Should we trust birth?

Here is the first blog post stepping outside the topic of circumcision and into other pseudoscientific territory. Enjoy!

“Trust birth” is a phrase that I’ve commonly heard among those in the natural or home birth advocacy movement. There are even Trust Birth groups springing up advocating this. Such groups may state that trusting birth is natural, and fearing or distrusting birth is unnatural and has simply been taught through our culture. Is this correct? Fear of childbirth has in fact been common throughout history, in all times and cultures. Why? Because while birth is a natural process, it is also naturally a dangerous process. Childbirth in humans is an evolutionary bottle neck, where the advantageous feature of large, well developed brains conflicts with the advantageous feature of narrow pelvises, to aid bipedalism. It is also a complex process, to which no other natural process can be an adequate comparison. Pregnancy itself precariously balances the needs and health of the fetus against the needs and health of the mother. The result is historically high rates of both perinatal (around the time of birth) mortality for the babies involved and maternal mortality. This has the evolutionary purpose of keeping head and pelvis size in check, yet as a human event each loss represents a tragedy. We are not willing to accept the death of a human being as simply “evolution in action.”

Improved sanitation and nutrition and modern medicine — including antibiotics, safer cesarean sections, improved ability to monitor the health of mom and baby during pregnancy and childbirth, and developments in neonatal resuscitation and life support, among many others — have dramatically decreased the perinatal and maternal mortality rates, although attempts to further reduce it are constantly being made. We now take these improvements in mortality rates for granted. We assume that mother and child will come through birth and be fine. Ironically, it is these very improvements that allow us to assume that birth is low risk and worthy of trust.

If we cannot trust birth, should we then fear birth? Are all interventions good and necessary, with no harmful side effects? Is the best response to make birth a completely medicalized event, attempting to remove all uncertainty? This position forgets that birth, as a natural physiological process, is not fully understood by science. We know of what can go wrong, but still often do not know why it goes wrong. We don’t fully understand the purposes of the natural physiology of birth — we can’t know for certain what elements in the process of birth serve a purpose in the health of the mother and child, and we don’t always know the long term effects of medical interventions.

I propose the best attitude of a birth attendant is not “trust birth,” nor is it “fear birth,” but rather is “respect birth.” That is, respect birth both as a natural physiological process which goes well much of the time, AND respect birth as a complex event with inherent and natural risks. Birth attendants need both to allow labor and birth to unfold, and to exercise vigilance and intervene when deviations from normal begin to put mother and child at risk. This balance isn’t easy, it likely takes significant training both in normal births and potential complications. It means accepting and responding to the scientific evidence on birth practices and interventions without prejudiced ideology. It means abandoning simple catch phrases or black and white positions and truly grappling with what we know, and what we don’t know.

Can’t you just take antibiotics? Circumcision and UTIs.

One of the most well grounded benefits of neonatal circumcision is a 90% reduction in the incidence of urinary tract infection (UTI) in boys in the first year of life. This benefit seems to raise a lot of questions for anti-circumcision advocates. One example can be seen in this response to the new AAP guidelines,

The AAP report inflates the benefits by stating in its summary, for example, that circumcision “prevents” urinary tract infection (UTI). The report text states, “Given that the risk of UTI among this population [boys under age 2] is approximately 1%, the number needed to circumcise to prevent UTI is approximately 100.” Therefore, 99 boys out of 100 receive no UTI “benefit” from circumcision. UTI is treatable with antibiotics. Good medical practice requires the least intrusive form of effective treatment. All the claimed “preventive health benefits” are debatable and insignificant.

There are numerous other arguments made against circumcision to prevent infection, one common claim is that that UTIs are “several times commoner” in girls, yet we aren’t considering surgical alteration to prevent their rate of infection. Sometimes the grounds for the claim in reduction itself are challenged, although this has become less frequent as the claims have become better and better supported by evidence. Do these arguments undermine this benefit?

