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A reader counters my analysis of these numbers:

On the issue of circumcision, you are biased and unbalanced. You call circumcision “male genital mutilation”. OK, that’s a bias you are entitled to. Attack circumcision as a moral abomination if you must, but eliminating circumcision will do little for healthcare costs. You cite its $1.8 billion cost and italicize it for emphasis. That is unbalanced. The data report you cite says that of the top 20 operating-room procedures, circumcision is the cheapest per procedure by far and is 20th on the list of 20. And the total cost of circumcisions is just 0.069% of total spending of $2.6 trillion on healthcare in 2010 in the US, and less than 1% of total OR procedures.

The biggest source of healthcare costs are in people over 65, of course, and the biggest source of healthcare costs in people over 65 are in the 25% or so of people with chronic diseases such as CHF, COPD or diabetes. The biggest driver of healthcare cost increases is medical technology driving new treatments to market. Circumcision has very little to do with medical costs.

Of course, mutilating infant boys’ genitals is a small factor in the context of the costs my reader cites. And yes, circumcision is itself not that expensive. But its ubiquity means a remarkable use of medical and operating room resources for an elective procedure. And by “elective”, I do not mean, of course, that the boys choose it. Their parents choose it without the patient’s consent. Another reader on the issue in general:

Okay, you win.

For years I’ve been a loyal reader despite the fact that you occasionally hammer on crusades that I can’t get behind – most notably, your war against “male genital mutilation”.  As a parent of two boys, I reflexively had them circumcised at birth; because I was, and because I’d never seen an uncircumcised one in real life, and because I didn’t want my boys to grow up wondering why they looked different than me “down there”.  In that context, I’ve always been annoyed by your relentless stance on this issue.

Until today.  You see, I’m a healthcare actuary by profession, so today you finally hit on an argument that resonates with me – that male circumcision is symptomatic of our society’s over-utilization of healthcare.  Way to keep attacking from different angles until your target finally yields …

Another really took the blogging to heart:

Just thought I’d share that your ongoing coverage reinforced the decision my wife and I made not to circumcise our son. We both come from Southern, conservative, Protestant families where circumcision has been the norm for who-knows-how-long, but our families haven’t made any complaints, and we feel we made the right choice.

Update from another:

I have always rolled my eyes at the term “male genital mutilation.” Same goes for some of the other hysterics of anti-circumcisionists. None of those arguments ever did much for me. (Less sensitivity? Things feel just fine for me down there, thank you. Psychological damage? Please. There are plenty of sources of adult neuroses other than the penis. The anesthetized trimming of a little skin is hardly the worst thing that happened to me in childhood.) And until a month ago I always would have thought that I would have my sons circumcised, like me. I am American, after all, and circumcision is just what we do, right? Why should I make my sons “different”?

But last month, with a newly-pregnant wife, my view changed for a very simple reason: I realized that I don’t have any reason to circumcise. I attended the bris of a friend’s son and saw it all happen. None of it grossed me out. Not the blood, not the scalpel. And the baby didn’t seem to be in any pain. But it struck me quite suddenly that while my Jewish friends have a very good, compelling reason to circumcise – a covenant with their God – I just don’t have one. And as a rational person, it is simply not in my nature to make a permanent and unalterable decision without a good reason.

A rebuttal from a reader:

When discussing what you call male genital mutilation, you keep saying that this is surgery that is done without the patient’s consent. Obviously, a new born can’t consent to anything but circumcision is a very different operation for a newborn than it is for an adult. Ignoring the issue of whether it is necessary surgery, it is a very minor procedure for a baby and a huge deal for an adult. A close friend of mine, born in China, was uncut. He had to be circumcised as an adult (I believe he had the same condition as Louis XVI) and it was as Joe Biden would say, “a big fucking deal.” He was in a lot of pain for a long time and the surgery came with risks of complications and scarring.

You argue that the parent makes the decision to circumcise an infant son without his consent but the parent is also essentially making the decision not to circumcise too. An adult may think/want/believe he is better off circumcised but if his parents did not make that decision for him as a baby, it may not be a realistic choice for him to make as an adult.

