Obstacles to Circumcision

[deleted15807]

Following up on :
Clean-Cut: Study Finds Circumcision Helps Prevent HIV and Other Infections: Scientific American

There still remains:
Obstacles Slow an Easy Way to Prevent H.I.V. in Men

Data points:

• Circumcision, which cuts men’s risk of infection by 60 percent or more, has been urged by health authorities since 2007.
• the most obvious, most cost-effective intervention we could use to dramatically change the course of H.I.V. in the near future.”
• cost about $2 billion, but would save $16.5 billion by preventing four million infections and their lifelong treatment costs.
• mass circumcision events, often held in vacation weeks, tens of thousands are performed
• two plastic devices being tested in clinical trials, which allow simpler and faster circumcisions without doctors, will speed adoption on a continent where health workers are scarce.

Fascinating a circumcision without doctors and no anesthesia. Win win.

 

[deleted704937]

All credibility went out the window at "prevents HIV."

 

[Snozzle]

"60 percent or more"
Or less, or not at all.

"Although this "research evidence is compelling," wrote the WHO panel assigned to the topic"
Ah yes, the invitation-only meeting in Montreux, Switzerland, in April 2007, whose membership has never been disclosed, but it's a fair guess that it included all the usual suspects (Halperin, Bailey, Gray, Schoen? Morris?) and a number of useful idiots who rubberstamped whatever was put in front of them.

 

[Dark_Operator]

THANK YOU Travis! lol

 

[mandoman]

Nope.
"Only about 10% to 20% of doctors use the Mogen clamp, according to Dr. David Tomlinson, who teaches family medicine at Brown University in Providence, R.I., and serves as the World Health Organization's chief expert on circumcision."

He also invented the "improved" Gomco, the "improved" Plastibell and the Accu-circ. No conflict of interest there!

I'm in his neighborhood. Halperin's, too. Bailey is nearly having a wet dream.
Does this sound professional to you?
“We’re hacking away at it every month,” Dr. Bailey said. “Those foreskins are flying.”
Such loving regard for his patients, as people. Kind of underwhelms you right here.
Dr. Stefano Bertozzi, director of H.I.V. and tuberculosis for the Bill and Melinda Gates Foundation, which finances circumcision programs, put it even more bluntly. . “This is the equivalent of a 60 percent effective vaccine for men."
No, a vaccine prevents disease. Circumcision is Russian roulette, with one bullet taken out of the chamber.
Bailey again:
“With drugs, you have to get people to take a pill,” which may cause side effects or require increasing doses, said Robert Bailey, an epidemiologist at the University of Illinois at Chicago, who helped design Kenya’s circumcision efforts. “Even if we had a vaccine, we’re probably going to need a booster. With circumcision, you don’t need a booster.”

Still going with the vaccine image, even though it is far from a vaccine. Isn't this irresponsible? Some kids are going to read the article, believe circumcision is like a vaccine, and not use condoms. No side effects? How about bleeding to death, meatal stenosis, hidden penis, MRSA infection, removing the head of the penis, death from anesthesia, you know, the usual things the CDC doesn't keep track of. Bailey forgets these. They're only the reason no medical organization of any country recommends routine infant circumcision. It's risky.
I wrote the editor of the New York Times about that one.
Even the title irritated me. "Obstacles Slow an Easy Way to Prevent H.I.V. in Men".
Easy? For whom? The doctor in the bush, or the guy who is losing half the skin of his penis?
And from yesterday's very pro circumcision paper, the LA Times, this little gem.
Use of Mogen circumcision device called into question - latimes.com
Talk about losing your head!

 

[deleted15807]

The New York Times is a liar? Hilarious.

 

[mandoman]

Jayson Blair - Wikipedia, the free encyclopedia

Times Reporter Accused of Plagiarism Is Said to Resign - NYTimes.com

 

[Hoss]

The New York Times is a liar? Hilarious.

