1. You cherry-picked studies showing a benefit for male circumcision. It's true that while numerous observational studies have shown a benefit in terms of UTIs and STDs, there are some studies finding no effect, or even an opposite effect. Non-experimental, observational studies are fundamentally flawed for this reason. That's why it's so important to look at randomized, controlled trials whenever possible.
2. The risk of UTIs in male infants is low and does not justify circumcision. I totally agree. The reduction in UTIs alone is not large or clinically important enough to advocate for this procedure.
3. The trials in Africa are flawed because they weren't double-blinded, and they were stopped early. OK, YOU design a study that does sham circumcision in the control group, and try to get that past an ethics committee. Stopping a trial early because of a significant benefit in the treatment group (and offering it to the control group) is the most ethical thing to do in this situation, since HIV is a life-threatening disease. It is true that stopping a study early for this reason tends to overestimate the benefit, and I might be suspicious of the results if they were seen in only one trial, but in fact, the benefits were seen in all three studies, in different parts of Africa. The Cochrane Group, which is extremely conservative in its recommendations, concluded, "Research on the effectiveness of male circumcision for preventing HIV acquisition in heterosexual men is complete. No further trials are required to establish this fact."
4. The trials in adult heterosexual African men don't apply to infants in the developed world. The majority of HIV infections in the U.S. and worldwide are due to unprotected sex. Sure, the absolute reduction in HIV infection with circumcision will be lower in the U.S. than in some parts of Africa, but relative risk reductions tend to remain constant over various patient populations. I do agree that if you're in a part of the world with extremely low rates of HIV infection (such as Australia -- which has a 0.004% annual risk of infection), routine circumcision may not make economic sense.
5. Why not promote safe sex instead? I'm not saying circumcision should be done instead of teaching safe sex. HIV prevention needs to be multi-pronged, and must also include education, free condom distribution, low-cost antiviral treatment (which reduces transmission rates) and needle exchanges.
6. Infants die from circumcision, and parents shouldn't be making this decision for them. Yes, babies will rarely die from circumcision, just as people will rarely die from having IVs inserted into their hands or having a severe allergic reaction to antibiotics (both of which I have seen). But AIDS is still a huge killer, even in developed countries. As for parents who want to let their sons make the decision about circumcision once they come of age, I think that's fine. Just realize that adult male circumcision is a bigger procedure, often involving general anesthesia, and may not be covered by insurance plans when done for purely preventive reasons.
7. Your story about Dr. Nick operating on your kid sounds fishy. Nope, absolutely true. I got a list of low-cost providers because I gave birth at my own, public county hospital.
8. You're a terrible mom. OK, I will concede that in the moment that I let Dr. Nick circumcise my son, I was a terrible mom. I'm an imperfect parent, which is why I think a lot of people read my blog. If I had to do it all over again, I would still have my son circumcised, but I'd go with this guy instead:
Extra credit if you can name this Simpsons character*
9. The foreskin is a part of normal male anatomy, and removing it is mutilation. It occurred to me that this argument probably should have been #1, as many of you have a philosophical objection to circumcision. You think it's wrong to remove normal foreskin for any reason, and I don't. There's nothing we can say that will change each other's minds on this point.
And so we have a parting of the ways.
*It's Krusty the clown's dad, Rabbi Hyman Krustofski.