The first thing to establish is what exactly we are talking about when we speak of a UTI in an infant boy. A UTI in an infant is a very different beast to a bladder infection in an older child or adult. The primary symptoms are not burning pain and discomfort, but instead a prolonged fever and irritability with no other obvious cause. The majority of UTIs in infancy involve the upper urinary tract, the kidneys, and not merely the bladder as is more common in older children and adults. It poses the very real risks of kidney damage or the development of sepsis, a blood infection, although these have become less common as better antibiotics have been developed.  Mortality was once a real danger from a UTI in infancy although this is now extremely rare. While antibiotics are an essential part of the treatment of such a urinary tract infection, treatment is not as easy as going and taking an oral medication. Hospitalization and the use of IV antibiotics are common  and unfortunately antibiotic resistance is becoming common among the pathogens in these UTIs. Even if response to the antibiotics is good, imaging follow up to look for urinary tract abnormalities and damage will often be necessary.

Contrary to the repeated claims that UTI is more common in girls, in early infancy it is in fact several times more likely in an uncircumcised boy than in a girl. This early period, under three months or so, is also the time of greatest risk overall for a febrile UTI. Within a few months, the prevalence of UTI in an uncircumcised boy is equal to that in girls, and soon the risk in girls surpasses the risk in boys. The most prevalent form of UTI also changes, as bladder infections become more common than the more serious kidney infections that are seen in early infancy.

Studies consistently show that circumcision reduces the risk of UTI significantly, with an overall reduction in risk of nearly 90%. Considering that what is being prevented is a serious infection and not a minor issue, is this alone sufficient reason to circumcise? A recent review determined that it would require 111 circumcisions to prevent one urinary tract infection, and assuming that the complications of circumcision are about 2%, concluded that this wasn’t sufficient to recommend routine circumcision. However, for certain subpopulations at greater risk of infection, the benefits would more clearly outweigh the risks. Moreover, if any of their assumptions about the complication rate of circumcision or the severity of the morbidity associate with UTI or circumcision were wrong, the numbers needed to treat might be quite different. The review didn’t consider any other potential benefits of circumcision besides the risk of UTI, so this might be only one piece to consider when making this decision.

Some New Stuff!

Ok ok ok, first things first.  We have two new contributors to the blog, and a part time author.  One contributor will be working with me on the issues with intactivism specifically, with occasional commentary on other topics of woo, and the other will give us a weekly blog about various topics of woo interest, sure to piss off those in the homebirth movement, anti-vaccination movement and the uber boobers.

Unfortunately, most of my comments are coming from the same people or same kinds of people.  People who, when I look up their email address, are active in assaulting virtually any web page, article or blog post that has anything remotely to do with circumcision.  I honestly wish I would hear more from other people, but perhaps it’s because I’m not writing in a way that seems inviting to parents who are questioning this issue.

With the new statement out from the AAP, I think it’s more clear than ever that the decision to circumcise or not circumcise is really up to the parents.  There are risks and benefits to either decision, and while for me, I don’t find the procedure necessary and therefore decline it, I’ve been moving further and further away from the idea that circumcision causes harm (other than the immediate harm of the procedure).

I know that intactivists are really banking on the coming-of-age of the boys circumcised after the anti-FGM legislation, but I really don’t think that equal protection can or would be applied in that way.  They’re very very convinced of this, but I think that’s a product of their echo chamber.  When you choose to surround yourself only with those of a like mind and a like opinion, who’ve accepted the same assertions as facts, then those assertions start to look more and more rock solid, as though they’re indisputable, widely known facts.  The truth is that this is an illusion, caused by limiting yourself to those sources of information.  As you become more and more involved, it becomes harder and harder to to accept any outside or dissenting source of information.  The fact is that the only people who consider FGM and RIC comparable ARE intactivists.  Virtually everyone else sees this for the nonsensical gross over-reaction that it is.  They’re hardly comparable, except on levels that enormous mental gymnastics are required to reach.  I’ll write a new blog post about this tomorrow, cross my heart and hope to die.

