TIME Magazine's Top 10 Medical Breakthroughs: #1 - circumcision prevents HIV

Time magazine claims that circumcision "can prevent HIV" infection. Apart from naming the lie that such an assertion is, what else can you do about it? I suppose you can write them a letter, go to their talk back page.

Let me share a little insight I have finally begun to rediscover recently. People in the United States are just not equipped to deal with issues requiring critical thinking skills. In this way, Americans are more tribal than our counterparts in the developed world. As such, people in this country by and large simply see nothing wrong with performing medical procedures of marginal value on patients of whatever age. If the parents or some perceived authority figure says it's ok, then it's ok. This is our reality in the United States.

Diseases, such as HIV/AIDS, will come and go as justification and the circumcision rate will rise and fall, but it is a practice that has integrated itself like some annoying viral infection into our DNA. Not until some major disruption comes along will the people of the United States in the masses learn to assess what is or is not good for them.

Link: Top 10 Medical Breakthroughs - 50 Top 10 Lists of 2007 - TIME.

Comments

[Joe in CA]

Already posted in the Talk Back page...

http://time-blog.com/talkback/fiftytoptens.php

Posted by Joe in CA in Salinas, CA
I must say TIME has really jumped the gun this time, posting circumcision to prevent HIV as a "Top Ten Medical Breakthrough." But that's only what can be expected from the biased American media. One can only guess that Ms. Guthrie is Jewish, married to a circumcised man, and/or a mother of circumcised children.

The studies she quotes have a great flaw in them, in that they do not correlate with reality. If circumcision "prevents HIV," how is it that the US suffers the highest HIV rate in the industrialized world, despite being the only country that routinely circumcizes its males? America has been routinely circumcising newborn children for nearly a century now. How is it that America has managed to have a higher rate of HIV than Japan, the UK, Denmark, Germany, or any other country in Europe that does not circumcise?

Shame on Time, for promoting a "medical break-through" that has yet to work in America. It seems fact-checking is not something respectable magazines do nowadays...

[Jack Sprat]

Don't be such sore losers guys. The truth is that the foreskin is a public health risk and that is that. Because you have a sexual 'thingy' for foreskins doesn't change that.

[Joe in CA]

Jack, the truth is that you are repeating a lie that can't be made true any way you slice it. (no pun intended) Instead of repeating lies to try to make yourself feel better for being mutilated at birth, how about actually checking up on the facts, hm?

[Joe in CA]

And watch who you accuse of having a "thingy" for foreskins. Just what do you call people that have a "thingy" for little boys' circumcised penises? Because it's "prettier" and "neater-looking?" It's called a sick, pedophilic fetish is what it is.

[J]

Hey Jack perhaps you could explain why in this very recently published study of the records 58,600 men attending a San Francisco municipal STD clinic between 1996 and 2005 that given the data this large study failed to find a significant association between circumcision status and HIV infection amongst heterosexual, bi, or gay males? You'll have to check the replies, the original author didn't bother to run the numbers.

As Dr. Van Howe said, a far cry from the results from Africa. So how can 10 years of medical records from a STD clinic differ so sharply from these "studies" from Africa? Perhaps for the same reason the Australian Federation of AIDS Organizations released the following July 2007 statement. These are the questions we need to be asking.

But it doesn't really matter because circumcised or not if you're not wearing a condom while having sex with a person whose HIV status is positive or unknown you're playing Russian roulette with your life. As the Australian Federation of AIDS Organization (AFAO) explained: How a man factors the known risk reduction alongside the unknown variables into his sexual decision-making is the important thing. Unless he opts to use condoms with all sexual partners whose HIV status is positive or unknown, he remains at risk of acquiring HIV (and if he does this, there is no need to be circumcised for added protection). That's good advice you should follow it.

The point is, especially considering circumcision's history, we have to be very careful when prophylactic claims are made and since there is a significant ethical component (particularly when discussing infants or children), these discussions also shouldn't occur in an ethical vacuum as it seems they have in the past and even recently.

