Circumcision Isn’t for Everyone Anymore

BY  |  Thursday, Mar 03, 2011 11:00am  |  COMMENTS (124)

While a new measure to ban male circumcision is taking shape this month in San Francisco, the American Academy of Pediatrics is poised to issue their new policy, which is expected to turn from a neutral position to one advocating for the procedure. A procedure that is already on the decline.

A study conducted last year found that fewer than half of American baby boys are being circumcised. In fact, the circumcision rate dropped from 56% in 2006 to 32.5% in 2009, a significant decrease especially considering the U.S. currently has one of the highest circumcision rates in the developed world with 80% of men circumcised. Until fairly recently the rate remained high with two-thirds of boys circumcised throughout the 80′s and early 90′s. But the data is not definitive as it does not include procedures done outside hospitals (like those at Jewish religious ceremonies) or those not covered by insurance.

The statistics were originally compiled to determine the rate of complications from the procedure rather than to measure the circumcision rate, but last summer a researcher for the Center for Disease Control (CDC) presented the data at the International AIDS Conference in Vienna, and word spread.

Opponents of male circumcision hail the findings as a triumph over what they consider to be genital mutilation. One such opponent, San Francisco resident Lloyd Schofield, has gone as far as to attempt to to make circumcision on males below the age of 18 illegal. The measure may appear on the ballot if Schofield can get the 7,138 signatures he needs by April 26. He asserts it’s a human rights issue given the city has already declared female circumcision illegal.

The World Health Organization, meanwhile, endorsed male circumcision in 2007 as an significant measure to reduce the risk of transmitting AIDS. The diminished risk, however, only pertains when referring to heterosexual sex and only appears to help shield the man from getting infected. (There is no evidence that circumcision helps prevent a woman from contracting aids from an infected male partner). Circumcision also does not seem to protect those at greatest risk, men who engage in sex with men.

So is it barbaric mutilation, a necessary health precaution or a sacrosanct religious ritual?

(Photo: Flickr/abbybatchelder)

124 Comments

  1. POSTED BY croiagusanam  |  March 03, 2011 @ 11:29 am

    Good info.

    Thanks for the tip.

  2. POSTED BY tomtraubert  |  March 03, 2011 @ 12:07 pm

    I see what you did there, Cro.

  3. POSTED BY croiagusanam  |  March 03, 2011 @ 12:33 pm

    Tom, it won’t be long now (as the rabbi said) till THE MODERATOR does too.

  4. POSTED BY kay  |  March 03, 2011 @ 12:34 pm

    LOL Cro!

    Aside from the question at hand … does this mean that the good people of San Fran have already had their precious tax money spent on such a ludicrous ballot initiative as banning female circumcision? I mean, really. This is the USA, right? Isn’t this akin to a ballot initiative banning pet polar bears? Or a prohibition on launching a dirigible from your back yard?

    Am I missing something here?

  5. POSTED BY hollykorusjenkins  |  March 03, 2011 @ 12:51 pm

    Cro, your comments make me laugh daily. Thank you for that. Kay, I’m confused….are you saying we are not allowed to have per polar bears? Crap if I’m going to have two very sad kids when the town comes to take away “Stay Puff”.
    Barbaric mutilation? No. Having a boy I read many pro’s and cons for both sides. I believe ultimately it should be for the parents to decide.

  6. POSTED BY croiagusanam  |  March 03, 2011 @ 1:12 pm

    Ah but Kay, San Francisco is different!

    Both dirigibles AND pet polar bears are legal there.

    http://www.airshipventures.com/img/photo008roger_cain_2.jpg

    http://www.michelelloyd.com/professional/images/PS_Bear9.jpg

  7. POSTED BY Conan  |  March 03, 2011 @ 2:42 pm

    What’s all the turmohel about?

  8. POSTED BY kay  |  March 03, 2011 @ 3:52 pm

    Cro, mo chara, you slay me!

    though I’d have to argue that the dirigible photo doesn’t necessarily prove that it was inflated in the back yards of Heritage Hill, or in Piedmont.

  9. POSTED BY Spiro T. Quayle  |  March 03, 2011 @ 6:29 pm

    So this guy goes to the mohel ( Jewish ritual circumcision dude) and says ” I want you to make me a suitcase from all the foreskins you throw away”.
    The mohel says, “no problem”.

    So the guy comes back a few months later, and the mohel hands him a wallet.

    They guy says, “I told you to make me a suitcase and you made me a wallet- what a rip-off”.

    The mohel says “Relax already, just rub it and it will turn into a suitcase”.

    ( GIves new definition to ROC’s mantra “watch your wallet” )

  10. POSTED BY Sandy  |  March 03, 2011 @ 6:42 pm

    Heard that joke 52 years ago abd ya know what? It still brings a smile to my face!

  11. POSTED BY danbollinger  |  March 03, 2011 @ 7:44 pm

    Parents considering infant circumcision should check out Circumcision Decision-Maker.

    http://circumcisiondecisionmaker.com

  12. POSTED BY Tudlow  |  March 03, 2011 @ 8:02 pm

    I like how the site linked to above is very objective. You have no idea what the creator of the site really feels about the issue. Well done.

  13. POSTED BY croiagusanam  |  March 03, 2011 @ 8:02 pm

    I was at the conference in Vienna and , while there was a great deal of serious work going on, there was occasion to kick back and party like only doctors and researchers can.

    I managed to get some video footage of a famous entertainer giving a musical intro to the CDC folks about to present their findings on circumcision:

    http://www.youtube.com/watch?v=6lZYAaQoks8

  14. POSTED BY Tudlow  |  March 03, 2011 @ 8:09 pm

    Oh acushla, I have always loved how you cut to the chase, and with such humor, on Baristanet/Baristakids.

  15. POSTED BY Georgette Gilmore  |  March 03, 2011 @ 8:14 pm

    cro,

    I love reading your comments.

  16. POSTED BY hollykorusjenkins  |  March 03, 2011 @ 8:41 pm

    Hahaha Tudlow! The best part is no matter what you click on circumcision is the wrong choice. Like I said before there are good arguments for both sides.

    Spiro you make me smile daily too!

    So when is Applegate Farms serving their breast-milk ice cream? Or perhaps gelato?

  17. POSTED BY Tudlow  |  March 03, 2011 @ 8:47 pm

    I know! The site was really quite funny. I kept trying to find a way that showed me the right choice was to choose circumcision, but I was foiled every time.

  18. POSTED BY bebopgun  |  March 03, 2011 @ 9:23 pm

    Is there anyway to know if sex is better with or without?

  19. POSTED BY Sandy  |  March 03, 2011 @ 10:12 pm

    More intense, more feeling WITH circumcision. The penis is not wearing a “sock” around it. :)

  20. POSTED BY croiagusanam  |  March 03, 2011 @ 10:15 pm

    One simply must ask Sandy how you could possibly know this?

  21. POSTED BY croiagusanam  |  March 03, 2011 @ 10:17 pm

    And in this age of enlightenment, bebop may have been wondering about the “catcher” as well as the “pitcher”, no?

  22. POSTED BY bebopgun  |  March 03, 2011 @ 10:27 pm

    I was thinking about the “pitcher” but being on the path of enlightenment the “catcher” perspective would be interesting.

  23. POSTED BY jbaker876  |  March 03, 2011 @ 10:37 pm

    Infant circumcision is not a “religious right”. Freedom of religion gives people the right to make their own decisions about their own religions, not to force their religions on others. Just because a parent wants to observe traditional Judaism does not mean that the man himself will want part of his d%^k chopped off. Put simply: your religious freedom ends at cutting up other people’s bodies.

    As for the HIV argument: babys don’t have sex. If your kid grows up and sleeps around a lot, he has the right to consider circumcision (although condoms would be a much, much, much better choice…)

    This procedure is not necessary, but does permanently remove the majority of the man’s sexually sensitive nerve endings. It therefore should not be done without the individual’s consent. True, if you do circumcise your son he may thank you later. But there is also a good chance he may deeply resent it, as do a large number of men. Do you really have the right to take that risk concerning someone else’s body?

  24. POSTED BY jbaker876  |  March 03, 2011 @ 10:40 pm

    And in reply to Sandy:

    You obviously know nothing about the male anatomy. When erect, the foreskin retracts (uncovers the rest of the penis). It is therefore much more sensitive, because the sensitive parts are protected and kept sensitive until sex, then uncovered.

    An erect uncut penis looks almost identical to a cut one.

  25. POSTED BY Tudlow  |  March 03, 2011 @ 10:53 pm

    I’ve been with men that have the sock and men without and both seemed to derive pleasure. And on a scale of 1 to 10, I’d say both were at a 10, well, I should say that I didn’t see a discernible difference btw the two to be more objective here. (I have not administered Likert scales after sex.) I haven’t met any men that have resented being circumcised b/c they feel that their sexual pleasure is lacking. I’m not pro- or anti- to be honest, but I don’t buy the circumcised guys are missing out approach.

  26. POSTED BY Tudlow  |  March 03, 2011 @ 10:55 pm

    Sorry, was that inappropriate? This is a kids and family website after all. Sorry Georgette!

  27. POSTED BY croiagusanam  |  March 03, 2011 @ 11:16 pm

    Mr. Hitchens has, as always, an interesting take:

    http://www.youtube.com/watch?v=Xx_ov2NiNo4

  28. POSTED BY Tudlow  |  March 03, 2011 @ 11:34 pm

    Interesting. But equating cutting off a female’s clitoris to male circumcision does not make anatomical sense. You’d have to cut off the whole thing if you’d want it to be close to equivalent.

  29. POSTED BY croiagusanam  |  March 03, 2011 @ 11:49 pm

    Hitchens’ point is that it is mutilation, done in the name of control and religion. The extent of the mutilation is not the point. “Only” one arm versus both, one eye versus both, etc. Clearly, the procedure on the female is an obvious example of practices in societies that see females as property and as creatures whose physical, emotional, and mental properties are for men to control. With males, for those who don’t engage in the practice for religious or cultural reasons it seems more a matter of cosmetics. Either way, I agree with Hitchens. It is a barbarous practice.

    Though I must say, I never laughed as hard in my life as I did several years ago when, driving late at night along a lonely upstate New York highway, I tuned in to WBAI and listened to a “survivors group” of circumcised men who, under hypnosis, relived their procedures — complete with screaming, crying, and “how could you, mommy?” wails. Shame on me, all I could think of was how I missed out on a great opportunity to bill some fools for this “therapy” and use the “schmuck money” for a nice fishing trip to Islamorada.

  30. POSTED BY spaceck  |  March 04, 2011 @ 12:00 am

    I was circumcised, and I’m very happy with it. My sons were circumcised and they say they are not unhappy with it. They really don’t care one way or the other at this point in their lives. Case closed.

  31. POSTED BY Tudlow  |  March 04, 2011 @ 12:03 am

    What, you don’t buy into that hypnosis story? I’m shocked.

    Well, now that you are shedding the jokes, I find the term barbarous to be a tad strong. Like Georgette posted, the AAP recommends it, although not very strongly it seems, for medical reasons. I’ll disclose this much: we decided to circumcise my son. With this crowd posting on this story, it’s not something I’m comfortable admitting. No religious reasons for us but I did consider the medical evidence. Maybe it was a mistake, I don’t know, and maybe my son will be filled with resentment later in life and will undergo hynosis to relive it and heal the psychological damage. (Seriously, that’s so
    stupid that’s it’s actually hilarious.) But I don’t think of myself as a barbaric mummy who just doesn’t like the way foreskin looks.

  32. POSTED BY croiagusanam  |  March 04, 2011 @ 12:21 am

    The AAP issued a statement last year (one they quickly backed away from) comparing female circumcision to ear piercing. Please be careful referencing this lot. they’ve been wrong as often as they’ve been right.

    You are certainly not a barbarian, Tudlow. At least, I see no evidence of it. But the practice is, in my view, barbaric. I doubt that your son will resent you for it. But I believe that Hitchens would say that you are making his point, albeit not in a religious context.

  33. POSTED BY Tudlow  |  March 04, 2011 @ 12:37 am

    I don’t much care for Hitchens despite my rather scientific approach to life.

    I hear you, croi, I get your message. Perhaps you’re right. But of all the things I worry about, quite frankly, my son resenting me for having him circumcised is very low on the list. But thanks for the ringing endorsement of my character.

  34. POSTED BY croiagusanam  |  March 04, 2011 @ 12:45 am

    Now Tud, don’t get testy. Its fine if you don’t like Hitchens. Full disclosure, he’s a friend of mine and I think he’s beyond brilliant. But that’s just my opinion.

    Of course your son won’t resent you. And anyway, like all men he’ll agree with D’Aureuilly that “next to the wound, what women make best is the bandage.”

  35. POSTED BY Tudlow  |  March 04, 2011 @ 1:00 am

    Beyond brilliant and being likable are not one in the same. Have you heard the words coming out of James Watson’s mouth as of late? Of course, it’s probably just some kind of frontal lobe dementia but that’s besides the point.

    Oh, I get testy when it’s past midnight and I haven’t finished my lesson plans to inspire the lambs as to why DNA replication is amazing and worth learning. I’m sorry.

    G’night, friend.

    (Are you also friends with Noam Chomsky?)

  36. POSTED BY croiagusanam  |  March 04, 2011 @ 7:14 am

    DNA replication? Fascinating stuff. What curs they must be not to see the wonder! Carry on, though. They’ll wake up one of these days.

    Don’t know Mr. Chomsky, and have no wish to meet him. I find him to be insufferable and his politics are (is?) insane. Watson is, I feel, simply a fascist who like many before him has no problem tailoring science to fit his own racism and homophobia.

    Anyway,I have to run now and bring Stephen Hawking his tea. He gets awfully pissy if its late, you know.

  37. POSTED BY bebopgun  |  March 04, 2011 @ 7:34 am

    Tudlow, thanks for the comments. The sexual reasons, I had always thought, would be the deciding factors for me. I had a daughter and the decision became moot.

    My friend decided in favor of circumcision for his son because he thought it would weird if he and his son had a different looking penis.

    Most of our lives, whether we’re religious or not, are shaped by religion. God may be dead but her children are alive and well.

    One couldn’t help notice Newt G say recently the problem in America was the absence of religion in our lives. I hope it’s not a precursor to his 2012 election strategy.

  38. POSTED BY croiagusanam  |  March 04, 2011 @ 8:23 am

    Bebop, I can’t wait for Newt to declare. I am on pins and needles anticipating the Vatican statement as to how the thrice married admitted adulterer is now welcomed into the Roman Catholic Church. I also scour the papers each day in search of a bishop’s suggestion that Newt be denied the sacrament, as has been urged in the cases of Andrew Cuomo, Mario Cuomo, Ted Kennedy, and John Kerry.

    Perhaps Newt’s censure will be unveiled at the same time that Rudy Guiliani’s is.

  39. POSTED BY bebopgun  |  March 04, 2011 @ 9:00 am

    All may be forgiven for Newt. He did, afterall, fund a documentary on the Pope’s role in bringing down communism in Poland. What’s a divorce or two when one’s created a cellulosic hero (perhaps soon to be saint).

  40. POSTED BY kay  |  March 04, 2011 @ 9:17 am

    Well! y’all made me laugh this morning, but especially The Divine Ms Tudlow: “And on a scale of 1 to 10, I’d say both were at a 10″

    My dear, this obviously has more to do with your skill, than anything else! :)

    Sandy, I will never look at socks the same way again!

    p.s. I can’t exactly search this subject on a proprietary computer (!) but isn’t cleanliness also an argument?

    p.p.s I recall that the AAP also changed their stance on how to put an infant to sleep – back or side.

  41. POSTED BY Nellie  |  March 04, 2011 @ 9:48 am

    This discussion has been interesting, but I’d say we’re at a cut-off point!

  42. POSTED BY croiagusanam  |  March 04, 2011 @ 9:55 am

    Just like you nellie, to bring things to a head.

  43. POSTED BY Nellie  |  March 04, 2011 @ 9:58 am

    That’s a good point, cro

  44. POSTED BY Tudlow  |  March 04, 2011 @ 12:44 pm

    What a funny crew we are. Seriously, I love the wit and silliness. After boring the chillen with the structure of DNA–c’mon, that double helix is absolutely gorgeous and how could you think otherwise–it’s a real treat to read these comments.

    Have to run, though. Dick Dawkins and I have a lunch date to discuss why students just can’t accept evolution.

    And croi–my friend Bobby DeNiro always told me not to be a name dropper. You might want to heed his advice.