I also recently saw a post in STFUParents with a woman whose husband said he was thankful for all the babies who still had their foreskins left.  I think, to me, this is so absurdly representative of the movement and how it’s just really missing the mark.  Though again, it goes back to the echo chamber environment, and the almost religious zeal it causes.   Are children who are kidnapped and sold into slavery EVEN MORE victimized if they were subject to RIC?  Should they be thankful all they have to deal with is daily rape, and not the horror that their most intimate parts were hacked away at birth by a doctor who only cared about the paycheck (rhetoric of the movement, not my opinion).

I recognize this blog post is sort of all over the place, there’s not much of a unifying theme to it, other than my belief that the online communities of intactivism are innately crippling.  If you were truly interested in the truth and empirical, evidence-based information, then you absolutely would not dismiss EVERYTHING that doesn’t bolster your viewpoint.  The only intellectually honest position is one that recognizes that there are pros and cons, or at the least that there is compelling information in the decision to circumcise; after all, if there wasn’t, why would anyone choose to?

Does the AAP Really Have “No Ethics”?

In the September issue of their journal Pediatrics, the American Academy of Pediatricians published a newly revised policy statement on circumcision. This was the first new statement on circumcision since 1999, and it took a much more strongly procircumcision stance, arguing that the benefits of circumcision outweighed the risk, and that the procedure should be covered by medical insurance so that parents were free to choose it regardless of their finances. The outcry from the intactivist community was loud indeed. Critiques were written of the policy, it was criticized as unethical and unscientific and the AAP was accused of being biased. See here, and here. In addition an initiative was begun which collected pictures of individuals with the phrase “AAP No Ethics” written on their palms.

I hope to devote future blog posts to a more thorough critique of each of the arguments against the AAP’s statement. There are so many allegations that I can’t address them all in one blog post, and I hardly know where to begin. Suffice to say that I don’t find the arguments against the science convincing; the evidence has been growing for real but moderate benefits to circumcision. Many of the criticisms show an ignorance about common scientific language or technique that invalidates their arguments. Some  don’t seem familiar with the AAP’s accompanying technical report which explained their reasoning and fleshed out the recommendations in the official policy statement. I plan to go through some of these objections to the statement in later posts, and point out where the objections are flawed and why. However, I want to start by touching on where I agree with the intactivist criticisms. This doesn’t mean that I think the AAP statement is invalidated, but I do think there are some legitimate complaints about it.

So, some criticisms which I believe have some merit:

The AAP has a cultural bias. 

Now, some of these criticisms claim that the AAP committee has a bias due to a reliance on scientific thinking, which I do think is absurd. In contradiction to the Circumcision Resource Center’s post, I think that the possible benefits and harms of circumcision are absolutely discernible through scientific inquiry, and controlled, replicable and falsifiable studies are a much better gauge of the truth than either feelings or common sense, which are far more subject to cultural bias. However, the researchers DO have a cultural bias: circumcision and the circumcised state are viewed as normal and acceptable, unless there are proven harms. I think that intactivists are somewhat correct in saying that scientists wouldn’t even be investigating circumcision and possible benefits if it weren’t already acceptable to a degree in Western society. However, just because this preexisting bias makes American doctors more willing to consider circumcision doesn’t mean that it doesn’t have real benefits, it just means that the researchers are more open to those benefits. And while there might be concern that this normalcy encouraged the researchers to be more procircumcision in their review of the scientific data, it is also possible that the cultural distaste for circumcision leads other groups to overlook or minimize possible benefits of circumcision. Bias goes both ways. It is definitely possible, however, that this bias influenced how much benefit the committee believes that one needs to see before circumcision is justifiable, and that leads to my next point.

The AAP placed no value on bodily integrity.