[Jack Sprat]

Come on guys to be psychosexually motivated is one thing but to try clothe it some sort of pseudo scientific rationale is pretty pathetic.

WHO and UNAIDS have found:
New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications
http://data.unaids.org/pu...mc_recommendations_en.pdf

"Conclusion 1: The research evidence is compelling
The research evidence that male circumcision is efficacious in reducing sexual transmission of HIV from women to men is compelling. The partial protective effect of male circumcision is remarkably consistent across the observational studies (ecological, cross-sectional and cohort) and the three randomized controlled trials conducted in diverse settings.
The three randomised controlled trials showed that male circumcision performed by well-trained medical professionals was safe and reduced the risk of acquiring HIV infection by approximately 60%.
The efficacy of male circumcision in reducing female to male transmission of HIV has been proven beyond reasonable doubt. This is an important landmark in the history of HIV prevention."

"Recommendations :
1.1 Male circumcision should now be recognized as an efficacious intervention for HIV prevention.
1.2 Promoting male circumcision should be recognized as an additional, important strategy for the prevention of heterosexually acquired HIV infection in men."

So when it comes to HIV and circumcision I know that I will believe that WHO and UNAIDS before a motley crew of anti-circumcision groups. Wise up!

[David]

Jack,

I see you have taken the WHO and UNAIDS conclusions at face value. This weblog is about digging beyond those conclusions and looking at all the factors involved, including human rights, appropriateness of prevention technologies in differing settings, modes of transmission, and especially the longstanding, well understood biases of Daniel Halperin, Robert Bailey, and their co-researchers in favor of circumcision.

None of these individuals are doctors. They are primarily statisticians with a desire and preference for circumcision based on reasons known only to themselves. The scientific and political world is desperate for a "breakthrough" in the HIV prevention field. As such, critical thinking, perhaps even by you as well, has essentially dried up on this issue.

If you wish to parrot the non-consensus line, that's fine. However, you'll be corrected in the comments fairly quickly. If you have a new point of view (rather than quotes from WHO and UNAIDS), it will make for a livelier debate.

And please refrain from ad hominem attacks. That goes for all posters viz other commenters or entire groups of people.

Thanks,

David
Editor

[Joe in CA]

"Come on guys to be psychosexually motivated is one thing but to try clothe it some sort of pseudo scientific rationale is pretty pathetic."

Closer inspection reveals who are really the psychosexually motivated in need of a rationale, Jack.

Circumcision is the forced, artificial phenomena, and having a foreskin is not, as it is normal healthy tissue every male is born with, unless it's cut off.

Clearly, it's not keeping the parts one is born with that needs rationale Jack, it's forcefully cutting them off of defenseless individuals.

It works the same with any other naturally occuring part of the body. Who needs to justify themselves? Those proposing that humans keep their toes, or those insisting they should be cut off?

Does it matter that some people might find the toes sexually attractive? And how does that shine on people that think the toe-less, square ended foot is more sexually appealing?

Should it be a person's individual choice to cut his/her toes off? Or can parents choose to cut them off if they think they are more "sexually attractive?"

I think who is "psychosexually motivated" and what party needs to make their side as medically-looking as possible is self-evident.

And you do a good job of parrotting WHO and UNAIDS without actually going into the details of the flawed studies themselves.

That still doesn't answer any of our questions.

Why hasn't circumcision prevented HIV in the US?

Why is it less rampant in other industrialized countries that do not circumcise? (UK, Denmark, Japan, Brazil...)

What's the point of preaching to a country that already circumcises? (But still manages to have a horrible HIV epidemic?)

Have your buddies up at WHO and UNAIDS address those please, instead of merely repeating what they say.

[Laura MacDonald]

Jack Sprat -
A very large study of women in Tanzania has showed this year that female genital cutting may have a significant protective effect against HIV.

http://www.ias-2005.org/planner/Abstracts.aspx?AID=3138

If this circ promotion programme is really about preventing HIV why are we not preparing for an RCT of labial exicision as an HIV preventative? After all female parts are rich in the Langerhans cells that have been demonised by UNAIDS. It all adds up.
It may even be that labial excision also prevents some cases of female genital cancer - more common than penile cancer and it commonly arises in the labia...

