Probably my last post on circumcision, for a while a least...

Following my two posts on male circumcision I have received a fair amount of feedback from which I have learned some new things. The commentators have pointed out where I have been wrong about things and they have also provided some great links that I would like to share with my readers here.

After my first entry on the subject I received one comment from anonymous with a link to a blog which is entirely dedicated to male circumcision. Here you can among other things, see pictures of the surgical procedure, and read about the similarities between male and female circumcision. I always thought that female circumcision was quite a bit worse, but it seems that this is not necessarily the case...

When I wrote my second entry I also received some very nice feedback. The first comment really makes the general point well. Beanie's Appa, who wrote the comment has got his own blog which you will find here. This is what he wrote (I agree completely with what he says).

"Wonderful post. Thank you for your words of wisdom. I'm one of those men who was cut as a baby, but I wish they hadn't done that to me. For me, there's no choice. My parents and the doctor took that from me. But for someone who wasn't cut at birth and wishes he was, he can do that stupid thing any time he feels like it."

A few days later I received a comment from TLC tugger who is in the business of helping circumcised men get back their foreskin, an honorable business indeed. You can listen to his podcast here. Apparently it is possible to restore your foreskin following circumcision using TLC's product, which amazingly does not require surgical interventions. (I am wondering whether this approach will give you back some of your sensitivity to the foreskin). TLC, having restored his own foreskin also pointed out that sex is a great deal more pleasant with the foreskin. Furthermore, TLC pointed out that only very rarely (1 case in 10,000) is there a medical reason for doing circumcision. For most problems, there are less invasive techniques available. For instance, if you have a tight foreskin, you can simply stretch it using a balloon. I am actually quite confused about peoples' readiness to pick up the knife whenever there is a problem with the penis. Surgical procedures are usually avoided until there are no other options, and for good reasons...

Concerning the supposedly positive health effects associated with male circumcision I read somewhere (I cannot remember where I read this) that the correlation between circumcision and a lower incidence of HIV would not occur even if we circumcised all males in Africa. The reason why not is really quite obvious (at least if you have ever been to an African hospital, which I have). A lot of people in Africa get HIV because a procedure is not done in sterile environments, that is, they are infected with the virus during the procedure. Furthermore, many circumcisions in Africa are not even done at a hospital. Sometimes the procedure is done with dirty and not so sharp knives (see picture), out in the nature. Man I would not want to be that baby... Maybe more sterile environments could be achieved, but I suspect that in Africa today a mass circumcision campaign would have greater costs than benefits.

Finally, just earlier today I received an email from Frank. He gave me a table with STD (sexually transmitted diseases) statistics for circumcised and non-circumcised men respectively. I found the original study in which it is shown that there are no significant differences (differences that are unlikely to be caused by chance alone) in the occurrence of sexually transmitted diseases for circumcised and non-circumcised men. In other words, to circumcise a baby will not reduce the overall risk of STDs in the future. In the study they conclude that parents should be informed about the costs and benefits associated with circumcision prior to the intervention. I agree.

Of course I am still very interested in what all of you have to say, both people who agree as well as my critics, so keep sending me comments...

Circumcision debate continues

A few weeks ago I wrote about the cruelty of male circumcision. I wrote that I am opposed to male circumcision because of the fact that the foreskin has many important functions.

Since my post some interesting posts with interesting subsequent discussions has appeared on other blogs. If you understand swedish, take a look on ergo ateism here and here, or you can also take a look at Tobias Malm's excellent blog here. In the discussions following these posts some objections to the circumcision objections appeared, that is there were some people who defended circumcision. The four main objections that I recall were.

1. People who have their foreskin cut off can have sex for a longer time without ejaculating.
2. Circumcision protects against all sorts of different diseases
3. "I am circumcised and I haven't noticed anything bad about it"
4. Sometimes circumcision need to be done for medical reasons (e.g. foreskin in too tight).

The first objection I think is a really bad one for several reasons. Without getting to concrete, I have heard from experts that sex is not just about how long the guy can do it. Furthermore, according to some studies that I have read (see my previous post for references), people who have been circumcised often suffer from too early ejaculation as well as delayed ejaculation. Doesn't sound so great if you ask me.

Concerning the second objection I actually asked the guy who claimed that circumcision protects you against all sorts of diseases whether he could be a bit more precise. He admitted that he may have overstated it a little. In fact, I am aware of only one disease which circumcision provides some marginal protection against: HIV. If circumcision provided a really good protection against HIV, then I think it might have been worth it, but that doesn't seem to be the case. Also if you are really serious about sacrificing your penis in order to get protection against disease, then why not cut off the whole thing while you are at it? Then you would really get protection!