Jayson Blair - Wikipedia, the free encyclopedia

Times Reporter Accused of Plagiarism Is Said to Resign - NYTimes.com

Blair is one of many, he just had the misfortune of getting caught.

 

[D_Miranda_Wrights]

I don't think you need to be a "liar" to write a disingenuous article. A few days ago NYT had an article on the Israeli/Palestine/U.N. thing, and every IR professor at my school (of every position on the issue) thought it was totally off-base on its interpretation. NYT reporters are often tasked with writing articles on issues that they know little about, and won't be punished for filtering through their personal biases. That doesn't make them liars; that just makes them fallible humans acting rationally under pressure.

I do think the research on circumcision and HIV has its compelling elements, but it's a complex issue that's not going to get sufficient treatment through such a short article that quotes folks with a vested interest of providing good p.r. for their preferred health policies. It's just like how I'd never trust a news article on a medical study that only quotes the authors: Their expertise is important, but they also aren't going to provide a balanced view, since their job is to "sell" their research/policies.

 

[thadjock]

this whole thing stinks like another engineered social experiment (note they're focussing their efforts on africa) not unlike that great Tuskegee study which gave placebos to african american males infected with syphillis, and "oops" forgot to tell them.

I hope there's an enterprising lawyer working up a class action lawsuit based on lack of informed consent right now, for all the men of developing countries being led like sheep to the slaughter.

bill gates needs to crawl back in his hobbit hole, and leave cultures that have survived for thousands of years (without his help) alone. making your effective message that getting circumcised protects you from HIV and most other STDs is not going to lower the rate of trasnimssion.....

and PS: If circumcision is that effective at preventing HIV why is it the US, which has one of the highest circ rates in the world does not also have the lowest rate of HIV in the world? maybe it's cuz medical studies only work when they're carefully designed and manipulated to arrive at a predetermined result?

 

[FuzzyKen]

The strange thing about this kind of study is that it has been around for many years and yet when others outside the "super advocates" try to duplicate that work they do not get the same results in their findings.

To me the worst part of this is that some individual thinks that by getting their "weinie whacked" that they are going to prevent something. The best prevention of HIV is the organ between the ears not the one between the legs.

Publication of things like this that could under the right circumstances cause an individual to take risks is fought with problems. I think I would rather think that prevention starts with common sense not with a circumcision.

 

[mandoman]

The really amazing part is how much it really begins to sound like a conspiracy, without even trying. There are three doctors, who conducted the famous South African trio of studies, Daniel T. Halperin, Robert C. Bailey, and Bertan Auvert.
Halperin:
"When asked if being Jewish affects his pro-circumcision bias, he denied it, but said that his Judaism has "crept in now and then". He explains, "think of it as maybe a kind of health/cultural innovation ahead of it's time. So it's made me appreciate my own heritage more. And who knows, maybe finding out to my surprise that my own granddad was a Mohel was a weird kind of confirmation that I'm maybe in some small way 'destined' to help pass along this health benefit to people in parts of the world where it could really make a difference and perhaps save many lives."

Bailey:
“We’re hacking away at it every month,” Dr. Bailey said. “Those foreskins are flying.”
http://www.nytimes.com/2011/09/27/health/27circumcision.

Auvert:
French researcher Dr Bertran Auvert of Versailles University suggested this week that 40% to 50% of circumcisions in Southern Africa were only “ritual” or “partial” circumcisions — where the foreskin was not completely removed.

HIV trials conducted in South Africa, Kenya and Uganda showed that only clinical circumcision could reduce the risk of males getting HIV, said Auvert.
quoted from the Times of South Africa

Dr. Stefano Bertozzi, director of H.I.V. and tuberculosis for the Bill and Melinda Gates Foundation, which finances circumcision programs, put it even more bluntly.

