A fallacy for every occasion

By Stephen Moreton, PhD.

January 2017

Like all pseudoscientists, intactivists commit a wide range of logical fallacies in pursuit of their agenda. Here are some of the common ones, listed by fallacy type, followed by examples and explanation. Some might even be more than one fallacy at the same time. A few are a little technical but have been used by intactivists, so merit inclusion.

 

CONTENTS

 


AD HOMINEM

Example: Circumcision proponent X is biased, gay, not qualified, a “circumfetishist”, profiting, etc.

Explanation: Attacking the person, not the argument. This is one of intactivists’ favourite fallacies, it being so much easier to attack the person than the evidence. Taken to extremes it descends into crude character assassination, as seen in scurrilous accusations on websites like Intact Wiki against critics of intactivism. Always be alert for it.

 


APPEAL TO AUTHORITY

Examples: Doctors Opposing Circumcision.

The letter by 38, mostly European, physicians criticizing the AAP for “cultural bias”.

The Royal Dutch Medical Association.

Explanation: The argument assumes that just because the one making a claim has relevant expertise or credentials, the claim must therefore be true. Whilst it certainly helps to be an expert, and an expert’s opinion should carry more weight than a non-expert’s, it does not follow that the expert is automatically right. They are still human, and fallible. And with experts on both sides in the circumcision debate, saying opposite things, they cannot all be right. Ultimately it should be the evidence itself that settles the matter.

With respect to the examples above, the first is a body of people opposed to circumcision, but which refuses to reveal how many members it has, and how many are actually medical doctors. Its board members include a retired air-line pilot (George Hill), two lawyers (John Geisheker and Zenas Baer) and two nurses (Gillian Longley and Michaelle Wetteland). They are not doctors. The habit of small bands of people with fringe views setting up professional-sounding bodies with pretentious names to give their views a veneer of credibility is familiar to debunkers of pseudoscience. An infamous example is the American College of Pediatricians. This organization was set up in 2002 in response to the American Academy of Pediatrics’ support for adoption by LGBT couples. It soon gained notoriety for spreading misinformation and homophobic propaganda. Yet its members are, by and large, genuine pediatricians and other healthcare professionals. But, at about 500 members, this band of largely religious conservatives is dwarfed by the 60,000 strong AAP.

The second was a letter written in reply to the AAP when it changed its policy on circumcision (Frisch et al., 2013) and is often cited by intactivists. The lead author (Morten Frisch) is a medical scientist with a track record of research and articles opposing circumcision, but the rest have no notable track record of research on this topic. They are physicians and researchers in hospitals and universities, mostly northern European, and about a third of them Scandinavian (Frisch is Danish). Why so many Vikings? It is not difficult for someone (presumably Frisch) to draft a letter and then email to it friends and colleagues he thinks may be sympathetic and have them add their names to it. This tactic is popular amongst creationists who commonly compile lists of scientists who doubt evolution, but those lists look a lot less impressive when one realizes just how tiny they are in percentage terms. In fact PhD scientists named “Steve” (or cognates thereof) alone outnumber all creationist PhDs combined (look up “Project Steve”). With respect to Frisch’s letter, there are about 1.7 million physicians in the EU, but he could only muster 37 plus one Canadian!

In 2010 the Royal Dutch Medical Association (KNMG) issued a position statement that is one of the most negative towards circumcision of any professional body. Little wonder intactivists love to cite it. What they don’t tell their audience is that the statement is not science-based. In sharp contrast to the AAP’s 29 page statement of 2012, with 248 references, which concluded that circumcision confers net benefit, the 19 page Dutch report, with 54 references, ignores most of the scientific literature on the topic, lacks detail, and cites studies known to be unreliable. But this is unsurprising when one learns it was primarily the work of a philosopher, Gert van Dijk, who lacks medical credentials, but has links with the intactivist movement. Seen in this light it looks a lot less authoritative than the AAP’s statement.

Reference:

Frisch, M. & 37 others (2013) Cultural bias in the AAP’s 2012 technical report and policy statement on male circumcision, Pediatrics, 131, 796-800. On-line: http://pediatrics.aappublications.org/content/early/2013/03/12/peds.2012-2896

APPEAL TO EMOTION

Examples: It’s mutilation!

Videos of screaming babies.

Pictures, and horror stories, of botched circumcisions.

Explanation: These are reminiscent of the emotive language and imagery used by anti-abortionists (“it’s murder!”, and gory images of aborted fetuses). The purpose is to trigger an emotional response in the audience, but emotion is not a reliable guide to making sound judgements. A rational evaluation of each in turn would show that they have no merit. Thus “mutilation” is generally taken to mean damaging or disfiguring, but circumcision is neither, indeed many people prefer the circumcised look. Babies are nowadays normally given local anesthesia, so videos showing them in agony are out of date. And circumcisions gone wrong can be matched by examples of foreskins gone wrong. Add in the death toll of diseases caught through the foreskin (e.g. HIV), or the distress of a baby boy with a UTI (ten times more common in non-circumcised ones), and the one-sidedness of the argument becomes very apparent.


APPEAL TO HISTORY

Example: “That the foreskin itself has a sexual function was well-known for centuries before secular circumcision became widespread.”

Explanation: Just because a thing has been widely believed for a long time does not make it true. It was “well-known for centuries” that the earth lay at the centre of the universe, disease was caused by evil spirits, and natural disasters were the wrath of God. The quote above came from prominent intactivist Hugh Young in a letter to the editor (BJU Int., 2007, 100, p. 699). This, and variants, are seen occasionally in intactivist polemics.


APPEAL TO NATURE

Examples: Nature knows best. All mammals have a foreskin.

Explanation: Aside from whether the latter of these is actually true these, and variants thereof, are based on the premise that what occurs in nature or is natural is good, unnatural bad. Such reasoning is common among purveyors of fringe or unscientific views, from GMO opponents, to fans of alternative medicines, to anti-vaxers. It is also cynically exploited daily by companies advertising their products as “natural”, or “back to nature”, as if this was something good.

It is also laughably easy to refute by example. Bubonic plague, deadly nightshade and mosquitoes are entirely natural. Blood transfusions, MRI scans, computers, central heating, in fact practically every benefit and comfort of modern civilization, right down to sliced bread, are not.


ARGUMENTUM AD POPULUM

Examples: Foreskin restoration devices are very popular.

Most of the world’s men are not circumcised.

Explanation: Also called the bandwagon fallacy, and closely related to the appeal to normality fallacy. Just because lots of people believe something, or follow the flock, doesn’t mean they are right. Irrational and pseudoscientific beliefs are immensely popular. One might as well point to the impressive sales of homeopathic remedies, magnetic bracelets, or any other pseudomedical quackery as “evidence” for how good they are. The same could be said for foreskin restoration devices, which may impart a placebo effect in those who succeed in stretching their skin, but lack hard scientific evidence that they have imparted any real, physical benefit, and can even cause damage.

As for most of the world’s men not being circumcised, so what? This just reflects lack of knowledge about the procedure, or lack of interest in it. Most of the world’s men have no higher education either, so does it follow that higher education is a bad thing? Globally 38 % of males are circumcised. In many countries it is the norm, which would turn the argument on its head.


CHERRY-PICKING

Example: A study by “Smith & Jones” found that circumcision harmed sexual function/was ineffective against disease/etc.

Explanation: Maybe their study did appear to “find” the claimed “finding”, but what about the dozen other studies that found the opposite, or that found nothing at all? Or what about the robust criticisms of “Smith & Jones” that exposed fatal flaws in the study design? Cherry-picking, and its close cousin ignoring criticisms, is the stock-in-trade of the pseudoscientist. Always look up subsequent issues of the journal in which the study was published. Very often there will be a round of criticism and response highlighting flaws in the original paper. And do a general literature search to see what else is out there that the intactivists have not told you about, for intactivists, like creationists, are consummate cherry-pickers.

Most, if not all, intactivists cherry-pick. There are too many examples to list here. Almost every time an intactivist cites a paper purporting to “prove” that circumcision has a negative effect, or fails to protect against a particular infection, one can be sure there is a whole bunch of other papers out there showing the opposite, and which they have ignored. Large reviews and meta-analyses of all the relevant literature, on every aspect of circumcision, from effects on sexual function, to medical benefits, consistently contradict the intactivist narrative of circumcision causing sexual harm, or having no benefits.


