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briandavidearp's profile
Brian D. Earp
Brian D. Earp
Brian D. Earp
@briandavidearp

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Brian D. Earp

@briandavidearp

@Yale; @UniofOxford; @hastingscenter; @TheAtlantic - psychology, philosophy of science, bioethics, tech, politics, gender and sexuality, etc. RT ≠ endorsement.

oxford.academia.edu/BrianEarp
Joined July 2011

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    Brian D. Earp‏ @briandavidearp 27 Dec 2018

    Here is a little window into how the medical literature can get biased by controversial opinions disguised as 'systematic reviews' for anyone interested. I'll walk you through an example. Take this highly cited review article in the flagship @jsexmed https://www.sciencedirect.com/science/article/pii/S1743609515301727 …pic.twitter.com/nq8xj5Ige3

    9:53 PM - 27 Dec 2018
    • 404 Retweets
    • 760 Likes
    • Jennifer Rorex Seditious_Percy Abdul Alhazeerd yung chadzillion roofking tadiyashi 🌲🇰🇷🇺🇸 Chad Chandler Richard Knott Carlos Osuna 🐸🇵🇾 Frances EHV87
    44 replies 404 retweets 760 likes
      1. New conversation
      2. Brian D. Earp‏ @briandavidearp 27 Dec 2018

        It purports to show that the "highest quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, or satisfaction." Okay, how was the quality of studies rated, who did the rating, and is that what the studies actually show?pic.twitter.com/wmAgq6dq5c

        3 replies 10 retweets 84 likes
        Show this thread
      3. Brian D. Earp‏ @briandavidearp 27 Dec 2018

        First, just notice that the authors report "no conflict of interest." Which is weird because the first author is co-founder of a pro-circumcision lobbying organization called the Circumcision Academy of Australia, several of whose board members derive their primary incomes frompic.twitter.com/ziuHul340d

        3 replies 27 retweets 179 likes
        Show this thread
      4. Brian D. Earp‏ @briandavidearp 27 Dec 2018

        performing medically unnecessary circumcisions (see https://www.tandfonline.com/doi/full/10.1080/17441692.2016.1184292 …); and the second author had, months before this publication came out, filed a patent application for a device he invented for performing such circumcisions.pic.twitter.com/slvWyqxdbl

        2 replies 11 retweets 114 likes
        Show this thread
      5. Brian D. Earp‏ @briandavidearp 27 Dec 2018

        See: https://patents.google.com/patent/WO2013173804A1/ko …. But no matter. Even if they didn't actually report their glaring conflicts of interest, perhaps they took care to build in strict precautions in their assessment of the available evidence to guard against any potential biases?pic.twitter.com/XIPfSXWtpo

        3 replies 8 retweets 82 likes
        Show this thread
      6. Brian D. Earp‏ @briandavidearp 27 Dec 2018

        Unfortunately not. Although they nominally used the SIGN criteria for assigning levels of evidence (http://www.guiasalud.es/egpc/traduccion/ingles/parto_normal/completa/documentos/apartado00/levels_of_evidence.pdf …), they failed to employ a "carefully assembled multidisciplinary group" as the guidelines for proper use of the criteria require. As @JennBossio et al. note

        1 reply 7 retweets 70 likes
        Show this thread
      7. Brian D. Earp‏ @briandavidearp 27 Dec 2018

        "It appears the two authors alone composed the group who rated the articles. According to the SIGN criteria they used, would their entire review in question not warrant a rating of 'low quality' based on the 'high risk of bias' introduced by the authors' well documented,pic.twitter.com/PeIVK8uGrY

        2 replies 7 retweets 80 likes
        Show this thread
      8. Brian D. Earp‏ @briandavidearp 27 Dec 2018

        unconditional support of the practice of circumcision?" (https://www.ncbi.nlm.nih.gov/pubmed/25761651 ). But as I explain in "The Unbearable Asymmetry of Bullshit" (https://www.healthwatch-uk.org/images/Newsletters/Number_101_BE.pdf …) such letters to the editor are MUCH less visible than original "systematic reviews,"pic.twitter.com/0gaYLJVipJ

        2 replies 9 retweets 88 likes
        Show this thread
      9. Brian D. Earp‏ @briandavidearp 27 Dec 2018

        so the latter continue to get cited (111 times since 2013 in this case), while the former are rarely noticed and tend 2 have little impact (6 citations to the Bossio et al. letter, 4 of them in articles by me). In another paper, Bossio et al. (https://www.sciencedirect.com/science/article/pii/S1743609515306391 …) notepic.twitter.com/E5TsmhN66z

