - in other words, exactly the same prophylactic and remedial approach to genitourinary health as is employed with girls.   Even something as simple as not smoking has been proven to have a greater effect upon reducing a man's chances of developing penile cancer than circumcision has.  

Above and beyond all this, circumcision causes extreme pain and distress to the neonate who is subjected to it.  For generations, circumcision was routinely performed without any pain-relief whatsoever in the absurd belief that infants are incapable of experiencing pain. Today, with over one million circumcisions still performed annually in the United States, the application of adequate or even any pain relief is by no means universal nor is it mandated by law.  By some estimates, even now, only 25% of children who are subjected to circumcision receive adequate anesthesia.

The AAP concedes that "existing scientific evidence is not sufficient to recommend routine circumcision."  And yet, lacking sufficient evidence-based medical justification for nontherapeutic circumcision, the position of the AAP, as articulated in its most recent policy statement (2012) is that "the final decision should still be left to parents to make in the context of their religious, ethical and cultural beliefs."  Why does the AAP, an organization of medical professionals that professes to be "dedicated to the health, safety, and well being of infants," continue to defend a painful and medically unnecessary surgery on the basis of "religious, ethical, and cultural beliefs"?  How is subjecting male infants to circumcision for cultural or religious reasons ethically any different from subjecting girls to "female circumcision," which is also performed for cultural and religious reasons?  Defenders of infant male circumcision in the United States are quick to claim that male genital cutting and female genital cutting are fundamentally dissimilar - but isn't this just a form of cultural arrogance?   It amounts to claiming "It's okay when we do it."  But it is merely the distorting lens of one's own cultural context that makes these two practices appear to be fundamentally different.  In a culture in which male circumcision has been normalized but female circumcision has not, the two practices are simply judged by different yardsticks.  Yet there is no rational scientific or medical basis for hypothesizing and studying the potential health benefits of surgical modification to male genitalia while denying a priori any comparable health benefits of surgical modification to female genitalia.  

This raises an important question:  If studies were to suggest that the "benefits" of female genital cutting outweigh the "risks," would the AAP likewise endorse "access to this procedure for families who choose it" (to use the AAP's parlance)?  That is not a farfetched hypothetical question.  In Egypt, where female genital cutting remains common, its defenders include physicians who claim, just as the AAP does on behalf of male circumcision, that female circumcision is medically justified.  It is probably not a coincidence that female circumcision is now, in the 21st century, increasingly becoming "medicalized" (that is, performed in hospitals under aseptic conditions and justified on medical grounds) just as male circumcision became medicalized in Great Britain and North America in the 19th century and is now becoming medicalized in Africa. (Indeed, one might reasonably speculate that the defenders of female circumcision have now taken a page from the AAP's book.)   Nor is it a coincidence that the "benefits" of female circumcision closely parallel the myriad claims that are routinely made in defense of male circumcision, including "improved aesthetics and hygiene."  The inescapable conclusion of all this is that the AAP endorses what is essentially a cultural practice that harms infants and causes them excruciating pain needlessly even as it acknowledges that there is insufficient medical evidence to support routine infant circumcision (RIC) and even though, as the AAP now acknowledges in its latest policy statement on neonate pain management, "there are significant research gaps regarding the assessment, management, and outcomes of neonatal pain; and there is a continuing need for studies evaluating the effects of neonatal pain and pain-prevention strategies on long-term neurodevelopmental, behavioral, and cognitive outcomes."