  45. POSTED BY croiagusanam  |  March 04, 2011 @ 12:49 pm

    Real friends of DeNiro’s know that he goes by “Cuachai”.

  46. POSTED BY bebopgun  |  March 04, 2011 @ 1:53 pm

    In thinking about socks–would that be an itchy wool sock or a silky smooth one? Itchy wool sounds dreadful but silky smooth–i may ask for a reattachment.

  47. POSTED BY hollykorusjenkins  |  March 04, 2011 @ 5:18 pm

    Tudlow, I stand corrected. If you are a grown man and have frostbite on your junk then…..it is “recommended”. I always love reading your comments as well as Kay’s :)

  48. POSTED BY Tudlow  |  March 04, 2011 @ 11:14 pm

    Oh whew, good to know, holly! And right back atcha.

  49. POSTED BY techydude  |  March 05, 2011 @ 4:27 pm

    Circumcision is medically unnecessary. Do you want this torture to happen to your children? : http://video.google.com/videoplay?docid=-6584757516627632617# Doctors oppose circumcision: http://www.doctorsopposngcircumcision.org San Fran circumcision ban bill: http://www.mgmbill.org http://www.thewholenetwork.org http://www.norm.org Circumcision is psychologically damaging and traumatic: http://www.cirp.org/library/psych/goldman1/

  50. POSTED BY frank  |  March 05, 2011 @ 5:12 pm

    Circumcision is a cultural phenomenon. It is a practice of habit whether or not we want to believe it or not. All the AAP is doing is trying to rationalize it as we try to do so every 5 years or so with a new scare or justification. One thing that Stacey Gill forgot to mention is that not only did women see no protection but in fact they had a 50% relative increase in infection. Not one single media outlet mentions this, and the researchers always place this fact on the backburner! Now, the STD and HIV prevention myth is false. If you want me to state the methodological flaws, I will do so. However, all you need to know is that 8 countries in Africa have higher infection rates in uncircumcised men and 10 countries in Africa have higher infection rates in circumcised men. The U.S. has higher STD infections than Europe as well as higher rates of circumcision. I’m flabbergasted that people can be so easily manipulated. I’m sick of the medical community lying to us.

  51. POSTED BY Tudlow  |  March 05, 2011 @ 7:15 pm

    To me, this thread has become rather flaccid.

  52. POSTED BY hugh7  |  March 05, 2011 @ 9:34 pm

    Circumcision never was “for everyone”. It’s currently not for well over 2/3 of the men in the world, and most of the others are Muslim. There’s no good reason it should be for healthy babies.

    @Spiro T. Quale: your joke just underlines that the foreskin is erogenous tissue.
    @bebopgun: it IS silky smooth. “he thought it would weird if he and his son had a different looking penis.” Yes and http://www.circumstitions.com/Images/looklike.gif
    @kay: there are lots of folds and crevices we could cut off (especially off girls) and they they’d be easier to clean. Cleaning under the foreskin is quick, easy and (whisper) fun.

  53. POSTED BY jakew  |  March 06, 2011 @ 7:33 am

    To respond to Frank’s comment:

    “One thing that Stacey Gill forgot to mention is that not only did women see no protection but in fact they had a 50% relative increase in infection. Not one single media outlet mentions this, and the researchers always place this fact on the backburner!” — Frank is presumably referring to Wawer’s study. The difference in infection rates was not statistically significant, so it is rather misleading to state that there was an increase.

    “Now, the STD and HIV prevention myth is false. If you want me to state the methodological flaws, I will do so. However, all you need to know is that 8 countries in Africa have higher infection rates in uncircumcised men and 10 countries in Africa have higher infection rates in circumcised men.” — this is a case of extraordinary selectivity. Generally, surveys in which information on (in this case) circumcision and HIV status is gathered are known as observational studies, and far more than 18 have been performed. The number is greater than 40, and possibly more than twice that number. Systematic reviews of this evidence have noted that the majority of these studies have noted a protective effect of circumcision. Looking towards stronger evidence (randomised controlled trials), all three of these have found a protective effect.

    “The U.S. has higher STD infections than Europe as well as higher rates of circumcision.” — unsurprisingly, as circumcision rates are not the only difference. The US has lower levels of sex education and subsequent condom usage. Clearly, this comparison fails to isolate the effect of circumcision itself.

  54. POSTED BY bebopgun  |  March 06, 2011 @ 8:38 am

    These days saying things are “just cultural” is as banal as saying what you had for breakfast.

    What isn’t cultural?

  55. POSTED BY Tudlow  |  March 06, 2011 @ 11:05 am

    Actually bebop, I would be quite interested to know what you had for breakfast.

    Thank you, jakew, for countering specious arguments with evidence, which is anathema to people with passionate opinions and an agenda.

    If someone who was anti-circumcision didn’t twist evidence or start with the whole medical community is lying to us conspiracy BS or compared cutting off a clitoris with circumcision, I think more people would actually listen to their arguments. I know I would. For instance, I accept the studies that have shown a decrease in STD infections, UTIs and penile cancer, but it is worthwhile and logical to point out that the incidence of these things is very low (and extremely low with penile cancer) to begin with.

  56. POSTED BY jakew  |  March 06, 2011 @ 11:26 am

    Thank you, Tudlow. Yes, you are quite right that it’s important to keep a sense of perspective. Penile cancer is indeed relatively rare – the lifetime risk is about 1 in 1,400 in the US. Urinary tract infections have always been presumed to be rare in males, but in 2007 the National Institute of Diabetes and Digestive and Kidney Diseases released statistics indicating that the lifetime risk in males is 13,689 per 100,000 (or 13.7%) (see p. 625, ch. 19, http://kidney.niddk.nih.gov/statistics/uda/). To be fair, though, most UTIs are relatively minor – severe complications occur in only a tiny proportion of cases.

  57. POSTED BY Tudlow  |  March 06, 2011 @ 11:32 am

    Thank YOU, jakew. It is always nice to hear from someone who actually knows what he/she is talking about.

  58. POSTED BY frank  |  March 06, 2011 @ 12:43 pm

    @Jakew
    “The difference in infection rates was not statistically significant, so it is rather misleading to state that there was an increase.”
    Yes, but so was the difference in infection rates between the circumcised men and uncircumcised men. The absolute risk reduction was less than 2%. Observational studies prove nothing for the effectiveness of circumcision. Mexico and Brazil have lower rates than we do. You note it yourself that education and condoms may have helped Europe out. I have a brilliant idea. Why don’t we focus on that policy instead?

  59. POSTED BY frank  |  March 06, 2011 @ 12:53 pm

    Flaws with the Studies

    A.)Circumcised men were told to abstain from sex for 6 weeks. This creates different exposure rates. With the pain these men were in, I’m inclined to agree that most of them cooperated. The control group was not given any limitations on their behavior.
    B.)Circumcised men were told that if they can’t wait for the full time to heal they must use condoms. They were educated about their merits, educated how to use them, and were given plenty of free condoms.
    C.)Circumcised men received continuous sexual health counseling during the 2 year trials.
    D.)The long term consequences are not being investigated, EXCEPT in Kenya. Dr. Robert Bailey returned and found NO differences between the two groups. This is hardly ever mentioned.
    E.) Around 30% of men suffered complications and this resulted in them delaying any return to normal sexual behavior.
    F.) Nonsexual infection sources such as intravenous drug use are not being investigated. 16 out of 67 cases in Uganda and 23 out of 69 cases in South Africa appear to be from nonsexual sources!
    G.) Circumcised men were encouraged to seek independent testing. In order to be included in the final numbers, men had to participate until the end. Drop outs are not accounted for and there were more drop outs than infection cases.

  60. POSTED BY frank  |  March 06, 2011 @ 1:02 pm

    POSTED BY Tudlow | March 06, 2011 @ 11:32 am
    “Thank YOU, jakew. It is always nice to hear from someone who actually knows what he/she is talking about.”

    This is rather hurtful and false. As you can see, I have in fact researched these studies. What I am doing is just merely noting some not so obvious things about the studies. Or things that researchers and media fail to mention. Am I anti-circumcision? Absolutely, I have nothing to hide and I find it unsettling. This was not always my policy though. And yes, I am circumcised (Although, I was 10 pounds at the time and I probably would’ve given a tougher fight today). Why do I care so much? I find it unsettling to force a permanent alteration to a nonconsenting human being. Furthermore, I’m really upset with the medical community lying repeatedly. It was promoted initially to prevent masturbation and then used to prevent feeble mindedness, gout, paralysis, crossed eyes, curvature of the spine, prolapsed rectum, gout, [Portion of comment removed.] etc. etc. etc. Circumcision is a cure in search of a disease in my opinion. By the way, I never compared cutting off a clitoris with cutting off of the foreskin. Please be respectful.

  61. POSTED BY Tudlow  |  March 06, 2011 @ 1:16 pm

    I wasn’t talking about you comparing the clitoris with the penis, frank, rather I was referring to croi’s good friend, Christopher Hitchens. (And don’t get me wrong, I quite like croi.)

    I see you have done some research and in no way do I not respect you posting your data and discrepancies/flaws with the studies. I thank you for it, in fact. (Lots of negatives in that first sentence so I’m saying I respect your research.)

    Re: the absolute risk reduction, approximately 2% is nothing to laugh about. When you multiply that number by the total population of males in the world, it seems significant to me. And circumcision and focusing on prevention of STDs through education are not mutually exclusive. I also don’t think the medical community is manipulating the public and lying to us. I used to work in health care and I’ve been a part of consensus groups making medical recommendations. Mistakes are made at times and as new data comes in, recommendations change–as they should. If they did not, that would be a very bad thing. And perhaps someday the recommendation for circumcision will change. I’m not an advocate for circumcision by any means and I think the matter is quite confusing to be honest. I just like evidence, that’s all. You posted some and so did jakew and people have to do some work to get to the bottom of it and draw a rational conclusion. It ain’t easy.

  62. POSTED BY Tudlow  |  March 06, 2011 @ 1:19 pm

    And, frank, you were a 10 lb newborn? Holy cow, that’s big!

  63. POSTED BY jakew  |  March 06, 2011 @ 1:30 pm

    Frank,

    “Yes, but so was the difference in infection rates between the circumcised men and uncircumcised men. The absolute risk reduction was less than 2%.” — you’re conflating two separate issues: the magnitude of the absolute risk reduction, and whether the reduction was statistically significant. Significance represents a test of how likely it is that a given result could occur through chance alone: a result that is sufficiently unlikely to have occurred through chance is termed “significant”.

    “Observational studies prove nothing for the effectiveness of circumcision.” — Experimental data (such as the RCTs) are more reliable, that is undoubtedly true.

    “You note it yourself that education and condoms may have helped Europe out. I have a brilliant idea. Why don’t we focus on that policy instead?” — that’s a possibility, sure, but don’t forget that circumcision and education/condoms are not mutually exclusive. Combining all three would, logically, produce the best results.

    To address your list of flaws:

    “Circumcised men were told to abstain from sex for 6 weeks. This creates different exposure rates.” — this is true, and it’s likely the reason why all three studies monitored HIV status at several points throughout the trials. If the results could be explained by the period of abstinence alone, there would be a difference in risk in the first period, and no difference afterwards. But what is actually seen is a slightly greater difference in the first period, with the protective effect continuing long after.

    “Circumcised men were told that if they can’t wait for the full time to heal they must use condoms. They were educated about their merits, educated how to use them, and were given plenty of free condoms” — both circumcised and uncircumcised men received safe sex counselling and condoms, so this could not explain the results.

    “Circumcised men received continuous sexual health counseling during the 2 year trials.” — as did uncircumcised men.

    “The long term consequences are not being investigated, EXCEPT in Kenya.” — and Uganda, see http://www.pediatricsupersite.com/view.aspx?rid=81074

    “Dr. Robert Bailey returned and found NO differences between the two groups. This is hardly ever mentioned.” — because it’s false. Bailey did report on a follow-up study, but contrary to your claim he found a 64% risk reduction at 4.5 years. See: http://www.hivandhepatitis.com/2010_conference/AIDS2010/docs/0802e_2010.html

    “Around 30% of men suffered complications and this resulted in them delaying any return to normal sexual behavior.” — Did you actually take the trouble to look at the studies at all? Auvert et al reported a complication rate of 1.0% (table 6, http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0020298#pmed-0020298-t006), Bailey et al reported a complication rate of 1.5% (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)60312-2/fulltext), and Gray et al reported a complication rate of 3.6% (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2807%2960313-4/fulltext).

    “Nonsexual infection sources such as intravenous drug use are not being investigated. 16 out of 67 cases in Uganda and 23 out of 69 cases in South Africa appear to be from nonsexual sources!” — this doesn’t matter, since the randomisation process would ensure that exposure to non-sexual risks would be approximately equal in each group.

    “Circumcised men were encouraged to seek independent testing. In order to be included in the final numbers, men had to participate until the end. Drop outs are not accounted for and there were more drop outs than infection cases.” — this doesn’t affect the results unless there is a plausible reason to believe that drop outs were different (in terms of circumcision and HIV relationship) than those who remained in the trial. It is difficult to construct a plausible reason why this might be so.

  64. POSTED BY frank  |  March 06, 2011 @ 1:34 pm

    Yeah, but I was a few weeks post mature or however you call it. So technically, I should’ve been like 3 weeks old at the time. Nevertheless, though, I do respectfully disagree with you about our medical system not trying to rationalize this. Cultures with certain social practices try to rationalize them. So yes, maybe the statistics and fears these days are more pertinent than they used to be, but….people forget that the reason it started was due to quackery. This is a fact. If we didn’t have anti masturbation crusaders and Dr. Remondino making absurd claims and benefits back in the late 1890s, I’m determined the majority of us would have been left uncircumcised and we would not be on a mission every 5 years to find out whether this is beneficial or not. Are there benefits? Absolutely, but…..there are benefits with everything. You can’t get phimosis if you’re cut and so forth, but I feel these are almost apologetics. Did you know if you shaved your kid’s head it reduces head lice almost 100%? You get my drift. And the 2% decrease may be small or big depending on who you ask, but don’t you find the methodology these researchers used shaky at best? There were three trials and one is no longer relevent. I’m just wondering what the long term results will be.

  65. POSTED BY jakew  |  March 06, 2011 @ 2:05 pm

    Frank, the study you cite is an observational study, conducted in the same geographical area, but it is not a follow-up study on the RCT participants. The study reported the following about the recruitment of participants: “The majority of Kisumu’s population belongs to the Luo ethnic group, one of Kenya’s largest and the only major group that does not traditionally practice circumcision. The study sample was selected by multi-stage random sampling with cluster definition and systematic sampling followed by random household selection. All men and women aged 15 to 49 years who slept in a selected household the night before the first study visit were eligible for study participation.”

  66. POSTED BY frank  |  March 06, 2011 @ 2:36 pm

    JakeW,
    Noted. However, you get my point. Observational studies that do not support the theory are not emphasized just like this one. By the way, the WHO has recommended the practice for VOLUNTARY circumcision. Infants do not count as voluntarily consenting. Will I ever believe that circumcision prevents HIV? Sure, when someone determines why with causation and not correlation studies. In 1993 it was because the foreskin had little Langerhans cells which protect against infection, then in 2000 it was due to the foreskin being abundant with Langerhans cells and now these cells are now suddenly more susceptible to infection. Now it’s because the foreskin rips easily or that the foreskin harbors bacteria and viruses (however, apparently the environment inside the vagina does not). So what is it? I believe the latter is the popular theory now. And like you said before, condoms and education work great. They’re 95 times more cost effective so maybe if we shifted our resources and money there it would have a better net effect. Why do you support circumcision so much? I told you my agenda. It is because I’m ethically against non-consensual surgery (infant) and historically looking at the practice…it has been used to solve everything. It looks like a cure in search of a disease. Please explain to me why we all have foreskins?….Well before they’re removed that is. It makes no sense to me that such an evolutionary mistake occurred. How about this?….If an adult after reviewing the benefits wants to go under the knife, they more than can. I absolutely do not care what an adult decides to do with his or her genitals. They can tattoo it, cut it, amputate it….none of my business.

    http://www.youtube.com/watch?v=lC5_z55aCxo

  67. POSTED BY jakew  |  March 06, 2011 @ 3:02 pm

    “Noted. However, you get my point. Observational studies that do not support the theory are not emphasized just like this one” — you’re probably right in that respect: there does seem to be media bias in favour of reporting studies finding associations (as opposed to those that do not). I’m not sure whether this is limited to circumcision, though I suspect not.