The third objection is not a valid one either because just like I cannot know what it feels like not to have a foreskin, a person without a foreskin cannot know how life would have been like with a foreskin. It is a fact that the foreskin has many important functions, and based on that I assume that removing it will take away those functions.

To me, only the last one of the four objections above sounds reasonable, and of course I am not opposed to circumcision when it occurs for medical reasons. I mean, sometimes we need to amputate someones’ leg to save the patient, but that doesn't make it alright to saw off everyones' leg at birth (I think these two examples are actually almost perfectly analogous).

To sum up, sure there are cased in which I think circumcision is ok. If there are medical reasons why the foreskin should be removed then go ahead. I also don't mind very much if a grown man decides to remove his foreskin, I think it is stupid, but it is not my decision to make. I do have a problem when parents want to cut off the foreskin of their baby without a good reason, in fact, I think this should be prohibited.

Evidence suggesting that there might be something to homeopathic remedies, and why I am still not convinced

In a previous post I have explained why I do not believe homeopathy works. To demonstrate how fair and objective I am =), I thought I would write about the so called “Belfast homeopathy results” (see citation below). These results have become famous because they show that a substance which once contained histamine-like molecules, but which have been diluted so much that there is almost not a single molecule left, still works like histamine. In essence this means that pure water can produce the same effects that histamine produces. Furthermore, the study has been replicated three times. Ennis, the investigator (see picture), seems to be just as puzzled as I am about this. If the experiment was indeed sound in all respects, then the findings are truly revolutionary.So why am I not convinced?

Before saying why I am not yet convinced I want to emphasise that I do not think there is any bogus here. I believe Ennis (unlike many others who do similar studies) is a serious researchers, and that her results should not be ignored. The reason I do not buy it is that it contradicts so much of what we know, or think we know. If there is something to the basic laws of physics and chemistry that we have found and that our society is based upon, then the conclusions drawn from Ennis study cannot be right. I see it as much more plausible that there is some methodological flaw in the experiments. I mean, is it more likely that in spite of everything we know, our world is not really made of atoms. Or is it more likely that one researcher has a flaw in the experimental design? I will go for the second option, but I suppose I could be wrong.

My scepticism is further reinforced by the fact that many previous studies testing homeopathic substances have returned negative results. In fact, as a general rule, the better the experiment, the smaller the probability of positive results. You can read about a follow up experiment that was done to check the validity of Ennis results here. Here Horizon magazine took upon the challenge and tried to replicate Ennis results. They even had the chance of getting a one million dollar award from James Randi foundation, should they succeed. The experiment failed.


Citation:

“MADELEINE Ennis, a pharmacologist at Queen's University, Belfast, was the scourge of homeopathy. She railed against its claims that a chemical remedy could be diluted to the point where a sample was unlikely to contain a single molecule of anything but water, and yet still have a healing effect. Until, that is, she set out to prove once and for all that homeopathy was bunkum.

In her most recent paper, Ennis describes how her team looked at the effects of ultra-dilute solutions of histamine on human white blood cells involved in inflammation. These "basophils" release histamine when the cells are under attack. Once released, the histamine stops them releasing any more. The study, replicated in four different labs, found that homeopathic solutions - so dilute that they probably didn't contain a single histamine molecule - worked just like histamine. Ennis might not be happy with the homeopaths' claims, but she admits that an effect cannot be ruled out.

So how could it happen? Homeopaths prepare their remedies by dissolving things like charcoal, deadly nightshade or spider venom in ethanol, and then diluting this "mother tincture" in water again and again. No matter what the level of dilution, homeopaths claim, the original remedy leaves some kind of imprint on the water molecules. Thus, however dilute the solution becomes, it is still imbued with the properties of the remedy.

You can understand why Ennis remains sceptical. And it remains true that no homeopathic remedy has ever been shown to work in a large randomised placebo-controlled clinical trial. But the Belfast study (Inflammation Research, vol 53, p 181) suggests that something is going on. "We are," Ennis says in her paper, "unable to explain our findings and are reporting them to encourage others to investigate this phenomenon." If the results turn out to be real, she says, the implications are profound: we may have to rewrite physics and chemistry.”

From issue 2491 of New Scientist magazine, 19 March 2005, page 30


End of citation

Faith in science

The title is meant to sound paradoxical. Faith is a belief that is not supported by evidence whereas science, by definition, is based on evidence. This distinction is crystal clear theoretically, however, if one looks at reality I think it is evident that there are religious people who modifies their faith in the light of evidence as well as scientists who do not base their theories entirely on evidence but rather use methods that resemble faith.