CONFIRMATION BIAS

Examples: Citing only materials favorable to the intactivists’ cause (see also “cherry-picking”), dismissing opponents because they are pro-circumcision (see also “ad hominem”), and reading or viewing only materials that one agrees with.

Explanation: Everybody has a natural tendency to preferentially read or view materials that one already agrees with. Psychologists call this “confirmation bias”, and it is a normal and very human trait that takes conscious effort to overcome. Unfortunately it is also a trap as intactivists, and other pseudoscientists, eagerly lap up literature and videos that support their viewpoint, and dismiss or ignore anything that does not. Consequently, they rarely see the materials that show their cherished beliefs to be nonsense, such as this website.


CONSPIRACY THEORIES

Examples: Doctors make money from circumcision.

Jewish editors, or editors with pro-circumcision agendas, block publication of anti-circumcision articles.

Explanation: In intactivism, this usually takes the form of asserting that something (i.e. circumcision) is being done for ulterior motives and/or that the truth (i.e. intactivist propaganda) is suppressed because it would jeopardize those motives.

The first example is common in internet debates, and even pops up in printed sources by prominent intactivists, e.g. Bollinger, (2010), who makes the extravagant claim that doctors can make up to $40,080 a year from the procedure. It is not difficult to refute this. Bollinger cites $167 for an infant circumcision, assumes five a week and then multiplies these figures over a year to get $40,080. But he ignores the costs to the physician in time, materials and tax. Include overheads etc. and doctors may get little more than their expenses back. Doctors also charge for vaccinations, and other procedures. Does this mean they are doing it for profit? Doctors provide services, including circumcision, because it is their duty as health care professionals. And they need to make a living, just like other members of the workforce.

The second example was a complaint by intactivist pediatrician Robert S. Van Howe (Van Howe, 2010). He found that he was having a hard time getting his anti-circumcision articles published in reputable journals. So he imagined it was because Jewish editors (who might have a religious interest in circumcision), or others with “decidedly pro-circumcision” agendas, were deliberately suppressing his work. Now it is certainly the case that some editors are biased, and refuse to consider articles that challenge their prejudices. And probably articles on both sides of this debate have failed to see the light of day for this reason (some anti-intactivist ones certainly have). But anyone familiar with Van Howe’s track-record of attracting critiques and rebuttals when his papers do eventually make it into print (often in low-ranked journals) will immediately think of a far simpler explanation for why his articles frequently get rejected: they contain serious errors and are, to be blunt, garbage.

References

Bollinger, D. (2010) Lost boys: an estimate of U.S. circumcision-related infant deaths. Thymos: Journal of Boyhood Studies, 4(1), 78-90.

Van Howe, R.S. (2010) How not to get published: the top ten pro-circumcision journals. The 11th International Symposium on Circumcision, Genital Integrity, and Human Rights, Berkeley.


ECOLOGICAL FALLACY

Example: Sales of Viagra and lubricant are much higher in America, where most men are circumcised. This is because circumcision makes these things necessary.

Explanation: Even assuming the claim about sales is true, it could be that circumcised American men use Viagra and lube to the same extent that non-circumcised ones do, in which case it has nothing to do with circumcision. To take population-level data and extrapolate it to the individual is called the ecological fallacy. In this case it is also an example of the principle that correlation is not causation. In one of the wealthiest and most decadent societies on earth one does not need to invoke circumcision to explain the popularity of sex aids.


EQUIVOCATION

Examples: Amputation. Mutilation.

Explanation: Equivocation is the use of words with more than one meaning, or with subtly different meanings, to confuse the reader, or impart the wrong impression. A common example with intactivists is “amputation”.

In the broadest possible sense, circumcision could be branded “amputation” in that it permanently removes a part of the body. But then so do tooth extractions and tonsillectomies. But we don’t talk about dental amputees, or tonsil amputees. In medicine the term is NOT used for the removal of a piece of skin, but a limb, digit, or the entire penis. In medical matters it is medical definitions that should be used. www.thefreedictionary.com does give “To cut off (a projecting body part), especially by surgery” as one definition, but medical dictionaries are more specific and their definitions refer only to limbs, digits or the whole penis.

“Mutilation” is another example – if one broadens the definition to include the slightest modification. In which case vaccines that leave a scar (e.g. on the upper arm) would be “mutilating” (at least to the small area left scarred). It also allows conflation with female genital mutilation, a practice that often entails grotesque injury and harm, and fully deserves the epithet.

Both “mutilation” and “amputation” are also examples of the appeal to emotion, as they are highly charged words that conjure up emotive images of disfigurement and harm.


FAKE EXPERTS

Examples: George Hill, Robert Darby, Brian Earp, Steven Svoboda, Peter Adler, Ryan McAllister, and many others.

Explanation: Related to the appeal to authority, this can also be called the appeal to false authority. Exaggerating one’s credentials, even fabricating them altogether, is commonplace in the pseudosciences. Phoney degrees bought from unaccredited diploma mills are ten a penny amongst charlatans and purveyors of woo. In intactivist circles it is more often lay people with no scientific or medical qualifications, or whose qualifications have no relevance to circumcision, that we encounter. Indeed, the majority of intactivists fall into this camp, and the Intact America website, in its “Intactivist of the month” series has complained that “It’s rare that a physician will speak out publicly against circumcision” (July 2013).

Now this does not automatically mean that what such people say can be dismissed. Lay people can become highly proficient in specialist topics, just as scientists can switch discipline and excel in their new field. And both sides in the circumcision wars have examples of non-relevantly qualified people contributing to the debate, this author included. So it would be improper, indeed ad hominem, to dismiss them just on the grounds of having no relevant qualifications.

Fake experts become apparent when they repeatedly get their facts wrong, make errors so egregious they make a real expert cringe, are unfamiliar with the scientific literature, misinterpret or misrepresent that literature, peddle discredited or fringe claims, and go against the mainstream opinion of genuine experts who do hold relevant formal qualifications. And having a non-relevant background is likely to make someone more vulnerable to doing all of the above.

The intactivists listed as examples here, between them, have committed all these academic sins and have attracted critiques and rebuttals in the scientific literature from genuine experts with real, relevant credentials. And not one of them has any academic background remotely relevant to circumcision. They are, respectively, a retired airline pilot and sugar farmer, a historian, a philosopher, two lawyers, and a physicist.


FALSE DICHOTOMY

Example: Accusing a critic of being “pro-circumcision” when all they are doing is criticizing intactivism.

Explanation: Offering only two options, where there may be others. In this case some (not all) intactivists have a very “black and white”, or “us versus them”, view of the world. The world, as they see it, is split into “cutters” and intactivists. Anyone who is not in their camp must belong to the other. Consequently, when skeptics, like myself, debunk their nonsense or criticise their actions, we find ourselves branded as “pro-circumcision”, or even “baby cutters”, “knife rapists”, and other such offensive nonsense. This is despite not taking a stance on circumcision itself. Even some opponents of circumcision, who eschew the bullying and bad arguments of the intactivists, may find themselves being thus mischaracterized.

In the real world, not the intactivists’ echo chamber, there are many people who are offended by the bad behavior of intactivists, and who see through their pseudoscientific arguments, but whose views on circumcision range from pro, to neutral, to anti. Being opposed to intactivism, does not automatically make one pro-circumcision.


FALSE EQUIVALENCE

Examples: We would not routinely cut off ear lobes/breast buds/labia/eyelids etc. to prevent future problems with these.

Explanation: Are we facing an outbreak of deadly “earlobitis” for which an effective prophylaxis is “earlobectomy”? Those using this style of argument have no conception of a risk/benefit analysis. None of the examples they cite confer net benefit to the recipient, only net harm or risk (or both), nor would any win a cost/benefit analysis (they would cost health services more money than they saved). They do not even make sense given the important physiological functions of some of those body parts. In contrast, male circumcision, its proponents argue, does win both a risk/benefit and a cost/benefit analysis. It confers net benefit with no harm, and so is in the recipient’s best interest. It also reduces health care costs. In short, users of this fallacy are not comparing like with like.

Interestingly, the first example (ear lobes) was used by well-known U.K. skeptic Michael Marshall in a podcast (http://www.merseysideskeptics.org.uk/2011/07/circumcision-genitial-mutilation-under-another-name/). Marshall works for the “Good Thinking Society”!