In addition to signing the “kill the gays” law, Ugandan president Yoweri Museveni approved an extraordinarily sweeping “anti-pornography” bill last week. “Pornography,” in this case, includes skimpy summer clothes:

According to Uganda’s Daily Monitor, [the law] bans “behavior or form of communication or speech or information or literature or publication in whole or publication in part or news story or entertainment or stage play or broadcast or music or dance or art or graphic or picture or photography or video recording or leisure activity or show or exhibition.” Ugandan media has largely focused on the possibility that the law would be a de facto ban on revealing clothing and has dubbed it the “miniskirt law.” … [I]f a Ugandan stages a play that includes sexualized, under-clothed thighs, she and the journalist who writes a review could both be locked up. Breaking the law could incur penalties of up to seven years in prison.

One consequence of the new law: women, like gays, now find themselves at increased risk of mob violence. Consider:

More than 40 women have been stripped naked in the different towns of Uganda, including the capital Kampala, in the last three days over misconception that they are breaking the law by wearing miniskirts. …

[A]n association of Ugandan women in parliament has lamented provisions of the new anti-pornography’s law that deals with women’s dressing. Rosemary Nyakikongolo, vice chairperson of the Uganda Women Parliamentary Association, claims “parliament rushed to pass the anti-pornography law.” She said the attacks on women are because “MPs passed the law [without] adequate public consultation.”

Earlier this week, police stopped 200 women from marching in Kampala to protest the law. In fact, if not for women’s earlier activism, the law would have been much worse:

Ever since Simon Lokodo, State Minister for Ethics and Integrity and lead proponent for a ban on miniskirts, announced that the Anti-Pornography Bill had been signed into law, women have faced violence, especially in taxi ranks. According to Lokodo, “If your miniskirt falls within the ambit of this definition then I am afraid you will be caught up by the law.”

Except that, despite Lokodo’s most fervent efforts, the miniskirt ban actually never made it into the final legislation. Women across Uganda shut it down. From #SaveTheMiniSkirt online campaigns to Save the Miniskirt parties to formal lobbying to organizing in the streets and off, women shut it down. Women understood that the issue of their clothing was nothing more or less than an attack on women’s autonomy. For Rita Aciro Lakor, the executive director of Uganda Women’s Network (Uwonet), “It’s about going back to controlling women. They’ll start with clothes. The next time they’re going to remove the little provisions in the law that promote and protect women’s rights.”

A recent NYT op-ed by Marcy Darnovsky warning about a procedure that uses donor-supplied mitochondria to allow women with mitochondrial diseases to give birth to healthy children has kicked off a new debate about “designer babies”. Nita Farahany, a member of the Presidential Commission for the Study of Bioethical Issues, emphasizes that using donated mitochondria doesn’t make the donor a “third parent,” as the scare stories would have it:

Embryos that result from these techniques have genetic material contributed from three different individuals, but the mitochondrial donor is not a parent — genetically, or otherwise. When using mitochondria from a donor egg, the resulting egg (which has the nucleus from the intending mother) has 99.9 percent of its coding DNA from the intending mother. The donor provides the energy necessary for the egg to function normally. When the egg is then fertilized by a sperm cell, the resulting embryo carries less than .1 percent of its DNA from the mitochondrial donor.

Ronald Bailey accuses the NYT of “immoral scaremongering”:

The mitochondrial replacement technique is not at all “deeply problematic.” In fact, the FDA panel has finally gotten around to considering a technique that the agency banned after essentially the same procedure was being successfully deployed by team led by fertility researcher Jacques Cohen 13 years ago. Cohen used the technique to help women to give birth to 20 children before the FDA shut down his work in 2001. At a conference some years later, I asked Cohen how the children were faring and he told me that 19 were healthy and one has an autism disorder. As it happens, some research finds a correlation between mitochondrial dysfunction and some cases of autism.