    “By the way, the WHO has recommended the practice for VOLUNTARY circumcision. Infants do not count as voluntarily consenting.” — yes, proxy consent is necessary for infant circumcision.

    “In 1993 it was because the foreskin had little Langerhans cells which protect against infection, then in 2000 it was due to the foreskin being abundant with Langerhans cells and now these cells are now suddenly more susceptible to infection. Now it’s because the foreskin rips easily or that the foreskin harbors bacteria and viruses (however, apparently the environment inside the vagina does not). So what is it? I believe the latter is the popular theory now.” — it seems unlikely that there’s a single answer. It’s more probable that there are several mechanisms acting together: the Langerhans cells in the foreskin itself, the tendency towards small tears, the fact that the preputial sac can hold virus close to the body for extended periods, the reduced risk of ulcerative conditions such as herpes, which can provide a portal of entry, and so on.

    “And like you said before, condoms and education work great. They’re 95 times more cost effective” — I know this claim has been published in the literature, but I find it rather improbable. A circumcision, after all, lasts a lifetime, while condoms must be used for every act of intercourse.

    “Why do you support circumcision so much?” — I’m not sure it’s accurate to say that I support circumcision, as I’m actually pretty neutral about whether parents circumcise their children or not. I do, however, frequently find myself defending circumcision by default in debates with anti-circumcision activists. That’s because when I started researching circumcision (sometime before 2003) I found that there was a great deal of misinformation about it on the Internet, generally on anti-circumcision sites, and I began debating because it was the only way I could think of doing something about that. I respect your right to oppose circumcision (I felt that way myself a few years ago), but I think it’s important to get the facts right.

    “historically looking at the practice…it has been used to solve everything. It looks like a cure in search of a disease.” — You could apply the same argument to hand-washing, though – originally a religious ritual, then only later (with the germ theory of disease) it was understood as a hygienic measure. It doesn’t make a lot of sense to oppose hand-washing on the basis of its history…

    “Please explain to me why we all have foreskins?….Well before they’re removed that is. It makes no sense to me that such an evolutionary mistake occurred.” — Bear in mind that we’ve only been wearing clothes for the past few thousand years. It is only relatively recently, then, that the foreskin’s protection has had little value – before then the foreskin probably helped to protect the core of the penis from damage. If the presence of the foreskin were a huge liability, a small number of generations might be sufficient for it to evolve away, but realistically, circumcision doesn’t have *that* much of a net benefit.

  68. POSTED BY Tudlow  |  March 06, 2011 @ 3:08 pm

    Well, I was going to back out of this b/c you two certainly have a high level of discourse going. (Jake, are you an MD or have an MPH?) But, frank, you brought up evolution and I love evolution so let me say that I recall reading a hypothesis as to why the foreskin exists: humans used to walk around naked and it was advantageous to have a protective sheath when walking through the jungles and savannas. So, thank goodness all you circumcised men now wear pants is all I have to say. See, with evolution, the environment changes and thus so does the species. Our environment is not the same as it was 3 mill years ago. Last year, though, my son had a bit of a chaffing problem while swimming in the ocean and I thought to myself, hmmmm, perhaps we made a mistake here. True story.

  69. POSTED BY walleroo  |  March 06, 2011 @ 3:20 pm

    It makes no sense to me that such an evolutionary mistake occurred. How about this?…

    Please tell me, frank, why nature gave me my knees? They are very unreliable, especially in the third set when I’m trying to serve and volley.

  70. POSTED BY walleroo  |  March 06, 2011 @ 3:21 pm

    Thanks, Tudlow, for making me cross and recross my legs.

  71. POSTED BY jakew  |  March 06, 2011 @ 3:35 pm

    Tudlow, no, I’m not an MD or MPH. I am, however, enough of a nerd that I consider books on epidemiology and biostatistics to be interesting reading. :-)

  72. POSTED BY joseph4gi  |  March 06, 2011 @ 3:56 pm

    The results in the Wawer study wer not “statistically significant,” because they didn’t reflect what Wawer and her husband, Gray wanted, which was a “reduction.” It seems to circumcision promoters, results are only “significant” when cicrumcision shows a “difference” in the “right” direction. (The reduction of something.)

    People should read up on who actually writes these “studies,” and why. You’ll notice that they’re usually the same group of people who have been trying to find some sort of “disease” for circumcision to cure for years. (Bailey, Gray, Wawer, Moses, etc., etc.) You’ll notice that that they pass the papers amongst themselves, stamping their own work, and this is what passes as “peer review.” Something is DEF. screwed up with the system if this is what is passing for “research.”

    People need to be careful about what Jakew refers to as “studies.” There were a few select trials, and then circumcision “researchers” have taken these few trials and written a myriad of others, recycling the data from the same few “studies.” All of a sudden, you have “forty different studies,” when they’re all basically just re-hashes of the same old thing. Nothing that’s actually “new.” Look who’s behind them, and it’s the exact same group of pro-circumisers trying to grind their axe.

    My god, HOW many times are they going to recycle the Rakai numbers? Not to mention the supposed “RCTs?”

    “The U.S. has higher STD infections than Europe as well as higher rates of circumcision.”

    Jakew: unsurprisingly, as circumcision rates are not the only difference. The US has lower levels of sex education and subsequent condom usage. Clearly, this comparison fails to isolate the effect of circumcision itself.

    Me: Actually, this very same “confounding factor” Jake tries to use, the fact that America has poor sex ed and condom usage is the same “reason” why circumcision proponents would have us believe all the men of Africa need to be circumcised… (Because condoms and sex ed aren’t working) Right… ::rollseyes::

    ““Yes, but so was the difference in infection rates between the circumcised men and uncircumcised men. The absolute risk reduction was less than 2%.”

    Jakew: you’re conflating two separate issues: the magnitude of the absolute risk reduction, and whether the reduction was statistically significant. Significance represents a test of how likely it is that a given result could occur through chance alone: a result that is sufficiently unlikely to have occurred through chance is termed “significant”.

    Me: Sure, to someone desparately trying to legitimize circumcision…

    “Observational studies prove nothing for the effectiveness of circumcision.”

    JakeW: Experimental data (such as the RCTs) are more reliable, that is undoubtedly true.

    Me: When and if those were actual RCTs; the validity of these “RCTs” are actually quite hotly debated. (Not by YOU of course…)

  73. POSTED BY joseph4gi  |  March 06, 2011 @ 3:56 pm

    Actually, I’m tired of exchanging jabs on “studies.” There is absolutely no justification for child abuse.

    The law would NEVER allow parents the “religious right” or “parental privilege” to circumcise their daughters. Not even if the procedure weren’t as “severe” as male circumcision. (Last year, the AAP tried to approve a “ritual nick” for girls… doesn’t remove anything at all… clitoris stays intact… didn’t go too well for them…)

    There would never be enough “studies” in the world to legitimize female circumcision. And yet, here we have supposed “scholars” arguing “net benefit.”

    Why aren’t we looking into disease prevention methods that DON’T involve cutting off part of the genitals?

    Why obsession with genital mutilation?

    It’s an obsession, it’s an obsession. Look behind who is performing these “studies.” Who is promoting circumcision.

    I encourage readers to research who this “jakew” fellow is. Google “jakew” and “circleaks.”

    You’ll find he’s interested in a bit more than just HIV prevention and your child’s health.

  74. POSTED BY jakew  |  March 06, 2011 @ 4:11 pm

    Joseph4gi:

    “The results in the Wawer study wer not “statistically significant,” because they didn’t reflect what Wawer and her husband, Gray wanted, which was a “reduction.” It seems to circumcision promoters, results are only “significant” when cicrumcision shows a “difference” in the “right” direction.” — no, Joseph, statistical significance is a mathematical test. Something is either significant or not, and it doesn’t depend on the observer or what they perceive to be “right”.

    “There were a few select trials, and then circumcision “researchers” have taken these few trials and written a myriad of others, recycling the data from the same few “studies.” All of a sudden, you have “forty different studies,” when they’re all basically just re-hashes of the same old thing.” — there have been perhaps four or five studies that have involved the same population, but probably no more than that.

    “Actually, this very same “confounding factor” Jake tries to use, the fact that America has poor sex ed and condom usage is the same “reason” why circumcision proponents would have us believe all the men of Africa need to be circumcised” — I’m afraid I don’t understand what point you’re trying to make. It’s a confounding factor in between-country comparisons. It’s obviously not a confounding factor if no comparison is taking place.

    [Re "Significance represents a test of how likely it is that a given result could occur through chance alone: a result that is sufficiently unlikely to have occurred through chance is termed “significant”."] “Sure, to someone desparately trying to legitimize circumcision…” — no, this is the definition of statistical significance. There’s a reasonable overview at: http://www.wisegeek.com/what-is-statistical-significance.htm

    “When and if those were actual RCTs; the validity of these “RCTs” are actually quite hotly debated.” — it’s true that anti-circumcision activists dispute them, yes, though they are widely accepted by the scientific community. Regardless, the fact remains that they *are* randomised controlled trials.

  75. POSTED BY joseph4gi  |  March 06, 2011 @ 4:13 pm

    Here is the bottom line:

    Circumcision is unnecessary procedure in healthy, non-consenting individuals.

    Circumcision is an elective procedure with dubious “benefits” that are easily out-shone by other cheaper, less invasive, more effective means.

    Even if the latest “research” were correct, sex education and condoms do a far better job, as evidenced by STD statistics between America and countries in Europe.

    A child is at ZERO risk for STD transmission, and when he grows up, he can choose whether he wants to become circumcised or follow safe sex practices. (jakew ALWAYS tries to tell me “children grow up.” Well DUH. And when they do, they become independent adults, capable of weighing the pros and cons for themselves.)

    Do we justify what Mengele did, because it was in the name of “science?”

    Do we ever justify the Tuskegee trials?

    Would we ever justify the exact same so-called “RCTs” in America?

    Why not?

    Why do we then approve of this when it happens in Africa and we treat black men like guinea pigs all over again?

    Why do we try to use those numbers to try and push circumcision on everyone else?

    Why don’t we perform the same “trials” in women to see if female circumcision prevents HIV in THEM? Who knows! Maybe mutilation can provide WOMEN protection as well!

    WHY do we “study” this?

    Does anybody else NOT think it’s scientifically illogical to be studying the deliberate destruction of people’s genitals?

    Progress means replacing the OLD with BETTER. That’s what progress means. That is what science is supposed to be about.

    Does anybody else NOT think it ass backwards to be “studying” circumcision? We might as well be “studying” to find a better way to build a guillotine!

    We need to demand study and research that focuses on PRESERVING our bodily integrity. PROTECTING our children. Not deliberately mutilating them.

    We need to demand better science.

    These studies are complete rubbish.

    Rub-bish.

    Any “science” that attempts to legitimize genital mutilation, the deliberate violation of basic human rights are complete RUBBISH.

  76. POSTED BY joseph4gi  |  March 06, 2011 @ 4:15 pm

    But here’s the real kicker:

    Without any medical or clinical indication whatsoever, how is it that American doctors can actually perform surgery on healthy, non-consenting minors, much less give parents any kind of “option?

    Are children born sick? Is the foreskin a congenital deformity? A genetic anomaly? A birth defect? How is the foreskin any sort of medical “problem” in need of correction?

    The answer is thus: The foreskin is not a birth defect. The foreskin is not a “disfiguring birthmark.” The foreskin is not a genetic anomaly akin to cleft or a 6th finger.

    The foreskin is normal, healthy tissue with which all boys are born with. It is being born WITHOUT a foreskin that is considered the exception.

    Taking a healthy child, strapping him down and forcefully cutting off part of his healthy genitals is by definition, genital mutilation.

    It is outright child abuse, a violation of basic human rights, and it is absolutely preposterous that there is actually a group of people saying that any number of “studies” can justify this.

  77. POSTED BY joseph4gi  |  March 06, 2011 @ 4:20 pm

    [Comment removed due to inappropriate content.]

  78. POSTED BY joseph4gi  |  March 06, 2011 @ 4:22 pm

    Circumcision is NOT for everyone.

    It is for those with medical necessity, or those who choose.

    Imposing circumcision on a healthy, non-consenting individual is abuse.

    In a healthy child, who has neither a medical or clinical indication, nor a risk for STDs, it is unmistakeable child abuse.

    It is a violation of basic human rights, and laws need to be put in place to stop it.

  79. POSTED BY jakew  |  March 06, 2011 @ 4:25 pm

    “And yet, you would have us believe that “studies in Africa” legitimize infant circumcision in America, right?” — not really, no. Infant circumcision in America didn’t suddenly become legitimate in 2005, with the publication of the first of the RCTs. In my view it was already legitimate. The RCTs just strengthened the evidence of an additional benefit.

    “Circumcision didn’t work in America, but all of a sudden it worked wonders in Africa ” — on what basis do you claim that circumcision didn’t work in America?

  80. POSTED BY joseph4gi  |  March 06, 2011 @ 4:35 pm

    “Circumcision didn’t work in America, but all of a sudden it worked wonders in Africa ” — on what basis do you claim that circumcision didn’t work in America?

    Oh no not that old thing again…

    The proof is in the pudding. If circumcision did anything for America, STD rates would be lower than rates in various countries in Europe. Plain and simple. Reality shows us that circumcision has done diddly squat.

    You tell us that “It’s because sex ed and condoms are rubbish in America.”

    Yet, these are the very same reasons why people like you would have us believe African men should be circumcised…

    Shows your double-think…

  81. POSTED BY joseph4gi  |  March 06, 2011 @ 4:39 pm

    Significance: All this really means is that certain “researchers” thought it was “significant,” nothing more.

    I’m sure in a perfect world science would be science, and the “researchers” and yourself would just be “messengers.”

    But closer inspection reveals that the circumcision “reseacrhers” are all driven by ulterior motives.

    Cultural and religious bias in many, if not all of these “researchers” cause them to welcome “evidence” that circumcision does something, reject evidence to the contrary as “insignificant,” and exaggerate the results.

    Readers would be wise to investigate who is performing the “research,” and who is promoting it. You’ll find the exact same group of people.

    Circumcision practices are largely culturally determined and as a result there are strong beliefs and opinions surrounding its practice. It is important to acknowledge that researchers’ personal biases and the dominant circumcision practices of their respective countries may influence their interpretation of findings.

    Siegfried et al. “Male circumcision for prevention of heterosexual acquisition of HIV in men.” Cochrane Library 3 (2003)

  82. POSTED BY joseph4gi  |  March 06, 2011 @ 4:41 pm

    Studying to replace the old with newer and better is progress.

    Studying to keep things THE SAME is DIgress.

    “Reseachers” should be looking for ways to replace ritual mutilation, not ways to keep it around.

    Circumcision “reseachers” have their heads on backwards and should all be dismissed as the quacks that they are.

  83. POSTED BY jakew  |  March 06, 2011 @ 4:44 pm

    “The proof is in the pudding. If circumcision did anything for America, STD rates would be lower than rates in various countries in Europe. Plain and simple. Reality shows us that circumcision has done diddly squat.” — that’s illogical. As I’ve pointed out above, such a comparison fails to isolate the effect of circumcision. Levels of sex education and condom usage are lower in the US, which one might reasonably expect to result in higher rates of STIs. (For information re sex education and condom usage, see, for example: Michael RT, et al. Private sexual behavior, public opinion, and public health policy related to sexually transmitted diseases: a US-British comparison. Am J Public Health. 1998 May;88(5):749-54. Weinberg MS, et al. AIDS risk reduction strategies among United States and Swedish heterosexual university students. Arch Sex Behav. 1998 Aug;27(4):385-401. Brick P. How does Europe do it? Fam Life Matters. 1999 Winter;(36):3)

    So you haven’t shown that circumcision has done nothing for America. Available evidence indicates that STI (specifically HIV) rates would, in all probability, be far worse than they are now if it were not for the relatively high rates of circumcision.

    “You tell us that “It’s because sex ed and condoms are rubbish in America.” Yet, these are the very same reasons why people like you would have us believe African men should be circumcised…” — there is a reasonable argument to be made for that, yes. I don’t understand why you call this “double-think”.

  84. POSTED BY craig  |  March 06, 2011 @ 5:10 pm

    [Comment removed due to inappropriate content.]

  85. POSTED BY craig  |  March 06, 2011 @ 5:11 pm

    A wide range of surgical complications occur in 2-10% of the cases.(1) Since there are approximately 120 million circumcised men in the United States today, it stands to reason that there are millions of men who suffer daily from the effects of these botched circumcisions.