FALSE PREMISE

Example: “What portion [of deaths of 35.9 circumcised infants] is circumcision-related and how may we extrapolate to the number of deaths after hospital release?… Gender-ratio data can help extrapolate a figure. Males have a 40.4% higher death rate than females … Assuming that the 59.6% portion is unrelated to gender, we can estimate that 40.4% of the 35.9 deaths were circumcision-related.”

Explanation: A false premise is an incorrect statement or assumption that forms the basis for an argument. Being based on a falsehood, the argument collapses.

The example here formed the basis for one of the most popular bogus statistics peddled by intactivists. Dan Bollinger (2010) attempted to estimate the number of deaths attributable annually to circumcision in the USA. Not having reliable data (or, at least, reliable data that suited his agenda) he sought some way of estimating the number of such deaths. He noted that infant mortality in the USA is slightly higher in boys than in girls. So he assumed this was due to circumcision as, unlike girls, US boys often get circumcised. On this basis he then calculated that about 117 baby boys die each year in the USA from complications of circumcision.

Problem is the same disparity is seen in countries where boys are not normally circumcised, so whatever causes the disparity it is not circumcision. This was pointed out by Morris et al. (2012) who listed countries for which data was available. Curiously, Israel, with a higher infant circumcision rate than even the USA, has hardly any disparity between male and female infant mortality, whilst non-circumcising Norway has a much higher disparity.

In short, the assumption that the disparity is due to circumcision is unfounded and likely false. So Bollinger’s estimate can be dismissed.

References

Bollinger, D. (2010) Lost boys: an estimate of U.S. circumcision-related infant deaths. Thymos: J. Boyhood Studies, 4(1), 78-90.

Morris, B.J., Bailey, R.C., Klausner, J.D., Leibowitz, A., Wamai, R.G., Waskett, J.H., Banerjee, J., Halperin, D.T. Zoloth, J., Weiss, H.A., Hankins, C.A. (2012) A critical evaluation of arguments opposing male circumcision for HIV prevention in developed countries. AIDS Care, 24(12), 1565-75.

  1. A more detailed demolition of Bollinger’s claim, and his various other errors, can also be seen here: http://circumcisionnews.blogspot.co.uk/2010/05/fatally-flawed-bollingers-circumcision.html


FRINGE SOURCES

Example: David Gisselquist and supporters

Explanation: A popular tactic amongst pseudoscientists is the use of fringe or discredited sources to support their own weak claims. Creationists do this routinely when they cite the works of other creationists, cranks, or mavericks, without letting on that they are not taken seriously by the scientific mainstream. Intactivists are no different as they incestuously cite each other’s publications without a hint that those works often reflect views that are not widely accepted in the medical scientific community. A layperson, unfamiliar with the literature, and what the current consensus actually is, will not know this, and will come away with the impression that the intactivists’ views have a scientific credibility they do not, in fact, possess. The example here is slightly different, in that the source being cited is not a noted intactivist, but he does hold views that are far out on the fringe, and which happen to suit the intactivists’ cause.

David Gisselquist is known to debunkers of intactivism’s ugly, conjoined sisters, HIV/AIDS denialism and anti-vaccinationism. Although he does not claim to belong to either group, his maverick views have earned him their admiration. For years he, and a small band of supporters, has been pushing the view that African HIV is iatrogenic, driven largely by poor health practices, in particular the use of contaminated needles during vaccination campaigns. So it is easy to see why he is cited by those who would deny that HIV causes AIDS, or who oppose vaccination programs.

This also suits intactivists as it downplays the role of sex in HIV transmission, providing them with another stick with which to bash the African circumcision trials. Robert S. Van Howe seems particularly fond of this ploy. For years he has peddled Gisselquist’s claims about iatrogenic HIV, and asserted that this undermines the African trials (Van Howe & Storms, 2011; Van Howe, 2013), as have other intactivists (e.g. Boyle & Hill, 2011).

All this is despite the fact that the claims of Gisselquist and his supporters have been comprehensively debunked in detail by experts from the WHO and elsewhere (Schmid, et al., 2004; White et al., 2007; Wamai & Morris, 2011). For more about Gisselquist, and the time and money wasted investigating his claims and showing them to be bogus
see here. His views command absolutely no respect among experts in the field, and are widely regarded as discredited.

And this has been repeatedly pointed out to intactivists, including Van Howe, (Wamai, R.G. et al., 2008; Morris et al., 2011; Wamai, et al., 2012; Morris et al., 2014). Yet, like true pseudoscientists, intactivists ignore all these criticisms and carry on citing Gisselquist’s claims as if they still had credibility. Indeed, as recently as 2015 Van Howe was still claiming that many African HIV infections are non-sexual in origin, and citing Gisselquist & co. in support (Van Howe, 2015). This last article was, as is usual for Van Howe’s works, swiftly and resoundingly debunked (Morris et al., 2017).

An economist and anthropologist by training, Gisselquist is ill-equipped to comment on epidemiological matters, and that he gets it so wrong, whilst employing the usual tricks of the pseudoscientific trade,  also qualifies him as a fake expert (see section on this topic, above).

References:

Boyle, G.J., Hill, G. (2011) Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns. J. Law Med., 19, 316-334.

Morris, B.J., Waskett, J.H., Gray, R.H., Halperin, D.T., Wamai, R., Auvert, B., Klausner, J.D. (2011) Exposé of misleading claims that male circumcision will increase HIV infections in Africa. J. Public Health Africa. 2(e28), 117-22.

Morris, B.J., Hankins, C.A., Tobian, A.A.R., Krieger, J.N., Klausner, J.D. (2014) Does male circumcision protect against sexually transmitted infections? Arguments and meta-analyses to the contrary fail to withstand scrutiny. ISRN Urology, Article 684706, 23 pages.

Morris, B.J., Barboza, G., Wamai, R.G., Krieger, J.N. (2017) Circumcision is a primary preventive against HIV infection: Critique of a contrary meta-regression analysis by Van Howe. Glob. Public Health. 2016 Apr 4, 1-11. [Epub ahead of print]

Schmid, G.P., Buvé, A., Mugyenyi, P., Garnett, G.P., Hayes, R.J., Williams, B.G., Calleja, B.G., De Cock, K.M., Whitworth, J.A., Kapiga, S.H., Ghys, P.D., Hankins, C., Zaba, B., Heimer, R., Boerma, J.T. (2004) Transmission of HIV-1 infection in sub-Saharan Africa and effect of elimination of unsafe injections. Lancet, 363, 482-8.

Van Howe, R.S. (2013) Sexually transmitted infections and male circumcision: A systematic review and meta-analysis. ISRN Urology, article 109846, 42 pages.

Van Howe, R.S. (2015) Circumcision as a primary HIV preventative: Extrapolating from the available data. Global Public Health, 10(5-6), 607-25.

Van Howe, R.S. & Storms, M. (2011) How the circumcision solution in Africa will increase HIV infections. J. Public Health in Africa, 2(e4), 11-15.

Wamai, R.G., and 47 others (2008) Male circumcision is an efficacious, lasting and cost-effective strategy for combating HIV in high-prevalence AIDS epidemics. Future HIV Ther., 2(5), 399-405.

Wamai, R.G., Morris, B.J. (2011) “How to constrain generalized HIV epidemics” article is misconstrued. Int. J. STD AIDS, 22, 415-6.

Wamai, R.G., Morris, B.J., Waskett, J.H., Green, E.C., Banerjee, J., Bailey, R.C., Klausner, J.D., Sokal, D.C., Hankins, C.A. (2012) Criticisms of African trials fail to withstand scrutiny: Male circumcision does prevent HIV infection. J. Law Med., 20(1), 93-123.

White, R.G., Cooper, B.S., Kedhar, A., Orroth, K.K., Biraro, S., Baggaley, R.F., Whitworth, J., Korenromp, E.L., Ghani, A., Boily, M-C., Hayes, R.J. (2007) Quantifying HIV-1 transmission due to contaminated injections. Proc. Nat. Acad. Sci., 104(23), 9794-9.


GENETIC FALLACY

Examples: Circumcision was originally advocated as a cure for masturbation.

Circumcision was originally a blood sacrifice to a tribal deity.

Explanation: This is a fallacy of irrelevance. So what if a long dead quack, or ancient tribe, held ideas about circumcision we, today, consider irrational? Those who advocate for medical circumcision do it on the basis of sound scientific evidence that is independent of these earlier reasons (and even contradicts the masturbation one). One might as well dismiss hand-washing because it was an ancient religious practice (in the Talmud; see also Exodus 30:18-21; Deut. 21:6-7; Psalms 26:6), or chemistry because it grew out of alchemy, or astronomy because its roots are in astrology.


