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.

The cruelty of male circumcision

Today it is quite unthinkable to question the cruelty of female circumcision if you are a relatively informed person. However, to my own amazement, male circumcision (see picture) is still considered by many to be perfectly justified. It must evidently be so, considering how often this surgery is performed on young naive infants.

At one point in my life I actually became a little bit ambiguous as to whether circumcision might perhaps be justified. It was last year when, during my exchange year at UCSB, I attended some highly entertaining and informative lectures on Human Sexuality taught by two very charismatic (and married) professors John Baldwin and Janice Baldwin. You can read more about the Baldwins' view on circumcision here. I am not being ironic when I say that these were indeed great lectures, and that is perhaps why they almost convinced me that the costs and benefits associated with male circumcision more or less cancels out. As far as I can remember they referred to two positive consequences associated with male circumcision. One is the supposedly improved hygiene, which by the way is one of the most common justifications that people in favor of circumcision refers to. However, bad hygiene under the foreskin is only a problem for guys who never clean under the foreskin, so if we would simply remind guys that they need to remember to clean their more private regions this would not be a big problem. In any case I hardly think that this justifies circumcision….

The other favorable effect of male circumcision, the one that made me think that perhaps it was justified, is the reduced risk of being infected with the HIV virus. A few studies of this kind have been made and the effects superficially seem quite large. However, the studies which have shown this difference have been of poor quality, with poor control. Just as an example, in one large and frequently cited study, circumcised males were given advice on sexual behavior whereas those who had not been circumcised did not get this offer. Was the lower incidence of HIV among the circumcised due to the sexual advice or the circumcision? Studies with better control i.e. studies which try to rule out alternative explanations, have found smaller effects (see here for more information). I will not go as far as to say that circumcision does not give any improved protection at all, on the contrary, I believe that there is some truth in this. Nevertheless, it seems that the effects are significantly smaller than what the original studies suggested.

The fact that there seems to be no great benefits of circumcision is however not my main problem with it. Neither do I dislike it just because it is very much entangled with religion. I think it is a good example of how religious beliefs sometimes takes the upper hand over rational arguments, but it is not the main reason why I disprove of male circumcision. So what is the main reason? The reason is that the foreskin, which is removed during a circumcision, has a lot of very important functions. I think that this is hardly surprising because if the foreskin had been completely useless or even a burden to us, natural selection would probably have taken care of it long ago. The benefits of having a foreskin are many. To name a few, the foreskin is important because it gives protection to the glans penis, it reduces friction during intercourse, it gives important feedback to our brain about the "state" of the penis, it aids erection, and it regulates the timing of the ejaculation (people who have been circumcised often either ejaculate too early or too late). You can read about these as well as other function of the foreskin on this excellent page.

However, I think that the most important function of the foreskin, and hence also the most important reason why circumcision should not be allowed, is that it brings sexual pleasure to its owner. This of course also means that lack of foreskin will result in reduced pleasure. Sex, along with drink and food and neuroscience (that last one is probably rather personal), are things that make life worth living, and taking away the pleasure associated with sex just seems rather cruel to me. Now I am not saying that circumcised people do not feel any pleasure, I would not know, all I am saying is that there is good reason to believe that they feel less pleasure.

Summing up, besides just being a nasty and invasive surgical procedure which could well cause some kind of trauma in the infant, taking away the foreskin is associated with many other disadvantages. Even if the risk of contracting HIV would be slightly reduced, this hardly justifies circumcision.

The virtue of changing your mind

More and more I have wondered why it is seen as such a disgrace to change your mind about things. I have had many different discussions on different subjects online as well as in real life, and almost invariably people hold on to their ideas and beliefs as if their life depended on it. I will haste to admit that I am also guilty of this type of behavior. Even when my opponent has brought up a really good point that threatens my entire argument, it is tempting to go "well you are just an ashole", or something equally relevant... When I am courageous enough to say, "that is a good point, you are right" it often feels like I have lost my dignity, and I will walk away like a dog with the tail between its legs. I wonder why it is so hard to admit that you were wrong? Is there some evolutionary explanation of this?