As controversial as nontherapeutic circumcision is, there remains one fact about it that is not in dispute that, to my knowledge, the AAP has never addressed.  This is that no infant ever consents to his own circumcision.  Consider again the AAP's position statement that "the procedure's benefits justify access to this procedure for families who choose it."  But, of course, it is not "families" who choose circumcision but parents.  The individual himself  - the one who is actually being circumcised and, therefore, the only person whose opinion should actually matter - has no say at all.  But by what right of parental authority is it ethical or appropriate for a parent to order the medically unnecessary amputation of a part of his or her child's body?  And by what principle of medical ethics does the AAP endorse such a parental prerogative?  Throughout the AAP's deliberations regarding its official stance on circumcision, how much weight was given to the right of the individual himself not to have part of his penis amputated without his consent?  Where is the AAP's recognition that every human being is born with an innate and sacrosanct right to ownership and control of his own body?   Infants, after all, do not remain infants forever. Circumcision, on the other hand, is permanent.  (And, of course, there is absolutely nothing to prevent an intact adult male from choosing for himself  to undergo a circumcision once he is old enough to weigh for himself the costs and potential benefits of circumcision.)  Where is there any acknowledgement by the AAP that the man the circumcised infant will one day become may object to having had a functional and erogenous part of his penis amputated on the basis of nothing more substantial than an amalgamation of superstition, cultural norms, religious beliefs, and tenuous medical justifications?  Was there ever even a passing consideration by the AAP's task force on circumcision  that that man may prefer to have experienced life with his body whole and his penis intact?   The AAP equivocates about the "risks" of circumcision (while conceding that no one actually knows for certain what those risks are) yet refuses to acknowledge even now that circumcision is a harm in and of itself.   If the AAP's refusal to recognize this fact is predicated on its dismissal of the functions and importance of the male prepuce, including its role in sexual sensation for both male and female and its functional role during coitus, it is predicated even more fundamentally on the AAP's apparent disdain for the right of the individual to decide for himself which parts of his body are important to him -  and to decide for himself which parts of his body he gets to keep and which parts get cut off. 

It's time for the AAP to live up to the lofty ideals of its professed mission "to attain optimal physical, mental, and social health and well-being for all infants, children, adolescents and young adults."  The AAP has an ethical duty to protect children; that ethical duty is incumbent upon each of its members, as well.  That duty includes refraining from subjecting neonates to painful and unnecessary surgeries, especially a surgery that results in the permanent loss of a functional and sensitive body part that every neonate, every infant, every child, every adolescent, and every man has a right to retain and to have retained into adulthood.  Revising its policy on circumcision so as to bring it into conformity with the AAP's recent policy statement on neonate pain-prevention - to say nothing of bringing it into conformity with the principles of medical ethics and into conformity with a basic respect for infants' and men's fundamental human right to physical integrity - would bring the AAP a long way toward realizing its stated goal of "preventing or minimizing pain in neonates."

Thursday, August 11, 2016

A Short Critique of the Women's Gymnastics Floor Routine

by David Balashinsky

I have long been bothered by the women's gymnastics floor routine and this, the quadrennial Olympics season, offers a suitable opportunity to explain why.  What bothers me is the sexism and the conspicuous gender-construction of it.  The cloying, cutesy-pie, mincing and prancing and the striking of peculiar and quasi-sexy poses makes the event unbearably awkward and embarrassing to watch.  These turn what ought to be a demonstration of athletic prowess into something akin to a latter-day Dance of the Seven Veils.  Could you imagine male gymnasts performing like this?  Gymnastics is gymnastics.  A summersault is a summersault.  Why is it necessary for gymnastics pyrotechnics to be punctuated by the gymnast's arching her back and sticking out her buttocks when the gymnast is a woman but not when the gymnast is a man?  Why is it  necessary for the routines to be accompanied by music and the tumbling interspersed with dance steps when performed by women but not when performed by men?  What do any of these absurd and uncomfortably sexualizing embellishments have to do with gymnastics, anyway?  Why is it not enough for women gymnasts to excel at gymnastics without having to overlay their floor routines with wheedling smiles, constructed and exaggerated femininity, and the sexualization of their bodies?

Consider the numerous other sports that female and male athletes both compete in: weight lifting, boxing, equestrian events, track and field - the list is long.  Yet in none of these other events are women expected to perform the sport in a manner that is so thoroughly permeated with gender that it alters the character of the sport itself and results in such an overt difference between the way women and men perform it.  Take the heptathlon, for example.  Could you imagine the women athletes having to perform one of the seven sports that comprise this event to music, and interspersing the activities - say, the shot put or the javelin throw - with mincing, prancing, and dancing around?  Why is the women's gymnastics floor routine treated differently?

