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Another factor that plays a role in instilling Fleiss (1999) reported strong bias in favor of circumcision in America is the local media. American television and theater treats the presence of the [[foreskin]] with ridicule and disdain, and praises circumcision as "clean" and "healthy," and news outlets are always ready to publish the latest "study" (usually conducted by American "researchers") that shows medical literature regarding male circumcision might have some kind of "benefit." Editors may also believe that American audiences, who already believe circumcision is beneficial, will want to read stories reinforcing their cultural assumptions. By contrast, a study showing no benefit (or even negative findings), may not be considered "news" by editors if their audience is expected to have little interest. Tabloid-type media especially may not want anything other than simplistic stories. Discussions carefully evaluating the validity of conflicting findings may be off-puttingly complex and not especially interesting to the reader who already believes circumcision as healthy, and see no need for further debate. These stories therefore might be less likely to be published. He reported:
{{Citation* Bias against studies critical of circumcision. |Title= |Text=Circumcision practices are largely culturally determined and as a result there * Bias in the type of studies that are strong beliefs and opinions surrounding its practiceperformed. It is important to acknowledge that researchers' personal biases and * Bias in the dominant circumcision practices acceptance of their respective countries may influence their interpretation studies before peer review.* Bias in peer reviewers.* Proliferation of findingsa false analogy between circumcision and immunization. |Author=Siegfried ''et al''* Bias in studies associating [[HIV]] infection with circumcision status. |Source= |* Bias in studies regarding penile cancer.<refname=<ref"fleiss1999" />Siegfried American researchers who have written studies critical of male circumcision usually have had to publish in the foreign medical literature. The journal ''et alPediatrics''. "Male circumcision , published by the [[AAP| American Academy of Pediatrics]], is noted for prevention its publication of heterosexual acquisition articles with a favorable view of HIV in mennon-therapeutic neonatal circumcision." ''Cochrane Library'' 3 (2003)</ref>}}
Bias
,Add link in SEEALSO section.
<BR CLEAR="all">
== Cultural bias ==
A scientist or researcher of [[circumcision]] may have a cultural bias in favor of [[circumcision]] if (s)he comes from a country, society, cultural background, or ethnic group where [[circumcision]] is common. A cultural bias is a conflict of interest because reporting accurate findings in studies regarding circumcision is at odds with what one has been conditioned to believe about the practice. A person may be [[circumcised ]] himself, married to a circumcised spouse, and/or a parent to circumcised children.
Circumcision is has been near-universal in the [[United States]], [[Israel]], the [[Tuli|Philippines]], and most Arab Muslim nations. Circumcision is also considered a rite of passage in some African tribes. In these societies, a man who has not been circumcised is often considered to be inferior, and in some cases, a social outcast, so there is a strong incentive to circumcise one's self and/or one's children. LeBourdais (1995) reported "the likelihood of a baby being [[circumcised]] is influenced by an expanding array of usually non-medical factors: [[Adamant father syndrome| circumcision status of the father]], attitude of the mother, age of the attending physician, gender and circumcision status of the physician, geographic location and religion factors that have little to do with the baby himself."<ref name="lebourdais1995">{{REFjournal |last=LeBourdais |first=Eleanor |init= |author-link= |etal=no |title=Circumcision no longer a "routine" surgical procedure. |journal=Can Med Assoc J |location= |date=1995 |volume=152 |issue=11 |pages=1873-6 |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1337997/pdf/cmaj00071-0145.pdf |quote= |pubmedID=7773907 |pubmedCID=1337997 |DOI= |accessdate=2021-07-25}}</ref>
=== American bias ===
Siegfried et al. observed:<blockquote>Circumcision practices are largely culturally determined and as a result there are strong beliefs and opinions surrounding its practice. It is important to acknowledge that researchers' personal biases and the dominant circumcision practices of their respective countries may influence their interpretation of findings.<ref name="siegfried2003">Siegfried N, Muller M, Volmink J, Deeks J, Egger M, Low N, Weiss H, Walker S, Williamson P. [http://www.cirp.org/library/disease/HIV/cochrane2003/ Male circumcision for prevention of heterosexual acquisition of HIV in men] (Cochrane Review). In: ''The Cochrane Library'', Issue 3, 2003. Oxford: Update Software</ref></blockquote> Because the [[United States ]] circumcises so many of its male infants, [[circumcision]] is often said to be an American cultural value, and it is has been accepted as “normal.” Cultural bias on this issue may be most obvious when considering the practice of female circumcision in Africa. Americans regard the practice with horror, the way Europeans, who do not cut the genitals of male or females, regard American circumcision.<ref name='CRC 2011"CRC2011-03-06'">{{REFweb
|last=
|first=
}}</ref>
American bias in favor of circumcision could be attributed to a number of different factors. The history of [[circumcision ]] in [[United States| America ]] goes back more than a centuryto the Nineteenth Century, when it began as a way to curb [[masturbation]] in boys and men.<ref name='Stay Free!'>{{REFweb
|quote=The operation should be performed by a surgeon without administering an anesthetic...