    Many Americans are surprised to hear that circumcision (the surgical removal of the foreskin) is uncommon in the western world. Foreigners are often shocked when they first hear that the practice of circumcision even exists in the United States. Circumcision was first introduced in the United States by an anti-sexual Victorian initiative which began during the 1830’s. Numerous publications from the 1830’s to times even as late as the 1970’s had advocated for circumcision as a means to prevent masturbation, and permanently desensitize the penis.(2,3,4,5,6,7,8,9,10,11,12)

    Circumcision advocates quickly moved on to manufacture a number of outrageous health claims. These claims were tailored to the fears and anxieties of the day. Circumcision has been claimed to cure epilepsy, convulsions, paralysis, elephantiasis, tuberculosis, eczema, bed-wetting, hip-joint disease, fecal incontinence, rectal prolapse, wet dreams, hernia, headaches, nervousness, hysteria, poor eyesight, idiocy, mental retardation, insanity, strabismus, hydrocephalus, clubfoot, cancer, STD’s, UTI’s, ect.(13) Doctors were eager to claim that they could cure many of these aliments,conditions and diseases because there were no treatments available then. Even though all of these claims have been throughly discredited, circumcision has remained a solution in search of a problem ever since. Many Americans are surprised to find out that female genital cutting (FGC) shares a strikingly similar history in the United States.(5,14,15,16,17,18,19) FGC was even covered by Blue Cross Blue Shield until 1977. Nowadays, many forms of FGC are now considered forms of female genital mutilation (FGM), which are banned in all western countries.

    Perhaps the most shocking fact is that circumcision continues to be practiced in the United States even though no official western medical organization in the world recommends it. The Royal Dutch Medical Society, The British Medical Association, the Canadian Pediatric Society, and the Royal Australian College of Physicians have all made official policy statements against circumcision. The American Academy of Pediatrics, the American Medical Association, the American Academy of Family Physicians, and the American Urological Association all do not recommend circumcision, and are also in agreement that there are no proven benefits.

    For some reason this information is not making it to parents. Studies have shown that doctors provide parents with almost no accurate or useful information about circumcision. One study showed that 40% of parents believed that their doctors failed to provide enough information, 46% reported that their doctors failed to give them any medical information at all, and 82.8% of parents regretted their decision they made within the first six months of their son’s life.(20) Another study found that physicians were less likely to circumcise their own sons.(21) This suggests that doctors are very well aware that circumcision is a non-therapeutic surgery (in short, a ritual); but they do not appear to share this knowledge with parents. A busy physician can supplement their income by as much as $60,000 per year from circumcision surgeries alone.(22) This incentive can cloud a physician’s judgment when it comes to providing parents with information about circumcision.

    Many parents are surprised to hear that anesthetics are used in only a minority of cases.(23) The use of local anesthetics significantly drives up the costs of surgery. When anesthetics are used, they can only reduce the pain. Infants can not be given general anesthesia because of the medical risks involved. In the recent past, anesthesia was rarely used, if ever. Because of this, circumcision has always been an extremely traumatizing experience causing an array of short and long term behavioral problems, including altered perceptions, and post traumatic stress disorder (PTSD)(24,25,26,27,28,29,30,31,32,33,34,35), and a possibly self destructive behavior(36,37). Many circumcised men, some of whom are doctors, experience a strong denial of loss which in turn fuels an emotional compulsion to repeat the trauma to normalize their loss.(38,39,40,41,42)

    What is the foreskin? is a question that many Americans would have trouble answering. Information about the foreskin is virtually absent during discussions of anatomy in biology classrooms, and yet, the foreskin provides a well-documented set of crucial sensory, protective, immunological, hygienic, and sexual functions. The foreskin is a double fold of skin that is twice as big as its appearance. It can make up to 80% or more of the penile skin covering, and includes around 12-20 square inches of skin (the size of a 3×4 or a 4×5 index card!)(43,46), and in turn includes a specialized sheet of dartos muscle(44)

    One of the functions of this mobile skin system is to glide up and down the shaft of the penis in order to facilitate non-abrasive stimulation during sexual activity without any need for artificial lubricant. This frictionless gliding mechanism is the principal source of stimulation for the intact penis and facilitates non-abrasive intercourse.

    The neuro-anatomy of the penis has been rigorously studied by respected anatomists of all kinds. The component tissues that comprise the foreskin are richly innervated with the greatest quantity and variety of sensory nerve endings than any other part of the penis.(45,46,47,48,49,50,51,52,53) Many people are surprised to discover that the glans or “head” of the penis is actually the least sensitive part.(46,52,53)

    To no surprise, this information was corroborated in a 2006 study which measured the sensitivity of all the parts of the penis. Researchers used an extremely sensitive pressure sensing probe while each test subject, whose view was blocked with a screen, reported a sensation of touch. To demonstrate precision they took each measurement multiple times. The results were statistically consistent. They concluded:

    “Five locations on the uncircumcised penis that are routinely removed at circumcision were more sensitive than the most sensitive location on the circumcised penis[...] The glans in the circumcised male is less sensitive to fine-touch pressure than the glans of the uncircumcised male[...]The most sensitive location on the circumcised penis is the circumcision scar on the ventral surface [...] When compared to the most sensitive area of the circumcised penis, several locations on the uncircumcised penis that are missing from the circumcised penis were significantly more sensitive.”(53)

    The foreskin, like the eyelid, also serves an important set of protective and immunological functions. The foreskin protects the delicate glans of the penis and puts the urethra at a distance form its environment protecting it from foreign contaminants of all kinds. While simultaneously shielding the penis from injury. The foreskins inner fold and the glans of the penis are comprised of mucous membrane tissue. These are also present in your eyes, mouth, and all other bodily orifices including the female genitals. These mucous membranes perform many immunological and hygienic functions. Certain components such as Langerhans cells(54), plasma cells(55), apocrine glands(56), and sebaceous glands(57), collectively secrete emolliating lubricants(58) rich in enzymes such as lysosomal enzymes, cathepsin B, chymotrypsin, neutrophil elastase, immunoglobulin, and cytokine(59,60) whose function is to sequester and “digest” foreign pathogens. The foreskin is also responsible for the production, retention, and dispersal of pheromones such as androsterone(61). In time we will discover even more information about the foreskin and its functional components.

    The intact penis is naturally clean and maintains a level of hygiene that is optimal when compared to a penis that has been altered by circumcision. In fact, a myriad of rigorously controlled studies performed by objective researchers among racially and socioeconomically homogeneous study groups in developed urban settings have shown that circumcision is often associated with an increased risk of bacterial infections, viral infections, and major STD’s (62,63,64,65,66,67,68,69,70,71,72,73).

    Needless to say, circumcised men have been denied normal bodily functions associated with anatomically correct genitalia.

    Refrences:
    (1)Williams, N; L. Kapila (October 1993). “Complications of circumcision”. British Journal of Surgery 80 (10): 1231-1236.
    (2) Lallemand C-F. Des Pertes Seminales Involontaires, 3 vols. Pasis: Becht Jeune 1836, 1839, 1842. Vol1.,pp.463-1: vol2., 70-162; vol. 3,.pp266-7,280-9
    (3) Dixon EH. A Treatise on Diseases of the Sexual organs. New York: Burgess, Stringer & Co. 1845. pp.158-65
    (4) Moses MJ. The Value of circumcision as a hygienic and therapeutic measure. New York medical journal 1871 Nov;14(4):368-74
    (5)Kellogg, J.H. (1888). “Treatment for Self-Abuse and Its Effects”. Plain Facts for Old and Young. Burlington, Iowa: F. Segner & Co. Plain Facts for Old and Young (1881 edition) at Project Gutenberg
    (6) Hutchinson J. On Circumcision as preventive of masturbation. Archives of surgery 1891 Jan;2(7);267-9
    (7) Remondino PC. Negro rapes and their social problems. National popular review 1894 Jan;4(1) 3-6
    (8) Cockshut RW. Circumcision. British Medical Journal 1935 Oct 19;2(3902):764
    (9) Guttmacher AF. Should the baby be circumcised? Parents Magazine 1941 sept; 16(9):26,76-8
    (10) Miller RL. Snyder DC. Immediate circumcision of the new born male. Am J Obstet Gynecol 1953, Jan;6 (1):1-11
    (11) Fishbein M. Sex hygiene. In: Fishbein M(ed). Modern Home Medical Adviser. Garden City, New York Doubleday& Company:1969. pp. 90. 119.
    (12) M. F. Campbell, “The Male Genital Tract and the Female Urethra,” in Urology, eds. M. F. Campbell and J. H. Harrison, vol. 2, 3rd ed. Philadelphia: W. B. Saunders, 1970),1836.
    (13) F. A. Hodges, “Short History of the Institutionalization of Involuntary Sexual Mutilation in the United States,” in G. C. Denniston and M. F. Milos, eds., Sexual Mutilations: A Human Tragedy (New York: Plenum Press, 1997), 35.
    (14) Robert Tuttle Morris, M.D. Is evolution trying to do away with the clitoris? American Association of OB/GYNs Vol.5, 1892, pp.288-302
    (15) T. Scott McFarland, M.D. Circumcision of Girls. Journal of Orificial Surgery. Vol.7,July 1898,pp.31-33
    (16) Benjamin E. Dawson, A.M., M.D. Circumcision in the Female: Its Necessity and How to Perform it. American Journal of Clinical Medicine. Vol.22, No. 6, June 1915, pp.520-525
    (17) Belle C. Eskridge M.D. Why not circumcise the girl as well as the boy? Texas State Journal of Medicine Vol. 14, May 1918
    (18) Mc Donald, C.F., M.D. Circumcision of the female. General Practitioner Vol. 18 No3, Sept 1958, pp.98-99
    (19) W.G. Rathmann M.D. Female Circumcision: Indications and a new Technique. General practitioner Vol. 20, No.3, Sept 1959, pp.115-120
    (20) Adler R, Ottaway S, Gould S. intactipedia.org. Pediatrics 2001 Feb;107(2):E20
    (21) Topp, S. (1978, January). Why not to circumcise your baby boy. Mothering, 6, 69-77.
    (22) Fleiss, Paul M.D. What your Doctor May Not Tell You About Circumcision. Warner books. New York. Sept 2002.
    (23)Stang , M.J., & Snellman, L.W. (1998). Circumcision practice patterns in the United States. Pediatrics, 101(6)
    (24)Gunnar MR, Fisch RO, Korsvik S, Donhowe JM. The effects of circumcision on serum cortisol and behavior. Psychoneuroendocrinology 1981; 6(3):269-75.
    (25) Porter FL, Miller RH, and Marshal RE. Neonatal pain cries: effect of circumcision on acoustic features and perceived urgency. Child Dev 1986;57:790-802.
    (26) Gunnar MR, Connors J, Isensee, Wall L. Adrenocortical activity and behavioral distress in human newborns. Dev Psychobiol 1988;21(4):297-310.
    (27) Anders TF, Chalemian RJ. The effects of circumcision on sleep-wake states in human neonates. Psychosom Med 1974;36(2):174-9.
    (28) Marshall RE, Stratton WC, Moore JA, et al. Circumcision I: effects upon newborn behavior. Infant Behavior and Development 1980;3:1-14.
    (29) Marshall RE, Porter FL, Rogers AG, et al. Circumcision: II effects upon mother-infant interaction. Early Hum Dev 1982; 7(4):367-74.
    (30) Lee N. Circumcision and breastfeeding. J Hum Lact 2000;16(4):295.
    (31) Anand KJS, Hickey PR. Pain and its effects in the human neonate and fetus. New Engl J Med 1987;317(21):1321-9.
    (32) Boyle GJ, Goldman R, Svoboda JS, Fernandez E. Male circumcision: pain, trauma and psychosexual sequelae. J Health Psychol 2002;7(3):329-43.
    (33) Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet 1997;349(9052):599-603.
    (34)LaPrairie Jamie L. Murphy Anne Z. Neonatal Injury Alters Adult Pain Sensitivity by Increasing Opioid Tone in the Periaqueductal Gray. Front Behav Neurosci 30 September 2009.
    (35) Rhinehart J. Neonatal circumcision reconsidered. Transactional Analysis J 1999;29(3):215-21.
    (36) Van der Kolk BA, Perry JC, Herman JL. Childhood origins of self-destructive behavior. Am J Psychiatry 1991; 148;1665-71.
    (37) Jacobson B, Bygdeman M. Obstetric care and proneness of offspring to suicide. BMJ 1998; 317:1346-49.
    (38) Van der Kolk BA. The compulsion to repeat the trauma: re-enactment, revictimization, and masochism. Psychiatr Clin North Am 1989;12(2):389-411.
    (39) Goldman R. The psychological impact of circumcision. BJU Int 1999;83 Suppl. 1:93-103.
    (40) Maguire P, Parks CM. Coping with loss: surgery and loss of body parts. BMJ 1998;316(7137):1086-8.
    (41)Hill G. The case against circumcision. J Mens Health Gend 2007;4(3):318-23
    (42)Goldman R. Circumcision policy: a psychosocial perspective. Paediatr Child Health 2004;9(9):630-3.
    (43) See photographic series in: lander MM. The Human prepuce. In: Denniston GC, Milos MF (eds). Sexual Mutilations: a human Tragedy. New York: Plenum Press; 1997. pp.79-81
    (44)Jefferson G. The peripenic muscle; some observations on the anatomy of phimosis. Surgery, Gynecology and Obstetrics 1916 Aug;23(2):177-81.
    (45) Moldwin RM, Valderrama E. Immunohistochemical analysis of nerve distribution patterns within preputial tissues. J Urol 1989 Apr;141(4):499A. (abstract)
    (46) Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized musocsa of the penis and its loss to circumcision. Br J Urol 1996 Feb;77(2): 291-5
    (47) Dogiel AS. Die Nervenendigungen in der Haut der ausseren Genitalorgane des Menschen. Archiv fur Mikroskopische Anatomie 1893:41:585-612
    (48)Bazett HC, McGlone B, Williams RG, Lufkin HM. Depth, distribution and probable identification in the prepuce of sensory end-organs concerned in sensations of temperature and touch; thermometric conductivity. Archives of Neurology and psychiatry 1932 Mar; 27(3):489-517
    (49) Ohmori D. Uber die Entwicklung der Innervation der Genitalapparate als peripheren Aufnahmeapperat der Genitalen Reflexe. Zeitschrift fur Anatomie und Entwicklungsgeschichte 1924;70(1):347-410.
    (50)Halata Z, Munger BL. The neuroanatomical basis for the protopathic sensibility of the human glans penis. Brain Res 1986 Apr23;371(2):205-30.
    (51)Winkelmann RK. The Cutaneous Innervation of the human newborn prepuce. Invest Dermatol 1956 Jan;26(1):53-67
    (52)Winkelmann RK. The erogenous zones: their nerve supply and significance. Mayo Clin Proc 1959;34(2):39-47.
    (53)Morris L. Sorrells, James L. Snyder. Fine-touch pressure thresholds in the adult penis . BJU 2006 Oct:22, pp. 864-869
    (54) Weiss GN, Sanders M, Westbrook KC. The distribution and density of Langerhans cells in the human prepuce: site of diminished immune response? Isr J Med Sci 1993 Jan;29(1);42-3
    (55) Flower PJ, Ladds PW, Thomas AD, Watson DL. An immunopathologic study on the bovine prepuce. Vet Pathol 1983 Mar;20(2):189-201.
    (56)Ahmed A, Jones AW. Apocrine Cystadenoma: a report of two cases occurring on the prepuce. Br J Dermatol 1969 Dec; 81(12):899-901.
    (57)Hyman AB, Brownstien MH. Tyson’s “glands”: ectopic sebaceous glands and papillomatosis penis. Arch Dermatol 1969 Jan;99(1):31-6
    (58)Parkash S, Jeykumar S, Subramanyan K, Chaudhuri S. Human Subpreputial collection: its nature and formation. J Urol 1973 Aug 110(2):211-2
    (59) Ahmed AA, Nordlind K, Schultzberd M, Liden S. Immunohisto chemical localization of IL-1 alpha-, IL-1 beta-, IL-6- and TNF-alpha-like immunoreactivities in human apocrine glands Arch
    (60) Frohlich E Shamburg-Lever G, Klesses C. Immunelectron microscopic localization of cathepsin B in human apocrine glands. J Cutan Pathol 1993 Feb;20(1):54-60
    (61) Cohn BA. In search of human skin pheromones. Arch Dermatol 1994 Aug; 130(8):1048-51
    (62)Dermatol Res 1995;287(8):764-6Smith GL, Greenup R, Takafuji ET. Circumcision as a risk factor for urethritis in racial groups. AM J Public Health 1987 Apr;77(4):452-4
    (63) Bassett I, Donovan B, Bodsworth NJ. Male circumcision and common sexually transmissible diseases in a developed nation setting. Genitourin Med 1994 Oct;70(5):317 -20.
    (64) Bassett I, Donovan B, Bodsworth NJ, Field PR, Ho DW, jeansson S, Cunningham AL. Herpes Simplex virus type 2 infection of heterosexual men attending a sexual health sentre. Med J Aust 1994 Jun 6:160(11);697-700
    (65) Van Howe R. Does Circumcision Influence Sexually Transmitted diseases?: a literature review. BJU Int 1999 Jan;83 Suppl 1:52-62.
    (66) Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States: prevalence, prophylactic effects, and sexual Practice. JAMA 1997 Apr2;277(13):1052-7
    (67) Dickson NP, Van Rood T, Herbison P, Paul C. Circumcision and risk of sexually transmitted infections in a birth cohort. J Pediatr 2008;152:383-7.
    (68) Cook LS, Koutsky LA. Holmes KK. Clinical presentation of genital warts among circumcised and uncircumcised heterosexual men attending an urban STD clinic. Genitourin Med 1993 Aug;69(4):262-4
    (69) Van Howe, Robert S. (May 2007). “Human papillomavirus and circumcision: A meta-analysis”. Journal of Infection 54 (5): 490–496.
    (70) Dinh, T.H.; M. Sternberg, E.F. Dunne and L.E. Markowitz (April 2008). “Genital Warts Among 18- to 59-Year-Olds in the United States, National Health and Nutrition Examination Survey, 1999–2004″. Sexually Transmitted Diseases 35 (4): 357–360.
    (71) Van Howe, R.S. (January 1999). “Circucmsion and HIV infection: review of the litarature and meta-analysys”. International Journal of STD’s and AIDS 10: 8–16.
    (72)Amir J. et al. Circumcision and Urinary Tract Infections in Infants. Am J Dis Child (1986), vol. 140, p. 1092.
    (73)Prais D. Shoov-Furman R, Amir J. Is circumcision a risk factor for neonatal urinary tract infections? Arch Dis Child Published Online First: 6 October 2008.