GISH GALLOP

Example: Lengthy treatises, often filled with references, attacking circumcision and posted in comments threads and on forums.

Explanation: Strictly speaking this is not so much a fallacy as an underhand debating technique. It takes its name from the late Duane Gish, a creationist who used this tactic to great effect in oral debates. He would launch into a lengthy torrent of nonsense, containing so many bogus claims it would take hours to debunk each in turn. His opponent would simply be overwhelmed and unable to properly address it in the few minutes available. In written form it is commonly seen as long tracts posted by intactivists in comments threads, complete with links or literature citations. To the uninitiated this may seem convincing, until one starts to tediously look up each source in turn and discover that they are to intactivist websites and articles, or to cherry-picked studies that have been discredited, or they misrepresent the sources cited. As few readers have time to do the checking needed, this debating technique by intactivists is very effective.

In fact the sheer volume of misleading articles intactivists are now flooding the literature with constitutes a Gish gallop as the beleaguered scientists, who find themselves having to debunk them, struggle to keep up. It is easy to generate piles of garbage; it is irritating, tiresome and time-consuming to rebut it all. Such is the unbearable asymmetry of bullshit.


GUILT BY ASSOCIATION

Example: X was a member of the Gilgal Society which was headed by a child abuser, (maybe followed by an insinuation that therefore X must be a pedophile too).

Explanation: Just because person A had dealings with person B who later turned out to be a criminal does not mean that person A is culpable too. The particular instance above is used on the Intact Wiki site against respected medical scientist Prof. Brian Morris and others accusing them of having been members of the Gilgal Society, or associates of it. In comments threads it goes further with offensive posts directly accusing them of pedophilia. This is like saying that anyone who worked alongside high profile celebrities, like Jimmy Savile, who were later unmasked as sex offenders, must be offenders too. It is nonsense.

The Gilgal Society was a two-man publishing outfit. There is no evidence that it ever had a formal membership. In good faith, Morris used it to publish some brochures, and linked to it on his website. How was he to know that, years later, one of those two men (Vernon Quaintance) would be convicted of historical child abuse offenses and end up serving time? When the scandal broke, Prof. Morris quickly and properly dissociated himself from Quaintance and (the now defunct) Gilgal. To try and make something out of this is scurrilous.


HALF TRUTH

Examples: “a recent YouGov survey concluded that fully 10% of American men wish that they had not been circumcised”.

Penile cancer is vanishingly rare, affecting only 1 in 100,000 men.

No medical body endorses routine infant circumcision.

Explanation: One of the most common tricks of intactivists, indeed of pseudoscientists generally, and also politicians or others with an agenda, is the half-truth. It works so well because it is true as far as it goes, but at the same time is highly misleading as it leaves out crucial additional information that puts it in an altogether different light. It therefore allows users to mislead their audience without actually lying outright (although it may be argued that a half-truth is also a half-lie of omission).

The first example is a survey by professional polling organisation YouGov (YouGov 2015), likely carried out on a representative sample of 1000 U.S. men (so not likely to be biased by intactivists jumping on board to skew the results, as they are apt to do). Intactivists like to cite it, or at least that part of it that suits their agenda, thus: “a recent YouGov survey concluded that fully 10% of American men wish that they had not been circumcised” (Frisch, 2015).

On the face of it this would suggest that a significant minority of circumcised males are unhappy with their status. But here is what Frisch does not tell his audience. The same poll found that 29% of non-circumcised males would rather they were circumcised! So failing to circumcise infants will actually result in more unhappy men than circumcising them will, at least in the U.S. A weakness of the study is that it says nothing about how unhappy either group are (just a slight preference the other way, or seriously angry?), nor why the 10% were unhappy (exposure to intactivist propaganda perhaps?)

The penile cancer claim is common on Internet comments threads, and anti-circumcision polemics. 1 in 100,000 sounds vanishingly rare, so serves to undermine the pro-circumcision argument that infant/childhood circumcision (but not adult) is highly protective against it. But what the intactivists don’t tell their audience is that it as a per annum estimate. One has to multiply by an average life expectancy (about 80 years for developed countries) to arrive at a lifetime risk. If one does this then it transpires that in the order of 1 in 1250 non-circumcised men will get this awful disease in the course of their lives. Not so rare now, is it? And one should take into account the proportion of non-circumcised males in the population of a country, since penile cancer is almost completely confined to non-circumcised men. In some developing countries it is one of the most common cancers in males and is turning up in young men (Bleeker et al., 2009; Favorito, et al., 2008; Thanh Nien News, 2013).

The “no medical body endorses male circumcision” example is immensely popular, judging by the number of times it appears in Internet debates or intactivist polemics. It is often accompanied by lists of cherry-picked quotes from the position statements of (mostly European) professional medical bodies apparently opposing infant circumcision. A repeat offender is Mark Lyndon, an intactivist from Manchester, U.K. who routinely deploys this strategy on Internet comments threads (where he posts under the name “ml66uk”). But many others do it too.

What the intactivists don’t say is that whilst it is true that no medical body endorses routine infant circumcision, none say infant circumcision should be banned outright, none support the intactivist narrative of circumcision ruining sexual pleasure, and all accept that circumcision (including of infants) is vitally important in high-HIV settings. This last point is actually medical scientific consensus, with not a single reputable body anywhere in the world opposing it, in stark contrast to the intactivists who remain stuck firmly in denial as it contradicts a core doctrine of their faith – that circumcision has no medical benefits.

One might also add that two major bodies (the AAP and the CDC) now accept that even in relatively low-HIV settings (e.g., the USA) circumcision’s benefits outweigh the risks and it should be made available to parents who choose it, although they stop short of recommending it be routine. (What is “routine” anyway? Some would say it means “mandatory”. But all medical procedures require consent, this being given by the parents or guardian in the case of children.) And the great majority of position statements the intactivists cite to bolster their cause are not only out-of-date, but ideological, rather than based on strong scientific evidence.

References

Bleeker, M.C.G., Heideman, D.A.M., Snijders, P.J.F., Horenblas, S., Dillner, J., Meijer, C.J.L.M. (2009) Penile cancer: Epidemiology, pathogenesis and prevention. World J. Urol., 27(2), 141-50.

Favorito, L.A., Nardi, A.C., Ronalsa, M., Zequi, S.C., Sampaio, F.J.B., Glina, S. (2008) Epidemiologic study on penile cancer in Brazil. Int. Braz. J. Urol., 34(5), 587-93.

Morris, B.J., Gray, R.H., Castellsague, X., Bosch, F.X., Halperin, D.H., Waskett, J.H., Hankins, C.A. (2011) The strong protective effect of circumcision against cancer of the penis. Adv. Urol. 2011, article 812366.

Frisch, M. (2015) Time for U.S. parents to reconsider acceptability of infant circumcision. 9 April.  On-line: http://www.huffingtonpost.com/morten-frisch/time-for-us-parents-to-reconsider-the-acceptability-of-infant-male-circumcision_b_7031972.html

Thanh Nien News (2013) Cleanliness is manliness. 20 June. On-line: http://www.thanhniennews.com/health/cleanliness-is-manliness-2055.html

YouGov (2015) Circumcision survey. On-line: http://cdn.yougov.com/cumulus_uploads/document/ugf8jh0ufk/toplines_OPI_circumcision_20150202.pdf

 


HYPOCRISY

Example: “In 2011 alone, nearly a dozen infant boys had to be treated for ‘life threatening haemorrhage, shock or sepsis’ as a result of their non-therapeutic circumcisions at a single children’s hospital in Birmingham.”

Explanation: Not so much a fallacy as sloppiness or bad behaviour. In intactivist propaganda it takes many forms, such as attacking another’s credentials, whilst lacking relevant ones oneself. The example above is particularly egregious and combines hypocrisy with being misleading by choosing to be selective with the data.

In a particularly bad article in the U.K. “Skeptic” magazine, intactivists Brian Earp and Robert Darby, without offering a jot of evidence, accused intactivisms’ bête noire, Prof. Brian Morris of drawing “on the highest possible extremes of available morbidity statistics” (Earp & Darby, 2014). Having made this accusation they go on to make the claim quoted above about patients at a hospital in Birmingham, England.