I think that this statement is true. I have seen this stated in a few sites or a few different ways, some more inflammatory than others. I agree that the AAP seemed to place no value on keeping the child’s body whole, rather they looked only for objective evidence of harms and benefits. Since the committee members view circumcision as normal and the circumcised state as normal as the intact state, they didn’t seem to require a large benefit to justify the procedure, evidence of  greater lifetime benefits than lifetime harms seems to be sufficient for them. However, in this document they also stress parental choice, and acknowledge that different parents will bring different values to their decision making. I also do not believe that this means that the AAP does not care about ethics or about the well being of boys, it just means that in their decision making system the presence or removal of the foreskin had no value, no decision making weight, in and of itself. The value was determined solely on the effects, positive and negative, on the child’s health and well being. This is certainly different to the philosophy of ethics of intactivists, but it is not an absence of ethics. It is perhaps a more utilitarian ethics.

The AAP does not make clear the magnitude of the benefits of circumcision.

Although the AAP does try to quantify the magnitude of any benefits and likewise the magnitude of any risks, I don’t believe that it provides sufficient evidence for parental decision making.  The most useful number is the “number needed to treat,” which indicates how many circumcisions are necessary to prevent one negative outcome in comparison to the intact state. This could be more easily compared with the numbers available on complication rates. The AAP technical report provided numbers needed to treat for the issues of urinary tract infection and penile cancer. For most other benefits, it provided information on relative risk ratios only. For instance, the report cites a CDC study which estimated a 15.7% reduction in the individual’s lifetime risk of HIV with neonatal circumcision but doesn’t provide information on the absolute risk of infection. A 16% reduction in a 1.87% absolute risk of contracting HIV may seem much less than persuasive to many. The CDC study did provide estimated numbers, which vary based on race. “The number of circumcisions needed to prevent one HIV infection was 298 for all males, and ranged from 65 for black males to 1,231 for white males.” This is the kind of information that is truly needed for a decision on the benefits of this procedure, and they suggest that the benefits for each individual are far from equal.

These listed criticisms are not minor. They are not, however, criticisms of the science itself, which I believe the AAP Technical Report shares in a fair manner. They are instead related to the application of those scientific findings to the decision of whether or not to circumcise. If one is going to argue against routine circumcision, then I feel that these are the points to focus on. I think it is important, however, to keep in mind that the question of “how much benefit is necessary to justify circumcision” is a question based on the parents’ own philosophy, and that different parents can make different decisions based on the same evidence, all while desiring the best for their son’s well being.

New Staff

Hi guys.  Writing yet another of my infrequent blog posts to let you know that we have new staff members who will write at least once a week and moderate comments for me.  All comments go through, but not until they’ve been seen first.  That will change when the blog becomes more active again.  They’ve got some interesting ideas to write about, and I think they’ll be very thought provoking.

You will also now be seeing comments about topics such as homebirth, vaccination, and things of that nature, as there’s only so much to write when it comes to using science/facts and statistics to discuss circumcision (no matter how many hours intactivists can spend in their echo chambers).  I have a contributor who will be writing a once or twice a week feature on homebirth, and I’m hoping to get some people to do that in other areas where ‘feelings’ are more important than ‘reason’ and ‘statistics’ and ‘studies’.

 

Obviously I’ve managed to push a lot of buttons over the last year that I’ve been up.  Hopefully this next year will be even better, with more frequent participation not just from my new staff, but from me as well!  As usual, expect thought-provoking posts from good people.  The comments are still moderated, and will stay that way til the blog picks up a little bit and we get our own commentator community, but NO BODY is deleted unless they’re spam.  It’s taken quite a long time for a post to go through moderation in the past because of my absence, but in general it should take no more than an hour or two for new commenters to get through.  If I can find a way for people who comment frequently to not have to wait for moderation I will put it up.  Gosh, even the people I disagree with .

Some Statistics For You (redux)

Copy of one of my first posts – I wanted to put it up again, because it’s way at the back, and I want people to see some of these statistics.