Of course, sexism has always determined which events women and men are permitted to compete in.  Nor is the gymnastics floor routine the only Olympic event in which an artificial and socially constructed gender difference is rigidly enforced.  But in the only other two notable Olympic events that I can think of in which it is - synchronized swimming and rhythmic gymnastics - the differentiation between female and male is so complete that males do not even get to participate in them.  In contrast, I am speaking here of precisely how the gymnastics floor routines - which both women and men do perform - are performed so differently when performed by each.  (And there is, of course, no rational, non-sexist reason why men should not compete in either synchronized swimming or rhythmic gymnastics.)

If you doubt anything I just wrote, watch any modern women's floor routine but imagine that it is a man performing.  I'm sure what you are seeing in your mind's eye will make you squirm (and if it doesn't, it should).  The male gymnast performing exactly those steps and striking exactly those poses would look foolish and ridiculous.  You'd likely consider it absurd and degrading (and if you didn't, you should).  What does it say about our culture that movements and poses that are considered cute and sexy when performed by women are considered absurd and degrading when performed by men? That we take it for granted that women gymnasts should perform their floor routines in a manner that would look degrading, foolish, and ridiculous when performed in exactly the same way by men demonstrates how thoroughly our concepts of male, female, and gender are shaped (and warped) by our culture. At the same time, it demonstrates how thoroughly the sport of gymnastics has been perverted by sexism.  For when you watch a women's gymnastics floor routine, what you are really witnessing is a sexual double standard: the sexism and the suffocatingly ubiquitous sexualization of women's bodies that is demanded of women when they are the focus of attention in the public sphere.

Let me anticipate a criticism of my thesis: the fact that there are so many other events - including certain women's gymnastic events, such as the uneven parallel bars and the vault - where there is little or no differentiation between female and male based on the social construct of gender.  I attribute this to two factors.

First, undoubtedly, the women's floor routine lends itself to being turned into a sort of dance routine simply because it is performed on a flat surface and involves movement that has  an essentially aesthetic component, as opposed to an objective component, such as hitting a bullseye or jumping higher, as measured in millimeters, than one's adversaries.  Gymnastics, after all, is judged largely by subjective rather than objective standards.  And where subjectivity prevails, cultural norms will tend to predominate.  But the men's floor routine is also performed on a large flat surface and incorporates movements that are judged largely by aesthetic criteria.  But whereas the men's floor routine tends to incorporate socially constructed notions of masculinity, the women's floor routine tends to incorporate socially constructed notions of femininity.  It goes without saying that, in the case of the men's floor routine, masculinity consists in strength, power, agility, determination, and seriousness (when is the last time you saw a male gymnast smile ingratiatingly at the audience during the performance of his routine?).  And in the case of the women's floor routine, femininity (as specifically tailored for this event - it is gymnastics, after all) incorporates, in addition to the strength, power, agility, determination, and seriousness of the gymnast herself, the additional obligatory characteristics of daintiness, cuteness, sexuality, and submissiveness (striking poses such as those that women gymnasts typically assume throughout the performance of their floor routines is analogous to a display of submissiveness in the animal kingdom so as to forestall an act of aggression when a threat is perceived: thus are women expected in our culture to forestall aggression with overt displays of ingratiation and subservience).

The second factor is simply this.  The failure of sexism to permeate the other events that women athletes engage in should not be interpreted as evidence that it is not sexism that has distorted the women's gymnastics floor routine.  Sexism in sports, because it reflects sexism in our culture, tends to manifest itself in different ways depending on the context.  It is not that sexism does not tend to push its tentacles into everything that it can.  It just tends to succeed better in some contexts than in others, in the way that a fungus or parasite will thrive on some hosts and in some environments better than others.  Alas, such is the case with the women's gymnastics floor routine.