  86. POSTED BY craig  |  March 06, 2011 @ 5:12 pm

    Genital warts, also known as human papilloma virus (HPV), is the most common STD in the U.S. Its association with circumcision, has been a heavily debated topic for many years. As more recent studies enact more rigorous controls and use larger study groups, the association between circumcision and HPV has become more clear.

    A classic 1993 study on HPV, came up with the conclusion that:

    “Uncircumcised men had a lower prevalence of genital warts then circumcised men… The presence of the foreskin may confer non specific protection of the proximal penis from acquisition of HPV infection.” [1]

    A meta-analysis Performed by D.r. Robert Van Howe in 2006 found no significant association between circumcision status and HPV infection.

    “The medical literature does not support the claim that circumcision reduces the risk for genital HPV infection” [2]

    Most studies on HPV performed before 2006 had poor controls and relatively small study groups. In order to clear up this confusion, a recent 2008 study on HPV had an enormous study group of almost nine thousand men in the United States. This is currently the largest study on circumcision and HPV ever performed in the U.S. And since the study was performed in the U.S., the results are directly applicable to people who live in the U.S. They concluded:

    “The percentage of circumcised men reporting a diagnosis of genital warts was significantly higher than uncircumcised men, 4.5% (95% CI, 3.6%–5.6%) versus 2.4% (95% CI, 1.5%–4.0%)”. [3]

    Circumcised men where about twice as likely to have HPV! The claim that circumcision prevents cervical cancer in women is a detestable myth with sexist implications. This is based on the presumption that circumcision prevents HPV and that HPV increases the risk for both cervical cancer and penile cancer. Since this HPV claim has been thoroughly discredited, the cervical cancer myth is also now debunked. It has now been shown that circumcision increases the risk for HPV. Hence circumcision may increase the risk of both penile and cervical cancer by increasing the spread and acquisition of HPV. The practice of circumcision could very well be a contributing factor to the prevalence of HPV in the U.S.

    Nevertheless pro circumcision advocates have continued to mine for data in inapplicable communities like rural Uganda with the intent to prove that circumcision does reduce the risk for HPV. Yet, when these studies are performed they get an incredible amount of press. Why did the previous study I present not gain any publicity?

    In the studies I have provided thus far, they have have used racially and socioeconomic homogeneous study groups in developed urban western settings. This is something that most if not all of these pro-circumcision studies do not account for.

    [edit] References

    1. ↑ Cook LS, Koutsky LA. Holmes KK. Clinical presentation of genital warts among circumcised and uncircumcised heterosexual men attending an urban STD clinic. Genitourin Med 1993 Aug;69(4): 262-4 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1195083/
    2. ↑ Van Howe, Robert S. (May 2007). “Human papillomavirus and circumcision: A meta-analysis”. Journal of Infection 54 (5): 490–496.http://www.cirp.org/library/disease/cancer/vanhowe2006b/. Retrieved 2008-09-18.
    3. ↑ Dinh, T.H.; M. Sternberg, E.F. Dunne and L.E. Markowitz (April 2008). “Genital Warts Among 18- to 59-Year-Olds in the United States, National Health and Nutrition Examination Survey, 1999–2004″. Sexually Transmitted Diseases 35 (4): 357–360.http://journals.lww.com/stdjournal/Fulltext/2008/04000/Seroepidemiology_of_Human_Papillomavirus_Type_11.8.aspx Retrieved 2011-03-5

  87. POSTED BY craig  |  March 06, 2011 @ 5:12 pm

    The mistaken idea that circumcision prevents the acquisition and spread of STD’s is an old myth from the 19th century. The claim that circumcision prevents syphilis first appeared in a publication that dates back to 1855, [1] in the days before germ theory! Doctors where eager to claim that they could treat and prevent the spread of syphilis because of its endemic among soldiers during the American Civil War.

    The theory that circumcision does prevent STD’s gained new impetus in the 1940s’ Through the determined efforts of urologist Eugene A. Hand. [2] At this time, there was a general panic in the medical profession over African American solders spreading STD’s. [3] It is important to remember that this was in the days before penicillin was cheaply and widely available. STD’s were hard to treat and doctors had little understanding about how they were transmitted. Doctors where desperate and eager to claim that they could treat and prevent STD’s.

    [edit] Sexually Transmitted Diseases (STD’s) and Circumcision

    Most American males with gonorrhea or syphilis were poor, uneducated, rural, lower class, sexually promiscuous, and usually a minority race. This category of American was less likely to be circumcised then middle-class white males who were born in private hospitals where compulsory newborn circumcision had been instituted.

    Even so, large-scale studies of all kinds performed by objective researchers have found that circumcised men have higher rates of most major STD’s than intact males. This is a shocking fact that circumcisers have tried to cover up.

    A famous study on nongonococcal urethritis (NGU) concluded:

    “a case-control study of active duty soldiers showed that both black and white circumcised subjects where 1.65 times as likely to have NGU as uncircumcised subjects.” [4]

    The authors of another valuable 1994 study on the relationship between circumcision and STD’s- especially the various types of gonorrhea- concluded that

    “circumcision of men has no significant effect on the incidence of common STD’s in this developed nation setting… we determined no association between circumcision status and a history of NGU or gonorrhea. In the case of gonorrhea this may have been because this was uncommon in our population; the slight trend was for the presence of a foreskin to be “protective”.” [5]

    An exhaustive 1994 study on herpes simplex virus type 2 (HSV-2) concluded:

    “We have found no evidence the presence of an intact foreskin being a risk factor for HSV-2 infection… Importantly, our study group was relatively racially homogeneous, lack of circumcision was not a marker of lower socioeconomic status .” [6]

    Dr. Robert Van Howe actually conducted the largest review of the scientific literature on STD’s and circumcision ever published. His conclusions are startling:

    “The medical literature does not support the theory that circumcision prevents STD’s” (6) Van Howe R. Does Circumcision Influence Sexually Transmitted diseases?: a literature review. BJU Int 1999 Jan;83 Suppl 1:52-62. [7]

    To confirm this, the National Health and Social Life Survey conducted at the University of Chicago, found:

    “First, Circumcision status does not appear to lower the likelihood of contracting an STD. Rather, the opposite pattern holds. Circumcised men were slightly more likely to have had both a bacterial and a viral STD in their lifetime.” [8]

    Furthermore a recent 2007 study determined.

    “Overall, up to age 32 years, the incidence rates for all STI’s were not statistically significantly different—23.4 and 24.4 per 1000 person-years for the uncircumcised and circumcised men, respectively. This was not affected by adjusting for any of the socioeconomic or sexual behavior characteristics.”(8) [9]

    Circumcised males had higher rates of all bacterial and viral STD’s. Circumcised males had higher rates of nongonococcal urethritis, herpes, and chlamydia–one of the most common STD’s today. One must ask why circumcisers have been insisting that circumcision does prevent STD’s and have been getting away with this bogus claim for so long.

    Behavior and socioeconomic status effect your likely hood of STD transmission far more then circumcision status. All studies conclude that this is the biggest factor for determining likelihood for STD contraction. The plain fact is that it is unimportant how much penis you have; what you do with it determines your risk for contracting STDs. Your sexual behavior and life style choices affect your risk of disease rather than your circumcision status. After all, STD’s are unable to fly through the air and infect innocent people. You have to work hard to get an STD. This category of disease is contracted as a result of poor decision making. Neither circumcision nor intactness can affect your decision making abilities. More important, neither circumcision nor genital intactness will save you from the consequences of poor decisions. Even if circumcision did prevent STD’s It would be irrational to use circumcision as a preventive measure for behavior your son may or may not even engage in. It is far more effective to teach your son how to make good decisions and practice good hygiene.

    [edit] Opposing Views

    Believe it or not some people take these claims seriously, even today! A 2006 meta-analysis claims that circumcision prevents syphilis, chancroid, and genital herpes. [10]

    For the association of male circumcision and HSV‐2 they used:

    “eight from Africa, one from India, and one from the United States”

    In order to examine Association of male circumcision and syphilis seropositivity they used:

    “Fourteen studies examined the association between male circumcision and serological evidence of syphilis infection (table 2), from sub-Saharan Africa (nine studies), the United States (two studies), Australia, India, and Peru.”

    In order to examine Association of male circumcision and chancroid they used:

    “Seven studies examined the association between male circumcision and chancroid. Three were from Kenya and the remainder from the United States, United Kingdom, and the US and Australian military”

    First of all, study’s from Africa are not applicable to developed nations like the United States, because of the drastically different sexual and hygienic behaviour that exists between the groups. This is discussed extensively in the section on HIV.

    Many of these observational studies this meta-analysis included used participants who have life styles that are not representative of average Americans or Africans. They used many studies on long distance truck drivers in Africa. [11] [12] [13] [14] [15] Some of these truck drivers engage in risky sexual activity with prostitutes at trucks stops. These are not indicative of your typical American or African life style. Should you surgically alter your son based on the poor decisions of long distance truck drivers in Kenya?

    As if flawed observational studies form Africa are not bad enough, the authors include a study from Australia for their syphilis claim which states the following:

    “However, the data for syphilis should be interpreted with caution because of the small number of cases” [16]

    Systematic literature searches, like the one used in this publication, should be assessed with a system of checks. If this study is not known to be accurately representative of syphilis in Australia then it is probably better not to use it. By including this study authors and peer reviewers reveal their bias. This makes the analysis look more weighted with study’s from developed nations by using garbage data. In any event the results is heavily weighted with data gatherd from inapplicable people and places in developing countries like those in Africa. Even if these study’s where well constructed they would still not be applicable to developed nations because true variable isolation is often impossible in reality. [17] [18]

    In any event syphilis is the biggest claim of this publication. Since it is so uncommon in developed western nations, even the biggest survey like the one by Laumann et al, could not detect a difference. [19]

    [edit] References

    1. ↑ Hutchinson J. On the influence of circumcision in preventing syphilis. Med Times Gazette 1855; 32; 542-3.
    2. ↑ Hand EA. CIRCUMCISION and venereal disease. Archives of Dermatology and Syphilology 1949 sep;60(3):341-6
    3. ↑ Heimoff LL. Venereal Disease control program. Bull US Army Med Dept 1945 Apr;3(87):93-100.
    4. ↑ Smith GL, Greenup R, Takafuji ET. Circumcision as a risk factor for urethritis in racial groups. AM J Public Health 1987 Apr;77(4):452-4 http://www.cirp.org/library/disease/STD/smith/
    5. ↑ Donovan B, Bassett I, Bodsworth NJ. Male circumcision and common sexually transmissible diseases in a developed nation setting. Genitourin Med 1994 Oct;70(5):317 -20. http://www.cirp.org/library/disease/STD/donovan1/
    6. ↑ Bassett I, Donovan B, Bodsworth NJ, Field PR, Ho DW, jeansson S, Cunningham AL. Herpes Simplex virus type 2 infection of heterosexual men attending a sexual health centre. Med J Aust 1994 Jun 6:160(11);697-700 http://www.ncbi.nlm.nih.gov/pubmed/8202004
    7. ↑ http://www.cirp.org/library/disease/STD/vanhowe6/
    8. ↑ Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States: prevalence, prophylactic effects, and sexual Practice. JAMA 1997 Apr2;277(13):1052-7 http://www.cirp.org/library/general/laumann/
    9. ↑ Dickson NP, Van Rood T, Herbison P, Paul C. Circumcision and risk of sexually transmitted infections in a birth cohort. J Pediatr 2008;152:383-7.http://www.ncbi.nlm.nih.gov/pubmed/18280846.
    10. ↑ Weiss HA, et al. Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis. Sex Transm Infect. 2006 Apr;82(2):101-9 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2653870/?tool=pubmed
    11. ↑ Rakwar J, Lavreys L, Thompson M L. et al Cofactors for the acquisition of HIV‐1 among heterosexual men: prospective cohort study of trucking company workers in Kenya. AIDS 1999. 13607–614.
    12. ↑ Manjunath J V, Thappa D M, Jaisankar T J. Sexually transmitted diseases and sexual lifestyles of long‐distance truck drivers: a clinico‐epidemiologic study in south India. Int J STD AIDS 2002. 13612–617.
    13. ↑ Rakwar J, Jackson D, Maclean I. et al Antibody to Haemophilus ducreyi among trucking company workers in Kenya. Sex Transm Dis 1997. 24267–271.
    14. ↑ Lavreys L, Rakwar J P, Thompson M L. et al Effect of circumcision on incidence of human immunodeficiency virus type 1 and other sexually transmitted diseases: a prospective cohort study of trucking company employees in Kenya. J Infect Dis 1999. 180330–336.
    15. ↑ Bwayo J, Plummer F, Omari M. et al Human immunodeficiency virus infection in long‐distance truck drivers in east Africa. Arch Intern Med 1994. 1541391–1396.
    16. ↑ Parker S W, Stewart A J, Wren M N. et al Circumcision and sexually transmissible disease. Med J Aust 1983. 2288–290.
    17. ↑ How independent are `independent’ effects? Relative risk estimation when correlated exposures are measured imprecisely. J Clin Epidemiol 1991;44:1223± 31
    18. ↑ David Smith G, Phillips AN. Confounding in epidemiological studies: why `independent’ effects may not be all they seem. BMJ 1992;305:757± 9
    19. ↑ Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States: prevalence, prophylactic effects, and sexual Practice. JAMA 1997 Apr2;277(13):1052-7 http://www.cirp.org/library/general/laumann/

  88. POSTED BY craig  |  March 06, 2011 @ 5:13 pm

    The Protective and Hygienic Function of the Foreskin

    The foreskin, like the eyelid, also serves an important protective and hygienic function. The foreskin protects the delicate glans of the penis and puts the urethra at a distance form its environment protecting it from foreign contaminants of all kinds. While simultaneously shielding the penis from injury.It is a double fold of skin which offers two layers of protection.

    Natural secretions of oil are achieved by sebaceous glands which are abound in the foreskins inner lining, these are not present in the glans. [1] They are also present in the eye lid and perform the same function in both places. They secrete the oils necessary to keep the glans surface soft, moist, warm, sensitive, and with a healthy red or purple color. This moisturizer keeps the surface of the glans glistening, smooth, soft, maintained PH balance, and optimal cleanliness. This is required to keep the surface of the glans healthy and clean via the cleaning effects of mucous secretions. This function is analogous to the eye lid. The glans are meant to be an internal organ covered and protected from the outside world.