Jessica Grose also dismisses the fears over designer babies and describes what’s at stake for the pregnant women:

When a woman’s eggs have severe mitochondrial abnormalities, they can have many miscarriages, stillborn children, or extremely sick babies who are unlikely to survive past early childhood. “They will suffer immensely because they can’t get the energy” in order for their brains and hearts to grow, says [Nita] Farahany. They can have extreme pain and difficulty breathing. Fixing this huge amount of suffering for both mother and child seems like a far cry from creating “designer babies,” and paramount to any hyped-up concern about a slippery slope.

Although the mitochondrial procedure may not entail the creation of designer babies, Drum figures we’ll get there eventually:

It’s about time we faced up to this, I think. As the technology for this steadily advances, and designer babies become possible, parents are going to get designer babies. If the United States bans it, they’ll go to Switzerland. If Switzerland bans it, they’ll go to China. If China bans it, they’ll go underground. But one way or another, if this technology exists, the demand for it is going to be irresistible.

Greg Grandin researches “the way the advancement of medical knowledge was paid for with the lives of slaves”:

The death rate on the trans-Atlantic voyage to the New World was staggeringly high. Slave ships, however, were more than floating tombs. They were floating laboratories, offering researchers a chance to examine the course of diseases in fairly controlled, quarantined environments.  Doctors and medical researchers could take advantage of high mortality rates to identify a bewildering number of symptoms, classify them into diseases, and hypothesize about their causes.

Corps of doctors tended to slave ports up and down the Atlantic seaboard. Some of them were committed to relieving suffering; others were simply looking for ways to make the slave system more profitable. In either case, they identified types of fevers, learned how to decrease mortality and increase fertility, experimented with how much water was needed for optimum numbers of slaves to survive on a diet of salted fish and beef jerky, and identified the best ratio of caloric intake to labor hours. Priceless epidemiological information on a range of diseases — malaria, smallpox, yellow fever, dysentery, typhoid, cholera, and so on — was gleaned from the bodies of the dying and the dead.

Update from a reader:

It’s important to note that this experimentation on slaves was an ongoing practice. For example, there is the case of J. Marion Sims, considered the “Father of Modern Gynecology.”

Sims created some of the first basic tools for gynecological examination.  But these breakthroughs came through the experimentation of untold, and largely unnamed, slave women (and later in New York City on destitute Irish immigrant women). I learned about Sims a few years ago on a visit to the State Capitol grounds in Columbia, South Carolina which features a beautiful memorial to Sims that presents him as a great hero and pioneer. There have been attempts to “right the record” and include a more complete story of his record along with the heroic inscriptions. These would include the sheer numbers of forced patients and the staggering numbers of surgeries (30 known on one patient).  These were all done without anesthetic, which was known and used at that time.  In any case it didn’t matter.  The pain of the patient wasn’t a consideration.  Gynecological problems that impeded their value as bearers of more slaves was what Sims was attempting to solve in these surgeries.

(Illustration: Diagram of a slave ship from the Atlantic slave trade. Via Wikimedia Commons)

James McWilliams, an avid long-distance runner, wonders whether he might be addicted to exercise:

Potentially addicted runners will cheat family time to run, sneak in runs without telling people, design vacations around exercise opportunities, will (if injured) count the days since their last run like an alcoholic counts the days since his last drink, and forgo sex to run (we often joke that nobody spends a Saturday morning running 20 miles because they have a great sex life). It seems certain that, if these symptoms are in any way common, running addiction will become an official disorder in due time.

The problem, from the perspective of these symptoms, seems quite real. But then what?

It’s hard to imagine how such “addicts” would be treated in a clinical setting. Would they be pushed to go cold turkey, as many drug and alcohol addicts are advised to do? That option would deny them the real benefits of a healthy activity they had merely taken too far. In the end, quitting could lead to a worse situation than the one the addict was already in. Scaling back, which is becoming an option for substance abusers, seems like it would be a more realistic option. But here, too, it’s hard to see how—given the tendency of the high to diminish for the exercise freak—the temptation to add one more mile could be resisted, especially when acute negative consequences do not result. It’s hard to imagine ever effectively treating this “disorder.”

