Talk:Bias

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Contents

Header

The header mentions "researchers" and "studies" but bias goes beyond this. I think we need to be more general.--Thedirt 06:04, 26 February 2011 (CST)

Jews against circumcision

Questions to consider. Do we want to create profiles for these intactivists? If so, where? If not, why not? Orly21 21:14, 27 February 2011 (CST)

Jewish influence

Should it be mentioned that even today, Israel is funding circumcision propaganda? Should we mention Operation Abraham, and the Avahan group in India?Orly21 21:14, 27 February 2011 (CST)

Don't forget IsraAID ("Israel Forum for Internation Humanitarian Aid"). Their news page has 27 stories showing humanitarian acts, and virtually all 27 articles are about circumcision.--Thedirt 06:19, 11 April 2011 (CDT)

Possible resources

The following seems like an excellent link for "personal bias."

Orly21 11:06, 7 October 2011 (CDT)

The influence of bias on medicine

The bias in favor of circumcision has credible psychosocial explanations. These explanations include the following:

  1. Ignoring evidence of harm and using medical claims to defend circumcision when that evidence is, at best, conflicting may be an unconscious way for some male physicians to avoid the emotional discomfort of questioning their own circumcision. Other doctors may dislike that they are circumcised. As one man said, "I wish I could circumcise every uncircumcised man in the world so they'd be like me. I don't have a foreskin, and no one else should have one either." A survey of randomly selected primary care physicians showed that circumcision was more often supported by doctors who were older, male, and circumcised.[1]
  2. The possible use of psychological defense mechanisms by physicians to deny some of the evidence may also serve, in part, to protect their self-esteem, which could be adversely affected by the conscious recognition that circumcision may harm infants. Because protecting self-esteem sometimes takes priority over being accurate or correct, potentially threatening information may be reinterpreted or dismissed, sometimes unconsciously.[2][3] This can sometimes take the form of selective confirmation bias of upon discussing the medical literature.
  3. Other research has demonstrated that people will continue an endeavor once they have invested time and effort.[4] Some circumcising doctors may be protecting their self-esteem in connection with hundreds or thousands of circumcisions they have performed throughout decades of practice.

Medical bias in favor of circumcision may also be financially driven.

Example of bias in public health education

The Harvard School of Public Health has a stated mission and objectives that seek to inform policy, debate, and disseminate health information. Its core values include a responsibility to improve and protect the health of all populations, especially the most vulnerable (e.g., children), provide information that empowers individuals to make sound health decisions, and respect the highest principles of scientific and academic conduct, foster open inquiry, and honor individual rights.[5]

Is the HSPH in compliance with these objectives and values regarding the topic of circumcision? A search of the term "male circumcision" on the HSPH website showed typical results promoted circumcision as a way to prevent disease, and none of the 45 results discussed the disadvantages and harm of circumcision.[6] There can be no policy debate on this health controversy when other points of view are excluded. The health of male infants cannot be protected, and sound health decisions by parents and professionals are less likely when there is no open inquiry. The rights of the child cannot be honored if the public and professionals are not aware of the rights that relate to circumcision.

Evidence of bias in medical literature

A pro-circumcision bias may influence what questions are researched and what questions are ignored in American medical circumcision literature. Most American studies that assess the advisability of circumcision focus on the search for a presumed benefit. This is consistent with an American Academy of Pediatrics (AAP) Circumcision Policy Statement Task Force member’s statement that the committee was formed “to determine if there was scientific evidence to justify circumcision.”[7] The answer is limited by the assumption in the statement of the problem. American circumcision studies invariably find a benefit, from treating epilepsy and mental disorders in the late 1800s to preventing sexually transmitted diseases today.[8] Though such claims generally do not withstand scrutiny by policy committees, their continued publication over the years can lead to medical myths while raising questions about some researchers’ motives.

Not only is the issue of harm generally avoided as a research question, the studies seeking to claim benefits ignore even the mention of potential harm from a perfectly performed circumcision. This omission reflects the common American belief that the foreskin has no value.[9] It also reflects the fact that circumcision advocates receive millions of dollars for their work and build their reputations based on finding potential benefits for circumcision.

“ The Money Factor
It is difficult to get a man to understand something, when his salary depends upon his not understanding it!
– Upton Sinclair

Findings that conflict with the current paradigm are difficult to get published because they are judged to be unacceptable.[10] (Publication outside of the U.S. is more likely.) Authorities that do peer review are dependent on maintaining the existing belief system.[11][12] For example, studies on circumcision and urinary tract infection with better methodology and results that conflicted with those previously published in Pediatrics were rejected, though the previously published studies were flawed.[13] One researcher had a submission rejected on the cost-utility of circumcision. The reviewer for JAMA “denied the existence of 23 studies that I used . . . in spite of the fact that all of these studies were referenced in my paper.”[14] There are numerous other examples of bias in medical publishing associated with circumcision and the presence of anger and hostility in the reviews of submissions on circumcision.[15][16] (Reviewers do not have to identify themselves to authors, a questionable practice.[17]) Researcher John Taylor chose to submit his article on the anatomy of the foreskin to a British medical journal instead of an American journal. He judged that the likelihood of acceptance would be better with a British publication because the lack of routine circumcision in England accounts for a different cultural attitude toward it.[18]

Furthermore, medical researchers do not necessarily approach the literature “objectively.” They routinely cite studies that support current medical thinking and, as mentioned previously, ignore studies that conflict with that thinking.[19] In addition, medical doctors prefer reports describing new treatments to those critical of current treatments.[20]

The deficiencies and biases found in circumcision literature illustrate the findings of renowned meta-researcher John Ioannidis. He reports that the conclusions of most medical research are false. [21]

Example of bias in pediatrics journal

The commitment of American medical journal editors to accuracy on circumcision is subject to question. The following letter was sent by this office to Jerald Lucy, M.D., editor of Pediatrics, on May 13, 2003. MEDLINE is the primary database for medical literature. The article in question, cited in the AAP’s latest policy statement on circumcision (1999), was used to support the policy statement’s claim that the rate of circumcision complications is low.