The data on which this claim was based came from a freedom of information request (Checketts, 2012). It spans the period from 2002 to 2011. Looking at all the numbers we see the annual rates of complications ranging from 0 to 2 until 2010 when they suddenly shoot up to 6, and the year after to 11. So, out of the entire data set, only one figure comes close to the claimed “nearly a dozen”, and the overall average is only 2.4. And yet they accuse Morris of picking extreme values! The expression, “pot calling the kettle black” comes to mind.

Earp and Darby’s article is replete with hypocrisy. They complain (without proof) that some of Prof. Morris citations were not peer-reviewed, but omit to mention that nor was their own “Skeptic” article (I asked the editor). And many of their citations likely are not either. Using selective quotations they imply that Prof. Morris’ credentials (he is a professor emeritus of medical science) are somehow insufficient to publish on circumcision, yet they have no medical scientific credentials whatsoever themselves. They point to criticisms of Morris’ work, yet their own has been heavily criticised too, as have some of the sources they cite. And, in a disturbing irony, their misleading, dishonest and thoroughly pseudoscientific article was published in “The Skeptic”, a magazine that purports to “to take a sceptical look at pseudoscience”.

References:

Checketts, R. (2012) Response to freedom of information request, FOI/0742. Birmingham Children’s Hospital, NHS Foundation Trust. On-line: http://www.secularism.org.uk/uploads/foi-bch-response-received-260612.pdf

Earp, B & Darby, R. (2015) Does science support infant circumcision? The Skeptic, 25(3), 23-30.


LYING

Examples: NOCIRC-SA’s website misrepresenting SAMA.

The “David J. Bernstein” hoax.

Explanation: Technically, it may be argued that lying (i.e. knowingly telling falsehoods, with the intention to deceive) is bad behaviour, rather than a logical fallacy. Although some may knowingly use fallacies for dishonest ends, which is when lying and fallacies meet. However, as deliberate conscious lying is part and parcel of intactivism, it deserves mention.

There are many ways to lie. Deliberately omitting contrary information is one (lying by omission). Knowingly misrepresenting one’s opponent, character assassination, citing claims one knows to be suspect, even discredited, are others, and all are used by intactivists.

Proving that a person is lying, and not just sloppy, stupid or ignorant, can be tricky, especially when ones’ opponents already are all these things combined. One is right to be suspicious when someone pops up on a comments thread saying he was circumcised as an adult and regrets it, and on another thread, someone with the same name claims to have been circumcised as a baby and resents it. Here I take two examples where lying is clearly proven. If I included every instance in which intactivists use data they know is suspect, even bogus, so deliberate dishonesty may therefore be reasonably inferred, there would not be enough space.

 

Example 1. Knowingly misrepresenting a source.

On the front page of the South African NOCIRC website (http://www.nocirc-sa.co.za/home/ ) is a quote purporting to be the position statement of the South African Medical Association (SAMA). It reads:

 

It is “unethical and illegal to perform circumcision on infant boys in this instance. In particular, the Committee expressed serious concern that not enough scientifically-based evidence was available to confirm that circumcisions prevented HIV contraction and that the public at large was influenced by incorrect and misrepresented information. The Committee reiterated its view that it did not support circumcision to prevent HIV transmission

 

As must always be done with intactivist claims I fact-checked this. I contacted SAMA, whereupon a very different story emerged. The saga began with a query to SAMA by NOCIRC-SA in February 2011 about infant circumcision being made available in KwaZulu-Natal, but only with parental consent. This was discussed at SAMA, and then an employee replied to NOCIRC-SA with the text quoted on their website, in a letter dated 23 June 2011. However, it was merely her interpretation of the discussion, and was issued without approval. It was not the official position of SAMA at all.

When SAMA became aware that this quoted text was being touted as their official position Dr Mabasa, then chairman of SAMA, wrote to NOCIRC-SA in a letter dated 5 July 2011 clarifying that SAMA does endorse adult circumcision as a strategy against HIV, which “has evidentiary backing”, but they do not support “universal circumcision of infant males” because of issues such as parental consent.

NOCIRC-SA did not budge, so Dr Mabasa wrote again on 22 July 2011, this time firmly stating,

 

Our previous correspondence, dated 5th July 2011, refers. This letter clearly clarified our position following an unintentional error in our initial correspondence, dated 23 June 2011.

Unfortunately it would seem that you decided to misrepresent our stated position on the above matter in recent communication to the Department of Health and on your website.

The correspondence you refer to was incorrect and has been withdrawn and superseded by our consequent letter. Our position is simple and clear – automatic circumcision of infant males IN THE ABSENCE OF PARENTAL CONSENT is not appropriate. Adult male circumcision is an accepted HIV prevention strategy.

Kindly read our second letter and desist from using incorrect correspondence to portray our position in addition to doing this on your website.”

 

Despite knowing that the original statement was issued in error, knowing it is not the official position of SAMA, and despite being asked TWICE to correct it, NOCIRC-SA continue to use the original text.

 

Example 2: Outright fibbing.

A spectacular case of outright fibbing is that of “David J. Bernstein”. For years he trolled the Internet and social media wailing about the harm his circumcision had caused him. He told and retold the standard intactivist narrative of how he had a loss of sensation, was keratinized, badly scarred, had painful erections, had to “jackhammer” his girlfriend and still couldn’t satisfy either himself or her, and so on. Examples may still be found with an Internet search, e.g. here: www.forward.com/news/196400/circumcision-studies-give-backing-to-supporters-of (in the comments thread below).

But, in 2014, he let slip in an intactivist Facebook group that his real name is Christian Wimmer, and he is not even circumcised! He was making it all up because “it works very well in discussions!” Shockingly, prominent intactivist Brian Herrity leapt to his defence, condemning those who exposed him, and saying that others are doing the same as Wimmer. Screenshots revealing the David J. Bernstein/Christian Wimmer hoax may be seen here: http://media.wix.com/ugd/b794cb_10450a6efcf24557a07deeb7f647cc6f.pdf


MISREPRESENTATION

Examples: “A recent Cochrane Review found no reliable evidence that infant circumcision does in fact protect against UTIs”.

“… penile cancer (which is so rare in Western countries that reliable statistics cannot be generated) …”

Explanation: Claiming a source says something that, in fact, it does not. If done deliberately it is lying (see “lying” for an example of this). A variant consists of misrepresenting an opponent to make it easier to attack him or her (see “straw man”). In the examples here, taken from Earp & Darby (2015), the misrepresentations consist of making bogus claims and giving them a semblance of authority by attributing them to credible sources. But those sources do not actually say what is being attributed to them.

The first, about urinary tract infections (UTIs), is attributed to Jagannath et al. (2012), but Jagannath et al. say no such thing. Theirs’ was an attempted review only of randomised controlled trials. They found none. That is not to say there is “no reliable evidence”, just no randomised controlled trials (in fact they missed one, which did find a strong protective effect). The fact that over 20 observational studies and two meta-analyses have consistently found a protective effect, means that the evidence in support of the ability of circumcision to reduce UTIs can be justly described as “reliable” (see Morris & Wiswell (2013), and references therein).

The second claim, attributed to Cancer Research UK (2014), again blatantly mispresents the source. It does NOT say that “reliable statistics cannot be generated”, rather, it says “Statistics for this cancer are harder to estimate than for other, more common cancers.” “Harder” does not mean “cannot”, and precise statistics are available even on the same website (which states 632 new cases for the UK in 2014).

That a magazine claiming “to take a sceptical look at pseudoscience” should publish such pseudoscience itself is deeply disappointing.

References:

Cancer Research UK (2014) “Statistics and outlook for penile cancer”. On-line: http://www.cancerresearchuk.org/cancer-help/type/penile-cancer/treatment/statistics-and-outlook-for-penile-cancer

Earp, B & Darby, R. (2015) Does science support infant circumcision? The Skeptic, 25(3), 23-30.

Jagannath, V.A., Fedorowitz. Z, Sud, V., Verma, A.K., Hajebrahimi, S. (2012) Routine neonatal circumcision for the prevention of urinary tract infections in infancy (Review). Cochrane Database of Systematic Reviews, 11, CD009129.

Morris, B.J. & Wiswell, T.E. (2013) Circumcision and lifetime risk of urinary tract infection:  systematic review and meta-analysis. J. Urol., 189, 2118—24.


MOVING THE GOALPOSTS

Example: The African randomized controlled trials were on adults, they say nothing about infants.

