Pharyngula

No more mangled wee-wees!

Mano Singham has discovered a good analysis of the claim that circumcision has health benefits. I agree with it entirely, because I looked at those same papers and came to the same conclusion a year ago! So they must be right.

The analysis points out a few new things I hadn’t noticed, in addition to the bad experimental design and the inflated statistics: the results were confounded by the fact that the newly circumcised individuals also got additional counseling about safe sex, and were restricted in their sexual practices by their surgical wounds. It’s bad research coming to impractical and unrealistic conclusions, and they suggest that there are better answers than promoting this shaky idea that circumcision reduces the risk of AIDS.

Rather than wasting resources on circumcision, which is less effective, more expensive, and more invasive, focusing on iatrogenic sources and secondary prevention should be the priority, since it provides the most impact for the resources expended.

Exactly — the defense of circumcision is ludicrous, it’s an unnecessary cosmetic surgery promoted entirely for historically religious reasons, and it’s time to stop.

Comments

  1. #1 J S Steiner
    July 2, 2012

    I hope your words help end this abuse, but no circumcision promoter will buy into the actual scientific facts and conclusions. Since Kellogg started to mix this ridiculous and cruel religious ritual with medicine, the promoters have used every sexual transmitted disease as a defense. Circumcision promoters will reach “into the bag” and find another rabbit to justify their psycho sexual urges.

  2. #2 Mack Hitch
    Colorado
    July 2, 2012

    I suspect the real source of all evidence for or again circumcision is based solely on whether one is circumcised or not. Religious prejudice may also play a large part. I am an Atheist and I might be an example of why circumcision started at all.

    My parents fully intended for me not to be circumcised. At age three, however, I began having trouble urinating because my foreskin was not growing but the rest of my penis was. (I have run across a clinical name for this apparently not unheard of condition, but I can’t recall it.)

    I do remember the day, though all other childhood days have slipped from my memory. I was given ether and awoke relieved of my condition. The only discomfort I recall was having to impatiently wait for my mother to tape a vaseline-smeared patch of gauze to my belly, with the penis secured beneath, before I could run outside and play.

    As to circumcision itself, I am sixes and sevens on the matter. I suspect whatever one is seems correct and natural. I have no more objections to this simple snipping than I have against any cosmetic procedure or against any operation for marginal benefit such as a tonsillectomy.

  3. #3 stevelaudig
    Minor islands
    July 2, 2012

    Male infant genital mutilation? If this practice of mutilating an infant’s genitals is sound rational practice then perhaps the same infant could make the decision himself upon reaching the age of reason. After all what’s the hurry to perform an irreversible procedure. And it is irreversible because THIS GOD has limits to his powers. How much faith can one have in this particular deity that is so weak that he/it became fatigued and had to rest a full day after only working six? It is a curiously limited deity. Especially disturbing is that I can find no record of this particular deity performing one particular spectacular [and persuasive of his/its existence] miracle…. there’s seems to be no story of GOD curing an amputee. So what if GOD should change its/his mind on the issue of male infant genital mutilation? This particular power [of regeneration of limb and/or foreskin] would seem to be an important skill this GOD lacks…heh heh. All in all I concur with the ageless wisdom that forewarned is forearmed particularly when it comes to being foreskinned.

  4. #4 Jon Mountjoy
    July 2, 2012

    Great post – I had just come across the same research.

    Have you seen that Germany just passed a ruling to ban circumcision. I hope it becomes law. I just blogged about it here: http://blog.jonmountjoy.com/2012/07/02/believing-something-is-right-because-weve-always-believed-it/

  5. #5 Hyperion
    July 2, 2012

    No offense, PZ, but that “good analysis” of the studies is pretty bad. The statistical analysis is laughably absurd, and they fail to note that the trial was stopped by the review board, not by the people conducting the trial.

    On the statistical side, the papers were correct to note that the reduction in HIV susceptibility was 60%. If 2.49% of the control group contracted the virus, and 1.18% of the circumcision group contracted the virus, then it is correct to say that it reduced the susceptibility by 60%. I see no reason to use the absolute percentage difference. If one were testing a vaccine, and 5% of the control group contracted the disease, and 0.1% of the treatment group contracted it, would we say that the vaccine caused a 4.9% reduction in susceptibility? Of course not!