|last=McLaren
|url=http://www.ibiblio.org/stayfree/10/graham.htm
|accessdate=2011-03-06
}}</ref> Thereafter American doctors began on a quest to medicalize the formerly religious practice of circumcision as a preventor claimed preventer of a myriad of diseases, and that endeavor continues to this day. ===Media bias=== Another factor that plays a role in instilling bias in favor of circumcision in [[United States| America]] is the local media. American television and theater usually treats the presence of the [[foreskin]] with ridicule and disdain, and praises circumcision as "clean" and "healthy," and news outlets are always ready to publish the latest "study" (usually conducted by American "researchers") that shows circumcision might have some kind of "benefit". Editors typically treat the [[American Academy of Pediatrics]] as a neutral authority, when in fact it is a [[Financial incentive| financially biased]] trade association seeking to advance the incomes of its fellows. Editors may also believe that American audiences, who already believe circumcision is beneficial, will want to read stories reinforcing their cultural assumptions. By contrast, a study showing no benefit (or even negative findings), may not be considered "news" by editors if their audience is expected to have little interest. Tabloid-type media especially may not want anything other than simplistic stories. Discussions carefully evaluating the validity of conflicting findings may be off-puttingly complex and not especially interesting to the reader who already believes circumcision as healthy, and see no need for further debate. These stories therefore might be less likely to be published. ===Medical literature bias===
There is a huge bias in favor of non-therapeutic and therapeutic circumcision in the American medical literature.<ref name="fleiss1999">{{REFbook |last=Fleiss |first=Paul M. |init=PM |author-link=Paul M. Fleiss |year=1999 |title=An Analysis of Bias Regarding Circumcision in American Medical Literature |url=https://books.google.com/books?hl=en&lr=&id=ljZZ9ZvD_kQC&oi=fnd&pg=PA379&ots=GA2KpzMECk&sig=jFqDYQhV0sqAWil6LDZWXnQdJO8#v=onepage&q&f=false |work=Male and Female Circumcision: Medical, Legal, and Ethical Considerations in Pediatric Practice. |editor=Denniston, George C., Hodges, Frederick Mansfield, Milos, Marilyn |edition= |volume= |chapter= |pages=379-401 |location=New York |publisher=Kluwer Academic/Plenum Publishers |isbn=0-306-46131-5 |quote= |accessdate=2020-08-08 |note=}}</ref> As a result of the long history of doctors condemning the presence of the [[foreskin]] and expounding the alleged virtues of [[circumcision]], curriculum regarding the [[foreskin]] and its [[Foreskin#Physiological_functions| multiple functions]] remain largely absent from American medical literature. Information on the [[Retraction of the foreskin| proper development of the foreskin]] is largely absent, diagrams of male genitalia present the [[penis]] as [[circumcised]], and if the foreskin is mentioned at all, it is in the context of circumcision. In short, most of what is taught in American medicine regarding the [[foreskin ]] is how to cut it off. When [[circumcised ]] doctors attempt to write a [[circumcision ]] policy, the outcome is likely to heavily biased in favor of circumcision.<ref name="goldman2005">{{REFjournal
|last=Goldman
|first=Ronald
|init=R
|author-link=Ronald Goldman
|etal=no
|title=Circumcision policy: a psychosocial perspective
|journal=Paedatrics Paediatrics & Child Health
|location=Ottawa
|date=2005-11
|DOI=10.1093/pch/9.9.630
|accessdate=2019-12-10