When I have written about science here on my blog I have discussed the ideal situation, that is, I have discussed science as if it always followed the fundamental principles that defines science. These principles include among other things, using evidence to build theories, openness to new ideas, adaptation to new empirical evidence, admitting that you were wrong when evidence becomes overwhelming, unbiased and objective accounts of new discoveries etc. When these principles are followed science is indeed a noble endeavour. Faith on the other hand, by definition, is not based on these principles of openness and adaption to new ideas. In fact, I would argue that faith stands in stark contrast to these principles.

Regrettably scientists are humans, and we all know that humans have trouble following the principles listed above to the extent that being a scientist requires. All too often I hear stories of how distinguished scientists will mock each other during presentations (just like in the English Parliament), and how scientists with opposite theories will become worst enemies. No, scientists are by no means perfect. Scientists are often proud people, and proud people do not like to change their mind (see my previous post about the virtue of changing your mind). It is perhaps not so strange that someone who has been a Freudian his (they are mostly male) whole life does not want to go out and say that he had been wrong his entire career and that the theory he has based his counselling on was wrong, yet that is what a true scientist should do. We should perhaps show some respect for Freud (see picture) who was after all an important philosopher and taboo breaker in his time, but to me the fact that Freud's books were part of the course literature in psychology here in Lund until quite recently appears to be nothing short of insanity. Sure, some of his theories, in modified versions has gained some experimental support, just like the old testament probably got some historical details right, but all together they are not worth much.

There are of course many more examples of "scientists" who hold onto theories as if it were their own children. However, there are also scientists who do follow the ideals and who more readily, and without making faces, accept evidence that contradict their views. All this in a sense is irrelevant though. The scientific ideals are ideals that we should strive towards, independent of whether we will ever get all the way. I firmly believe that our world would be a better place if more people did this. In contrast, striving towards the ideals of faith i.e. beliefs that do not have any foundation in evidence, I think, would have a negative effect because it becomes so much harder to solve arguments. If I do not care about evidence then you can throw any argument at me and it will just bounce of. Solving arguments requires a scientific mindset.

The placebo effect

As far as I can remember I have always been opposed to, or at least skeptical towards the use of medicine that has not been properly tested and compared to placebos . I think that medicines should be tested extensively before they are released on the market. If you will, I am a bureaucrat in these matters, but why? Before I dwell further into this it is probably good with a definition of the placebo effect, here is one:

"A physical or emotional change, occurring after a substance is taken or administered, that is not the result of any special property of the substance. The change may be beneficial, reflecting the expectations of the participant and, often, the expectations of the person giving the substance."

But this sounds great does it not? If this is true then we can stop all administration of conventional medicine and thereby avoid all the associated side effects. As long as we can convince patients that water will heal them, it will, right? Just as a parenthesis, I think this is how homeopaths achieve their results. They are after all administering water with no active substance left in it.

The problem with a heavy reliance on placebos is that people would have to have a certain state of mind in order for a placebo to have any effect. Perhaps it is possible to create this state of mind by saying, for instance, that water will cure whatever it is the patient is suffering from. However, if this deception became a standard medical procedure I think that in the end people would cease to believe the doctors and then the placebo effect would disappear, and we would have no effective cures. Now some will probably object and say that it is not deception, but I think it is. If they were honest they should say that the medicine might have an effect, depending on whether you believe in it or not, and that is different. Similarly, if doctors would, on a large scale, tell their patients that they were getting for instance Prozac when in fact they were only given sugar, then this scam would eventually be detected and people would start to distrust their doctors which would diminish the placebo effect. In sum, apart from requiring doctors to lie to their patients, using placebos on a large scale would only achieve results for as long as doctors were able to keep their deception in the dark.

In the above I have tried to reserve some space for a few positive words. It should be clear by now that placebo effects are dependent on the state of mind of the person taking the placebo, it is not an intrinsic property of the substance that is taken. This means that certain therapies, such as for instance homeopathic medicine, will work on some people (probably those who believe in it) but not on others. Thus if we were to analyze the set of beliefs that a particular patient has then it should be possible to give that patient whatever he or she believes in and achieve an effect. In essence I am saying that if someone believes that acupuncture will achieve miracles, then give them acupuncture, or if someone thinks that homeopathic medicine is good against headaches, then, by all means, give them their homeopathic substances. However, because the placebo effect is rarely as strong as the effect of conventional medicine, I think this approach should be confined to less serious conditions.

I see one further application or lesson from the above. I think that doctors should do their best to encourage their patients. Make them feel good, and tell them that they can help themselves in the healing process (not a lie). I think that a lot could be achieved by giving patients a sense of their intrinsic ability to heal themselves. The first essay I wrote at Lund University was about this. If you are interested you can read it here.