Individual Preferences Need Not Be Cost-Effective

With an opening paragraph like this, I’m inclined to cheer:

A group of top world economists said Wednesday that adult male circumcision, a global priority for preventing HIV infection, is not nearly as cost-effective as other methods of prevention.

They’re economists. I generally expect sensible reasoning from economists, so this is good. Except, reading beyond this first paragraph reveals something unexpected:

The group told representatives of global organizations at Georgetown University that more cost-effective ways to prevent the spread of the disease are an HIV vaccine, infant male circumcision, preventing mother-to-child transmission of the disease and making blood transfusions safe.

Including infant male circumcision in that list is offensive. Like medicine there’s more to economics than just numbers. We cannot ignore the ethical human rights violation involved in non-therapeutic male child circumcision in favor of saving a few dollars.

To be fair, stating that (forced) infant male circumcision is more cost-effective than (voluntary) adult male circumcision is not an endorsement of the former. It will be read as such, and there may be some willingness amongst these economists to endorse that view. I don’t know, so I’m going assume the most charitable reading possible.

However, to demonstrate the importance of including ethics, consider a hypothetical: a bullet is cheaper than life-extending medical care for terminal patients. Is it reasonable (i.e. ethical) to state that euthenasia and suicide are more cost-effective than treatment unlikely to work without also acknowledging the very important ethical caveats in the cheaper solutions?

Consider this from the article:

A successful adult male circumcision effort would require “a large public campaign to get people into the clinic,” said Bjorn Lomborg, director of the Copenhagen Consensus Center, a Danish think tank focused on cost-effective public spending that commissioned the panel.

Getting men to volunteer to be circumcised would not be easy and “it could cause more risky behavior,” Lomborg said.

If it won’t be easy getting men to volunteer, and I think he’s correct, then it’s unethical to force circumcision on a child. Circumcising a child removes the choice from that male to have himself circumcised or not as an adult when we readily understand and accept that he won’t likely volunteer if left with his choice.

Also, to my knowledge, there has been no assessment of whether forced infant male circumcision is effective at preventing reducing any risk of HIV transmission. Assuming that infant and adult male circumcision are the same is unscientific.