Explanation: This fallacy can take different forms, but the usual one is the version above, also known as “raising the bar”. When it looks like the opposing side is close to proving their point, the defenders suddenly demand more evidence, even to the extent of making demands that are impossible to meet. Thus, they move the goalposts just when the opposition is about to score.

In the form above, the argument sometimes pops up in internet discussions, as if to imply that just because adult circumcision has been shown in randomized controlled trials (RCTs – the highest quality type of epidemiological study) to be effective against HIV, does not mean that infant circumcision will be too. Aside from multiple non-RCT studies showing it is, it would be impractical to conduct a RCT on infants. It would take 20 years to get an answer, during which time many participants would disperse and be lost to the study, and the researchers themselves may retire or die. And, as it is now scientific consensus that circumcision protects against HIV, such a study would be unlikely to gain approval by an ethics committee. So it is unreasonable to demand a RCT on infants before accepting that infant circumcision will protect against HIV.


NIRVANA FALLACY

Example: Circumcision only partially protects, one must still use a condom, so why bother?

Explanation: This is the error of dismissing a solution because it falls short of perfection. The real world is not perfect, and often partial solutions and/or compromises have to be made. Should we stop wearing seatbelts because they don’t absolutely guarantee you won’t get killed in a motor vehicle crash? Should we give up anti-smoking campaigns because some people will still smoke regardless? Should we not bother to reduce our carbon emissions because other countries are failing to reduce theirs’? Circumcision is only a partial solution to the various diseases it protects against, but that is no reason to reject it. All the more so when one considers that the other solutions touted by intactivists (e.g. condoms) are only partial solutions too. Condoms used consistently provide about 80 % protection (Weller & Davis-Beaty, 2002), circumcision about 70 % (Lei et al., 2015). One might compare this with seat belts and air bags. As with condoms and circumcision, neither provides 100 % protection. Seat belts need to be used each time. Air bags are always in place. Both used together maximise protection.

References:

Lei, J.H., Liu, L.R., Wei, Q., Yan, S.B., Yan, L., Song, T.R., Yuan, H.C., Lu, X., Han, P. (2015) Circumcision status and risk of HIV acquisition during heterosexual intercourse for both males and females: a meta-analysis. PLoS ONE, 10(5), 1-9.

Weller SC, Davis-Beaty K. (2002) Condom effectiveness in reducing heterosexual HIV transmission. Cochrane Database of Systematic Reviews, Issue 1. Art. No.: CD003255. DOI: 10.1002/14651858.CD003255.


OBFUSCATION

Example: Use of unnecessarily complex statistical manipulations to create the impression that ambiguous, even contrary, data actually supports ones’ case.

Explanation: Strictly speaking this is not so much a logical fallacy, as an underhand debating technique to cover up, or divert attention away from, contrary evidence. The best practitioners of this tend to be those with real academic credentials who know the terminology and can blind their audience with science. A repeat offender is Robert S. Van Howe, a paediatrician with a Master’s degree in statistics and public health. He is fond of using his knowledge of statistical jargon to bamboozle his audience (including some journal editors) and create the impression that the data supports his argument when, in fact, it does not.

His track record speaks for itself. Meta-analysis is a method of combining data from multiple studies to even out random variations and achieve a higher degree of statistical significance than can be achieved from a single study. If conducted well it is a powerful tool, and the results carry weight. But done incorrectly, or in the hands of someone with an agenda, it can be highly misleading.

Van Howe has so far attempted five meta-analyses on circumcision-related topics. The first concluded that circumcision increases the risk of contracting HIV, contrary to what almost every previous study (including properly conducted meta-analyses) had concluded (Van Howe, 1999). It was swiftly debunked when it was shown he had not collated the data correctly, and so had fallen into a statistical trap known as Simpson’s paradox. It is now, literally, a textbook example of how NOT to do a meta-analysis (Borenstein et al., 2009).

Two more followed close together in 2007. One was an attempt to investigate the relationship between circumcision and sexually transmitted genital ulcerative disease (GUD) and urethral infections (Van Howe, 2007a). Unfortunately for him the data he cited was not present in the sources he claimed it came from. This was pointed out (along with other problems) by his critics (Waskett et al., 2009). Van Howe had to issue a correction (Van Howe, 2009).

The other was an attempt to show, contrary to overwhelming evidence, that circumcision is not protective against human papillomavirus (HPV) (Van Howe, 2007b). It was shot down in flames by highly respected researchers from the Catalan Institute of Oncology, whose output on HPV and the cancers it causes is prodigious making them world authorities on the topic. Van Howe’s meta-analysis, they concluded, was so bad it ought to be retracted from the literature (Castellsagué et al., 2007).

His fourth was an attempt to show that circumcision is ineffective against a range of STIs, including HPV (Van Howe, 2013). Again it was shredded by the critics, who showed, amongst other things, that he was using inappropriate “corrections” to manipulate the data, and unnecessarily complex statistical procedures in order to arrive at his desired conclusion. As well as recommending retraction they also commented that his statistical manoeuvres were designed to create the impression of sophistication and so mislead his audience into thinking he had a case. They compared him to the “man behind the curtain” scene in the “Wizard of Oz” (Morris et al., 2014). For those unfamiliar, the wizard has no magical powers, but merely creates the illusion he has by means of mechanical devices operated from behind a curtain.

His fifth (a meta-regression) was an attempt (again) to discredit the protective effect of circumcision against HIV (Van Howe, 2015). This time he avoided Simpson’s paradox, but was unable to manipulate away the link, the evidence by now being just too strong, though he managed to downplay it. As usual, his effort was shown to be unnecessarily complex and flawed. His presentation of results was described as “opaque” and his use of unpublished data precluded replication. The critics concluded that “Van Howe should be congratulated on the statistical manoeuvers he has performed, but not on the validity of the results obtained. Moreover, instead of communicating his results in a lucid manner, the reader is expected to be well versed in statistical jargon to interpret the incomplete statements that appear in his Results section” (Morris et al., 2016).

Van Howe is not alone in obfuscating the data. Morten Frisch, a Danish epidemiologist, has taken to publishing works attacking circumcision, again using statistics to torture his desired answer out of weak data. His oft-cited study “proving” that circumcision adversely affects sexual function being an example (Frisch et al., 2011). On the face of it, the data presented in his paper show little difference between circumcised and non-circumcised males. It was only after some statistical jiggery-pokery that he managed to tease out an apparent effect. This led Prof. Michael King, of University College London, who is emphatically not a circumcision advocate, to call the supposed effect “tiny” and the data “over-analysed” (King, 2011). Soon after came a detailed critique by Morris et al. (2012) which triggered a petulant response from Frisch (2012), followed by further criticism (Morris et al., 2013). The American Academy of Paediatrics also weighed in with similar criticisms (Blank, et al., 2013).

So watch out for sophisticated-seeming papers “proving” a marginal effect, and written by noted intactivist academics. Always read the round of critiques and replies they almost inevitably attract. There are lies, damned lies, and intactivist statistics.

References

Blank, S., Brady, M., Buerk, E., Carlo, W., Diekema, D., Freedman, A., Maxwell, L., Wegner, S. (2013) Cultural bias and circumcision: The AAP Task Force on Circumcision Responds. Pediatrics,131(4) 801–4.

Borenstein, M., Hedges, L., Higgins, J. P. T., Rothstein, H. R. (2009). Introduction to meta-analysis. Chichester: Wiley.

Castellsagué, X., Albero, G., Clèries, R., Bosch, F.X. (2007) J. Infection, 55(1), 91-3.

Frisch, M., Lindholm, M., Grønbaek, M. (2011) Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark. Int. J. Epidemiol., 40(5), 1387-81.

Frisch, M. (2012) Author’s response. Int. J. Epidemiol., 41(1), 312-4

King, M. (2011) Interview in “Women’s Hour”, BBC Radio 4, Thursday 10:00 a.m., 21 June 2011. On-line: http://www.bbc.co.uk/programmes/b011zzh8

Morris, B.J, Waskett, J.H., Gray, R.H. (2012) Does sexual function survey in Denmark offer any support for male circumcision having an adverse effect? Int. J. Epidemiol., 41(1), 310-2

Morris, B.J. & Krieger, J.N. (2013) Does male circumcision affect sexual function, sensitivity, or satisfaction” – a systematic review. J. Sex. Med., 10(11), 2644-57.