“That we have men that are willing to be circumcised and we haven’t been able to mobilize the resources to get them circumcised — it’s really inexcusable that it’s taking as long as it is,” he said. “This is the equivalent of a 60 percent effective vaccine for men. It’s my No. 1 priority in Africa. It’s clearly the most obvious, most cost-effective intervention we could use to dramatically change the course of H.I.V. in the near future.”

Really? More than condoms? Is circumcision really the equivalent of a vaccine, or are Bertozzi and Bailey full of shit, when Bertozzi says it is equivalent, and Bailey says, “Even if we had a vaccine, we’re probably going to need a booster. With circumcision, you don’t need a booster.” as if circumcision were a vaccine?

Why did studies in 6 other African countries find that men with foreskins were less likely to get infected with HIV?
Where Circumcision Doesn't Prevent HIV - The WHOLE Network: Accurate Circumcision & Foreskin Information

Why were the 3 South African studies never finished? Why did they accept self-identification for circumcision status, when it is so error prone?

Dr. David Tomlinson, teaches family medicine at Brown University in Providence, R.I., and serves as the World Health Organization's chief expert on circumcision. So, it is really a tiny number of doctors, each reinforcing the other, which is presenting us with this information. Tomlinson also invented the "improved" Gomco, the "improved" Plastibell and the Accu-circ. No conflict of interest there!

 

[dude_007]

All credibility went out the window at "prevents HIV."

Actually you are misquoting. It does not claim circumcision prevents HIV, it states that circumcision helps prevent HIV, which is true. Nothing prevents HIV that is transmitted sexually, except abstinence.

 

[Snozzle]

it states that circumcision helps prevent HIV, which is true.

That's a factoid. All we know for sure is that less than two years after circumcising a total of 5,400 paid adult volunteers for circumcision. 64 of them had HIV, 73 fewer than the non-circumcised control groups. 703 men dropped out of the trials, their HIV status unknown. There was no contact tracing, so we have no idea how any of them contracted HIV. At one of the trial sites, Rakai, Uganda, a man risks death for admitting to sex with another man. Dirty needles and medical instruments are rife in Africa. Blood transfusions may not be safe. It is a wild assumption that heterosex was responsible for all the infections and circumcision is responsible for all the difference.

 

[Uncutsouthernboy]

If you look at a breakdown of every country as to its own particular HIV percentage rate, you will see there are countries with a low circumcision rate with high HIV rates and countries with Low circumcision rates with very low HIV rates, countries with high circumcision rate AND high HIV rate. Some of the non-circumcising countries, i.e. Japan, have lower rates than Saudi Arabia or Israel. Some of the circumcising countries in Africa, i.e. Gambia (a muslim nation) has an extremely high HIV rate. Canada and Mexico have low circumcision rates AND low HIV rates. Both are lower than the USA. When you look at it this way, where is the proof that circumcision does anything to prevent HIV?

 

[SirConcis]

I am susprised people still try to compare circ/HIV between africa and western nations.

In africa, it is an epidemic touching the heterosexual population, and men catch it via vaginal sex where the inner foreskin is in direct contact with the HIV virus in the female.

In north america, it is not an epidemic, and poeple get it either via dirty needles (drugs) or via penis or anal sex. Circumcision does nothing to prevent infection via dirty needles or anal. So it has little impact on HIV rates in north america.

But this does not mean that it does not have a significant impact in Africa.

There is also a large question of social behaviour. In western nations, women sleep with far fewer men and when they say "no" it usually means "no". In africa, this is not the case, and a female that gets infected will generally infect many more men beause she will be sleepiing around a lot more. This is where any measure that reduces the spread becomes significant.

While condoms are more effective, one must look at real life. If condoms are worn only 50% of the time, they reduce spread by 50%. Circumcision is worn 100% of the time by a circumcised male, and reduces incidence by 60%.

And different nations have different social values with regards to polygamy in young adults, and different education/social values with regards to condom use. Remember that the previous USA administration was against funding programmes that promoted condom use in africa prefering to fund only programs that promoted abstinence.