Stanton Peele asserts that “people can become addicted to anything, whether drugs, alcohol, food, shopping, gambling, love, or sex, if it is the focus of an encapsulating experience that alleviates bad feelings and buttresses their self-esteem”:

Contrary to the common view of addiction as a choice-nullifying disease, this approach holds people accountable for their actions. Addicts are actively involved in building their attachments and can modify their behavior when they have an incentive to do so. Alcoholics drink moderately at home with their parents, for instance, and addicted smokers wait all morning during work until they can smoke outdoors. They might prefer to indulge their addictive impulses instantly, but those impulses can be resisted and ultimately eliminated.

Update from a reader, who happily calls herself an “enabler”:

My husband has to run/bike/swim/burn calories regularly, otherwise I don’t want to be around him. He gets grumpy and unpleasant. So is that the sign of an addiction? Possibly. Endorphins are powerful things. But so what? He’s healthier for it, and in a better mood. He doesn’t spend tons of money on equipment or a gym membership – or expensive cars, electronics, or pharmaceuticals (legal or not) to feel better. He, his sister, and father spend a lot of time bonding over triathlons, mountain bike wrecks, and equipment. He takes our kids out with him on their bicycles, and as soon as the baby is old enough, will take him in the jogging stroller, giving me time to sleep. I’ll happily enable this particular addiction! (And our sex life doesn’t suffer from his exercise. Quite the opposite, I’d argue.)

Contrary to conventional wisdom, rape in conflict zones is far from universal:

A recent study by the Peace Research Institute of Oslo of all 48 conflicts and all 236 armed groups – including state, rebel groups, and pro-government militias – in Africa between 1989 and 2009 found that 64 percent of armed groups were not reported to have engaged in any form of sexual violence. Of course, in most contexts, especially war, sexual violence is underreported. But even after 2000, when wartime rape became a highly salient public issue actively investigated by NGOs, more than half of armed groups were not reported to have engaged in sexual violence.

Why does this matter? Instead of framing rape as an inevitable outcome of war, by understanding which groups engage in sexual violence – and which do not – and what accounts for the difference, advocates and policy makers will be far better positioned to limit – and perhaps even to end – this scourge of war.

The above video is the trailer for the Oscar-nominated live-action short film “Aquel No Era Yo” (That Wasn’t Me), which contains a brutal rape scene. Update from a reader:

While everyone can agree that raising awareness of the horrible physical and sexual abuse of child soldiers and women in civil wars, particularly in Africa over the past 30 years, is a good thing, my partner and I just had to write in to let you know that Aquel no era yo has major, major issues.

We attended a screening of all of the Oscar-nominated shorts a few weeks ago, and while four of them were very interesting and well-done (our pick for the winner is the French Avant que tout perdre, an amazingly tense snapshot of a woman and her children fleeing an abusive husband/father), Aquel left an extremely bad taste in our mouths.

Awareness is a good thing, but not this type of awareness. Not a film which – spoiler alerts – so crudely portrays African blacks as aggressors and European whites as victims; not one in which the white man screams “You have lost your humanity!” just before the black child shoots him; not one where the army storms in and shoots all the rebels, but, apparently to keep from offending an audience’s sensitivities, we see no bodies of children among the slain; and not one where the young black protagonist and narrator, a child “saved” by the courageous white woman who overcomes her rape to take him to safety, redeems himself only by telling his story, contrite and eventually understanding of the “wrong” he did, to an auditorium full of white/Spanish teenagers while his benevolent saviour looks on, smiles, and knows she did the right thing.

This story should not be about the white woman who gets raped by a black man in the Congo. It should be about the children. Though it would no doubt have been agonizing, in that movie theater at that moment, we would have far preferred to see documentary footage of the multiple recovery programs for child soldiers in Africa – or perhaps, yes, even footage of the horrible events themselves if such a thing existed.

Aquel is propaganda, pure and simple. At first we were very surprised to see from the credits that Save The Children and Amnesty International had attached their names and presumably their funding to it; in hindsight, it feels like the cynicism and scaremongering of Kony 2012 all over again. The victims deserve better.

