Session on Ethics in Biomedical Prevention fails to address male circumcision

The International AIDS Society can hardly be blamed for the failure to address male circumcision in their Ethics in Biomedical Prevention session. The 4th IAS Conference is dependent on the submission of abstracts to cover whatever issues are covered. Yet it is quite amazing that at least some researcher somewhere hasn't taken up this issue. So far it's all been lay organizations and the grass roots, with a few exceptions such as Aggleton's paper [pdf].

Still, there is one abstract with lessons that apply to the male circumcision context. How Informed is consent? Using a continuous consent process ... acknowledges that a few, short cursory questions and answers hardly addresses all the issues in any intervention.  The problem of course is that in the microbicide trials under study the ongoing nature of the intervention makes any breakdown in consent easy to correct either by stopping the trial or refreshing the knowledge necessary for consent to remain informed. Obviously, male circumcision is not amenable to this process.

Another concern is that male circumcision is typically researched and promoted by advocates, not scientists seeking purely scientific answers. Therefore, it is highly likely that the information imparted to participants will likely omit certain information and overstate other information. The reason researchers such as Bailey et al can make overbroad statements that "this is as good as evidence gets" is because so far researchers have not followed up on their study participants. A follow up is likely to  change the conclusions.

Bailey has recently said that the slow adoption of male circumcision is because money is not to be made from the procedure. Of course, this is a lie. But more importantly, money isn't the only motivator. Reputation and career ambition motivate, too. And Bailey is a prime exhibit of this.