Wednesday, May 6, 2009

Listen to the Medical Doctors: Circumcise Now!

Below are just a couple of quotations from some noted medical doctors that I think we all should respect. Of course, the FLs ("foreskin lovers") will disparage these docs in the misguided, ongoing anti-circ effort to protect their beloved foreskin. But with a respected doctor like Anthony Fauci says, "Circumcise!" maybe the American Academy of Pediatrics will listen.

“Medically supervised adult male circumcision is a scientifically proven method for reducing a man’s risk of acquiring HIV infection through heterosexual intercourse,” says NIAID Director Anthony S. Fauci, M.D. “This new research provides compelling evidence that circumcision can provide some protection against genital herpes and human papillomavirus infections as well.”

“The cumulative scientific evidence supporting the public health value of medically supervised male circumcision is now overwhelming,” says Thomas C. Quinn, M.D., study co-investigator, chief of the International HIV/STD Section in NIAID’s Laboratory of Immunoregulation and co-author of the study. “This new research confirms the substantial health benefits of male circumcision, including reduced acquisition of HIV, genital herpes, HPV and genital ulcer disease.”

"These findings have significant public health implications for the control of HIV, genital herpes and HPV in areas of high prevalence, such as Africa, and further suggest that efforts to scale-up male circumcision could have tremendous benefit,” said Dr. David Serwadda, co-principal investigator and dean of Makerere University’s School of Public Health.

In the eyes of the anti-circumcision fanatics, these doctors must just be looney.

11 comments:

  1. These doctors don't know dick because they are missing 75% of theirs. Intact men do not promote circumcision. I have a real problem with people wanting to cut anothers genitals. This is the inconvenient truth you are not saying: Langerhans cells secrete Langerin which kills HIV. There are more Langerhans cells in the tonsils than in the foreskin. Are we to do tonsillectomies? Further:

    http://www.futuremedicine.com/doi/full/10.2217/17469600.2.3.193?cookieSet=1
    Future HIV Therapy
    May 2008, Vol. 2, No. 3, Pages 193-199
    (doi:10.2217/17469600.2.3.193)

    Lead time bias, in which circumcised men likely have fewer seroconversions in the first weeks owing to their inability to have sex in the post-operative period, is exaggerated in early termination studies.

    Typically, attrition of a small portion of participants is not a cause for concern, but in these trials, the number lost was far greater than the number who contracted HIV.

    Nonsexual transmission
    Another problem in the RCTs is the large proportion of HIV infections that study participants contracted from nonsexual risks. According to the reported sexual behavior of the males in the Orange Farm trial, 23 of the 69 infections occurred in men who reported no unprotected sex during the observation interval. Similarly, in the Uganda trial, 16 of the 67 infections occurred in men who reported either no sex partners or 100% condom use. The trial in Kenya did not provide data on sexual exposures as related to HIV incidence. The proportion of nonsexual
    transmission in participants suggests that circumcision may not have the impact on the HIV crisis that is being promoted [9], and, indeed, could be contributing to the infections.

    Lack of risk calculation
    Another concern about the three RCTs is the failure of the study teams to report the results in a way that compared HIV incidence per sexual exposure between the circumcised and uncircumcised populations. Per-incident risk calculation is necessary in order for men to weigh potential expected benefits from the surgery, based on anticipated sexual behaviour, against the risks and costs of circumcision. Without this information, men cannot be said to have given fully informed consent [9].

    Other factors and conditions were present in the three RCTs that are not representative of the real world, potentially influencing the study results. These include the following:
    •Condom use and safe-sex practices were repeatedly reinforced
    •Participants were provided 2 years of free medical care
    • Participants were paid to participate
    •Participants were solicited who wanted to be circumcised, and who may, therefore, not be representative of the general population
    •The trials were conducted in atypically sanitary and well-resourced settings that are unlikely to be replicated in mass African circumcision campaigns.

    A recent study showed that female partners of newly circumcised HIV-positive males had a significantly increased risk of contracting HIV [16]. In Uganda, health officials do not have the resources to test for HIV in the men they plan to circumcise [108]. Mass circumcision of adults without HIV testing could increase the risk of HIV transmission to females.