Similarly, the catholic pope was, until recently , opposed to the use of condoms.

Circumciison is not THE solution. It is one means to reduce the rate of spreading the disease. And at 60% effectiveness, it is a significant tool.


Of course, you only need 0.1% to catch the disease. But by reducin the odds, it raises the odds that the young adult will find a stable mate and marry before catching it.

 

[Snozzle]

I am susprised people still try to compare circ/HIV between africa and western nations.

So compare it between western nations, and there is no correlation, and compare it between circumcised and intact men within African nations, and the correlations are all over the place.

In africa, it is an epidemic touching the heterosexual population, and men catch it via vaginal sex where the inner foreskin is in direct contact with the HIV virus in the female.

Actually, in Africa a large, but largely unacknowledged source of transmission is contaminated needles and other medical instruments. Contaminated blood supplies and mother to child transmission are also very important.

In north america, it is not an epidemic, and poeple get it either via dirty needles (drugs) or via penis or anal sex. Circumcision does nothing to prevent infection via dirty needles or anal. So it has little impact on HIV rates in north america.

Correct (except that it is epidemic within some populations).

Circumcision is worn 100% of the time by a circumcised male, and reduces incidence by 60%.

This, as I said above, is a factoid (and even then only for female-to-male transmission).

Circumciison is not THE solution. It is one means to reduce the rate of spreading the disease. And at 60% effectiveness, it is a significant tool.

Anyone who thinks that is free to have himself circumcised.

Of course, you only need 0.1% to catch the disease.

????

 

[thadjock]

snozzle is right on every point above.

and anyway there's always somebody trying to invent a new reason for pervs to cut on baby penises, and what's a better ad campaign than "it prevents hiv" that's way better than the other fear based promotions of the past....i mean at this point most (though i'm sure some still think it does) know it doesn't stop masturbation.

Despite all the hygene-hype, and cult/religious obsession with circ, the worlds men remain 80% uncut, and i'm happy to be part of the majority,....to paraphrase the 2nd amendment crowd: "if they want to take my foreskin, they'll have to pry it from my cold dead hand" in the mean time i'll manage my own disease risk with my brain, not a scalpel.

but to get back to the thread title: the main obstacle preventing circ gaining traction in the war against HIV is that big pharma can't monetize a circumcision the same way they can retro-virals and (if they succeed in developing one) a vaccine. Circumcision takes boots on the ground, a pill or vaccine can be manufactured in a lab in NJ and sold to gov't's for a 10,000% profit. there's a reason drug companies rule the world.

foreskin doesn't spread HIV (or any STD), promiscuity does.

 

[SirConcis]

Circumcision in Africa is not done to babies. It is meant as an "urgent" means to curb spread of the epidemic amongst young adults. Young adults are the ones who catch AIDS, so circumcising them is the priority.


Circumcising babies does not help the spread of AIDS now. Circumcising young adults does. So this is where efforts are being made. And young adults are perfectly capable of deciding if they want it or not. So the ethical issue is not a problem here.

 

[thadjock]

Circumcision in Africa is not done to babies. It is meant as an "urgent" means to curb spread of the epidemic amongst young adults. Young adults are the ones who catch AIDS, so circumcising them is the priority.


Circumcising babies does not help the spread of AIDS now. Circumcising young adults does. So this is where efforts are being made. And young adults are perfectly capable of deciding if they want it or not. So the ethical issue is not a problem here.

In the first place, you don't "catch" AIDS, you get exposed to hiv and hiv can, in some people, develop into a random assortment of immune deficiency related diseases. AIDS isnt' a disease, it's a clumsy catch-all label used incorrectly and interchangeably with HIV.

I agree, circumcising babies does nothing to reduce HIV infection rates. but the RIC crowd wasted no time in including these false studies in their tool chest of fear bashing dogma they spew at parents. And promoting unnecessary surgery on the un-informed or ill-informed is a big ethical issue regardless of age.