Wednesday, July 27, 2016

On "Mom's Simple Invention Works Wonders in the NICU" in Scary Mommy, July 26th, 2016

by David Balashinsky

http://www.scarymommy.com/zaky-weighted-glove-nurtured-by-design-nicu-babies/

As touching as this is, I think that there is a gigantic moral inconsistency in this story that deserves to be addressed.  The motivation for Ms. Jackson's invention was clearly to provide comfort for her son in his mother's absence, and it seems to have succeeded spectacularly.  I don't think there are many among us, in this enlightened age, who do not regard it as axiomatic that all infants, those born prematurely or otherwise, should be welcomed into the world with loving kindness, gentleness, and provided with as much comfort as possible.  But in a study of its effects on "preemies" in the NICU, it was discovered that the "Zaky" produced physiological benefits as well, with significantly decreased rates of apnea and bradycardia.  It should come as no surprise that a neonate who is made to feel protected, nurtured, and comforted will do better, by objective measures, than one who is isn't, and this is what the study, comparing preemies with the Zaky to those without it, appears to have confirmed.  But if providing comfort for a neonate is better than not providing comfort, doesn't it stand to reason that even withholding comfort is still more beneficial than the infliction of pain and suffering? Shouldn't every neonate be treated in a way that maximizes its sense of wellbeing? Shouldn't every neonate be treated with a deference to its fragility by respecting that infant's basic human right not to be subjected to unnecessary and painful genital-alteration surgery?

Along comes the startling and paradoxical news in this otherwise heartwarming story that Ms. Jackson's enterprise received a start-up grant from none other than Oprah Winfrey. This is the same Oprah Winfrey who has shilled for SkinMedica, a company that manufactures anti-wrinkle face cream which is made from the stolen prepuces of helpless infants who have been subjected to nontherapeutic circumcision - a totally unnecessary genital surgery that annually in the United States takes the lives of over 100 infants and leaves over one million more scarred for life.  Ms. Winfrey, it should be noted, is also an outspoken opponent of female genital mutilation.  Evidently, male genital mutilation is perfectly okay as far as Oprah is concerned.  And if a biotech company can profit from the pain and suffering of infant boys, so much the better. Perhaps more importantly, if celebrities like Oprah, who can afford SkinMedica, can preserve their youthful complexions at the expense of the pain and suffering of infant boys, that's also okay.   But is it?  It strikes me as the height of hypocrisy to vociferously oppose female genital mutilation while supporting male genital mutilation.  Similarly, it is the height of hypocrisy to underwrite a product that is intended to comfort and aid neonates while simultaneously shilling for a company that exploits them;  - while shilling for a product the manufacture of which depends upon causing infants excruciating pain, needless suffering, and permanent diminution of function and sensation of their genitalia.

I commend Ms. Jackson for inventing this product but I am disappointed that she accepted seed money from a tainted source.  There have been a number of notable cases of philanthropic or otherwise beneficent organizations refusing or returning donations from discredited donors and, in my opinion, that is what Ms. Jackson should now do. For example, in 2005, Queens University returned a pledged gift of $1 million from David Radler after he pled guilty to mail fraud.  Another notable case is that in which the Harvard Divinity School ultimately rejected a $2.5 million endowment from Sheikh Zayed. (Zayed was the leader of the United Arab Emirates and one of the world's richest men who, among other things, engaged in human trafficking, child slave labor, and funded an institution that promoted Holocaust denial and anti-Semitism.)  

A cardinal principle of non-profits that rely upon donations, as Paul Dunn writes in Nonprofit Quarterly ("When a Donor Becomes Tainted," March 21, 2010) is the principle of "value incongruence."  This refers to "the degree of compatibility between the norms, values, and actions of an external stakeholder with the core values, beliefs, and activities of an organization."  Ms. Jackson's company may not be a non-profit but I think it safe to assume that Jackson's aspirations for her company are that it embody core principles that are in line with those of biomedical ethics.  Her product, after all, is intended for use in hospital NICUs and was designed specifically to provide comfort to neonates. Accordingly, Jackson's company ought to embody the values and ethics that should guide any healthcare provider or organization.  Chief among these, of course, is the dictum, "primum non nocere": "first, do no harm."   But this core value is morally irreconcilable with the core value of a company that profits from the needless pain and suffering of infants.  And while I have no reason to believe that Oprah herself profits from the sale of SkinMedica's foreskin beauty cream, nor that she has received blood money from this company for her endorsement of its product, the fact remains that even if Oprah Winfrey does not profit  directly or even indirectly from the unethical use of stolen body parts, she continues to be associated with a company that does.  And her endorsement of this product contributes to the perpetuation of the billion dollar circumcision industry. Winfrey's association with the Zaky, therefore, taints the Zaky itself.