    Circumcision itself is known to spread HIV in Africa via contaminated medical instruments. One study estimates that circumcision increases the chance of infection by 300% [17]. Mass circumcision campaigns are not likely to have the same level of operator training or sanitary conditions as the clinical trials. For countries with limited economic resources to provide circumcision in a medical setting, these campaigns will encourage the inevitable 'bush' circumcision market.
    Regardless of the ratio between clinic and 'bush' situations, both could ultimately increase HIV transmission.

    If the men in the three RCTs accurately reported their sexual behavior, many infections must have come from blood exposures, not sexual contact. Instituting mass surgery could further exacerbate the transmission of HIV through blood exposures in the clinics and hospitals where circumcisions will occur. Rather than promoting circumcisions, an alternate strategy to cut HIV incidence may be to
    improve infection control in hospitals and clinics [9].

    Despite agreement that safe-sex messages must be built into circumcision campaigns, reports are already appearing that African males are indeed absorbing the message that circumcision means protection and other measures to prevent HIV are unnecessary [109]

    The French Conseil National du SIDA (National AIDS Council) recently issued a statement that sums up most of the above concerns:
    "Implementation of male circumcision as part of a raft of preventive measures could destabilize healthcare delivery and at the same time confuse existing prevention messages. The addition of a new 'tool' could actually cause a result opposite to that which was originally intended" [20].

    Circumcision costs & harms outweigh potential benefits
    Very little attention is being given to the surgical complications associated with circumcision or the cost of treating these complications. Even if mass circumcision campaigns produce complication rates similar to the extraordinarily low complication rates in the RCTs, which is unlikely, tens of thousands of African
    males will still suffer from them. A more realistic complication rate of 20.2% was documented in a study of Nigerian neonates circumcised by medical practitioners [21]. A true cost–benefit analysis cannot be carried out without accurate complication rates. Estimates of the cost of complications are likely to mushroom with the inclusion of infection rates in unsanitary conditions, need for repeat surgeries for poorly performed circumcisions and treatment of inflammation of
    the urinary meatus leading to stenosis (occurring in up to 10% of circumcised males) [110].

    While it is not possible to make a direct comparison of the cost of condoms versus the cost of circumcision, it is worthwhile to consider the significant cost discrepancies between these two strategies. In the RCTs, circumcisions were performed at a cost of approximately US$69 each [22]. Condoms cost three cents each [111]. African males require an average of 84 condoms per year [23]. For the cost of one circumcision, which, according to the RCTs, might be 50% effective, a
    man could receive a 32-year supply of condoms and protect himself and his partner(s) 87–100% of the time [24].

    The millions of dollars that would be directed toward circumcision could have a far greater impact on health outcomes in Africa if used toward promoting safe-sex campaigns, HIV testing, provision of antiretrovirals and other core public health needs.

    Vaccine analogy is misleading
    Comparing male circumcision to a 'vaccine' is misleading, as it plays on the general perception that vaccines offer near-complete protection from an illness with few side-effects. This 'vaccine' claim gives a false sense of security because individuals who engage in high-risk behaviors will be at high risk for HIV infection, whether they are circumcised or not. If a pharmaceutical HIV vaccine was available and was only 50–60% effective and likely to decrease condom use and other safe-sex practices, it would not be acceptable because it could increase the HIV-infection rate by altering behavioral patterns [8].

    The erroneous message of protection from circumcision given to African males is alarming and dangerous. Dr Robert Bailey, one of the RCT authors, was recently quoted as saying, "[Circumcision is] the most effective prevention method we know about for heterosexual guys, if it's done properly" [114]. With statements like this in the news, it is easy to understand why some males may mistakenly conclude that if they are circumcised, they no longer need to use condoms.

    ABC programs offer nearly full protection from HIV infection, yet even if circumcision's effectiveness matches the 50–60% effectiveness the RCTs reported, it only partially protects men, does not protect women at all, and leaves women more vulnerable to unsafe sex practices being forced upon them.