    In the genitally intact penis the urine stream flushes out the urethra and foreskin of foreign microbes. In healthy individuals, urine is sterile and has a disinfectant quality. Researchers have demonstrated that the swirling action of urine as it rushes through the foreskin flushes it out effortlessly and naturally. [2] Though urine passes through the foreskin every day, the inner foreskin is remarkably free of urea-a by-product of liver metabolism that is secreted in urine. Studies demonstrate that washings from the foreskin are rich in fructose, acid phosphatase, and mucin, but never urea. It appears that the secretions of seminal vesicles, prostate, and urethral mucous glands, collectively or individually, keep the foreskin clear and clean as well. [3] At birth, the foreskin is usually attached to the glans(head) of the penis, akin to how a fingernail is attached to a finger. [4] At infancy the foreskins tubular neck(prepucial orifice) is often long and narrow while the sphincter muscle in the tip of the foreskin keeps its opening closed. This acts as an extension of the urethra. [5] [6] Together these property’s prevent the entry of contaminants. The idea that the foreskin is “dirty” or “unclean” is a scientifically unfounded superstition.The intact penis is naturally clean and maintains a level of hygiene that is optimal when compared to a penis that has been altered by circumcision.

    The circumcised penis needs much more care after circumcision, due to the open wounds and raw bleeding flesh. Surgically externalized glans are dirty rather then clean because of constant exposure to dirt abrasion and contaminants. [7] This study also concluded that circumcised boys are also found to be more likely to develop balanitis, meatitis, coronal adhesions and meatal stenosis. [8]
    [edit] The Immunological Function of the Foreskin

    The foreskins inner fold and the glans of the penis are comprised of mucous membrane tissue. These are also present in your eyes, mouth, and all other bodily orifices including the female genitals. These are the first line of immunological defensive for the body’s orifices. These mucous membranes perform many immunological and hygienic functions. Certain components such as Langerhans cells [9], plasma cells [10] , apocrine glands [11] , and sebaceous glands [12] [13] [14] [15], collectively secrete emolliating lubricants [16] Apocrine glans perform a crucial funtion by secreting enzymes such as lysosomal enzymes, cathepsin B, chymotrypsin, and neutrophil elastase. [17] There is also strong research to suggest that lysozyme can protect against HIV infection [18] Apocrine glands also produce cytokine, [19] cytokine is a very important nonantibody protein that generates immune response when in contact with specific agents. Plasma cells which increase in number in response to pathogens levels, secrete immunoglobulin. [20]

    It is also very important to note that Langerhans cells that are present in the foreskin produce Langerin, a substance that has been proven to kill the HIV virus on contact. [21] All of these function to sequester and “digest” foreign pathogens. All these substances play an important role in protecting the penis from viral and bacterial pathogens. The immunological functions of the human prepuce have been extensively documented by respected researchers for quite some time. [22]

    In infancy, simple sugars in breast milk, like antibacterial oligosaccharides, are acquired from the mothers milk and excreted in urine. University studies have shown that these substances cling to the mucosal lining of the inner foreskin and protect against urinary tract infections [23] , as well as infections in other parts of the body. [24] Babies excrete in their urine about 300-500 milligrams of obligosaccharides each day. These compounds prevent virulent strains of Escherichia coli from adhering to the mucosal lining of the entire urinary tract, including the foreskin and glans. For these reasons breast-milk is highly efficacious at preventing UTI. [25] Rigorous study’s have repeatedly demonstrated that breast feeding protects against urinary tract infections. [26] [27] [28] Researchers have shown that premature foreskin retraction can expose the penis to hospital strains of Escherichia coli and can result in UTI. [29] Hence the protective function of the foreskin is in the child’s best interest especially during chemically treated diaper wearing years where feces mixed with urine can not only contaminate the permanently exposed urinary meatus but also the amputation wound from the circumcision surgery itself.

    It is important to note that women have a higher risk of UTI. This is because the shorter urethra offers less protection via the immunological function of the urethra’s mucosal lining. By the same observation we see that the tubular tip of the foreskin, and its mucosal lining, act as an extension of the urethra hence providing more of that same protection via mucosa immunology and the adherence of antibacterial substances in breast milk. Removal of the foreskin destroys all this functionality.

    [edit] References

    1. ↑ Hyman AB, Brownstien MH. Tyson’s “glands”: ectopic sebaceous glands and papillomatosis penis. Arch Dermatol 1969 Jan;99(1):31-6
    2. ↑ Parkash S, Jeykumar S, Subramanyan K, Chaudhuri S. Human Subpreputial collection: its nature and formation. J Urol 1973 Aug 110(2):211-2
    3. ↑ Parkash S. Penis: some facts and fancies. Journal of Physician’s Association pf Madras June 1982: pp.1-13
    4. ↑ Diebert GA. The separation of the prepuce in the human penis. Anatomical Record 1993 Nov;57(4):387-99.
    5. ↑ Hunter RH. Notes on the development of the prepuce. Journal of Anatamy 1935 Oct;70(1):6875.
    6. ↑ Glenister TW. A consideration of their process involved in the development of the prepuce in man. Br J Urol 1956 Sep;28(3):243-9
    7. ↑ Van Howe RS. Variability in penile appearance and penile findings: a prospective study. Br J Urol 1997; 80: 776-782.
    8. ↑ Van Howe RS. Variability in penile appearance and penile findings: a prospective study. Br J Urol 1997; 80: 776-782.
    9. ↑ Weiss GN, Sanders M, Westbrook KC. The distribution and density of Langerhans cells in the human prepuce: site of diminished immune response? Isr J Med Sci 1993 Jan;29(1);42-3
    10. ↑ Flower PJ, Ladds PW, Thomas AD, Watson DL. An immunopathologic study on the bovine prepuce. Vet Pathol 1983 Mar;20(2):189-201.
    11. ↑ Ahmed A, Jones AW. Apocrine Cystadenoma: a report of two cases occurring on the prepuce. Br J Dermatol 1969 Dec; 81(12):899-901.
    12. ↑ Hyman AB, Brownstien MH. Tyson’s “glands”: ectopic sebaceous glands and papillomatosis penis. Arch Dermatol 1969 Jan;99(1):31-6
    13. ↑ Delbanco E. Über das gehäufte Aufreten von Talgdrusen an der Innerflähe des Präputium. Monatshefte für praktishe Dermatologie 1904; 38:536-8.
    14. ↑ Piccinno R, Carrel C-F, Menni S. et al. sebacous glands mimicking molluscum contagiosum Acta Derm Venerol1990;70:344-5.
    15. ↑ Krompecher St. Die Histologie der Absonderung fur Smegma Praeputi. Anatomischer Anzeiger 1932; 75:170-176.
    16. ↑ Parkash S, Jeykumar S, Subramanyan K, Chaudhuri S. Human Subpreputial collection: its nature and formation. J Urol 1973 Aug 110(2):211-2
    17. ↑ Frohlich E Shamburg-Lever G, Klesses C. Immunelectron microscopic localization of cathepsin B in human apocrine glands. J Cutan Pathol 1993 Feb;20(1):54-60
    18. ↑ George Hill Summary of evidence that the foreskin and lysozyme may protect against HIV infection.7 September 2003 http://www.cirp.org/library/disease/HIV/hill1/
    19. ↑ Ahmed AA, Nordlind K, Schultzberd M, Liden S. Immunohisto chemical localization of IL-1 alpha-, IL-1 beta-, IL-6- and TNF-alpha-like immunoreactivities in human apocrine glands Arch
    20. ↑ Flower PJ, Ladds PW, Thomas AD, Watson DL. An immunopathologic study on the bovine prepuce. Vet Pathol 1983 Mar;20(2):189-201.
    21. ↑ de Witte L, Nabatov A, Pion M, et al. Langerin is a natural barrier to HIV-1 transmission by Langerhans cells. Nat Med 2007 (Published on line ahead of print March 4)http://www.cirp.org/news/healthday2007-03-05/
    22. ↑ P M Fleiss, F M Hodges, R S Van Howe. Immunological functions of the human prepuce. SEXUALLY TRANSMITTED INFECTIONS (London), Volume 74, Number 5, Pages 364-367, October 1998.http://www.cirp.org/library/disease/STD/fleiss3/
    23. ↑ Hanson LA, Karlsson B, Jalil F, et al. Antiviral and antibacterial factors in human milk. In: Hanson LA, ed. Biology of Human Milk. New York Raven Press; 1988. pp. 141-57
    24. ↑ Coppa GV, Gabrielli O, Giorgi P, Catassi C, Montanari MP, Veraldo PE, Nichols BL. Preliminary study of breast feeding and bacterial adhesion to uroepithelial cells. Lemcet 1990 Mar 10;335(8689):569-71.
    25. ↑ Gothefors L, Olling S, Winberg J. Breastfeeding and biological properties of faecal E. coli strains. Acta Paediatr Scand 1975 Nov;54(6):807-12
    26. ↑ Mårild S. Breastfeeding and Urinary Tract Infections. Lancet 1990;336:942
    27. ↑ Pisacane A, et al. Breastfeeding and urinary tract infection. The Lancet, July 7, 1990, p50
    28. ↑ Pisacane A, Graziano L, Mazzarella G, et al. Breast-feeding and urinary tract infection. J Pediatr 1992;120:87-89.
    29. ↑ Winberg J et al. The Prepuce: A Mistake of Nature? Lancet 1989, pp.598-99.

  89. POSTED BY craig  |  March 06, 2011 @ 5:15 pm

    [Comment removed due to inappropriate content.]

  90. POSTED BY jakew  |  March 06, 2011 @ 5:51 pm

    Craig’s post is clearly copied & pasted, so I won’t waste too much time on correcting it. Just a few points:

    “A wide range of surgical complications occur in 2-10% of the cases.(1)” — actually, this figure is just an estimate, as Craig’s source acknowledges. The most recent systematic review of circumcision complications found a median complication rate of 1.5%; the median rate of complications judged “serious” was 0%. http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/20158883/?tool=pubmed

    “Perhaps the most shocking fact is that circumcision continues to be practiced in the United States even though no official western medical organization in the world recommends it. The Royal Dutch Medical Society, The British Medical Association, the Canadian Pediatric Society, and the Royal Australian College of Physicians have all made official policy statements against circumcision. The American Academy of Pediatrics, the American Medical Association, the American Academy of Family Physicians, and the American Urological Association all do not recommend circumcision, and are also in agreement that there are no proven benefits.” — Craig is correct that these organisations do not recommend circumcision, but (with the exception of the Dutch) he is incorrect in claiming that incorrect the organisations he lists are against circumcision. He is also incorrect in claiming that they state that there are no proven benefits. For example, “the American Urological Association recommends that circumcision should be presented as an option for health benefits.” http://www.auanet.org/content/guidelines-and-quality-care/policy-statements/c/circumcision.cfm

    “What is the foreskin? [...] It cincludes around 12-20 square inches of skin (the size of a 3×4 or a 4×5 index card!)(43,46)” — Only one study in the literature has ever conducted a systematic measurement of the foreskin’s surface area. This study (by Kigozi et al) found that it averaged at 36.8 square centimetres (5.7 square inches). See: http://www.ncbi.nlm.nih.gov/pubmed/19770623

    “The neuro-anatomy of the penis has been rigorously studied by respected anatomists of all kinds. The component tissues that comprise the foreskin are richly innervated with the greatest quantity and variety of sensory nerve endings than any other part of the penis.(45,46,47,48,49,50,51,52,53)” — none of the sources Craig cites support this claim.

    “Many people are surprised to discover that the glans or “head” of the penis is actually the least sensitive part.(46,52,53)” — they probably would be, especially if they actually have a penis! Schober et al actually studied this matter, and found that the foreskin is the least sexually responsive part of the penis. http://www.ncbi.nlm.nih.gov/pubmed/19245445

    ““Five locations on the uncircumcised penis that are routinely removed at circumcision were more sensitive than the most sensitive location on the circumcised penis[...] The glans in the circumcised male is less sensitive to fine-touch pressure than the glans of the uncircumcised male[...]The most sensitive location on the circumcised penis is the circumcision scar on the ventral surface [...] When compared to the most sensitive area of the circumcised penis, several locations on the uncircumcised penis that are missing from the circumcised penis were significantly more sensitive.”(53)” — See critique by Waskett and Morris at: http://www3.interscience.wiley.com/cgi-bin/fulltext/118508593/HTMLSTART

    “The foreskin, like the eyelid, also serves an important set of protective and immunological functions. The foreskin protects the delicate glans of the penis and puts the urethra at a distance form its environment protecting it from foreign contaminants of all kinds. While simultaneously shielding the penis from injury. The foreskins inner fold and the glans of the penis are comprised of mucous membrane tissue. These are also present in your eyes, mouth, and all other bodily orifices including the female genitals. These mucous membranes perform many immunological and hygienic functions. Certain components such as Langerhans cells(54), plasma cells(55), apocrine glands(56), and sebaceous glands(57)” — Apocrine glands are a type of sweat gland, and recent histological studies reveal that neither sweat nor sebaceous glands are present. “unlike true skin of the penile shaft and outer surface of the prepuce, the mucosal surface of the prepuce is completely free of lanugo hair follicles, sweat and sebaceous glands.” Taylor JR, et al. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol 1996;77:291-295. “Postmortem specimens of normal prepuce collected from five neonates, five children under seven years of age and five adults were studied. [...] No secretory tissue or glands were found in any specimen.” Lakshmanan S., Prakash S. Human prepuce: some aspects of structure and function. Indian J Surg 1980;44:134-7. “A detailed study of the subpreputial collections and histological study of 128 specimens led us to conclude that there appears to be no evidence of any glandular tissue in the subpreputial region of the penis.” Parkash S, et al. Human subpreputial collection: its nature and formation. J Urol 1973;110(2):211-2.

    “The intact penis is naturally clean and maintains a level of hygiene that is optimal when compared to a penis that has been altered by circumcision. In fact, a myriad of rigorously controlled studies performed by objective researchers among racially and socioeconomically homogeneous study groups in developed urban settings have shown that circumcision is often associated with an increased risk of bacterial infections, viral infections, and major STD’s (62,63,64,65,66,67,68,69,70,71,72,73).” — Amusingly, many of the sources cited by Craig contradict his claims. For example, ref 63 states “From the findings of this study, circumcision of men has no significant effect on the incidence of common STDs in this developed nation setting.” Ref 64 states “Neither increasing age nor lack of circumcision was associated with HSV-2 infection” Ref 66: “We find no significant differences between circumcised and uncircumcised men in their likelihood of contracting sexually transmitted diseases.” Ref 67: “Overall, up to age 32 years, the incidence rates for all STIs were not statistically significantly different-23.4 and 24.4 per 1000 person-years for the uncircumcised and circumcised men, respectively. This was not affected by adjusting for any of the socioeconomic or sexual behavior characteristics.” But, of course, cherry-picking studies proves nothing, on either side of the debate. The typical method for getting an overview of scientific studies is that of the meta-analysis. For example, here is a 2006 meta-analysis of the association between syphilis, chancroid, and genital herpes and circumcision: http://www.ncbi.nlm.nih.gov/pubmed/16581731 Here is the latest Cochrane review of the association between circumcision and HIV: http://www.ncbi.nlm.nih.gov/pubmed/19370585

  91. POSTED BY cyndavaz  |  March 06, 2011 @ 6:37 pm

    [Comment removed due to inappropriate content.]

  92. POSTED BY cyndavaz  |  March 06, 2011 @ 6:38 pm

    [Comment removed due to inappropriate content.]

  93. POSTED BY cyndavaz  |  March 06, 2011 @ 6:38 pm

    [Comment removed due to inappropriate content.]

  94. POSTED BY cyndavaz  |  March 06, 2011 @ 6:42 pm

    [Comment removed due to inappropriate content.]

  95. POSTED BY cyndavaz  |  March 06, 2011 @ 6:44 pm

    Medical Organization Official Policy Statements on Circumcision:

    http://www.cirp.org/library/statements/

  96. POSTED BY cyndavaz  |  March 06, 2011 @ 6:51 pm

    [Comment removed due to inappropriate content.]

  97. POSTED BY thedirt  |  March 06, 2011 @ 7:33 pm

    [Comment removed due to inappropriate content.]

  98. POSTED BY thedirt  |  March 06, 2011 @ 7:33 pm

    [Comment removed due to inappropriate content.]

  99. POSTED BY bebopgun  |  March 06, 2011 @ 9:45 pm

    Tudlow–since you asked, I had an awesome breakfast. We went to a neighbor’s and started with a coffee and mimosa. This was followed by french toast with blueberry syrup, scones, and a few bloody mary’s.