I hope that the Zaky finds widespread use in NICUs around the world, bringing comfort and improved health to preemies.  Still, as unfortunate as it is, premature delivery is largely a natural phenomenon.  If we really want to ameliorate distress, pain and suffering in neonates when their occurrence is something that we cannot prevent, shouldn't we simply avoid causing these things in the first place when we can?

Friday, April 1, 2016

On "It happened to me: I was born without a vagina hole" by Anonymous in xoJane

by David Balashinsky

I recently came across the essay cited in the title of this post in xoJane, "It happened to me: I was born without a vagina hole," by Anonymous (a better term than "vagina hole" would have been "vaginal introitus.")  (A link to the essay is provided below.)  As silly and as poorly written as this piece is, it does serve to underscore an important point: every human being is born with the right to ownership and control of her or his own body. From an ethical standpoint, it would be as wrong to deny this young woman the corrective genital surgery that she sought as it is to impose a non-corrective genital surgery on an infant that he has not sought nor consented to. Private parts are private property: they don't belong to the state and they don't belong to one's parents.
This narrative also underscores a more fundamental principle. Because we experience self-awareness, our bodies are important to us. That is no less true and maybe even more true of our genitalia. Hence, it is not merely the physical control of one's body that is a fundamental human right but the freedom to value and define the significance of one's own body that is a fundamental human right. That is why it is so offensive when opponents of genital rights dismiss the significance of the prepuce by saying "it's just skin."  To impose one's own judgment of the significance of a part of someone else's body that has been stolen from him or her is just as much an affront to human dignity and human rights as depriving him or her of the functional use of that body part, to say nothing of depriving him or her of the body part itself.  This principle is well illustrated by this narrative. Why else would Anonymous have written about her experience if her vagina were not an integral part of her self-concept as a human being with free will and personal agency? Why did she compile a list of reasons why she needed the surgery? Without knowing all of the specific reasons on that list, it is nonetheless evident from this essay that Anonymous attached a meaning and a value to the structure and configuration of her genitalia. Moreover, that the shape, structure, and function of her genitalia were intrinsic and central to her ability to live her life as she wanted to live it. The principle of bodily- and genital integrity, then, goes to the very heart of what it is to be human: to define oneself, to value oneself, and to differentiate oneself from every one and everything else.
The physical boundaries of one's body - its external limits - are analogous to a political border or a property line. Our bodies declare to the world, "no trespassing." Without the sanctity of being secure in one's own physical person, the individual is denied full personhood. That is why this young woman sought to exercise control over her vagina. Because the importance of its structure transcends the discrete purposes of its physiological function and instead matters to this young woman's ability to live her life freely in pursuit of her own interests.
That is why Intactivists fight for the right of boys, girls, and intersex children to determine for themselves what parts of their bodies they get to keep. That is why non-consensual genital surgery is a human-rights violation: it deprives the victim not only of the functional use of the part that has been stolen but of the right to define himself. It violates the sanctity of his personal borders. Non-consensual genital modification surgery - infant circumcision - deprives the victim of his right to full personhood.

http://www.xojane.com/it-happened-to-me/born-without-a-vagina-hole

Monday, February 22, 2016

For Whose Benefit? (An Open Letter to Karen Remley, Executive Director and CEO of the American Academy of Pediatrics)

by David Balashinsky

http://pediatrics.aappublications.org/content/137/2/1.61

Dear Dr. Remley;

Recently, your organization, the AAP, published a revised policy statement regarding procedural pain in neonates.  The very first recommendation, as it appears in the Abstract section of the new policy statement (AAP Gateway, Pediatrics; February 2016, Volume 137 / Issue 2) is that "The prevention of pain in neonates should be the goal of all pediatricians and health care professionals who work with neonates. . . ."  In the Background section, the revised policy also states, in part, "The prevention and alleviation of pain in neonates . . . is important not only because it is ethical but also because exposure to repeated painful stimuli early in life is known to have short- and long-term adverse sequelae."  Your policy also states (again, returning to the Abstract): "every health care facility caring for neonates should implement . . . a pain-prevention program that includes strategies for minimizing the number of painful procedures performed. . . ."  