Off with them i say, after all, the labia are only there for pleasure and protection, like the foreskin...

What, you don't agree? You think women should have the right to choose to have safe sex and use condoms, rather than be excised as children on presumption about their future behaviour?

Funny that.

I hope you have a very happy festive season. My Christmas wish is that you and people like you do a little bit more research into the history of male circumcision, and open your minds up to the horror of it, and the history of obsessive promoting by people who don't want others to enjoy a sexual part they had torn from them at birth.

It will help if you look at what it involves - there's a video with sound available at www.intact.ca

One final word on complications....Commonly we hear that female circ can result in ulceration - just one of the many reasons to ban it they say. This poor agonised little boy will be very likely (20-30%) to experience ulceration of the tip of his glans as a result of his circ. Despite the pain this will cause him as acidic urine seeps into it day after day and the risk it raises of a urethral blockage developing, Doctors and pro-circers, in their infinite wisdom, have decreed that meatal ulcers be considered so minor a complication they are often not even reported in the typical stats you read about adverse effects.

For me, that fact says it all about the hypocrisy of the way female and male genital cutting are viewed.

[J]

Jack like Dave said you have to dig deeper and perhaps apply some critical thinking. Again I draw your attention to the a recent publication by Australian Federation of AIDS Organizations statement released in July 2007 where they were sure to point out that:

• “Male circumcision has no role in the Australian HIV epidemic”
• “African data on circumcision is context-specific and cannot be extrapolated to the Australian epidemic in any way.” Do you think the US is anthropologically more like Australia or Africa?
• Oh and this one is my favorite: “The USA has a growing heterosexual epidemic and very high rates of circumcision”

The French National Council on Aids (Conseil national du SIDA) in their September 2007 report concluded: The recommendations of the WHO state that this strategy is aimed at countries with high prevalence, and not at countries with low prevalence or in countries where it relates specifically to one part of the population such as in France or the United States. Do you think the US is anthropologically more like France or Africa?

The Kenya report spotlighted a 53% reduction of HIV acquisition in circumcised men relative to genitally intact men. However, only 47 of the 1,391 (one in 30) genitally intact men in the study contracted HIV, compared to 22 of the 1,393 (one in 63) circumcised men. These figures showed that about 56 circumcisions were needed to prevent one HIV infection, and 55 out of 56 circumcised men received no benefit. In the Uganda study, investigators estimated that 67 circumcisions were needed to prevent one HIV infection while the rate of moderate and severe circumcision complications was about 4%. Therefore, the chance of such a complication was more than 2.5 times greater than the chance of protection from an HIV infection, not including complications that would appear years later. In addition, an association between circumcision and HIV infection does not prove a cause and effect relationship. There could be confounding variables. For example, the study does not account for cultural bias on the part of researchers. We recommend using the common sense test: if any other healthy body part (e.g., finger, toe, ear) were recommended for removal to prevent an unlikely disease, would American observers respond with equal approval?

We also need to keep in mind that 50%/60% represents a relative risk reduction not a prevention. From the example above, we see the absolute risk reduction is about 2%. The absolute risk reduction would be far lower in a country like the US, at least in the tenths but perhaps even in the hundredths of a percent which is, in part, why the Australians and the French published what they published. Even if we were to assume that the same relative risk reduction would be seen in the US (say from 0.2% to 0.1% or 0.02% to 0.01%), the number of circumcisions required to save one individual would be far more, at least 6 times higher. Six time more boys who would receive no benefit, six time more boys that would be put at risk for moderate to serious complications. All so that we can prevent HIV in one individual who should have been using a condom anyway. It is also, in part, why the Tasmanian Children's Commissioner, Paul Mason, has called for a ban on infant male circumcision and has recently gained the support of the Australian Medical Association.