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  2. Only 2 in 1000 intact adults choose to get circumcised. The rare men who are cut due to medical complications might get alleviation of whatever they were suffering, but as a Korean study shows, 3 times as often they sorely miss sexual pleasure. In most US cases, simpler effective remedies were not tried before amputation. In countries where the normal anatomy is valued, they treat foreskin infections with medication, and tight foreskin with gentle stretching. Swedish studies prove fewer than 1 child in 10,000 needs a circumcision to solve a medical problem.

    About 200,000 men are non-surgically restoring their foreskins through a tedious but painless tension process. They can't get back the lost 20,000 nerve endings, but they regain protection for the glans and mucosa for maximum suppleness and sensitivity. The skin expands until they have the normal amount of slack skin, which provides an awesome frictionless rolling/gliding mode of stimulation during intimacy. Once they have slack shaft skin, their surviving nerve endings can fire as nature intended, from the bending and straightening of the skin as it rolls around. The adult foreskin is 15 square inches of exquisite sexual interface.

    Three-fourths of the US men who have died of AIDS were circumcised at birth. The mostly-cut US adult population has three times the HIV rate that mostly-intact Europe has. The African nations of Cameroon, Ghana, Lesotho, Malawi, Rwanda, Swaziland, and Tanzania have markedly higher HIV rates among the circumcised. The men cut in the recent African controlled trials were found MORE likely to infect their partners, and the cut men DID contract HIV - at a rate 6 times higher than the rate of new infections in African-American men. Recent research has shown even if the faulty African HIV trials proved true, condom distibution would be 95 times as cost effective at fighting HIV there, which explains how Thailand and Cambodia have been so successful at reducing AIDS rates despite heavy sex tourism, without circumcising.

    There is no culture mutilating girls that does not also circumcise boys. FGM is horrid, but the most extreme forms are not usual. Many of the cut women in the world have lost far fewer nerve endings than are taken in an average circumcision. Luckily, 94% of world's population is protected from female genital cutting by law (if not by enforcement). We must protect boys, too.

    The way the internet is archived, today's cut baby will know later exactly what info was available to his parents before he was born. Any parents who do not at least sit through an unabridged video of a circumcision and a 10 minute video education on the functions of the foreskin will have some uneasy explaining to do when their boy starts asking why the most sensitive part of his body was amputated.

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  3. To his credit, Fauci refers only to ADULT male circumcision. If adult men choose to have part of their penis cut off - or all of it, which would certainly provide 100% protection against female-male HIV - that's nobody's business but theirs.

    This has nothing to do with non-consensual baby and child circumcision, which is a human rights issue. At 50% protection (in two years) at best, a man has a right to choose some more effective method/s of protecting himself against HIV.

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  4. Some "experts" suggest that STDs and AIDS can be prevented by using condoms. This is simply not true. Here is what some real experts are saying about condom use:

    Wikipedia says: Condoms are widely recommended for the prevention of sexually transmitted diseases (STDs). They have been shown to be effective in reducing infection rates in both men and women. While not perfect, the condom is effective at reducing the transmission of HIV, genital herpes, genital warts, syphilis, chlamydia, gonorrhea, and other diseases.
    A 2006 study reports that proper condom use decreases the risk of transmission for human papillomavirus by approximately 70%.
    The FDA says...http://www.fda.gov/oashi/aids/condom.html
    There's no absolute guarantee even when you use a condom. But most experts believe that the risk of getting AIDS and other sexually transmitted diseases can be greatly reduced if a condom is used properly.
    In other words, sex with condoms isn't totally "safe sex," but it is "less risky" sex.
    http://www.youngwomenshealth.org/malecontraceptives1.html says: Latex condoms protect against only certain types of STDs.
    http://contraception.about.com/od/overthecounterchoices/p/Condom.htm says : STD Protection: Condoms help reduce the risk of sexually transmitted infections. Condoms do not offer prevention of HPV/Genital Warts or Herpes.
    http://www.rho.org/html/hiv_aids_special_focus-condoms.htm says: The effectiveness of condoms has been the subject of a great deal of research. One recent review of multiple studies found that the consistent use of condoms during sexual intercourse results in an 80 percent reduction in HIV incidence.
    http://www.siecus.org/index.cfm?fuseaction=page.viewpage&pageid=579&grandparentID=477&parentID=572 says: Latex condoms, when used consistently and correctly, can reduce the risk of transmission of Gonorrhea, Chlamydia, and Trichomoniasis.
    Studies show condoms are 80% effective in preventing HIV transmission if they are used correctly every time you have sex. They also reduce the risk of spreading other sexually transmitted diseases.