This will probably take a while for me, because I’m going to attempt to provide the claims provided by intactivists and then counter them for  you.  I’d like to add a note here that I am very against RIC.  That does not mean that I support the position to lie and twist facts in order to convince other people to join your cause or convince them not to circumcise.

The NYT Article:

Here’s the NYT article.   They even admit in the article that the numbers are not definitive and are reported from hospitals:

A little-noted presentation by a federal health researcher last month at the International AIDS Conference in Vienna suggested that the rate had fallen precipitously — to fewer than half of all boys born in conventional hospitals from 2006 to 2009, from about two-thirds through the 1980s and ’90s.

Last week, officials at the Centers for Disease Control and Prevention cautioned that the figures in the presentation were not definitive. But they are already stirring a sharp debate on the Internet.

Well, yeah.  They stirred a sharp debate that’s based on a very specific presentation of numbers.  Then they admit just how they performed this slight of hand in the following paragraph:

The slide portrays a precipitous drop in circumcision, to just 32.5 percent in 2009 from 56 percent in 2006. The numbers are based on calculations by SDI Health, a company in Plymouth Meeting, Pa., that analyzes health care data; they do not include procedures outside hospitals (like most Jewish ritual circumcisions) or not reimbursed by insurance.

Andrew Kress, the chief executive of SDI Health, cautioned that the data had not yet been published and was still being analyzed, but he confirmed that the trend had been toward fewer circumcisions each year.

That’s right.  That’s circumcisions done in hospitals, based on calculations (so no raw numbers are given) and do not include procedures outside of the hospital or self-pays (procedures not reimbursed by insurance).  The data hasn’t even been published, but here it is in a newspaper article.

So, from reading the above paragraphs, does it seem as though this is a legitimate statistic to use?  I think not.  Now, lets take a look at some different numbers.

HCUP

Here’s a neat little chart from HCUP (Health Cost and Utilization Project),  which is not just about circumcision, but procedures for children done in the hospital.  The provide a nice little table that I’ll post here for you.

Table 3. Most common all-listed procedures received by children in U.S. hospitals, 2009*
All-listed procedure	Number of procedures	Rate of discharges per 10,000 population†
1. Prophylactic vaccinations	1,329,600	1,783.5
2. Circumcision	1,147,700	1,539.5
3. Respiratory intubation and mechanical ventilation	226,700	304.1
4. Enteral and parenteral nutrition	165,100	221.5
5. Blood transfusion	109,400	146.8
6. Appendectomy	89,800	120.5
7. Repair of obstetric laceration	54,600	73.2
8. Cancer chemotherapy	47,900	64.3
9. Artificial rupture of membranes to assist in delivery	35,700	47.9
10. Incision and drainage of skin and subcutaneous tissue	35,600	47.8
* Excludes diagnostic testing. † Calculated using resident population for July 2009 from the U.S. Bureau of the Census, accessed on February 28, 2011. From: http://www.census.gov/popest/national/asrh/NC-EST2009-sa.html. Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Kids’ Inpatient Database(KID), 2009

Lets do a little simple math, and then I’ll provide some statistics from the CDC to  back that up (You watching, Intactivists?) The birth rate in 2009 was 4,136,000.  51.5% of that is 2,130,040, which would be the number of males born in 2009.   Divide 4,136,000/2,130,040 and you get .5388 which equals 53.88% or around 54%.   Now, I’m really really bad at math, but I’m pretty sure that 54.8% =/= 32.5%.  You saw how I got my numbers.  Even then, that’s counting in-hospital procedures, and does not include circumcisions done in-office, in an outpatient surgery center, or ritually, such as a Bris.  Which means that number could be anywhere from 57% (3% Jewish population) to 65%, depending on how many in-office, outpatient surgery center or ritual circumcisions done that year, which we don’t know.  So a conservative estimate is 54%, and we know that number is too low.

Now, to verify my numbers.
The CDC

Here is the MMR (morbidity mortality report) from 2009.  It’s discussing trends in in-hospital circumcision rates.  Again, this is not including ritual circumcision, in-office or outpatient surgery circumcisions.