    As to the USAID trials being halted, they were halted because the independent reviewers felt that it would not be ethical to continue the trial, given the risks posed to the control group by witholding treatment.

    As for condoms, I don’t see it as an either-or thing. Condoms are obviously far more effective…when worn. Given the prevalence of HIV in sub-Saharan Africa, I’m going to guess that perhaps condoms are not being worn very often. There’s also the problem that circumcision’s benefits appear to be mostly for the male partner in vaginal intercourse, but does not seem to offer any protection during anal intercourse (although a Cochrane Collaboration review found that there was evidence of possible benefit for the inserting partner in studies of anal sex among men who have sex with men). So circumcision would not be of great help in reducing the spread of the virus from men who are already infected.

    However, if circumcision has any effect on slowing the spread of the virus, I see no reason to advocate against its use as one part of the toolkit. The arguments laid out in that analysis to which you link are faulty and I am surprised that those flaws were not blatantly apparent to you.

  6. #6 RJ
    July 3, 2012

    Why do your posts titles sound like they were written by a 12 year old girl?

  7. #7 dissembly
    July 3, 2012

    I, for one, find it refreshing to see scientists communicate with the public in a clear and un-circuitous fashion.

  8. #8 sammy
    July 3, 2012

    we should castrate all infant males, because #procreationisimmoral

  9. #9 Daniel
    July 3, 2012

    I would ask you to start to examine the reasons why this bad science has been endorsed by the WHO as well as UNAIDS and the Gates Foundation.

    circleaks.org is a good place to start.

  10. #10 chintchary
    July 3, 2012

    Did the participants really abstain for two months? The sources I found online suggest one month max.

  11. #11 Becky
    July 3, 2012

    I don’t know, I’m hesitant to accept these claims over the assessment of the WHO and the CDC, for instance. The trials weren’t perfect, but some of the claims I’ve seen in their critiques haven’t held up when I’ve done more reading.

  12. #12 Becky
    July 3, 2012

    And I should clarify that I don’t like circ, and I have in the past been very opposed to circ, but I think the evidence is increasing, not decreasing, in favor of potential health benefits.

  13. #13 Ron Low
    Chicago
    July 3, 2012

    It’s notable that WHO hasn’t updated its adult voluntary circumcision policy since 2007. In 2009, its Wawer/Gray research team reported that the Ugandan men they circumcised infected their partners with deadly HIV 50% MORE often than the men they left intact did.

    No national medical association of doctors (not even Israel’s) endorses routine infant circumcision. The most up-to-date policy statement is Holland’s from 2010. It states that doctors must “actively and insistently” discourage families from circumcising due to an “absence of medical benefits and danger of complications.”

    The statement is very well footnoted yet concise. Google KNMG circumcision policy to read it in English.

  14. #14 Robert Darby
    Canberra, Australia
    July 4, 2012

    It is possible to acknowledge that circumcision could reduce the risk of a male’s acquiring HIV through unprotected intercourse with an infected female partner (the small print that always gets left out when the media report “circumcision prevents AIDS”) without concluding that it is a reasonable prevention strategy. Prophylactic removal of breast tissue would infallibly eliminate the risk of breast cancer in both males and females; removal of one testicle would probably halve the risk of testicular cancer; and prophylactic amputation of a leg would probably eliminate the risk of football and motor bike injuries. The question is whether you accept the body as it has evolved and try to protect all of it from disease, injury and deformation of all kinds, or whether you try to re-engineer the body so that it conforms to some mad scientist’s ideal, some sort of armour-plated fortress that will repel the assaults of the micro-organisms that feed on us – but in the process destroy much of our humanity. The human genitals deserve to be accepted as nature made them, not as they might have been designed by a committee of tunnel-visioned medical experts. Micro-organisms have many cunning ways of getting into the body, but the idea of stopping them by amputating or steel-plating all the possible entry points belongs not to the world of evidence- and ethics-based medicine, but the nightmare world of Dr Frankenstein.

    The “circumcision for AIDS” strategy reminds me of a nasty joke I heard many years ago: that the female genitalia ought to be moved to their shoulders, so as to protect them from the risk of rape by midgets. And also of the gothic horror world of Shintaro Kago’s “Punctures”, in which people pre-emptively remove various body parts (teeth, fingers, internal organs) so that they won’t have to worry about anything subsequently going wrong with them. [1] (Though at least these are adults doing it to themselves, not – as with circumcision – to non-consenting children.)