    Since neither condoms or circumcision prevent STDs and AIDS completely, employing both is a useful strategy. And since even children are having sex these days, usually unprotected, having protection that is always there is better than no protection, even if it is only about 60% effective. Circumcision gives protection from some STDs where a condom will not even help. The idea that parents have no right to give their children the best possible protection or that circumcision is mutilation are radical nonsense. One mother of a daughter recently blogged that the new HPV vaccine is only 60% effective, about the same as circumcision, and that both should be encouraged. Know why she didn't mention condoms? They offer no protection from this sometimes killer. The idea that a condom will protect you always and completely are misconceptions. They are even only 98% effective at preventing pregnancy!

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  5. Anonymous seems to grasp at any statistic that agrees with him/her. "One mother of a daughter recently blogged that the new HPV vaccine is only 60% effective..." And we should pay her a microsecond's attention because...? And while Wikipedia can usually be relied on for facts that are not in dispute, on this kind of topic it is not a reliable source of information.

    Isn't it interesting that as little as a year ago, HPV and HSV-2 weren't even on the radar when circumcision was being discussed. It was all about HIV then. And before that UTIs. And before that cancer. There's something funny :( about circumcision.

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  6. Yes, there is something funny about circumcision, and it's called learning. Here is a medical expert's opinion. I realize that experts are often just smart people with a bunch of facts.

    Why circumcision is a biomedical imperative for the 21(st) century?

    School of Medical Sciences and Bosch Institute, Building F13, The
    University of Sydney, Sydney, New South Wales 2006, Australia.

    Circumcision of males represents a surgical "vaccine" against a wide
    variety of infections, adverse medical conditions and potentially
    fatal diseases over their lifetime, and also protects their sexual
    partners. In experienced hands, this common, inexpensive procedure is
    very safe, can be pain-free and can be performed at any age. The
    benefits vastly outweigh risks. The enormous public health benefits
    include protection from urinary Tract infections, sexually transmitted
    HIV, HPV, syphilis and chancroid, penile and prostate cancer,
    phimosis, thrush, and inflammatory dermatoses. In women circumcision
    of the male partner provides substantial protection from cervical
    cancer and chlamydia. Circumcision has socio-sexual benefits and
    reduces sexual problems with age. It has no adverse effect on penile
    sensitivity, function, or sensation during sexual arousal. Most women
    prefer the circumcised penis for appearance, hygiene and sex. Given
    the convincing epidemiological evidence and biological support,
    routine circumcision should be highly recommended by all health
    professionals.

    BioEssays 29:1147-1158, 2007. (c) 2007 Wiley Periodicals, Inc.
    PMID: 17935209 [PubMed - as supplied by publisher]

    We can trust the cynic whose main opinion is that nobody else can be trusted, or medical science. That's the funny thing about science!

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  7. Ah yes, Prof. Brian Morris, who never saw a reason for circumcising he didn't like, including to prevent "bathroom splatter" and because "the prepuce can become entrapped in zippers". (ibid. p 1153)

    If you read that article carefully and follow the references, you find, for example, that when Prof Morris says "Recurrent UTIs occur in 19% of uncircumcised boys, but in none of the circumcised." (p. 1151) his 19% is actually five boys out of 26 known not to be circumcised - out of 36 whose circumcision status is known, out of 68 boys who have any UTI, out of about 34,900 boys altogether. The words in quotes cross the line into scientific fraud.

    Prof. Morris is an expert in his field, molecular biology. On circumcision he is just another person with an axe to grind - very literally.

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  8. Doctors pimping circumcision! Like the repentant
    Dr. Benjamin Spock? You should look at http://birthpsychology.com/birthscene/circ.html

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  9. be wise ! Circumcise!!

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  10. Every healthcare provider should switch to an EMR solution. Paper based records and prescriptions are a thing of the past now and it would be best for both doctors and patients to take advantage of their features and accessibility.

    Medical Billing I Free EMR

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