Matt Ford considers the relationship between city planning and social unrest:

In many ways, France pioneered the conscious use of urban design for political purposes. Paris in the early 19th century was essentially a medieval city, suffocating from overcrowding and poor infrastructure. Baron Haussmann’s urban renovations under Napoleon III in the 1850s and 1860s gave the City of Light a modern sewage system, beautiful suburban parks, and a network of train stations. He also took the opportunity to demolish unruly lower-class neighborhoods, banish their impoverished inhabitants to suburbs, and replace their cramped, narrow alleys with spacious, grand boulevards. In the event of an uprising, like those that took place in 1789, 1830, and 1848, French authorities hoped the wider streets would be both harder for revolutionary Parisians to barricade and easier for columns of French soldiers to march through to suppress revolts.

Similar calculations are still made today.

In 2005, Burma’s ruling junta moved the government from Yangon, a sprawling metropolis of 5 million people, to the new inland capital at Naypyidaw for security reasons. Isolated from other population centers, Naypyidaw is populated mostly by government functionaries and military officials who spend as little time as possible in the eerily desolate city. Burmese officials claim almost a million people live there, although the true population is likely far, far lower than that. When the Saffron Revolution erupted two years later, in 2007, the large-scale protests that rocked other Burmese cities never took hold in Naypyidaw, and the country’s military rulers remained in power after a brief but brutal crackdown.

Even if the city’s population had been large enough for demonstrations, where would they have taken place? Broad boulevards demarcate the specially designated neighborhoods where officials live, with no public square or central space for residents, unruly or otherwise, to congregate. A moat even surrounds the presidential palace. One journalist described the city as “dictatorship by cartography.”

Update from a reader:

Just a quick note from a working cartographer: this is dictatorship by geography, not cartography. While there are many instances of maps as tools for propaganda (Monmonier and de Blij is a good start for this), and as much as someone like me would be flattered by that type of power, dictatorship by cartography is a highly inaccurate turn of phrase.

(Photo: Aerial view of the purposefully-built capital city of Naypyidaw, Myanmar on May 23, 2008. By Stan Honda/AFP/Getty Images)

Eric Holder on Monday tossed some live bait to right-wing critics by telling state attorneys general that they don’t have to defend state laws they believe are discriminatory:

Comparing today’s gay rights fight to the civil rights movement in the 1950s and 60s, Holder said he would have challenged discriminatory laws on the books during the time of racial segregation. “If I were attorney general in Kansas in 1953, I would not have defended a Kansas statute that put in place separate-but-equal facilities,” Holder said.

While Holder later clarified that AGs should appoint independent counsel to represent the state in such cases, Byron York still finds fault with his argument:

So the full version of Holder’s position on one-man, one-woman marriage laws is: State attorneys general should not defend them, but they should hire private lawyers who will. It was a much more nuanced opinion than what was reported in the headlines. And it left some attorneys general pretty unhappy. They have sworn to uphold the laws and constitutions of their states, and there has been no Supreme Court decision invalidating those state laws and constitutions. So they should just make a judgment on their own not to defend?

“It’s troubling to have the attorney general advise you that you can ignore your oath to uphold and defend the constitution and laws of your state,” said Luther Strange, the attorney general of Alabama, who was at the meeting. “We certainly don’t advise him how to enforce federal laws, how to do his duty — so that was a little unusual, to say the least.”

Morrissey is also troubled:

It’s not necessarily unusual to bring in outside counsel, certainly for corporations (who don’t usually keep litigators on salary), and occasionally for public-sector agencies. It might be a little more unusual to see that in an AG office, which presumably has a plethora of capable litigators available for assignment. However, the retention of outside counsel for any legal effort usually comes in response to a gap in skills or specialties, not in a primary area such as defense of existing statutes for an AG. That’s a key part of the job, after all — what the clients (voters) hired the AG to do. Forcing a client to pay for additional counsel just because an attorney doesn’t particularly like the issue should raise significant ethical questions about lawyers who make that kind of choice. The ethical choice would be to resign from the case, or in this context, to resign from the office so that the client can hire an attorney that wants the job.