}}</ref> <ref name="hill2007">{{REFjournal
|last=Hill
|first=
|init=G
|author-link=George Hill
|title=The case against circumcision
|journal=Journal of Men's Health and Gender
|date=2007
|volume=4
|issue=3
|pages=318-23
|url=https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=04ace5046cc27f01b8fbe4aa359c059778983912
|quote=
|format=PDF
|accessdate=2023-10-02
}}</ref>
== Religious bias ==
[[Image:Religious syms.png|right|thumb|]]
Cultural or religious importance to circumcision may pre-dispose one to view the practice of circumcision in a positive light, to welcome evidence that it is medically beneficial, perhaps even necessary or required, and to dismiss arguments and research to the contrary.
Like anyone else, a scientist or researcher of circumcision may have a bias in favor of circumcision if s/he adheres to a religion where circumcision is a religious requirement. A religious bias is a conflict of interest because reporting accurate findings in studies regarding circumcision is at odds with a conviction to defend what has been a historically controversial and ethically problematic religious practice.
Circumcision is viewed as a religious requirement in [[Operation Abraham| Judaism]]. It is also considered an important religious tenet in Islam by many, though it is not mentioned in the Koran; not all adherents of Islam are circumcised or consider circumcision to be a requirement. People in some sects of Christianity, such as Coptic Christians, consider circumcision to be a religious requirement, though it is expressly forbidden to gentiles (see [https://www.biblegateway.com/passage/?search=Galatians+5&version=NASB Galatians 5]).
Circumcision is an important, often indispensable religious custom for many religious people, and attempts to question its propriety are often seen as blasphemous. Yet, there is a recognition that medical validity is important to maintain justification for the surgery.
=== Jewish influence on circumcision literature ===
Though American circumcision practice is generally believed to be independent of Jewish circumcision practice, they are connected; some of the most outspoken advocates for circumcision tend to be Jewish. The [[American Academy of Pediatrics]] has consistently disproportionately stuffed its "circumcision task forces" with Jewish doctors. It is believed that not a single member of an AAP Task Force on Circumcision has ever had a foreskin. This suggests a religious or cultural bias on the part of these advocates. Of course, there are also Jewish doctors that oppose circumcision, but they are disproportionately outnumbered by those who advocate circumcision. For example, of all the letters to the editor in response to the 1999 [[American Academy of Pediatrics ]] Circumcision Policy Statement, the most pro-circumcision responses were from Jewish doctors, including two whom also perform Jewish ritual circumcisions.<ref>{{REFjournal |last=Bailis |init=S. |title=Circumcision: the debate goes on. '' |journal=Pediatrics'' |date=2000; |volume=105: |page=682.}}</ref><ref>{{REFjournal |last=Kunin |init=S. |title=Circumcision: the debate goes on. '' |journal=Pediatrics'' |date=2000; |volume=105: |pages=683.}}</ref><ref>{{REFjournal |last=Shechet |init=J, |last2=Tanenbaum |init2=B. |title=Circumcision: the debate goes on. '' |journal=Pediatrics'' |date=2000; |volume=105: |pages=682-683.}}</ref> The voices of Jewish doctors--— [[Abraham L. Wolbarst| Wolbarst]], [[Abraham Ravich|Ravich]], [[Gerald N. Weiss| Weiss]], [[Aaron J. Fink| Fink]], [[Edgar J. Schoen| Schoen]], and others--— are disproportionately prominent in circumcision advocacy.