The thing is that it is very likely that the African "study" doesn't travel well. At least two recent studies found that circumcision had no protective value for bi/gay men and a very recently published study examining the clinical records of 58,600 men in San Francisco showed no significant protective effect for heterosexual, bi, or gay men. The respondents performed the calculation which showed a substantial difference from what was "learned" in Africa. The relative risk reduction for a heterosexual man was a mere 7%, an absolute risk reduction would be a pittance.

But lets dispense with all this "analysis"; it completely misses the point. Rather lets get down to the proverbial brass tacks and answer me this one question. If you are circumcised can you have unprotected sex with a partner whose HIV status is positive or unknown and NOT worry about getting infected?

If you say Yes, we clearly have a problem (well not me because I'll say No). If you say No then you must agree with the AFAO statement: How a man factors the known risk reduction alongside the unknown variables into his sexual decision-making is the important thing. Unless he opts to use condoms with all sexual partners whose HIV status is positive or unknown, he remains at risk of acquiring HIV (and if he does this, there is no need to be circumcised for added protection). And I then have to ask if the actual method of prevention (condoms) doesn't change based on circumcision status why bother? Particularly in the US where HIV is confined to certain high risk groups, sanitary conditions and access to doctors is sufficient, and the average age of infection is something like 36. To be sure if an adult wants that extra 2%, 0.2%, 0.02% or perhaps even less, they are free to get a circumcision if they want it; however, when talking about infants or children who have no ability to consent to a procedure whose benefits wouldn't be realized, particularly in the west, until a child has reached majority requires a wholly different ethical analysis. Would you support circumcising your daughter based on the results of this study of circumcised African women in Tanzania? They found that the female circumcision may have a significant protective effect against HIV. Now for mass implementation I am not thinking glass scalpels and dirty huts but a nice doctor in a white lab coat in a sanitary hospital with clean implements and your daughter restrained spread eagle in the maternity nursery perhaps a day or so after she was born.

The world health community (as it pertains to Africa) is desperate, as Dave said perhaps because they're out of good ideas. This is a dangerous place to be and we can only hope that common sense wins out because when the media, study authors, and other people use a word like prevents rather than reduces risk in conjunction with a problem as serious as HIV in Africa they run a very real risk of undoing much of the hard work that has been performed to get people to begin to protect themselves; a message that is beginning to show results. Stating that circumcision prevents rather than reduces risk is a message that has a very real chance of being misinterpreted and it is already happening, in this recent article we have this gem "Aah," one subject said during trials, "I have a natural condom." There is a circumcised man who will get HIV in part because now he believes he has a "natural condom".

[Joe in CA]

Similar study that suggests women "benefit" from genital cutting...

http://www.ias-2005.org/planner/Abstracts.aspx?AID=3138

It's only a matter of time before WHO and UNAIDS realizes these studies too, I'm sure.

[Joe in CA]

AND!!! Speaking of those nasty Langerhans cells...

http://www.cirp.org/news/healthday2007-03-05/

How EVER did those studies arrive at their conclusions.

Oh, dear DEAR.

[Jack Sprat]

You must try some independent thought and some critical thinking in these matters. How do you expect to be taken seriously when all you can do is cite chapter and verse from some anti-circ website? Just see a rote regurgitation of stuff other people have told you to believe and you just snap to attention and believe it. I would recommend that a little more time be spent making your own minds up rather than merely following the leader. Take this site for example its sole purpose seems to be to be to attempt to undermine the connection between the lack of male circumcision and a higher rate of female to male HIV infection. Now the one thing that is absolutely clear is that this blogs aim is a lost cause that's why other stuff has to be introduced to try to make the case. Its not working. This blog is irrelevant and is making participants a laughing stock through their blind faith cult like behavior. It really is sad to see.

[Joe in CA]

"You must try some independent thought and some critical thinking in these matters... Just see a rote regurgitation of stuff other people have told you to believe and you just snap to attention and believe it. I would recommend that a little more time be spent making your own minds up rather than merely following the leader."

Quoth the guy who cut and pasted from UNAIDS and WHO.

Jack, not merely believing accepting what people say at face value and asking questions is what independent and critical thinkers DO.