All three data sources underestimate the actual rate of NMC because none of the datasets include NMC performed in the community. Rates of NMC through the first 28 days of life were calculated for the most recent 10 years of available data from each data source (i.e., 1999–2008 data from NHDS and NIS, and 2001–2010 data from CDM), and a Poisson regression model was used to calculate the average annual percentage change (AAPC). The changes in incidence estimated from the three data sources were compared using the trends homogeneity test.

Even here they admit it’s an underestimation.  Let’s read further.

For the period 1999–2010, the weighted analysis yielded 11,789,000 (59.1%; 95% confidence interval [CI] = 59.1%–59.2%) of 19,933,000 and 12,347,096 (57.8%; CI = 57.8%–57.8%) of 21,359,690 newborn males circumcised in the United States from NHDS and NIS, respectively. Of 2,339,760 newborn males recorded in CDM, 1,306,466 (55.8%; CI = 55.7%–55.9%) were circumcised.

Incidence of NMC decreased from 62.5% in 1999 to 56.9% in 2008 in NHDS (AAPC = -1.4%; p<0.001), from 63.5% in 1999 to 56.3% in 2008 in NIS (AAPC = -1.2%; p<0.001), and from 58.4% in 2001 to 54.7% in 2010 in CDM (AAPC = -0.75%; p<0.001) (Figure).

When compared using the trends homogeneity test, the decreases in incidence were statistically different (p<0.01) for the 8 years of commonly available data (2001–2008); however, the maximum difference in absolute incidence did not exceed 5.9 percentage points for any given year.

So…haven’t intactivists been telling us that the circumcision rate is dropping precipitously, and has been for years?  Well, that’s not what this article says, which examines rates from 3 different sources.  All they have is the NYT article.

So now I’ve (in detail) shown that they prefer to twist facts about the rate circumcision is being performed.  Even if they don’t want to find these easily available statistics, they could at least read more than just the 32.5% part of the NYT article, which shows it’s a very lowball estimate.

Lets move on.

Death by Circumcision

Do I think it’s possible?  Absolutely, yes.  Do I think we have any hard numbers on it?  No.  Neither do the men who published this “study“, or more appropriately, an article, in my opinion.  Let’s look at the abstract:

Author Dan Bollinger presents a study regarding circumcision deaths. Baby boys can and do succumb as a result of having their foreskin removed by circumcision. Circumcision-related mortality rates are not known with certainty; this study estimates the scale of this problem. This study finds that approximately 117 neonatal circumcision-related deaths (9.01/100,000) occur annually in the United States, about 1.3% of male neonatal deaths from all causes. Because infant circumcision is elective, all of these circumcision deaths are avoidable. This study also identifies reasons why accurate data on these deaths are not available, some of the obstacles to preventing these deaths, and some solutions to overcome them.

Well, that’s not a promising start.  An approximation?  But it’s quoted as a fact!  How many times have you seen ’117 boys die every year from circumcision’ or ‘over 100 boys die every year due to that elective procedure’.  However, lets look at what this article actually says:

About 1.3 million boys are circumcised each year in the United States (HCUP, 2007); however, the number of boys who died from those surgeries has not been reported or estimated in any credible way. Some reasons include record-keeping practices,
indifference, and—no doubt—concerns about liability. Death certificates typically do not list circumcision as the immediate or leading
cause of death and rarely list circumcision as an underlying cause. Incomplete and inaccurate death certificates for children are a common phenomenon (Cunniff, Carmack, Kirby, & Fiser, 1995). Thus, many circumcision-related deaths are more often reported
as surgical mishap, infection, hemorrhage, cardiac arrest, stroke, reaction to anesthesia, or even parental neglect.

So basically he’s saying he has no way to come to the number he came to.  I’m not going to spend a bunch of time on pointing out the flaws of this paper, since this blog does it for me.