Although physicians may act with what they consider to be sound medical judgement, some Jewish physicians may be influenced also by non-medical consideration. Cultural background of many Jewish circumcision advocates predisposes them to view the practice in a positive light, to welcome evidence that the most particular and problematic religious custom of their people is medically beneficial, and to dismiss arguments to the contrary. The presence of a large and influential population of Jewish physicians in this country, their concentration in leading centers of research and publication, and their remarkably active participation in the century-long debate on circumcision seems too obvious and too significant to be rejected out of hand, or worse, to be avoided because it might be wrongly interpreted as gratuitous defamation.<ref>{{REFbook
|last=Glick
|first=Leonard B. |init=LB
|author-link=Leonard B. Glick
|year=2005
|chapter="This Little Operation"
|pages=183-184
|location=New York, NY |publisher={{UNI|Oxford University |Oxon}} Press
|isbn=0-19-517674-X
|note=The presence of a large and influential population of Jewish physicians in this country...
|accessdate=2011-02-19
}}</ref> According to a MEDLINE search, the late [[Edgar J. Schoen| Edgar Schoen]], a strong Jewish advocate, has been was published 20 times in the medical literature on the subject of circumcision.
==== Circumcision discourse and the Jewish presence ====
According to the AAP Circumcision Policy Statement of 1999, in regards to infant circumcision, "It is legitimate for parents to take into account cultural, religious, and ethnic traditions, in addition to the medical factors." Furthermore, "parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision," and that they should "should not be coerced by medical professionals to make this choice."<ref name="aap1999">{{REFjournal |last=AAP Task Force on Circumcision. [ |url=http://aappolicy.aappublications.org/cgi/content/full/pediatrics;103/3/686#B119 |title=Circumcision Policy Statement]. '' |journal=Pediatrics'' |date=1999; |volume=103( |issue=3): |pages=686-693. - AAP Policy Statement 1999 Retrieved |accessdate=2011-03-13}}</ref>
The AAP puts physicians in a difficult position; on the one hand, they should be giving accurate and unbiased information to parents, but on the other, providing any information discouraging circumcision would put doctors in a position of attacking religious belief. This suggests that religion may be a factor that inhibits the full disclosure of medical information and medical views on circumcision and that American discussion or questioning of the issue is affected by the Jewish presence. Therefore, the creators of this wiki believe that mentioning religious affiliation is relevant to assessing potential bias when it comes to the subject of circumcision.
=== Circumcision and Islam ===
Although circumcision is never mentioned in the Qur'an, male circumcision is deeply rooted in the [[Genital cutting in Islam| Muslim tradition]]. Muhammad is reported to have prescribed cutting the [[foreskin ]] as a fitrah, a measure of personal cleanliness. Modern Muslims see [[circumcision ]] as essential to their faith, although they have also come to lean on arguments of "medical benefits." A conference of Islamic scholars in 1987 stated that modern circumcision studies “[reflect] the wisdom of the Islamic statements”.<ref>Gollaher, David L. ''Circumcision: A History of the World's Most Controversial Surgery''. New York: Basic Books, {{GollaherDL 2000.}}</ref>
== Personal bias ==
Like anyone else, a scientist or researcher of [[circumcision]] may have a personal bias in favor of circumcision if he is [[circumcised]], a father of [[circumcised ]] children, or if she is married to a [[circumcised ]] partner and/or is a mother of [[circumcised ]] children. <ref name="lebourdais1995" /> A personal bias is a conflict of interest, because reporting accurate findings in studies regarding circumcision is at odds with a personal interest in defending the irrevocable procedure of circumcision for one's self, a [[circumcised ]] spouse, or one's [[circumcised ]] children. The interests of a circumcision "researcher" may also lie in a personal sexual fixation with the [[circumcised ]] penis and/or the act of [[circumcision ]] itself. (See [[circumfetish]].)
