Monday, March 15, 2010

Actress Thanks Congress for Strong Circumcision Support

Actress Debra Messing, better known as Grace Adler in the TV sitcom "Will & Grace," told members of Congress last week that circumcision was a key to reducing HIV/AIDs. Messing testified before the House Foreign Affairs Committee on behalf of PSI, a global health organization, after she returned from Zimbabwe which has an aggressive circumcision program.

Here's what Messing told legislators:

"I would like to tell you today about two prevention tools that could make a difference if there is continued investment: male circumcision and HIV testing and counseling.

"First, voluntary adult male circumcision. There is now strong evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by about 60 percent, yet only about one in ten Zimbabwean adult men are circumcised. PSI and its partners run circumcision clinics in Zimbabwe and other countries, with support from PEPFAR and other donors.

"I was invited to observe the procedure, which is free to the client, completely voluntary and according to the young man I spoke with who underwent the procedure, painless. The cost of the procedure at that clinic—including follow-up care and counseling—is about $40 U.S. dollars.
UNAIDS and the World Health Organization have issued guidance stating that male circumcision should be recognized as an important intervention to reduce the risk of heterosexually acquired HIV infection in men.

"Even with no demand creation, the clinic I visited serves upwards of 35 clients per day. It is estimated that if male circumcision is scaled up to reach 80 percent of adult and newborn males in Zimbabwe by 2015, it could avert almost 750,000 adult HIV infections—that equals 40 percent of all new HIV infections that would have occurred otherwise without the intervention—and it could yield total net savings of $3.8 billion U.S. dollars between 2009 and 2025. Male circumcision programs get robust support from the U.S. government in Zimbabwe and other countries, but greater resources would yield greater results."

Zimbabwe does have a massive commitment to circumcise 1.3 million males over the next few years, and the country is beginning efforts to encourage newborn circumcision. In the long run, countries recognize that achieving universal 100% circumcision rates is best obtained by circumcising baby boys before the leave the hospital.

What is ironic to me is that while Messing thanks Congress for its "robust support" for the male circumcision programs in Africa, nobody says anything about America? It's time for government leaders to speak out with just the same passion on the value of circumcising every male in this country.

Sunday, March 14, 2010

Newborn Circumcision: An Old Tried & True Friend

I like old books, so take me to a flea market and I am sure to find something that interests me. Not long ago, I bought for an original red-covered book for $1 entitled "Modern Home Medical Adviser." It was first published in 1935 but updated seven times until its last publication in 1953, still way long before I was born. The book was designed for parents to consult on just about any ailment in the body. Of course, I looked in the index under "circumcision" and it was a treasure trove of good advice.

I don't know how popular newborn circumcision was back in the 1930s, but these docs sure liked it. "The baby boy should be carefully examined to see if he needs circumcision. If the foreskin can be completely and easily retracted most authorities think circumcision should not be done, but when there is the least doubt about the matter decision should be made in favor of the operation, which is a trivial one when done within the first week or two of life."

Back in the 1930s, people did worry more about boys masturbating. These docs were modern. "Masturbation is probably far less harmful than has been supposed." But they certainly didn't recommend it, and observed the obvious: "When the foreskin is tight or adherent there will accumulate under it secretions which will produce bad odors and cause pain and itching. Such a child is likely to get into the ugly habit of pulling at and handling the genitals." We know that all boys play with their penises, but uncircumcised boys clearly have more reasons for doing that than clean-cut boys.

While the medical reasons for circumcision have certainly grown with the advance of medical science, back in the 1930s there were many more uncircumcised fathers in America and many more parents in general who did not have access to the latest medical developments. This is where the authors of "Modern Home Medical Adviser" get interesting, urging parents of the day to get informed about the latest medical advances and to take responsibility for their children's health.

"It is said that in times of old, parents had the power of life and death over their childrend and could make away with them or sell them into slavery. Atrocious! Nevertheless, parents still have the power of life and death over their children. Parents can neglect their young, and frequently do neglect them, so that they die of the results. We have in mind parents who are probably ruining a child by refusing to have him circumcised. . . . ."

Seventy-five years later, we still have parents who not only refuse to circumcise their sons but also make outrageous claims about the 'dangers' of circumcision and the 'benefits' of a foreskin. I find this all very ironic because the prescient doctors of the 1930s did not have all the medical studies of today. But they knew circumcision was valuable and recommended it. Today, with much more evidence of this "trivial" procedure's medical value, the medical organizations representing today's doctors (like the American Academy of Pediatrics and the Centers for Disease Control) are much more timid than their ancestors.

As we await some definitive conclusions from the AAP and the CDC, perhaps they might consult the docs of an earlier era -- and add a little backbone to taking a strong stand for newborn circumcision. Just saying . . . .