I take it as axiomatic that the starting point for "preventing or minimizing pain" is avoiding unnecessary pain in the first place.  That being the case, I am curious to know how the AAP reconciles these humane and common-sense recommendations with its continued support for  nontherapeutic infant circumcision.

Nontherapeutic infant circumcision, which is still routinely practiced in the United Sates, in contrast to most of the developed world, and which is overwhelmingly practiced here for reasons of custom or cosmesis, is a medically unnecessary surgery that violates the four most basic and important principles of medical ethics.  First, not to do harm.  Second, not to provide a treatment in the absence of a medical problem (such as a disease or harmful congenital deformity). Third, to opt for the least invasive or aggressive treatment available when there is a disease or other medical problem.  And, fourth, to obtain consent from the patient before rendering care unless the patient is incapable of providing consent and the treatment is required urgently to save life or limb. Nontherapeutic infant circumcision violates every one of these principles.  Every one of the "health benefits" on the basis of which  infant circumcision is rationalized can be achieved through the use of non-painful and non-invasive means, such as the practice  of basic hygiene, the administration of the HPV vaccine, the use of a condom in order to prevent the spread of STIs, or the use of antibiotics or other non-painful and minimally invasive treatments when a pathological condition, such as a UTI for example, does occur - in other words, exactly the same prophylactic and remedial approach to genitourinary health as is employed with girls.   Even something as simple as not smoking has been proven to have a greater effect upon reducing a man's chances of developing penile cancer than circumcision has.  

Above and beyond all this, circumcision causes extreme pain and distress to the neonate who is subjected to it.  For generations, circumcision was routinely performed without any pain-relief whatsoever in the absurd belief that infants are incapable of experiencing pain.  Today, with over one million circumcisions still performed annually in the United States, the application of adequate or even any pain relief is by no means universal nor is it mandated by law.  By some estimates, even now, only 25% of children who are subjected to circumcision receive adequate anesthesia.

The AAP concedes that "existing scientific evidence is not sufficient to recommend routine circumcision."  And yet, lacking sufficient evidence-based medical justification for nontherapeutic circumcision, the position of the AAP, as articulated in its most recent policy statement (2012) is that "the final decision should still be left to parents to make in the context of their religious, ethical and cultural beliefs."  Why does the AAP, an organization of medical professionals that professes to be "dedicated to the health, safety, and well being of infants," continue to defend a painful and medically unnecessary surgery on the basis of "religious, ethical, and cultural beliefs"?   How is subjecting male infants to circumcision for cultural or religious reasons ethically any different from subjecting girls to "female circumcision," which is also performed for cultural and religious reasons?  Defenders of infant male circumcision in the United States are quick to claim that male genital cutting and female genital cutting are fundamentally dissimilar - but isn't this just a form of cultural arrogance?   It amounts to claiming "It's okay when we do it."  But it is merely the distorting lens of one's own cultural context that makes these two practices appear to be fundamentally different.  In a culture in which male circumcision has been normalized but female circumcision has not, the two practices are simply judged by different yardsticks.  Yet there is no rational scientific or medical basis for hypothesizing and studying the potential health benefits of surgical modification to male genitalia while denying a priori any comparable health benefits of surgical modification to female genitalia.  