    [1] http://kc-anathema.livejournal.com/pics/catalog/40853

    It’s also possible to acknowledge that limited, targeted circumcision of informed adults at high risk of HIV in regions with high levels of female infection could be helpful without agreeing that mass, indiscriminate programs are acceptable in such places, much less that children should be circumcision; much much less that the strategy should be applied in developed countries with low levels of female to male transmission; and much much much less that it should be applied to children in such environments. The circumcision promoters are always quick to insist that circumcision is not enough, and that men must continue to use condoms as well; in which case, why not forget the circ and just use the condoms?

    What strikes me as a medical historian is the consistency of the historical pattern since nineteenth century medicos demonised the foreskin: as soon as a new disease leaps to the forefront of public anxiety, circumcision enthusiasts suggest that the foreskin has something to do with it and that yet more circumcision is the answer. The claim that mass circumcision (ideally of children, since adults are not so easily coerced) is necessary to control AIDS is largely a re-run of the nineteenth century conviction that mass circumcision was necessary to control syphilis. In each case, an incurable disease had so terrified the public that they were ready to accept almost anything if it offered the possibility of increasing their safety without the need to change their habits.

    What gets forgotten is that HIV is not a particularly contagious disease and that you have to go to some trouble to contract it; apart from blood transfusions, tattoos, surgery and intravenous drug use (where circumcision would obviously make no difference), the only way you can become infected with HIV is through unprotected intercourse with an infected partner. The simplest way to run no risk of HIV infection, therefore, is not to be promiscuous and to practise safe sex. This policy has successfully kept HIV infection at a very low level in countries such as Australia, Germany and Britain, but western health agencies seem to have much the same attitude towards Africans as the military doctor Eugene Hand [2] exhibited towards American Blacks: because they are too stupid to use condoms and too sex crazed not to be promiscuous, the only thing that can be done is to circumcise them in the hope of slightly reducing the risk. The foreskin is targeted not because it is a particularly useful point of intervention, but because it is an easy target for surgical removal and a once-off procedure, after which the agencies can congratulate themselves that they have done all that they possibly can, and the experts can fly home to enjoy their lavish consultancy fees. (Thanks, Bill.)

    [2] http://www.historyofcircumcision.net/index.php?option=com_content&task=view&id=63&Itemid=52

    It should also be remembered that there are strong cultural pressures to use the AIDS scare as the latest means of preserving circumcision as a routine procedure among the cultures that traditionally practise it. The billions poured into the World Health Organisation and UNAIDS represent a bizarre alliance between American medical research money, African tribalism and Muslim religiosity, all of which forces have an emotional commitment to finding new and “scientific” justifications for continuing their traditional practices.

    At one time circumcision (of consenting adults) was seen as a possible adjunct to control of HIV in places with high levels of heterosexual infection and female to male transmission. Now the true believers in circumcision see it the other way round: HIV is a golden opportunity to enforce circumcision on a mass scale – as admitted by long-time fanatical crusader Edgar Schoen, who is not satisfied with foisting it onto vulnerable and desperate Africans, but hopes that the authoritarian Chinese can be persuaded to enforce it on their own people: “In China there is a powerful and increasingly prosperous central government ruling 1.2 billion people, and once a decision is made there is the will and the wherewithal to quickly and decisively implement any circumcision program, whether targeting high risk men or involving the entire population.” He “ends his (self-published) book with an admission of his true aim: “Universal newborn circumcision is becoming an achievable goal.” (Edgar Schoen, Circumcision, God, Sex, and Science, pp. 154 & 158).

  15. #15 Johannes
    July 4, 2012

    “Agreed”, said a German state court, and ruled that wanton chopping without medical grounds constitutes bodily harm.

    http://www.guardian.co.uk/world/feedarticle/10308116

  16. #16 FieseZahnfee
    Germany
    July 4, 2012

    Last week I was wondering why these Studies are used to justify the circumcision of infants and toddlers (along with the claim that “it’s cleaner”), now I’m wondering how they can be used to justify circumcision at all.

  17. #17 perna de pau
    France
    July 4, 2012

    Those who agree that it is time to stop it may wish to sign a petition to support the German law forbiding circumcision before the age of 14:

    http://www.change.org/en-CA/petitions/german-minister-of-justice-protect-children-s-rights-to-bodily-integrity-age-restrict-circumcision

  18. #18 William van Druten, MD
    Lake Superior Freethinkers, Duluth, MN
    July 5, 2012

    Hey, and Ok, NOW I see.
    But golly what about ME?
    I’m nearly eighty,
    That’s in years, matey.