== "Anti-circumcision bias" ==
Advocates of [[circumcision]] may claim there is an "anti-circumcision bias" in research and in public health policy. They support their claim only with their judgment that substantial medical evidence favors their view.<ref>[[{{REFjournal |last=Schoen |init=E |author-link=Edgar J. Schoen |last2=Wiswell |init2=T | Schoen E]], [[author2-link=Thomas E. Wiswell | Wiswell T]], last3=Moses |init3=S. |title=New policy on circumcision: Cause for concern. '' |journal=Pediatrics'' |date=2000; |volume=105: |pages=620-623.}}</ref> It is significant that circumcision advocates never offer any rationale or research to explain why someone would have an anti-circumcision bias and why, for example, some circumcised men, Jews, and doctors who performed routine (non-therapeutic) circumcisions (and stopped) would adopt a position opposing circumcision that is not evidence-based.<ref>{{REFweb
|quote=Circumcision was more often supported by doctors who were circumcised.
|last=
}}</ref>
A recent debate in [[Denmark ]] shows a good example of how biased [[Circumfetishist|circumcision advocates]] try to blame anti-circumcision advocates (who are no outspoken [[intactivist]]s) of having an "anti-circumcision bias". As circumcision on minors without [[medical indication ]] is a genital mutilation by definition, those who advocate allowing this genital mutilation, are obliged to justify the reasonableness which seems impossible. Those who speak out for [[human rights ]] of defenseless children and oppose genital mutilation on minors, do not have any obligation to justify a non-intervention.<ref>{{REFweb
|url=https://uniavisen.dk/en/feud-over-circumcision-is-now-at-the-university-of-copenhagen/
|title=Feud over circumcision is now at the University of Copenhagen
|first=Anders
|last=Fjeldberg
|publisher=University Post, {{UNI|University of Copenhagen|KU}}
|date=2020-04-16
|accessdate=2020-04-17
== So who's biased? ==
It is very easy to make the claim that opponents of [[circumcision]] have an "anti-circumcision bias." When determining bias, it is important to do so considering the greater scope of medicine. Usually, medicine aims to cure or prevent disease placing primacy in the preservation of the integrity of the human body; surgery and/or the [[amputation ]] or extraction of body parts is usually reserved as a very last resort, when there is a medical condition present that necessitates it, and when all other methods of treatment have failed.
Circumcision "research" is unique in that no other "study" or "research" aims to vilify a particular, normally ocurring body part to necessitate, even require, its deliberate destruction. While most other research seeks to prevent or cure disease in order to avoid surgery, or the loss of a body part, circumcision "research" seeks to necessitate the [[amputation ]] of normal, healthy tissue.
The creators of this wiki believe that wanting to prevent disease while preserving the integrity of the human body is a perfectly acceptable, even preferred bias to have in medical research, if it could even be called that.
{{SEEALSO}}
* [[American Academy of Pediatrics]]
* [[Circumfetish]] -- A bias sicker than the rest.
* [[Issues with American urologists and the practice of male circumcision]]
* [[Psychological issues of male circumcision]]
* [[Circumcised doctors]]
* [[Circumcision study flaws]]
* [[Google bias on circumcision]]
* [[Wikipedia bias on circumcision]]
{{LINKS}}
* {{REFweb
|url=https://circumcision.org/cultural-and-medical-bias/
|title=Cultural and Medical Bias
|last=Goldman
|first=Ronald
|author-link=Ronald Goldman
|publisher=Circumcision Resource Center
|accessdate=2021-10-23
}}
{{REF}}
[[Category:MotivesBias]][[Category:Motive]]
[[Category:Islam]]
[[Category:Judaism]]
[[Category:From IntactWiki]]
[[de:BefangenheitVoreingenommenheit]]