    Usually I just have oatmeal & yogurt or natto & rice. Today was an exception.

    What did you have?

  100. POSTED BY Tudlow  |  March 06, 2011 @ 10:02 pm

    Oh, bebop, that sounds divine. Bloody Mary’s are my favorite drink–I always ask for them spicy but it really has to be the right combination of horseradish and tabasco, you know? I had one yesterday at a seafood restaurant near Sandy Hook and it upset my stomach, I don’t know why.

    But today I had some dry Life cereal around 11. Isn’t that pathetic? I’ve been at my computer much of the day wishing I had not participated in this thread. Oh my eyes, they’re burning!

    I really should make more of an effort to eat breakfast. Yes, I really should.

  101. POSTED BY bebopgun  |  March 06, 2011 @ 10:22 pm

    I hear ya Tudlow. Sometimes I have to force myself to stay off my computer on the weekends. It usually doesn’t work but I try.

    I just can’t stop myself from checking in on Baristanet and a few other sites.

    Sometimes breakfast seems like the least important meal of the day but when it’s good, it can be very good.

    Now I gotta get some work done before bed. Yawn.

  102. POSTED BY craig  |  March 06, 2011 @ 10:54 pm

    Jake goes on to use another study of self assessment in determining the sensitivity of the foreskin. [33] Oeople are not even able to determine their own circumcision status(34) much less the five components of the foreskin and their s…ensitivity.

    In any event Jake has combed the internet for what ever information, flawed or not, he required in order to rationalize his projections.

    (33)Schober JM, et al. Self-ratings of genital anatomy, sexual sensitivity and function in men using the ‘Self-Assessment of Genital Anatomy and
    (34)Sexual Function, Male’ questionnaire. BJU Int. 2009 Apr;103(8):1096-103. Epub 2009 Feb 24.

  103. POSTED BY craig  |  March 06, 2011 @ 10:58 pm

    “For example, here is a 2006 meta-analysis of the association between syphilis, chancroid, and genital herpes and circumcision: http://www.ncbi.nlm.nih.gov/pubmed/16581731

    i tear this apart in my STD post above

    “See critique by Waskett and Morris at: http://www3.interscience.wiley.com/cgi-bin/fulltext/118508593/HTMLSTART
    This critique ha been thoroughly discredited by another critique
    http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2007.07072_1.x/full

  104. POSTED BY jakew  |  March 07, 2011 @ 4:48 am

    [Comment removed due to inappropriate content.]

  105. POSTED BY jakew  |  March 07, 2011 @ 8:49 am

    [Comment removed due to inappropriate content.]

  106. POSTED BY craig  |  March 07, 2011 @ 3:30 pm

    Sudys from Africa not not applicable to people who live in developed nations. I explain this in detail in my section on HIV below.

    HIV

    Of all the accusations leveled against the human foreskin none warrant a closer examination then HIV. In order to defend the circumcision industry from its now eminent decline, circumcision advocates have sought to manipulate our fears of a slow and plain-full HIV/AIDS related death.

    Lower socioeconomic minorities are more often intact and usually have a greater number of sexual partners. Most men who have contracted HIV are suffering the consequences for a life time of poor decision making. In the U.S. HIV is often always contracted by homosexuals who have engaged in promiscuous activity, and/or men who have engaged in a life time of drug use and promiscuous sexual activity. Besides, children born to day will likely have and HIV vaccinate available by the time thy are sexually active adults.

    All studies have repeatedly shown that number of sexual partners generates the biggest increase in STD infection risk. Therefore comparing a circumcised upper class and an intact lower class or comparing circumcised African Muslims to intact African Non-Muslims, is inapplicable because of the significant difference in hygienic and sexual behavior which affect the results far more then circumcision status which in turn is also related to tribal affiliation. Therefore the rates of exposure for each group within their separate communities is a co-founding factor.

    Studies performed in Africa could never be extrapolated to populations in the U.S., because of the drastically different culture. Pro-circumcision “studies” taken from rural Africa routinely and deliberately neglect these plain and obvious flaws during their data mining operations in rural Africa. Viral load is often a co-founding factor that is not controlled for. Viral load has been suggested to drastically increases HIV infection risk(1)

    It is also very important to note that Langerhans cells that are present in the foreskin produce Langerin, a substance that has been proven to kill the HIV virus on contact.(2) Pro-circumcision advocates claim that Langer cells allow for the entry of the HIV virus, however Langerhans cells exist though out all the skin of the penis therefore it would not be logical to remove all the skin of the penis to prevent HIV.

    Many observational studies use participants who have life styles that are not representative of average Americans or Africans. There have been many studies on long distance truck drivers in Africa(3). Some of these truck drivers engage in risky sexual activity with prostitutes at trucks stops. These are not indicative of your typical life style. Should you surgically alter your son based on the poor decisions of long distance truck drivers in Kenya?

    Yet, time and time again, researchers who actually value science have sought to correct these flawed assessments. For every study that claims a benefit there is another, if not more studies that found no benefit.

    A 1999 meta-analysis on HIV concluded :

    “…on the 29 published articles where data were available. When the raw data are combined, a man with a circumcised penis is at greater risk of acquiring and transmitting HIV than a man with a non-circumcised penis [...]Based on the studies published to date, recommending routine circumcision as a prophylactic measure to prevent HIV infection in Africa, or elsewhere, is scientifically unfounded.”(4)

    Since homosexuals are one of the biggest proliferators of HIV in the U.S. it is important to determine what effect HIV has on the homosexual transmission of HIV.

    A 2008 meta-analysis of 15 observational studies, including 53,567 gay and bisexual men from the United States, Britain, Canada, Australia, India, Taiwan, Peru and the Netherlands (52% circumcised), stated that the rate of HIV infection was non-significantly lower among men who were circumcised compared with those who were uncircumcised.(5)

    The flaws with these new Randomized “Controlled” Trials (RCT).

    Why go to Kenya(6), Uganda(7), and Sub-Saharan Africa(8) to perform randomized “controlled” trials(RCTs) on circumcision and HIV? These are some of the only countries in Africa where circumcised communities have a lower prevalence of HIV(9). Hard-line circumcision advocates with and known bias, know this, and they often exploit the cultural differences in these communities that cause intact communities to acquire HIV more often. This is how they are mining the data they need to promote their agenda. After receiving criticism for observational studies circumcision advocates have sought to use these randomized controlled trials in order to control for the cross-cultural differences that studies in these places have been criticized for in the past. However there are still obvious flaws in methodology that can not be denied. Here are just some of the variables that where not controlled for in many studies used to claim that circumcision prevents HIV, and specifically in the RCT’s .

    1)The time needed for healing for those circumcised before the trial was initiated means less exposure time. Circumcision is a serious injury, men who have just been circumcised can not be expected to continue normal sexual behavior during the trial. Behavior always effects your risk by many orders of magnitude more then circumcision ever could.
    2)Dry sex is A practice that is common in many of these communities. It entails drying the vagina with dirt, sand, dried leaves, corn meal, or powders to absorb lubrication. This practice is unsanitary and causes lesions and other entry points that increase risk for STD transmission.(10)
    3)Genital warts and ulcers re-occurrence, how they were treated, the final efficacy of that particular treatment (Excision or chemical). And the irresponsible sexual behavior on both men(11) and prostitutes while afflicted with genital ulcer disease(GID)(12). GUD is an endemic in parts of Africa.
    4)One U.S. study showed that circumcised men were more likely to engage in riskier and “more highly elaborated” sexual practices including anal sex, and sex with multiple partners(13). These factors may not come into play for an intervention group immediately after circumcision. This also shows that sexual behaviors for those circumcised as infants may not reflect sexual behaviors of those circumcised as adults. Therefore results determined in circumcising an intervention group are not applicable to men circumcised as infants.
    5)Female circumcision: where male circumcision exists female circumcision usually exists as well.
    6)Anal sex
    7)Homosexual sex
    8)The accuracy of the tests to determine rates of false or negative determinations
    9)The time needed to manifest all seroconversions
    10)In the case of these new RCT’s any chance of a follow-up was lost because the test was stopped early and all subjects were circumcised.
    11)Equal amount of “safe-sex counseling” for both groups

    Some of these new short term studies, determined that circumcised significantly less likely to acquire HIV then genitally intact men. This does not mean this benefit exists in the real world. Repeat exposure to partners with HIV will eventually lead to the acquisition of HIV. If the real world reduction was significant we would see a significant difference among intact and circumcised populations, when in reality we do not see any clear association. The conductors of these studies took a quick snap shot of the data before the results turned on them and then circumcised all study participates so that a follow-up survey could not be performed. If they tried to present this to any reputable organization who wished to maintain scientific integrity, they would be laughed out of the room, as they have. Attributing the results of their tests to anatomically correct male genitalia is not only ludicrous but plainly irrepressible. What we have here are “studies” performed in an abstracted theoretical situation. This theoretical situation is unrealistic and does not represent real world situations. In the real world people are sexually active for more then twelve or twenty months of their life. In the real world people would not wear a condom that is only marginally effective. The only thing that can prevent HIV is safe sex or abstinence.

    A recent study performed by researchers without any declared conflicts of interest concluded.

    “Circumcision status was not associated with HIV/HSV-2 infection nor increased high risk sexual behaviors. In males, preference for being or becoming circumcised was associated with inconsistent condom use and increased lifetime number of sexual partners.” (14)

    This study also reveals the moral hazard this circumcision campaign has created in Africa. People may mistakenly assume circumcised men are immune to HIV infection, therefore validating reckless sexual behavior. In any event condoms have proven to be far more efficacious then circumcision could ever be.

    What about male to female HIV transmission?

    “ there is consistent evidence that female-to-male HIV transmission, compared with male-to-female transmission, is much higher in Europe than in the USA …Data from the European Multicenter Partners Study and comparable research from the USA suggest that the ratio of female-to-male transmission (compared with male to female transmission) is about 10 fold higher in Europe.”(15)

    Why not perform controlled short term trials to find how circumcision affects male to female transmission? If such studies where performed researchers may not find what it is they are looking for.

    The U.S. Is the only western nation with a large number active circumcised males. The prevalence of circumcision in the U.S. could possibly explain why the male to female transmission of HIV is so high. This could explain why the United States has the highest rate of HIV in the developed world, even higher then many third world nations!(16)

    A Randomized controlled trial in Uganda was performed to test the HIV transmission to female partners of circumcised men. The found:
    “17 (18%) women in the intervention group and eight (12%) women in the control group acquired HIV during follow-up (p=0·36)”(17)
    Women of circumcised partners where 50% more likely to contract HIV! This may be due to the lack of the mobile foreskin and its self lubricating function during intercourse. Without the foreskin, abrasive sex can open up micro fissures In the vaginal wall and may allow the HIV virus an easy entry target. Vaginal abrasion has already been shown to increase HIV infection risk via “dry sex”(10). This study has met criticism as it was performed by researches with a proven bias and a noted conflict of interest. The study was ended early because of “futility” and before a statical value known as p could warrant accurate results. One ought to suspect that it was deemed futile because the results were not what researchers wanted. In any event there are several other studies and publications that suggest the same result which have not met the same criticism.
    “partner circumcision … remained strongly associated with HIV-1 infection even when simultaneously controlling for other covariates”(18)

    “Male circumcision may in fact worsen the epidemic. It is imperative, therefore, that further studies be conducted to determine the overall effect before implementing mass circumcision campaigns to control HIV infection.” (19)

    (1)Gray RH, Wawer MJ, Sewankambo NK, et al. Relative risks and population attributable fraction of incident HIV associated with symptoms of sexually transmitted diseases and treatable symptomatic sexually transmitted diseases in Rakai District, Uganda. Rakai Project Team. AIDS 1999;13(15):2113-23.
    Quinn TC, Wawer MJ, Sewankambo N, et al, for the Rakai Project Study Group. Viral load and heterosexual transmission of human immunodefficiency virus type 1. N Engl J Med 2000; 342: 921-29.
    (2)de Witte L, Nabatov A, Pion M, et al. Langerin is a natural barrier to HIV-1 transmission by Langerhans cells. Nat Med 2007 (Published on line ahead of print March 4).
    (3) Rakwar J, Lavreys L, Thompson M L. et al Cofactors for the acquisition of HIV‐1 among heterosexual men: prospective cohort study of trucking company workers in Kenya. AIDS 1999. 13607–614.
    Manjunath J V, Thappa D M, Jaisankar T J. Sexually transmitted diseases and sexual lifestyles of long‐distance truck drivers: a clinico‐epidemiologic study in south India. Int J STD AIDS 2002. 13612–617.
    Lavreys L, Rakwar J P, Thompson M L. et al Effect of circumcision on incidence of human immunodeficiency virus type 1 and other sexually transmitted diseases: a prospective cohort study of trucking company employees in Kenya. J Infect Dis 1999. 180330–336.
    Bwayo J, Plummer F, Omari M. et al Human immunodeficiency virus infection in long‐distance truck drivers in east Africa. Arch Intern Med 1994. 1541391–1396.
    (4)Van Howe, R.S. (January 1999). “Circumcision and HIV infection: review of the literature and meta-analysis”. International Journal of STD’s and AIDS 10: 8–16. doi:10.1258/0956462991913015. http://www.cirp.org/library/disease/HIV/vanhowe4/. Retrieved 2008-09-23.
    (5)Millett GA, Flores SA, Marks G, Reed JB, Herbst JH (October 2008). “Circumcision status and risk of HIV and sexually transmitted infections among men who have sex with men: a meta-analysis”. JAMA 300 (14): 1674–84. doi:10.1001/jama.300.14.1674. PMID 18840841. http://jama.ama-assn.org/cgi/content/short/300/14/1674.
    (6)Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007 Feb 24;369(9562):643-56.
    (7)Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007 Feb 24;369(9562):657-66.
    (8)Auvert B, Taljaard D, Lagarde E, Sobngwi- Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med. 2005 Nov;2(11):e298. Erratum in: PLoS Med. 2006 May;3(5):e298.
    (9)Vinod Mishra, Rathavuth Hong, and Yuan Gu, and Amy Medley and Bryant Robe . Levels and spread of HIV seroprevalence and associates factors: evidence form national household surveys. USAID 2009 Feb; 51-53
    (10) Runganga A, Pitts M, McMaster J. The use of herbal and other agents to enhance sexual experience. Soc Sci Med 1992 Oct;35 (8):1037-42.
    Runganga AO, Kasule J. The Vaginal use of herbs/substances; an HIV transmission facilitatory factor? AIDS Care 1995;7(5):639-45.
    Sandala L, Lurie P, Sunkutu MR, Chani EM, Hudes ES, Hearst N. “Dry sex” and HIV infection among women attending a sexually transmitted disease clinic in Lusaka Zambia. AIDS 1995 Jul;9 Suppl 1:s61-8
    Brown JE, Ayowa OB, Brown RC. Dry and tight: sexual practices and potential AIDS risk in Zaire. Soc SCI Med 1993 Oct;37(8):989-94
    Dallabetta GA, Miotti PG, Chip hangwi JD, Liomba G, Canner JK, Saah AJ. Traditional vaginal agents: use and association with HIV infection in Malawian women. AIDS 1995 Mar;9(3):239-7.
    Gresenguet G, Kriess JK, Chapko MK, Hillier SL, Weiss NS. HIV infection and vaginal douching in central Africa. AIDS 1997 Jan;(1):101-6.
    Baleta A. Concern voiced over “dry sex” practices in South Africa. Lancet 1998 Oct 17;352(9136):1292
    Beksinska ME, Rees HV, Kleinschmidt I, McIntyre J. the practice and prevalence of dry sex among men and women in South Africa: a risk factor for sexually transmitted infections? Sex Transm infect 1999 Jun;75(3):178-80
    Nyirenda MJ. A study of the behavioural aspects of dry sex practice in urban Lusaka. Int Conf AIDS 1992;8:D461
    Van de Wijgert J, Mason PR, Ray CS, et al. Use of intravaginal preparations, presence of lactobacillus in the vagina, and risk for HIV in Zimbabwean women. Int Conf AIDS 1996;11:34 (abstract no MoC 223).
    Morar NS, Karim SS. Vaginal insertions and douching practices among sex workers at truck stops in KwaZulu- Natal. South Afr Med J 1998;88:470.
    Civic D, Wilson D. Dry sex in Zimbabwe and implications for condom use. Soc Sci Med 1996;42:91–8.
    Hira SK, Mangrola UG, Mwale C, et al. Apparent vertical transmission of human immunodeficiency virus type 1 by breast-feeding in Zambia. J Pediatr 1990;117:421–4.
    Mann JM, Nzilambi N, Piot P, et al. HIV infection and asso-ciated risk factors in femalesocal concerns prostitutes in Kinshasa, Zaire. AIDS 1988;2:249–54.
    Irwin K, Mibandumba N, Mbuyi K, et al. More on vaginal inflammation in Africa. N Engl J Med 1993;328:888–9.
    Mbizvo MT, Chipato T, Mashu A, et al. Trends in HIV-1 prevalence and risk factors in pregnant women measured by clinic on-site testing and laboratory confirmation in Harare, Zimbabwe. Int Conf AIDS 1996 (abstract no MoC 1485).
    Jinju M, St Louis ME, Mbuyi K, et al. Risk factors for heterosexual HIV transmission: a case-control study among married couples concordant and discordant for HIV-1 infection. Int Conf AIDS in Africa. Dakar, December 1991 (abstract no TO 105).