Morris, B.J., Barboza, G., Wamai, R.G., Krieger, J.N. (2016) Circumcision is a primary preventive against HIV infection: Critique of a contrary meta-regression analysis by Van Howe. Global Public Health, (ePub ahead of print, 11 pages).

Morris, B.J., Hankins, C.A., Tobian, A.A.R., Krieger, J.N., Klausner, J.D. (2014) Does male circumcision protect against sexually transmitted infections? Arguments and meta-analyses to the contrary fail to withstand scrutiny. ISRN Urology, 23 pages.

Van Howe, R.S. (1999) Circumcision and HIV infection: review of the literature and meta-analysis. Int. J. STD AIDS, 10, 8-16.

Van Howe, R.S. (2007a) Genital ulcerative disease and sexually transmitted urethritis and circumcision: a meta-analysis. Int. J. STD AIDS, 18, 799-809.

Van Howe, R.S. (2007b) Human papillomavirus and circumcision: A meta-analysis. J. Infection, 54, 490-6.

Van Howe, R.S. (2009) Erratum. Int. J. STD. AIDS, 20, 592.

Van Howe, R.S. (2013) Sexually transmitted infections and male circumcision: A systematic review and meta-Analysis. ISRN Urology, 42 pages.

Van Howe, R.S. (2015) Circumcision as a primary HIV preventive: Extrapolating from the available data. Global Public Health, 10(5-6), 607-25.

Waskett, J.H., Morris, B.J., Weiss, H.A. (2009) Errors in meta-analysis by Van Howe. Int. J. STD AIDS, 20, 216-8


QUOTE-MINING

Examples: “Adverse self-reported outcomes associated with foreskin removal in adulthood include impaired erectile functioning, orgasm difficulties, decreased masturbatory functioning (loss of pleasure and increase in difficulty), an increase in penile pain, a loss of penile sensitivity with age, and lower subjective ratings of penile sensitivity.”

And, “in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher.”

Explanation: Quote-mining was a term coined to describe the tactic used by creationists of taking sound-bites out of context to convey the impression that the original authors support the point being made when, in fact, they do not. Mined quotes take time to investigate, explain and expose so they often go unchallenged. It is therefore prudent to automatically be suspicious of quotes, and to get into the habit of looking up the original sources to see what they actually say.

The first of the examples above was mined by Adler (2016) from Bossio et al. (2014). Going to the primary source (Bossio) we find that the previous paragraph contains the statement, “Documented improvements in self-reported sexual functioning following adult circumcision include better erectile functioning, greater ease of orgasm, less pain during intercourse, increased overall satisfaction with sexual functioning, and improvement in the sexual problem that precipitated the circumcision.” The same paragraph opens with, “Research exploring sexual functioning across circumcision status has produced mixed results”. Bossio et al. then list the “documented improvements” and follow on with the “adverse self-reported outcomes”. Seen in context, the passage Adler cites was intended by its authors to illustrate the contradictory nature of the literature on the topic, and not to indicate that circumcision is harmful, or that there was a consensus. Indeed, the whole tone of their paper is nuanced, acknowledging both the positive and negative qualities reported for circumcision, and identifying areas where further research is required.

Adler gives absolutely no hint of this. Instead he uses it to support a bold claim that “circumcision does adversely affect men’s sex lives” (his emphasis) and that this is “the prevailing opinion worldwide”. This is emphatically not what Bossio et al. say.

The second example above is an intactivist favourite, and multiple examples can be found by copying it into a search engine. It is mined from Mishra et al. (2009). Here the quote-mine takes the form of ignoring key caveats that qualify the statement being quoted. Thus, on page 14, we find “some of the estimates presented in this report are based on small numbers of cases in survey samples, and should be interpreted with caution” and, in a footnote on p. 110, “Note: HIV prevalence estimates for ‘not circumcised’ men for Guinea and Niger are based on small numbers of cases.” Looking at the raw data in the table above the footnote we see that data for Senegal, and arguably also Haiti and Cote d’Ivoire, are also too small to enable conclusions to be drawn. The first four of these countries were among the ten said to have higher HIV prevalence in circumcised men. So, from the statistical point of view, the numbers are not significant. They could just be chance findings. Nor do the authors make any attempt to assess the statistical significance of the rest. This is routinely ignored by intactivists using the quote, so anyone coming across it for the first time would have no idea that some of the data it is based on is so weak as to make nonsense of the numbers in the quote.

References:

Adler, P.W. (2016) The draft CDC circumcision recommendations: medical, ethical, legal, and procedural concerns. Int. J. Children’s Rights, 24(2), 239-264. Quote is on p. 245.

Bossio, J.A., Pukall, C.F., Steele, S. (2014) A review of the current state of the male circumcision literature, J. Sex. Med., 11, 2847-64. Quote is on p. 2853, left column.

Mishra, V., Medley, A., Hong, R., Gu, Y., Robey, B.. (2009) Levels and Spread of

HIV Seroprevalence and Associated Factors: Evidence from National Household Surveys. DHS Comparative Reports No. 22. Calverton, Maryland, USA: Macro International Inc. Quote is on p. 103.


POST HOC

Example: After I was circumcised I lost all the sensation in my penis. Sex now is like seeing in black and white, rather than in full colour. Getting circumcised was a huge mistake.

Explanation: Post hoc ergo propter hoc, to give this fallacy its full name, takes the form, “Y followed X therefore Y was caused by X”. In intactivist circles, this usually takes the form above. A young man gets circumcised, and then reports a negative effect on his sexual function and pleasure, such as a loss of sensation. Such anecdotes are gleefully touted by intactivists as “proof” of the “harmful” effects of circumcision, and are common on websites and comments threads. It even features in a YouTube video in which a young intactivist (Nicholas Kusturis) claims to have lost penile sensation following his circumcision at age 18 (https://www.youtube.com/watch?v=NAHGFx95D80 ).

Even if we assume, for the sake of argument, that the stories are true (a risky assumption – see the section on “Lying”) they are still examples of fallacious reasoning. Sexual dysfunctions are extremely common. Probably most men will experience a problem at some time in their lives, whether brief, or lasting. A recent study in the U.K., where most males have foreskins, found that 9.1 % had experienced a sexual dysfunction lasting 3 months or more in the preceding year (Mitchell et al., 2016). And this was for 16 to 21 year-olds, i.e. young males in their sexual prime. Problems reported (most common first) were premature ejaculation, lack of interest in sex, difficulty achieving orgasm, erectile problems, lack of enjoyment, anxiety, lack of arousal, and pain during sex.

Loss of sensation was not directly addressed in Mitchell’s study, but is another very common dysfunction, with multiple causes including diabetes, alcohol, smoking, side effects of drug use and medication, Peyronies disease, hormonal problems, nerve entrapment or pathology, and depression. Cycling is notorious for causing this problem (Sommer, et al., 2001). Often there is no apparent cause, or it may be psychological. Onset may be gradual, or sudden. Brain chemistry is likely involved in some cases. Anti-depressants are noted for causing sexual problems, including loss of sensation (Higgins, et al., 2010). They influence serotonin levels, which affect penile function and sensation, and also the body’s nervous system more generally. And depression itself is a cause (Baldwin, 2001), which must put sufferers in a catch 22. Be depressed, and risk sexual dysfunction, or take antidepressants, and risk sexual dysfunction, whilst leaving the physician wondering if the dysfunction is due to the illness, or the treatment.

A detailed discussion of the causes of dysfunction is unnecessary to see the flaw in the intactivists’ reasoning. The key point is that sexual dysfunctions, for reasons totally unrelated to circumcision, are very common. And so is circumcision, it being one of the most common surgical procedures in men. So inevitably, by chance alone, some men will suffer a sexual dysfunction that coincides with a circumcision. And they will then put two and two together and make five. To compound matters, their dysfunction may then cause depression, which causes dysfunction, which sustains the depression, etc., thereby trapping them in a vicious circle.

We see the same fallacious reasoning in other popular pseudomedical movements. Thus, a child is given MMR vaccine, and shortly after is diagnosed with autism. Therefore MMR caused the autism. Or a patient tries homeopathy for an ailment, and soon after she feels better, therefore the homeopathy worked.

It is in large part for this reason that scientists eschew personal testimonies as evidence in medical science, whilst pseudoscientists love them. The whole point of conducting clinical trials, with good experimental design (controls, randomization, statistical analysis, etc.) is to eliminate the possibility of chance associations, and the very human tendency to make connections where there are none. And when one looks at the best-designed scientific studies on circumcision, and the reviews of the same, one consistently finds that sexual dysfunctions occur at the same rate in both circumcised and non-circumcised males (Morris & Krieger, 2013; Tian et al., 2013; Cox et al., 2015; Homfray et al., 2015; Shabanzadeh et al., 2016).