That circumcision does not prevent HIV is self-evident.

Continuing to assert that it does, despite the painful reality, is an insult to people's intelligence.

"I would recommend that a little more time be spent making your own minds up rather than merely following the leader."

And I would recommend that you follow your own advice.

[Joe in CA]

"Take this site for example..."

As an example of what?

"...its sole purpose seems to be to be to attempt to undermine the connection between the lack of male circumcision and a higher rate of female to male HIV infection."

There is no need to disprove the self-evident.

You have yet to explain why circumcision hasn't prevented HIV in the US.

Jack? Countless countries in Europe do not circumcise. Yet, they seem to have a lower HIV rate than the US, which does.

Why is this?

You can attempt at dismissing this question as "taken from an anti-circ site," but that is still clearly EVASION, and not an answer.

Are you going to even address this? Or are you going to cut and paste more WHO and UNAIDS statements?

[Joe in CA]

"Now the one thing that is absolutely clear is that this blogs aim is a lost cause that's why other stuff has to be introduced to try to make the case. Its not working. This blog is irrelevant and is making participants a laughing stock through their blind faith cult like behavior. It really is sad to see."

Jack, you found this blog relevant enough to post in it.

Could you tell us what that is?

[Jack Sprat]

Ok, now I understand. Critical thinking only applies to studies which produce results that are not foreskin friendly. I'm a little concerned about the intellectual dishonesty of that approach but hey if that's what you guys are into then I can merely observe in morbid fascination.

Why not demonstrate your critical thinking ability by applying it to the NOCIRC study? Show me how you would analyze that crock in the same rigorous way you would if the result was not foreskin friendly. I dare you.

[Joe in CA]

Look, this conversation has gone ridiculously off topic.

It all boils down to one question:

DOES circumcision prevent HIV?

The answer is no.

The fact is that circumcised men contract HIV and die of AIDS every day.

At a much higher rate in the US, where circumcision is common practice, than in countries in Europe, where it is not.

There is nothing WHO or UNAIDS can do to deny this reality.

Circumcision does NOT prevent HIV, and TIME magazine is doing the AIDS movement a disservice by publishing "Circumcision Prevents HIV" as a "medical break-through."

[Joe in CA]

"Ok, now I understand. Critical thinking only applies to studies which produce results that are not foreskin friendly. I'm a little concerned about the intellectual dishonesty of that approach but hey if that's what you guys are into then I can merely observe in morbid fascination."

Well for once you are using your head.

Any "study" that suggests the amputation of a normal, healthy body part in order to prevent some sort of medical condition should raise eye-brows.

Doctors are supposed to CURE things. Find a way in which a disease can be alleviated while trying their best to preserve the bodily integrity of an individual as much as possible.

A woman can elliminate her chances of ever getting breast-cancer by removing her breasts.

I suppose a woman, or the doctor who is trying to preserve the integrity of her breasts has some sort of "morbid fascination" with breasts?

I may develop diabetes, and I might develop hammer-toe as a result. I suppose I might have a "morbid fascination" with my toes for not wanting to cut them off early.

[Joe in CA]

"Why not demonstrate your critical thinking ability by applying it to the NOCIRC study? Show me how you would analyze that crock in the same rigorous way you would if the result was not foreskin friendly. I dare you."

This makes absolutely no sense whatsoever.

The Sorrell's study of which you speak deals with the effects of circumcision on the sensitivity of the penis.

Circumcision does not prevent the contraction of HIV, and TIME is publishing lies.

That there are studies that say that circumcision desensitizes the penis or not is irrelevant.

[J]

Jack - Lets dispense with all this "analysis"; it completely misses the point. Rather lets get down to the proverbial brass tacks and answer me this one question. If you are circumcised can you have unprotected sex with a partner whose HIV status is positive or unknown and NOT worry about getting infected?