    I can’t find my tip
    To sew it back, anew?
    So what should I do?
    Whom do I sue?

    Must I remain forever a crip
    Just cause of that long ago vile snip?
    How do I now keep my remainder,
    I still use it, out far from danger?

    As wasn’t consulted when
    when they decided to sever
    me from my cover, so am I
    doomed now and forever?

    Pharyngula friend,
    where is thy power
    to remove the sting
    from my dear old thingy-ding?

  19. #19 'Tis Himself
    July 5, 2012

    William van,

    You have set yourself up as an enemy of the anti-circumcision brigade. You were circumcised as an infant yet you don’t feel crippling angst over the loss of several square millimeters of skin. The anti-circumcisers won’t accept that. It’s their belief that any circumcised male has been physically and mentally crippled by their circumcision, unable to function sexually, and totally unable to achieve any sort of sexual relief.

    At least that’s the impression I got the one time I mentioned I was circumcised as an infant yet felt fully functional without a foreskin. Some of the more fanatical foes of circumcision appear confused, equating circumcision with castration. Some of them feel a man’s manhood resides in his foreskin, the loss of which automatically makes him a eunuch.

  20. #20 'Tis Someone else
    Canada
    July 6, 2012

    @’Tis Himself

    As an “anti-circumciser,” I don’t hold any of the beliefs that you claim some people do. I believe that many men who have been circumcised go on to lead fulfilling lives. That’s not the issue. The problems are instead:
    A. Nearly all men who are circumcised did not have a say in the operation at the time
    B. Many Western Medical associations do not believe that their is any valid medical reason for routine circumcisions
    C. Some men have botched circumcisions, leading to loss of function or serious complications
    D. Children sometimes die because of this unnecessary procedure

  21. #21 ExMuslim
    July 6, 2012

    Dear Dr.Myers,

    Sorry if this is not the place to ask the following;
    Could you please clarify, if Humans are all children of Adam and Eve, will not our DNA show a trail back to Adam and Eve instead to a group in Africa.

    Thank you.

  22. #22 Sean Phipps
    Montana
    July 8, 2012

    Another flaw with the study is that the men probobly had less sex due to the fact that women in Africa are probobly more apt to be turned off by the sight of a circumcised penis. I am makeing the assumption that circumcision is fairly rare in Africa.

  23. #23 circosceptic
    July 9, 2012

    Phipps, circumcision is in fact a common initiation rite for African teenage boys, so much so that maybe a majority of African men are circumcised, nearly always under unsanitary and barbaric conditions. Circumcision may have begun in Africa thousands of years ago. This widespread African circumcision is a good thing, because it enable comparing rates of HIV positivity across circumcising and noncircumcising tribes. Most comparisons of this sort favour intact. A major exception is Kenya and Uganda, which is why 2 of the 3 clinical trials were performed there. But the epidemiological evidence in the USA, Canada, and most of Africa suggests that circumcision is irrelevant to the battle against AIDS.

  24. #24 Phillip
    July 12, 2012

    It is NOT time to stop. You leave other peopl’e peckers out of this. The only thing that should be stopped is stupid liberals thinking that someone else’s health is their business. Now, THAT has to stop. You have no domain nor rights in someone else’s healthcare business. Mind your own business and stay out of everyone else’s business.

  25. #25 Phillip
    Toilet
    July 12, 2012

    example:

    Parents may choose as their sovereign right to do so, to circumcise their boy. You have no rights nor say so in the matter. If you intervene the child will still be circumcised and you will also be circumcised from the neck up by the father of that boy for being an interloper. That’s what sticking your nose in other people’s business usually gets you.

  26. #26 Augie
    July 15, 2012

    I remember the hardcore left wing marxist propganda “hero” and the “evil jewish doctor” cartton that was put out last year in the communist gestapo of california. Even germany has banned circumcision. Sad. After all these years the nazis are still after the Jews.

    Message to marxists,nazi,islamphites,and pagan assholes: leave other people’s junk alone. You always give the excuse about some silly “its my body” bullshit when you want to murder your baby in the womb, so at least respect some one else’s body outside of the womb eh? idiots.

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