    (11) Peoin J, Quigley M, Todd J, Gaye I, Janneh M Van DyckE, Piot,P, Whittle H. Association between HIV-2 infection and genital ulcer diseases among male sexually transmitted diseases patients in the Gambia. AIDS 1992 May;6(5):489-93.
    O’Farrell N, Hoosen AA, Coetzee KD, van den Ende J. Sexual behavior in Zulu men and women with genial ulcer disease. Genitourin Med 1992 Aug;68(4):245-8.
    De Vincenzi I Mertens T. Male circumcision: a role in HIV prevention? AIDS 1994 Feb;8(2)
    (12)Kaul R, kimani J, Nagelkerke NJ, Plummer FA, Bwayo JJ, Brunham RC, Ngugi EN, Ronald A. Risk factors for genital ulcerations in Kenyan sex workers: the role of human immunodeficiency virus type 1 infection. Sex Transm Dis 1997 Aug;24(7):387-92
    (13)Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States: prevalence, prophylactic effects, and sexual practice. JAMA 1997;277:1052-7.
    (14)Westercamp M, Bailey RC, Bukusi EA, Montandon M, Kwena Z, et al. (2010) Male Circumcision in the General Population of Kisumu, Kenya: Beliefs about Protection, Risk Behaviors, HIV, and STIs. PLoS ONE 5(12): e15552. doi:10.1371/journal.pone.0015552 http://tinyurl.com/4tmaal8
    (15) De Vincenzi I. Heterosexual transmission of HIV. JAMA 1992; 267: 1919.
    (16) Report on the Global HIV/AIDS Endemic. June 2000 UNAIDS, Geneva, 2000, pp. 124-132
    (17)Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomized controlled trial. The Lancet, Volume 374, Issue 9685, Pages 229 – 237, 18 July 2009
    (18)Chao A, Bulterys M, Musanganire F, Habimana P, Nawrocki P, et al. Risk factors associated with prevalent HIV-1 infection among pregnant women in Rwanda. National University of Rwanda-Johns Hopkins University AIDS Research Team. Int J Epidemiol. 1994;23:371–380.
    (19)Jonathan Sykes. Male Circumcision Increases Risk for Females PLoS Med. 2006 January; 3(1): e72. Published online 2006 January 31. doi: 10.1371/journal.pmed.0030072. PMCID: PMC1360646

  107. POSTED BY jakew  |  March 08, 2011 @ 4:32 am

    “i tear this apart in my STD post above” — let’s have a look at that, then.

    “First of all, study’s from Africa are not applicable to developed nations like the United States, because of the drastically different sexual and hygienic behaviour that exists between the groups.” — to be fair, sexual activity doesn’t vary all that much between continents, and suggesting otherwise isn’t terribly realistic. Consequently, the studies are indeed relevant.

    “Many of these observational studies this meta-analysis included used participants who have life styles that are not representative of average Americans or Africans. They used many studies on long distance truck drivers in Africa. [11] [12] [13] [14] [15] Some of these truck drivers engage in risky sexual activity with prostitutes at trucks stops. These are not indicative of your typical American or African life style.” — what matters is the ratio between the risk in circumcised and uncircumcised men. If the men are engaged in high-risk activity that, say, doubles their risk, the ratio is unchanged.

    “As if flawed observational studies form Africa are not bad enough, the authors include a study from Australia for their syphilis claim which states the following: “However, the data for syphilis should be interpreted with caution because of the small number of cases” [16]” — meta-analyses increase the effective sample size by incorporating data from a large number of studies. Broadly speaking they work as a weighted average. The weight given to each study is the inverse of the variance, which means that studies with small numbers of cases, such as this, won’t receive much weight.

    “Systematic literature searches, like the one used in this publication, should be assessed with a system of checks. If this study is not known to be accurately representative of syphilis in Australia then it is probably better not to use it. By including this study authors and peer reviewers reveal their bias.” — meta-analyses *must* include all studies that are a) identified through their systematic search and b) meet their inclusion criteria. They can’t arbitrarily exclude studies.

    “Even if these study’s where well constructed they would still not be applicable to developed nations because true variable isolation is often impossible in reality. [17] [18]” — this is a non sequitur.

  108. POSTED BY walleroo  |  March 08, 2011 @ 8:20 am

    Baristas, you might want to collect all the inappropriate comments made in this thread and publish them as a compendium. Call it, Wise Cracks from the D*ck Heads. It will sell like hot cakes. Oprah would love it. (You might offer me an originator’s award of 5 percent off the top.)

    I wonder if anybody aside from jakew, craig and joseph4gi has even read all this rubbish. I’m not sure even Tudlow is nerd enough for that.

  109. POSTED BY craig  |  March 08, 2011 @ 11:51 am

    Listen, if you feel observational study’s from Africa, with dry sex, hi viral loads, female circumcision, truck drivers, and prostitutes with genital ulcers, are applicable to your American sons life, then i must question your logic. This is not a big difference? Dry sex is widely reported! I have never heard of an American women who has heard or wanted to have dry sex with dirt, dry-leaves, cornmeal, and sand.

    If you have hi viral loads, such as STDs of all kinds which are an endemic in Africa, this effects the immunological functionality of the foreskin mucosa.

    If you think comparing celibate Muslims to intact Africans is legit, then you have no logic.

    “what matters is the ratio between the risk in circumcised and uncircumcised men. If the men are engaged in high-risk activity that, say, doubles their risk, the ratio is unchanged.”

    Theres no way to determine the relationship between all these risk factors and circumcision. Its a physical impossibility.

  110. POSTED BY kay  |  March 08, 2011 @ 11:54 am

    (Oh ‘Roo, How I Missed Yoo!!)

  111. POSTED BY jakew  |  March 08, 2011 @ 12:25 pm

    “Listen, if you feel observational study’s from Africa, with dry sex, hi viral loads, female circumcision, truck drivers, and prostitutes with genital ulcers, are applicable to your American sons life, then i must question your logic.” — Certainly many of these things can affect the risk, so the important question is whether they differentially affect circumcised or uncircumcised men? If so, they can affect the risk ratio.

    “If you have hi viral loads, such as STDs of all kinds which are an endemic in Africa, this effects the immunological functionality of the foreskin mucosa.” — Sorry, that doesn’t make any sense. Viral load is a property of viral STDs only, and usually affects the ability to infect another person.

    “If you think comparing celibate Muslims to intact Africans is legit, then you have no logic.” — which studies did this?

    “Theres no way to determine the relationship between all these risk factors and circumcision. Its a physical impossibility.” — it’s actually fairly trivial, using a logistic regression model, to identify the effect of several risk factors simultaneously. And many (though not all) studies do so.

  112. POSTED BY craig  |  March 08, 2011 @ 12:46 pm

    “Sorry, that doesn’t make any sense. Viral load is a property of viral STDs only, and usually affects the ability to infect another person.”

    for instance “Plasma cells which increase in number in response to pathogens levels”
    here we can see that with viral loads, we have changes in mucosa properties.

    Viral load has been suggested to drastically increases HIV infection risk(1)

    “using a logistic regression model, to identify the effect of several risk factors simultaneously.”
    FYI i am an engineer. These models can only approximate reality. This model does not take into account the effect on foreskin immunology that come with co-founding factors like hi viral loads.

    (1)Gray RH, Wawer MJ, Sewankambo NK, et al. Relative risks and population attributable fraction of incident HIV associated with symptoms of sexually transmitted diseases and treatable symptomatic sexually transmitted diseases in Rakai District, Uganda. Rakai Project Team. AIDS 1999;13(15):2113-23.

  113. POSTED BY craig  |  March 08, 2011 @ 1:10 pm

    its also worth mentioning that pro biotic bacteria live in the mucosa lining of intestines, the unitary tract and the foreskins and glands. these also play an important role in mucosa immunology.

    http://en.wikipedia.org/wiki/Probiotic

  114. POSTED BY jakew  |  March 08, 2011 @ 1:33 pm

    “These models can only approximate reality. This model does not take into account the effect on foreskin immunology that come with co-founding factors like hi viral loads.” — Actually, they can, quite easily, if measured, but I’m afraid you’re still not being sufficiently clear. Please specify the load of what particular virus you’re talking about, and whose viral load (the owner of the penis we’re concerned with, or his partner).

  115. POSTED BY craig  |  March 08, 2011 @ 1:41 pm

    “Please specify the load of what particular virus you’re talking about”
    in Africa GUD is most common.
    Syphilis, gonorrhoea, and HIV are all endemic status as well. Among many others!
    In science when you make a claim you actually have to try and disprove your hypothesis. You dont just get up and run away with the result you want as soon as you get them.

    “whose viral load (the owner of the penis we’re concerned with, or his partner).” — Both.

  116. POSTED BY jakew  |  March 08, 2011 @ 3:14 pm

    [Re “Please specify the load of what particular virus you’re talking about”] “in Africa GUD is most common.” — okay, which GUD?

    “Syphilis, gonorrhoea, and HIV are all endemic status as well. Among many others!” — Syphilis and gonorrhoea are bacterial infections, not viral.

    “In science when you make a claim you actually have to try and disprove your hypothesis. You dont just get up and run away with the result you want as soon as you get them.” — I quite agree, though am somewhat perplexed as to why you raise this particular point.

  117. POSTED BY Tudlow  |  March 08, 2011 @ 4:05 pm

    Good one, wally! My nerdiness does run deep but I do have a limit and it ended at, well, all those links that Georgette deleted. Really, though, it’s been quite illuminating to realize how much the “anit-circs” hate the “pro-circs.” I see a movie, or at least some kind of HBO documentary, in the works here. If only we could find a good writer….

  118. POSTED BY craig  |  March 08, 2011 @ 4:09 pm

    All GUD’s among populations in Africa

    Bacterial infections are co founding factors too, along with the standard of living and general health. In Africa, health is worse in most category’s. All these effect mucosa immunology,

    “I quite agree, though am somewhat perplexed as to why you raise this particular point.”
    ur assuming study’s form Africa are relevant to us even tho these loads on general health in Africa don’t exist in developed nations. Dismissal of all this confounding then extrapolation to the U.S. is a unscientific leap that assumes some sort of variable isolation is possible.

  119. POSTED BY jakew  |  March 08, 2011 @ 4:36 pm

    “All GUD’s among populations in Africa” — Which ones, Craig? To remind you, you said: “This model does not take into account the effect on foreskin immunology that come with co-founding factors like hi viral loads.” Now, you can’t mean all GUDs, because not all GUDs are viral (hence it’s nonsense to talk about high viral loads). So which of the viral GUDs affect foreskin immunology in proportion to viral load?

    “Bacterial infections are co founding factors too, along with the standard of living and general health.” — the latter two are likely to affect circumcised and uncircumcised men equally. The former can vary by circumcision status, though many studies controlled for other STDs.

    “ur assuming study’s form Africa are relevant to us even tho these loads on general health in Africa don’t exist in developed nations.” — What is a “load on general health”?

    “Dismissal of all this confounding then extrapolation to the U.S. is a unscientific leap that assumes some sort of variable isolation is possible.” — to some extent or other, confounding is inevitable in observational studies such as those that we’re discussing. Some studies are better than others, of course, but inevitably some populations will have inherent confounding that bias one way, and others will do so in other directions. Different study designs, too. The nice thing about meta-analyses is that, given enough studies and study designs, confounding factors tend to cancel out to some extent. This was illustrated rather dramatically by Weiss et al in “Male circumcision for HIV prevention: from evidence to action?” (AIDS. 2008 Mar 12;22(5):567-74), who demonstrated that the results of meta-analysis of higher quality HIV observational studies were *identical* (within a few percent) to those of meta-analysis of the RCTs!

    Please understand that I’m not saying that meta-analyses of observational studies are perfect. They’re not (even RCTs aren’t perfect, and they’re much stronger evidence). But if done competently, they’re generally pretty good.

    Incidentally, variable isolation is a concept that applies within a study; to understand the effect of something (in this case circumcision), it’s necessary to isolate it. This means to construct a measurement or test that either holds other variables equal or (if that can’t be done) records them and incorporates them into a mathematical model, such that their effect can be subtracted.

  120. POSTED BY robertsam  |  March 09, 2011 @ 1:36 pm

    The basic problem that Jake is facing is that he has a bunch of SMALL, flawed studies he is trying to push, while we have studies with millions of cases that prove the studies fail to meet the basic SCIENTIFIC requirement for fulfillment of prediction AND other studies that contradict his claims.

    IF he was versed in science he would be aware that when we have both conflicting studies and empirical, contradictory evidence, the claims cannot be considered SCIENTIFICALLY valid.

    Now, we have evidence from Ethiopia, the USA and Japan that shows the failure to fulfill prediction for HIV reduction by circumcision by 88X and 10X for Ethiopia and the USA. IF he claims other factors cause this discrepancy, he needs to address with valid stats and used in a working model. Nebulous excuse are not accepted by science.

    it is not sufficient to provide a lot of nebulous EXCUSES for this failure, but SCIENTIFIC evidence to explain away this failure..

    Now I am wondering when we get some solid evidence to support these excuse.

  121. POSTED BY robertsam  |  March 09, 2011 @ 2:36 pm

    “They’re not (even RCTs aren’t perfect, and they’re much stronger evidence).”

    Yes, IF they are REALLY RCT’s and not just some bastardized version of REAL RCT’s masquerading as something scientific.It takes more than stealing and misapplying a term to try to lend credence to a bunch of questionable statistics.

    RCT’s CONTROL for ALL variables except the one chosen to be altered. not just some game playing with numbers from self-reporting…WITHOUT any controls!

    BTW, Most epidemiological research studies are worthless:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1182327/

  122. POSTED BY robertsam  |  March 09, 2011 @ 2:42 pm

    “This means to construct a measurement or test that either holds other variables equal or (if that can’t be done) records them and incorporates them into a mathematical model, such that their effect can be subtracted.”

    I see you finally understand the concept, so when can we see this applied to the empirical evidence to explain away the huge discrepancy?

    Try starting on the huge discrepancy we see when comparing Ethiopia, the US, and japan..and IF and WHEN you are able to do this, we can advance to the other many failures to fulfill prediction.

    Remember it only takes one failure to fulfill prediction to disqualify an hypothesis in science.

  123. POSTED BY robertsam  |  March 12, 2011 @ 2:41 pm

    Continuing on this thought, the “fulfilling prediction” test is the most valuable tool in all of science.

    When one sees a claim for something or other, look to the REAL WORLD stats to see if the prediction is actually fulfilled…and if not, is this failure accounted for by valid numbers. If not, then the study this prediction is predicated upon is worthless.

    If you do this for any and all claims for a benefits for circumcision, you will immediately find that there are no valid benefits.

    Circumcision has been a cure in search of a disease for over 100 years.

    Remember a consensus of OPINION is a very poor substitute for consensus of valid evidence…this is what distinguishes the difference between SCIENCE and “medical science”.

Leave a Reply

Baristanet Comment Policy:

Baristanet has specific guidelines for commenting. To avoid having your comment deleted -- or your commenting privileges revoked -- read this before you comment. Violators will be banned from commenting.

Report a comment that violates the guidelines to comments@baristanet.com. For trouble with registration or commenting, write to comments@baristanet.com.

Commenters on Baristanet.com are responsible for all legal consequences arising from their comments, including libel, infringement of copyright or actions that threaten a third party. By submitting a comment, you agree to indemnify Baristanet LLC, its partners and employees from any legal action arising from your comments.

In order to comment on the new system, you need to register a new Baristanet account. To get your own avatar next to your comments, sign up at Gravatar.com

You must be logged in to post a comment.

Follow, Friend, Subscribe