        1 reply 4 retweets 63 likes
        Show this thread
      10. Brian D. Earp‏ @briandavidearp 27 Dec 2018

        that the big headline conclusion that male circumcision has no negative impact on sexual function, sensitivity, or satisfaction does not even line up with the evidence actually presented in the review by Morris & Krieger, but is more their "interpretation of trends" (see below).pic.twitter.com/qneFzBxmWM

        3 replies 8 retweets 82 likes
        Show this thread
      11. Brian D. Earp‏ @briandavidearp 27 Dec 2018

        Another author has argued (again, in a much less visible publication), that the ratings of study quality by M&K have more 2 do with the *results* of the study (whether it favors their conclusion or not) than the actual quality of the study (see screenshot) https://file.scirp.org/pdf/ASM_2015033116102429.pdf …pic.twitter.com/MtTj7xT9h4

        1 reply 5 retweets 67 likes
        Show this thread
      12. Brian D. Earp‏ @briandavidearp 27 Dec 2018

        Nevertheless, this "systematic review" - with its headline conclusion that is not even supported by the evidence presented in it - continues to be referenced as the 'final' word on the subject in key sources used by unsuspecting doctors like @UpToDate http://www.littlesproutings.com/wp-content/uploads/2015/07/Neonatal-circumcision_-Risks-and-benefits.pdf …pic.twitter.com/GRDLEVKx1A

        1 reply 6 retweets 68 likes
        Show this thread
      13. Brian D. Earp‏ @briandavidearp 27 Dec 2018

        In sum, that is how a polarized position held by a small, committed coterie can get dressed up as an objective-seeming "systematic review" which goes on to distort the subsequent literature (and associated policy) for years to come, as discussed here https://www.tandfonline.com/doi/abs/10.1080/17441692.2016.1272939?journalCode=rgph20 …pic.twitter.com/IoO0ulOVBT

        1 reply 20 retweets 113 likes
        Show this thread
      14. Brian D. Earp‏ @briandavidearp 27 Dec 2018

        And because it is so much harder (not to mention time-consuming) to get a proper rebuttal of such biased reviews into the same flagship journals that initially published them, you get an "asymmetry of bullshit" situation as noted here https://www.healthwatch-uk.org/images/Newsletters/Number_101_BE.pdf … (credit: @ziobrando)pic.twitter.com/ishJjd7bHN

        5 replies 66 retweets 257 likes
        Show this thread
      15. Brian D. Earp‏ @briandavidearp 27 Dec 2018

        As for the issue of sexually-relevant effects. Circumcision removes the most sensitive parts of the penis to light-touch; so penile sensitivity is *necessarily* affected by circumcision (see my discussion here https://onlinelibrary.wiley.com/doi/abs/10.1002/tre.531 …). Whether that amounts to a sexual harm is ...

        3 replies 6 retweets 81 likes
        Show this thread
      16. Brian D. Earp‏ @briandavidearp 27 Dec 2018

        complicated but @RobDarbyCanberr and I have a lengthy discussion of the concept of sexual harm as it relates to the available evidence here: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2986449 …

        3 replies 6 retweets 64 likes
        Show this thread
      17. Brian D. Earp‏ @briandavidearp 28 Dec 2018

        P.S. When I say "small coterie" I mean this kind of thing (see screen shot) - from Retraction Watch https://retractionwatch.com/2016/11/22/journal-editor-resigns-over-firestorm-from-circumcision-article/ …pic.twitter.com/vjXEwZKA6v

        6 replies 5 retweets 63 likes
        Show this thread
      18. End of conversation
      1. New conversation
      2. La bête philosophe‏ @Atrxc 28 Dec 2018
        Replying to @briandavidearp @jsexmed

        The part about conflict of interest. It's sort of vague if it's not for profit. For ex, would you have to disclose your interest in anti-circumcision activism?

        1 reply 0 retweets 4 likes
      3. Brian D. Earp‏ @briandavidearp 28 Dec 2018
        Replying to @Atrxc @jsexmed

        When I publish empirical work in this area I explicitly disclose that I have written articles on the medical ethics of non-therapeutic genital cutting in children & state what measures I’ve taken to guard against any potential bias, yes. https://www.researchgate.net/profile/Brian_Earp/publication/320719227/inline/jsViewer/59f7676faca272607e2d8198 …pic.twitter.com/zzWL7rRtaJ

        1 reply 2 retweets 39 likes
      4. Brian D. Earp‏ @briandavidearp 28 Dec 2018
        Replying to @briandavidearp @Atrxc @jsexmed

        Also, I am not interested in “anti-circumcision activism” and am not opposed to circumcision per se. I apply standard medical ethics analyses to non-therapeutic surgeries of various kinds performed without consent on children of all sexes

        1 reply 1 retweet 29 likes
      5. 1 more reply

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