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  • David Wilton

    David Wilton is a lawyer by training. He has a long-standing interest in issues of body integrity and HIV/AIDS. He maintains this site and blogs from San Francisco, California. His primary interests outside of nurturing a debate on the controversial measure of removing sexual tissue to reduce the spread of HIV are in the areas of international relations, languages, and journalism.
  • Adrienne Soti
    Adrienne Soti has provided research and monitoring of the media for Male Circumcision and HIV. A native of Hungary who came to the US in 1990, she lives with her husband and two small children in New Jersey. She has a B.A. in Psychology and Philosophy from Rutgers University. She lists biology and medicine among her many interests and is particularly interested in bio-ethical issues. The circumcision controversy came to her attention after the birth of her son in 2005.

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« Circumcised men experience more pain and have greater difficulty penetrating, study shows; authors, BBC wish it were otherwise | Main | Notebook: Circumcision as Lucky Charm »

Tuesday, January 08, 2008

Running the numbers: relative vs. absolute satisfaction for the intact vs. circumcised

I lifted these numbers from the forums on Mothering.com. Thanks to the posting party, "jwhispers." The interesting point here is the absolute vs. relative values that lead to broad conclusions that may or may not in fact be instructive (or for that matter, misleading). The complexity of informed consent is really hard to fathom with these kinds of numbers.

Some 98.4% (2460) of the circumcised men reported satisfaction, compared to 99.9% (2498) in the control group.

Or rather 1.6% (40) of the circumcised men reported dissatisfaction and 0.1% (2) of the control group.

In terms of ability to penetrate, 98.6% (2465) of the circumcised group reported no problem, compared with 99.4 (2485) of the non-circumcised group.

Or rather in terms of ability to penetrate, 1.4% (35) of the circumcised group reported problems, compared with 0.6% (15) of the control group.

So what they're really saying is 20x more circumcised men reported dissatisfaction and more than 2x as many reported problems with respect to penetration.

To be fair, people who say circumcision does not provide a level of protection against HIV have sometimes stated their position in absolute numbers. But the point here is that people like Gray, Halperin, Klausner, and Bailey gloss over this counterpoint to their relative numbers, but then use absolute numbers in an attempt to persuade the skeptical that it's all ok to submit to a very serious surgery. In fact, their claim is that there is NO difference ("statistically insignificant") when in fact there IS a difference.

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Comments

Closer inspection reveals that this study really shoots pro-circumcisionists in the foot.

Regardless of what group is more satisfied (and clearly, even according to this rigged study [Seriously. Who believes self-reporting anymore? Would you have unprotected sex with someone who "told" you they were HIV negative?], it is the group with normal penises who report a higher level of satisfaction), circumcision does not prevent AIDS. "Level of satisfaction" is irrelevant.

"Level of satisfaction" is related to HIV prevention, kind of like how cheese is related to chalk.

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Elsewhere on the Web

  • Circumcision and AIDS at MGMbill.org
    A decidedly anti-circumcision site with a calm approach to addressing the human rights issues likely to become problematic in the rush to roll out circumcision as an HIV prophylactic.
  • Circumcision and HIV at circumstitions.com
    One of the most thorough reviews anywhere of circumcision and the history behind the HIV prevention community's study of it. The science behind this prophylactic tool is much more equivocal than the most recent researchers would have you believe. New Zealand based.
  • Circumcision and HIV: Harm Outweighs Benefits from circumcision.org
    From the Circumcision Resource Center, Boston, Massachusetts. This human rights organization has published such books as Questioning Circumcision: A Jewish Perspective and Circumcision: The Hidden Trauma. Sitting on its board are a number of individuals affiliated with Harvard and other Ivy League institutions.
  • Circumcision and HIV infection from CIRP.org
    From the Circumcision Information Resource Pages. Not as up-to-date, but an excellent primer on the issue.
  • Doctors Opposing Circumcision statement on HIV
    Doctor's Opposing Circumcision is a Seattle based physicians group that provides education, information and advice on medical circumcision and its effects.
  • Statement on AIDS and Circumcision from the International Coalition for Genital Integrity
    Another thorough treatment of male circumcision's likely impact on the spread of HIV from an "alliance of organizations dedicated to protecting the normal anatomy of males, females and the intersexed ... [that] was formed to coalesce the many activist organizations, each with a specific focus, into one, common voice."
  • Does circumcision prevent HIV infection? - NORM-UK
    John Dalton puts together a critique of the African studies and their weaknesses. He examines the evidence, appropriateness, and possible outcomes from promoting circumcision and calling it a "prevention."

Sources

  • HIV/AIDS Medscape [free registration required]
    This site is owned by WebMD.com. It is a great source for breaking news. I wouldn't necessarily trust it completely on the issue of circumcision as it is US-based. But the HIV/AIDS coverage is pretty good.
  • UCSF HIV InSite Gateway to HIV Information
    The University of California - San Francisco is a leading medical teaching and research university in the HIV/AIDS field. Generally very reliable, it occasionally oversells or misstates the prevention message, most obviously and unfortunately regarding circumcision.
  • IRIN PlusNews
    I don't like this source because it tends to be a bit sensationalist, in my opinion. But it is pretty good for divining which way the wind is blowing.
  • Aidsmap: Circumcision News
    An otherwise great source, they have recently begun to climb on the bandwagon. The tone of the reports seem reticent as evidenced by their providing some great quotes. Coincidence? Inadvertent? Maybe, but hope not.

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