If you say Yes, we clearly have a problem (well not me because I'll say No). If you say No then you must agree with the AFAO statement: How a man factors the known risk reduction alongside the unknown variables into his sexual decision-making is the important thing. Unless he opts to use condoms with all sexual partners whose HIV status is positive or unknown, he remains at risk of acquiring HIV (and if he does this, there is no need to be circumcised for added protection). And I then have to ask if the actual method of prevention (condoms) doesn't change based on circumcision status why bother? Particularly in the US where HIV is confined to certain high risk groups, sanitary conditions and access to doctors is sufficient, and the average age of infection is something like 36.

The critical point is this you have only two options:

A. You don't need a circumcision, but you need to always wear a condom and you ought to be choosy about your sex partners.

B. You can get a circumcision but you need to always wear a condom and you ought to be choosy about your sex partners.

The primary advice simply doesn't change, you still need to always wear a condom and you must limit and be choosy about your sex partners. Along side condoms and selectivity, circumcision is not a fail-safe it is irrelevant. Which makes a campaign like this not only unethical but also a resource sink draining what little money there is into an intervention that still needs the support of less invasive more effective methods anyway.

To consider circumcision is to consider a situation where you might try and forgo the condom for whatever reason and presume that since your circumcised it's fine. All that shows is that the neither the man nor the woman are thinking too hard. In a low HIV prevalence population this is a bad idea, in a pandemic zone this is suicidal. But if adults think their circumcisions will protect them, spin the barrel, pull the trigger you only have to be wrong once.

[BDF]

I'm not really an activist when it comes to circumcision but I have lurked around some of these boards a bit and it's a little sad. Even on the sites that are in favor of circumcision, the only intellgent and rational arguments are coming from the anti-circ side. Not only do they cite sources and facts, but they rationally and logically defend the facts withouth throwing hissy fits and chilishly insulting the other side.
And the pro-circs? Sad to say, I have as yet to see any pro circ give a rational or intelligent defense of circumcision. Like, I said, I haven't been lurking these boards for very long, things look a little mismatched. Jack Sprat here is a good example. Note that in none of his rants does he even attempt to answer the questions asked of him. It seems to me that Jack doesn't even really belive any of what he says in fundamental way, as he cannot defend it in any way. He has so far copied directly from websites reporting bad data from dlawed tests, and when confronted with this fact, said that people needed to make up their own minds.
Can you say tactics?
Jack tried to convince us that circumcision prevents HIV by quoting flawed data, and when he was presented facts, he gave us this drivel

"You must try some independent thought and some critical thinking in these matters. How do you expect to be taken seriously when all you can do is cite chapter and verse from some anti-circ website? Just see a rote regurgitation of stuff other people have told you to believe and you just snap to attention and believe it. I would recommend that a little more time be spent making your own minds up rather than merely following the leader."

Not only do his arguents make no sense, but he can't even defend THEM in an original way. Jack accuses the anti-circs of having "blind faith" and "cult-like" behavior. But only ONE person on this board has not been able to back up anything he said. We're looking at you Mr. Sprat.
But this is just a lead in to the main problem. WHY are people unwilling to have an open mind to the fact that MAYBE circumcision isnt this wonderful wonderful medical breakthrough? Even when shown conclusive evidence and even (dare I say it?) proof of just that?
It's because of a problem gripping america, and indeed the whole world. Just plain not wanting to deal with sh**. People don't want to call circumcision what it is becasue they are unwilling to admit such a terrible thing could possibly happen to their country, there friends, indeed to them.
But not calling circumcision mutilation doesnt change the brutality of what has happened to and is happening to bilions of men. No matter who's feelings hurt, we have to star dealing with things as they are

[SunkenShip]

It appears Jack is having fun imitating David W on the Time talkback page. How mature.

BDF, you're spot on when you say that the pro-circ people rarely come up with mature, intelligent responses when they're challenged. They're all huff and puff.

[Joe in CA]

HAH!

Talk about "following the leader..."

[Jack Sprat]

Merry Christmas boys!

When challenged with: "Why not demonstrate your critical thinking ability by applying it to the NOCIRC study?" the response was "This makes absolutely no sense whatsoever."

heh heh heh ... may I suggest you start at the beginning and look at how the participants in the NOCIRC study were recruited.