According to Dan Bollinger, who I’ve spoken to personally (and operates this site…and if you look at this part of his site, he again uses inaccurate statistics to quote a 32% circumcision rate.  Again, if you can’t be accurate about something as basic as the percentage of boys being circumcised, how can you be trusted to provide an accurate ‘guesstimate’ of deaths?)  he’s had professional epidemiologists examine his paper and found no problem with the methodology.  The issue is, that doesn’t mean much.  First, how do I know he’s telling the truth?  He’s misleading visitors to his website about the percentage of circumcisions performed.  Secondly, it’s now obvious intactivists will say just about anything to make their case seem stronger, if he did have an actual epidemiologist examine it, I have no doubt they are an intactivist.

This is about all I can get through for right now.  I may add some more later today, for instance, about attributing a hard number to retractability.
What I want you to get from this blog is not that I think circumcision is wonderful, or that I support RIC.  I definitely support circumcision for Jews, because it’s so integral.  I support it for medical necessity, or personal desire…for the person who the penis is attached to.  I think it’s understandable that parents choose to circumcise, considering the cultural attitude about the intact penis.  Understanding why they would make that decision is very different from supporting it, however.  That doesn’t mean I feel that it’s appropriate to bully parents who circumcise or are considering circumcision.  I think using emotionally loaded words like ‘mutilation’ or ‘victimization’ does nothing to get people to listen to what we have to say.  I think that twisting facts or using inaccurate sources (that say they’re inaccurate in the same article you selectively quote) is just flat wrong.  It’s lying.  So for that reason, I’m not an intactivist, and I have a problem with intactivists.  Because those are the methods they demand you use.  And if you’re not quoting the same 10 sources or pieces of information, then you’re the enemy.

Circumcision is legal.  It’s the parents choice.  Is it a choice that more parents could research better?  Yes, on both sides.  Is circumcision the ideal choice for an anatomically normal, non-Jewish infant?  Not in my opinion.  However, I’d prefer to use as accurate information and as I can.  I’d prefer to use reasonable words instead of emotional rhetoric.

Who am I?  I’m not an intactivist, but I did not circumcise my own sons.

My Absence

As I stated in a prior post, things are quite frantic right now.  Unfortunately that means infrequent updating of my blog.  However, there’s quite a lot of good information in my blog…and most of my readers are intactivists, so I doubt they’re sitting here refreshing their screens constantly waiting for an update.  I’m not giving up on the blog, don’t worry.  My opinion also hasn’t changed.  I do not circumcise, I don’t think circumcision is necessary.  I also do not approve of the tactics used by intactivists, and were they to change those tactics, I would support them wholeheartedly.  Much like the rabid pro-life crowd, intactivists generally resort to appeals to emotion, twisting of facts, offering up studies (that they haven’t even read) claiming they say one thing, when in fact they do not (relying, instead, on the fact that many will not actually read the study, simply providing one counts as support of their argument), sometimes outright lying.  That includes setting up studies in such a way as to pre-determine the outcome.    These are things that I disagree with, and will continue to disagree with.  Since most intactivists, instead of actually reading my site objectively, believe that I am actually pro-circumcision and that my site advocates for circumcision, I’m attacked quite often.   However, I’m not trying to go into a pity-party for myself.  I don’t feel sorry for myself, and honestly, it’s pretty much what I expected.

So, a few things – Hugh Intactivist, based on the sheer bulk of commentary, I’m having a hard time determining whether you’re a troll or legitimate.  If you want to comment, please keep it within as few comments as possible per reply.  I’d greatly appreciate it.  If you’re legitimate.  If you’re simply trying to troll me, well, then I’d appreciate if you’d stop.

I’m also soliciting for guest authors right now, and have a dear friend that’s already agreed to post for me sometime in the near future.  She’ll be writing a few articles, and I’ll edit them and then post them.  So hopefully this will be updated a little bit more frequently, but perhaps not by myself.