"Dear Dr. Lucey:
The following abstract is copied from the MEDLINE online database.
Pediatrics 1976 Dec;58(6):824-7
Neonatal circumcision: a ten-year overview: with comparison of the Gomco clamp and the Plastibell device.
Gee WF, Ansell JS.
The records of 5,882 live male births were reviewed to ascertain the incidence and nature of complications following neonatal circumcision. Approximately one half of the patients were circumcised with the Gomco and half with the Plastibell. The incidence of complications was 0.2%; most frequent were hemmorrhage [sic], infection, and trauma, there were no deaths; and no transfusions were given.
PMID: 995507 [PubMed - indexed for MEDLINE]
According to the article, the 0.2% figure is not correct. It represents only “really significant” (p. 827) complications. The correct incidence of complications reported in this article is 2% (p. 825).
I suggest that you submit the correct information to MEDLINE so that this abstract will be consistent with the results of the article. Please let me know your response to this matter and any response you receive from a MEDLINE administrator.
Thanks for your time and consideration.
Very truly yours,
Ronald Goldman, Ph.D."

No response was received. A followup letter was sent on September 15, 2003. Again no response was received. A third letter was sent to the AAP Executive Director Joe Sanders, Jr., M.D., requesting assistance and a response. No response was received. The error is still uncorrected. Apparently, the AAP does not have a high priority on correcting known errors to their circumcision literature that continue to be repeated in subsequent literature citations.

References

  1. ↑ Stein M, Marx M, Taggert S, Bass R. Routine neonatal circumcision: The gap between contemporary policy and practice. Journal of Family Practice 1982; 15: 47-53.
  2. ↑ Raynor J, McFarlin D. Motivation and the self-system. In: Sorrentino R, Higgins E, eds. Handbook of Motivation and Cognition: Foundations of Social Behavior. Guilford, New York, 1986.
  3. ↑ Steele C, Liu T. Dissonance processes as self-affirmation. Journal of Personality and Social Psychology 1983; 45: 5-19.
  4. ↑ Arkes H, Blumer C. The psychology of sunk cost. Organizational Behavior and Human Decision Processes 1985; 35: 124.
  5. ↑ http://www.hsph.harvard.edu/about/core-values/index.html.
  6. ↑ http://www.hsph.harvard.edu/
  7. ↑ Shoemaker C. Deposition: Flatt v. Kantak 2002. Available from URL http://www.boystoo.com/legal/shoemakerdepo.htm#Craig%20Shoemakers%20Depositions.
  8. ↑ Gollaher D. Circumcision: A history of the World's Most Controversial Surgery. Basic Books, New York, 2000.
  9. ↑ Kelalis D, King L, Belman A. Clinical Pediatric Urology. Harcourt Brace Jovanovich, Philadelphia, 1992.
  10. ↑ Kuhn T. The Structure of Scientific Revolutions, 3rd edn. University of Chicago Press, Chicago, 1996.
  11. ↑ Horrobin D. The philosophical basis of peer review and the suppression of innovation. Journal of the American Medical Association 1990; 263: 1438-1441.
  12. ↑ Stehbens W. Basic philosophy and concepts underlying scientific peer review. Medical Hypotheses 1999; 52: 31-36.
  13. ↑ Van Howe R. Peer-review bias regarding circumcision in American medical publishing. In: Denniston G, Hodges F, Milos M, eds. Male and Female Circumcision: Medical, Legal, and Ethical Considerations in Pediatric Practice. Kluwer Academic/Plenum Publishers, New York, 1999; 357-378.
  14. ↑ Van Howe R. Peer-review bias regarding circumcision in American medical publishing. In: Denniston G, Hodges F, Milos M, eds. Male and Female Circumcision: Medical, Legal, and Ethical Considerations in Pediatric Practice. Kluwer Academic/Plenum Publishers, New York, 1999; 357-378.
  15. ↑ Van Howe R. Peer-review bias regarding circumcision in American medical publishing. In: Denniston G, Hodges F, Milos M, eds. Male and Female Circumcision: Medical, Legal, and Ethical Considerations in Pediatric Practice. Kluwer Academic/Plenum Publishers, New York, 1999; 357-378.
  16. ↑ Fleiss P. Peer-review bias regarding circumcision in American medical publishing. In: Denniston G, Hodges F, Milos M, eds. Male and Female Circumcision: Medical, Legal, and Ethical Considerations in Pediatric Practice. Kluwer Academic/Plenum Publishers, New York, 1999; 379-402.
  17. ↑ Godlee F. Making reviewers visible: Openness, accountability, and credit. Journal of the American Medical Association 2002; 287: 2762-2765.
  18. ↑ Personal communication, 1996.
  19. ↑ Kessner D. Diffusion of new medical information. American Journal of Public Health 1981; 71: 367-368.
  20. ↑ Payer L. Medicine and Culture: Varieties of Treatment in the United States, England, West Germany, and France. Henry Holt and Company, New York, 1988.
  21. ↑ Ioannidis J. Why most published research findings are false. PLoS Med 2005; 2: e124.
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