Consequently, anecdotes along the lines of “I got circumcised and I lost sexual function afterwards” are of no merit, and should be dismissed. And, lest anyone thinks this is unfair, the argument works both ways. Excepting cases where circumcision was used to cure a problem, stories along the lines of “I got circumcised and it was wonderful” are equally worthless.

References:

Baldwin, D.S. (2001) Depression and sexual dysfunction. Br. Med. Bull., 57(1), 81-99.

Cox, G., Krieger, J.N., Morris, B.J. (2015) Histological correlates of penile sexual sensation: Does circumcision make a difference? (Systematic review). Sex. Med., 3(2), 76-85

Homfray, V., Tanton, C., Mitchell, K.R., Miller, R.F., Field, N., Macdowall, W., Wellings, K., Sonnenberg, P., Johnson, A.M., Mercer, C.H. (2015) Examining the association between male circumcision and sexual function: evidence from a British probability survey. AIDS, 29(11), 1411-1416.

Higgins, A., Nash, M., Lynch, A.M. (2010) Antidepressant-associated sexual dysfunction: impacts, effects and treatment. Drug, Healthcare and Patient Safety. 2, 141-150

Mitchell, K.R., Geary, R., Graham, C., Clifton, S., Mercer, C.H., Lewis, R., Macdowall, W., Datta, J., Johnson, A.M., Wellings, K. (2016) Sexual function in 16- to 21-year olds in Britain. J. Adol. Health, 59(4), 422-8.

Morris, B.J., Krieger, JN. (2013) Does male circumcision affect sexual function, sensitivity, or satisfaction? A systematic review. J. Sex. Med., 10(11), 2644-57.

Shabanzadeh, D.M., During, S., Frimont-Moller, C. (2016) Male circumcision does not result in inferior perceived male sexual function – a systematic review. Dan. Med. J., 63(7), A5245

Sommer, F., Konig, D., Graf, C., Schwarzer, U., Bertram, C., Klotz, T., Engelmann, U. (2001) Impotence and genital numbness in cyclists. Int. J. Sports Med. 22(6), 410-3.

Tian, Y., Liu, W., Wang, J.Z., Wazir, R., Yue, X., Wang, K.J. (2013) Effects of circumcision on male sexual functions: a systematic review and meta-analysis. Asian J. Androl., 15(5), 662-666.


RED HERRING

Example: The foreskin is the most sensitive part of the penis to fine-touch.

Explanation: So what? The argument is irrelevant, even if factually correct.

In this instance, from Sorrells et al. (2007), a paper endlessly cited by intactivists, even if we allow, for the sake of argument, that the foreskin really is the most sensitive part of the penis to fine-touch, does fine-touch really matter? A far more fine-touch sensitive part of the body is the fingertips, being full of the nerve endings responsible (Meissner’s corpuscles). One does not get aroused by rubbing fingertips.

A review of the most up to date histological data indicates that fine-touch has nothing to do with the pleasurable erogenous sensations enjoyed during sexual activity. The nerve endings responsible for feelings of sexual pleasure are concentrated in the glans, and underside of the shaft, not the foreskin (Cox, et al., 2015). In short, Sorrells et al. were studying the wrong thing.

References:

Cox, G., Krieger, J.N., Morris, B.M. (2015) Histological correlates of penile sexual sensation: does circumcision make a difference? Sexual Medicine, 3(2), 76-85.

Sorrells, M.L, Snyder, J.L., Reiss, M.R., Eden, C., Milos, M., Wilcox, N., Van Howe, R.S. (2007) Fine-touch pressure thresholds in the adult penis. BJU Int., 99, 864-9.

 

 


SELECTIVITY

Examples: Cherry-picking, half-truths, quote-mining.

Explanation: It is standard practice amongst pseudoscientists of all kinds and, for that matter, politicians and others with an agenda, to be “economical with the truth”. By selectively telling their audiences only those pieces of information that suit their agenda, whilst concealing anything that contradicts it, the impression can be created that the evidence is on their side, without them having to tell outright fibs and thereby risk being exposed as liars. Although it may be fairly argued that being selective with the data is intellectually dishonest. If done knowingly then it is lying by omission.

There are multiple ways of being selective, and all are employed by intactivists. See the sections above on cherry-picking, half-truths and quote-mining. See also the “Hypocrisy” section for an example of intactivists picking extreme data – a form of cherry-picking.


STRAW MAN

Example: You don’t apply Bonferroni correction to a mixed model.

Explanation: A straw man argument is when the critic attacks something his opponent did not actually say, so it is a form of misrepresentation. Straw men can require careful reading to spot, as the misrepresentation may be subtle. Most people will not check that the critic has accurately portrayed his opponent’s position, so often the tactic succeeds in creating the impression that the opponent has been successfully rebutted, when that is not the case.

The example above is the gist of a response by prominent intactivist Robert S Van Howe to a criticism, but requires some background explanation. It involves some statistical jargon, but don’t worry, one does not need to know any statistics to see the straw man. In 2007, a paper (Sorrels et al., 2007) was published with Van Howe as co-author. This study of fine-touch sensitivity of the penis listed its initial results, including the p values (the statistical probability of the result being significant) in table 2. The data were further analysed using a technique called a mixed model (if you are a stats geek Wikipedia has an explanation, but it is not necessary to know what it is for the purposes here). The mixed model results were put in table 3.

Along came the critics, Jake Waskett (who does seem to be something of a stats geek) and Prof. Brian Morris. They spotted a problem with the data in table 2. Basically, when multiple comparisons are made there is a risk that chance may result in false positives. And the data in table 2 contained multiple comparisons. The usual way of correcting for this is by the Bonferroni correction method (again, you don’t need to know the details, but if you are keen Wikipedia explains it). So they applied Bonferroni and found that the results in table 2 were not statistically significant after all. They published their findings, along with other criticisms, in a letter to the editor in the same journal (Waskett & Morris, 2007).

Years later Van Howe responded by referring to the mixed model results in table 3 and inferring that Waskett & Morris had applied the correction to those (Van Howe, 2014). One does not apply Bonferroni corrections to mixed models, and if Waskett & Morris had done so then Van Howe’s criticism would stand. But they didn’t. They applied the correction to table 2, where it was appropriate, and used separate criticisms for the mixed model, as Morris later pointed out (Morris & Krieger, 2016). In short, Van Howe was attacking a straw man.

References:

Morris, B.J. & Krieger, J.N. (2016) Re: Examining penile sensitivity in neonatally circumcised and intact men using quantitative sensory testing. J. Urol., 195, 1821-6.

Sorrells, M.L, Snyder, J.L., Reiss, M.R., Eden, C., Milos, M., Wilcox, N., Van Howe, R.S. (2007) Fine-touch pressure thresholds in the adult penis. BJU Int., 99, 864-9.

Van Howe R.S. (2014): Math is your friend: a consumer’s primer to understanding epidemiology. Presented at Genital Autonomy 2014: 13th International Symposium on Genital Autonomy and Children’s Rights. Boulder, Colorado, July 24, 2014.

Waskett, J.H. & Morris, B.J. (2007) Fine-touch pressure thresholds in the adult penis. BJU Int., 99, 1551-2.


TELEOLOGICAL FALLACY

Example: “it’s actually meant to be there.”

Explanation: A favourite of religious apologists, but not exclusive to them. This fallacy consists of ascribing purpose where there is none. In this case it assumes there is a purpose behind the presence of a foreskin – it is meant to be there. Not so. It could be a vestigial trait, like the eyes of blind cave animals, or the little muscles that enable some people to twitch their ears. In which instance it is an evolutionary relic that once served a function but does so no longer. Or it could be a spandrel. Male nipples are an example, or the useless bony bumps pandas have on their heels that correspond to the useful pseudothumbs on their wrists. These are mere quirks of developmental biology, and serve no practical purpose.

This fallacy was employed by Michael Marshall in a podcast (http://www.merseysideskeptics.org.uk/2011/07/circumcision-genitial-mutilation-under-another-name/ ). Marshall is a well-known U.K. skeptic and debunker. He also works for the “Good Thinking Society”. Oh, the irony!