This raises an important question:  If studies were to suggest that the "benefits" of female genital cutting outweigh the "risks," would the AAP likewise endorse "access to this procedure for families who choose it" (to use the AAP's parlance)?  That is not a farfetched hypothetical question.  In Egypt, where female genital cutting remains common, its defenders include physicians who claim, just as the AAP does on behalf of male circumcision, that female circumcision is medically justified.  It is probably not a coincidence that female circumcision is now, in the 21st century, increasingly becoming "medicalized" (that is, performed in hospitals under aseptic conditions and justified on medical grounds) just as male circumcision became medicalized in Great Britain and North America in the 19th century and is now becoming medicalized in Africa. (Indeed, one might reasonably speculate that the defenders of female circumcision have now taken a page from the AAP's book.)   Nor is it a coincidence that the "benefits" of female circumcision closely parallel the myriad claims that are routinely made in defense of male circumcision, including "improved aesthetics and hygiene."  The inescapable conclusion of all this is that the AAP endorses what is essentially a cultural practice that harms infants and causes them excruciating pain needlessly even as it acknowledges that there is insufficient medical evidence to support routine infant circumcision (RIC) and even though, as the AAP now acknowledges in its latest policy statement on neonate pain management, "there are significant research gaps regarding the assessment, management, and outcomes of neonatal pain; and there is a continuing need for studies evaluating the effects of neonatal pain and pain-prevention strategies on long-term neurodevelopmental, behavioral, and cognitive outcomes."

As controversial as nontherapeutic circumcision is, there remains one fact about it that is not in dispute that, to my knowledge, the AAP has never addressed.  This is that no infant ever consents to his own circumcision.  Consider again the AAP's position statement that "the procedure's benefits justify access to this procedure for families who choose it."  But, of course, it is not "families" who choose circumcision but parents.  The individual himself  - the one who is actually being circumcised and, therefore, the only person whose opinion should actually matter - has no say at all.  But by what right of parental authority is it ethical or appropriate for a parent to order the medically unnecessary amputation of a part of his or her child's body?  And by what principle of medical ethics does the AAP endorse such a parental prerogative?  Throughout the AAP's deliberations regarding its official stance on circumcision, how much weight was given to the right of the individual himself not to have part of his penis amputated without his consent?  Where is the AAP's recognition that every human being is born with an innate and sacrosanct right to ownership and control of his own body?   Infants, after all, do not remain infants forever. Circumcision, on the other hand, is permanent.  (And, of course, there is absolutely nothing to prevent an intact adult male from choosing for himself  to undergo a circumcision once he is old enough to weigh for himself the costs and potential benefits of circumcision.)  Where is there any acknowledgement by the AAP that the man the circumcised infant will one day become may object to having had a functional and erogenous part of his penis amputated on the basis of nothing more substantial than an amalgamation of superstition, cultural norms, religious beliefs, and tenuous medical justifications?  Was there ever even a passing consideration by the AAP's task force on circumcision  that that man may prefer to have experienced life with his body whole and his penis intact?   The AAP equivocates about the "risks" of circumcision (while conceding that no one actually knows for certain what those risks are) yet refuses to acknowledge even now that circumcision is a harm in and of itself.   If the AAP's refusal to recognize this fact is predicated on its dismissal of the functions and importance of the male prepuce, including its role in sexual sensation for both male and female and its functional role during coitus, it is predicated even more fundamentally on the AAP's apparent disdain for the right of the individual to decide for himself which parts of his body are important to him -  and to decide for himself which parts of his body he gets to keep and which parts get cut off. 

It's time for the AAP to live up to the lofty ideals of its professed mission "to attain optimal physical, mental, and social health and well-being for all infants, children, adolescents and young adults."  The AAP has an ethical duty to protect children; that ethical duty is incumbent upon each of its members, as well.  That duty includes refraining from subjecting neonates to painful and unnecessary surgeries, especially a surgery that results in the permanent loss of a functional and sensitive body part that every neonate, every infant, every child, every adolescent, and every man has a right to retain and to have retained into adulthood.  Revising its policy on circumcision so as to bring it into conformity with the AAP's recent policy statement on neonate pain-prevention - to say nothing of bringing it into conformity with the principles of medical ethics and into conformity with a basic respect for infants' and men's fundamental human right to physical integrity - would bring the AAP a long way toward realizing its stated goal of "preventing or minimizing pain in neonates."