That dreaded word, "recommendation" - Page 2

[brant31]

There seems to be plenty of room for all positions regarding the RCTs -- bunk, skepticism, cautious optimism, inquisitiveness, tentative embrace or bulletproof.

Where I personally draw the line is extrapolating the results beyond very specific claims about environment/conditions and direction (F-to-M). We already know the trials showing circumcision and M-to-F were disappointing at best and damning at worst (50% greater risk of a circumcised pos male passing HIV vs an intact male). Ethical researchers draw the same line, and publicly state it.

[craft_media_hero]

Umm, yeah, and you can still get HIV even with a cut foreskin. Duh. Cutting the foreskin does not prevent transmission if you are having intercourse with an infected partner. Even if circ does reduce the risk (debatable), it does not eliminate the risk of virus transmission!

It seems like if these studies become accepted fact, people may use circumcision as artificial insurance against transmission of STDs.

[serendipity22]

Nobody is dismissing the studies out of hand.

I don't like the way the mantra circ reduces HIV by 50% (or 60% rounded up) has been thrown around out of context. One circumcisionist doctor was advertising on his website: Circumcision reduces HIV by 60%.

The relative reduction is about 1-1.5% in 2 years. Doesn't sound quite so impressive does it.

The 3 studies all hang on about 2 dozen men out of thousands.

I think the stats for entire countries are more important. There are at least 6 African countries where circumcised men are more likely to have HIV than intact men. There are also countries with high HIV and high circ and countries with low circ and low HIV. No pattern really.

[Fellow Traveler]

Originally Posted by serendipity22

I don't like the way the mantra circ reduces HIV by 50% (or 60% rounded up) has been thrown around out of context. One circumcisionist doctor was advertising on his website: Circumcision reduces HIV by 60%.

This seems to be unfortunately common it's something I would expect from the media but we have no shortage of doctors and researchers making the same out of context claim. That's why it's important that when we see this, rather than completely trying to dismiss the claim we re-frame it in the correct context. By adding that it's a relative risk reduction or that such advice applies in limited contexts.

Originally Posted by serendipity22

The relative reduction is about 1-1.5% in 2 years. Doesn't sound quite so impressive does it.

That is the absolute risk reduction in the tested populations, 50% is the relative risk reduction. In the US the risk reduction would be on the order of a few thousandths of a percent over a lifetime. Much less over a two year period like they tested.

Originally Posted by Papai

Pretending like the three RCTs are unchallengable does more of a disservice to honest, open dialogue.

I'm quite pro-science, but when three studies tout some magnanimous benefit that doesn't seem to play out in the real world, then I question how "real" the results of that study were.

It's not about saying the three RCTs can't be challenged but it's about challenging them in a way that is credible. And truthfully I feel our most compelling argument at this point is the one presented by Mama Metis, beru and others; that is that even if one accepts the results of the three RCTs as accurate their applicability is limited and excludes most countries, and none outside Africa.

Originally Posted by Mama Metis

There are huge differences in HIV in Africa versus the US. There are communities in Africa that lost 80% of their population in ten years' time. Households are run by children. There are no teachers left, no nurses left, no mechanics left. Commerce fails. Complete disintegration of society. Would I consider circ as one way to stem an ongoing human catastrophe? Yes.

I am curious Mama Metis, since you're at least peripherally involved in this. What really drives the epidemic in Africa? All that I've read seems to indicate that nobody really knows. Specifically, what makes it worse in Africa and limited elsewhere? It seems to me that this is the question that should be pursued.

I'll add that I don't seem to recall such momentum to flood the continent with condoms, drugs, and such. It seems that circumcision is enjoying a unique surge of support that heretofore has not been seen in the HIV fight in Africa.

Originally Posted by brant31

Where we all agree -- and by all, I mean even the directors of the studies in question -- is that the African studies do not provide relevant or appropriate guidance for developed nations. Thus we ask: why are the CDC and AAP so absolutely determined to bring it up?

An excellent question I doubt you would get straight answer.

[Papai]

Fellow Traveler,

Saying that it has no context outside of Africa might win battles in the States, but it does nothing to save African boys and men from being coerced, cajoled, peer pressured or in some cases assaulted into circumcision. It troubles me deeply that millions upon millions of dollars are going into "education" that will make intactness (already the minority on the largely circumcising African continent) something of a scarlet letter.

[Fellow Traveler]

Originally Posted by Papai

Fellow Traveler,

Saying that it has no context outside of Africa might win battles in the States, but it does nothing to save African boys and men from being coerced, cajoled, peer pressured or in some cases assaulted into circumcision. It troubles me deeply that millions upon millions of dollars are going into "education" that will make intactness (already the minority on the largely circumcising African continent) something of a scarlet letter.

It troubles me greatly too but I have to fight the local battles first. Most of the money and influence comes from the US in the first place. If we can firmly turn the tide in the US, we will have more reasonable minds down the pike, I admit it's a long game strategy.

[fruitful womb]

I think people who are quick to dismiss the studies will also wonder:

Why not "study" to see if it would lower the transmission of [scary disease] if the labia and clitoral hood was removed from an "African female specimen".

We would never stand for it. It seems, women are protected from being used like a lab rat.

Why aren't there studies being conducted to show benefits of the removal of any other body part?


These same people also know that circumcised researchers have always been manipulating studies to contour their desired hypothesis.

* 1875 Lewis A. Sayre declares that foreskin causes curvature of the spine, paralysis of the bladder, and clubfoot. [Spinal anaemia with partial paralysis and want of coordination, from irritation of the genital organs. Transactions of the American Medical Association 1875;26:255-74]

"CIRCUMCISE TO PREVENT CLUBFOOT"

* 1890 William D. Gentry declares that circumcision cures blindness, deafness and dumbness. [Nervous derangements produced by sexual irregularities in boys. Medical Current 1890 Jul;6(7):268-74]

now, thats just stupid people actually fell for it


* 1894 P.C. Remondino says circumcising blacks will help prevent them from raping whites. [Negro rapes and their social problems. National Popular Review 1894 Jan;4(1):3-6]



To say "Circumcise to prevent HIV", "Its an invisible condom!" which is exactly what some people are saying according to those studies.


It is no different than any other propaganda.


That's what those studies are. Its propaganda used to implement universal circumcision and reinstate insurance coverage.

ETA:
The truth about circumcision and HIV