It is of course important to point out that it would also be a problem if people changed their mind too easily. Many of the ideas that are today seen as obvious, were ridiculed when first articulated (the earth revolves around the sun? I don't think so!). I don't know where to put the limit, but in general it seems that people are probably a little bit too slow in changing their mind.

I think that if people were better at changing their minds, we would have a better world. As a scientist the ideal-me should be able to change his mind if enough evidence against my belief is shown to me. This is by the way a difference between science and faith. In the latter you are not supposed to doubt, no matter what happens. I think that this inflexibility is probably the main problem with religion. Richard Dawkins in his documentary "the root of all evil" tells us about one of his professors who had been working on a theory for a decade or so when an American colleague came and showed him overwhelming evidence that the theory was wrong. The professor, unbelievably, admitted right there and then, in front of loads of people, that he had been wrong, Wow!

The reason I started to think about these issues was that someone very dear to me, after reading my post about homeopathy, said that I should be a bit more careful when I denounce ideas such as biodynamical foods. She said that these comments might come back to haunt me when I become a famous scientist. This is true indeed, but why should it be so hard to say that "that was my belief at the time, now I believe this and this". People should be allowed to change their mind. (of course, I should probably check my sources carefully before I throw out accusations). Knowing what we know today I think that the Iraq war was a bad idea, but back before the war I thought it was probably a good idea to get rid of Saddam and the WoMD that I thought were there.

This is what I am going to do. When I have written a certain number of posts on this blog I will review my posts, and then make a new post about which things I have changed my mind about, great idea is it not? I mean, it would be kind of remarkable if I got everything right the first time. So keep sending the good comments and tell me when you think I am wrong, you might just be able to change my rock-hard mind.

True cyborgs now a reality!

Muscular movements are controlled by the central nervous system. Right now my brain is actively planning the muscular contractions that will make my fingers exert a force on different buttons on my keyboard, ultimately resulting in the text that you are hopefully enjoying right now. How does this work? Well, there are many unsolved mysteries, but we have also learned quite a lot.
Two areas of the brain, the "supplementary motor area" (SMA) and the "premotor area" (PMA), seems to be involved in planning the exact series of muscle contractions that are required in order to do something such as writing this text. How do we know this? Put a person in an fMRI machine and ask them to imagine doing something, and wallah, SMA and PMA lights up (meaning that more blood is going to these areas, mening that more glucose gets there, meaning more activity in those cells)! In order to actually move you will also have to get your motor cortex involved. It is from this area that axons travel down into the spinal cord and elicits movements. If you stimulate the motor cortex electrically during a surgery (this is sometimes done to see how the body is mapped onto the motor cortex), then the corresponding muscles will contract, perhaps resulting in an arm or a leg flapping out. So when your SMA and PMA have planned the contractions they will communicate with the motor cortex which then sends signals down to the alpha motor neurons in your spinal cord which in turn will release acetylcholine onto the muscles causing them to contract. All this happens within a few milliseconds! (Of course other areas such as the basal ganglia and my own darling, the cerebellum are also involved in movements, this was merely a simplified account.)

Who cares?, where are the applications? Back in 1982 a guy named Georgopoulos measured the activity in the motor cortex of a monkey while it was performing some well defined motor tasks. Georgopoulos found that a certain movement would be associated with a particular pattern of activation in the motor cortex. Thus, merely by looking at the activation in the motor cortex he could predict that the monkey was trying to move say, its left index finger. This could be very useful for people suffering from paralysis. Theoretically it should be possible to measure motor cortex activity and from that see what movements the motor cortex is trying to do. Then, to help a paralysed patient what you need to do is to connect a robotic arm programmed to move in response to neuronal activity. This procedure is no longer science fiction, it is reality. In this article it is described how some surgeons used signals coming from the motor cortex to make a prosthetic arm move, in other words they made a true cyborg out of lucky Mitchell, 24.

Although I am pessimistic about the prospect of creating a brain that is as complex as our own I do think that in the future more and more applications like this one will appear.