Can anyone "translate" this?

[Kim22]

A friend (pediatric student) of mine sent me this link and said that he thought I might find it interesting, but I don't have the brain power right now to figure out what it's saying! (That's what happens after a 3-year-old and 1-year-old turn a mommy's brain to mush after a very long day!)

#1) http://medicine.plosjournals.org/per...pmed%2E0020393
and
ETA: Here's another link that he just sent me-
#2) http://adc.bmjjournals.com/cgi/conte...l/90/8/853?eaf

[hummingbear]

OK I just took a glance, from the top of my head.........

The AIDS related one: which I quote from "no causal relationship between male circumcision and HIV prevention could be confidently assumed". The only thing that comes to my mind is the research that we have been seeing a lot of lately which claims that circumcision offers some protection against aquiring AIDS which has not been published by any peer based medical journal. This article takes into consideration those who are advocating circumcision as a national health policy in countries faced with a quickly growing AIDS population and yet concludes that more conclusive studies and thought would be needed before doing so.

And the UTI one: well it concludes that circumcision would not be an effetive approach in any but those who are prone to UTI's.......... and it doesn't go on to say this but I assume that this would only be true during the first year (or less?) since the statistics of UTI's do not differ much past that age. Even then, UTI's can be treated effectivellly with drugs whereas there is no method I am aware of to replace the original foreskin once it has been removed. (Restoration may offer a close substitute but substitute it is.)

So these actually seem to support the position that circumcision has no medical benefit. Was your friend trying to prove a point?

OK sometime soon I will muster the energy to look up the data to respond in a more legitimatly informed manner........or someone else might beat me to it

[Frankly Speaking]

Originally Posted by hummingbear

And the UTI one: well it concludes that circumcision would not be an effetive approach in any but those who are prone to UTI's.......... and it doesn't go on to say this but I assume that this would only be true during the first year (or less?) since the statistics of UTI's do not differ much past that age. Even then, UTI's can be treated effectivellly with drugs whereas there is no method I am aware of to replace the original foreskin once it has been removed. (Restoration may offer a close substitute but substitute it is.)

I also noticed that they quoted a complication rate of 2% - 10% but used the lowest, 2% in the computations. They said that if a higher complication rate was used, then the risk was greater than the benefits even in the boys that were prone to UTIs. They also noted a confounder of possible false diagnosis due to contamination of the urine samples that were not accounted for and that would also have been enough to flip it over to the risks being greater for circumcision than the benefits, even for those boys prone to UTIs.



Frank

[emdeecee_sierra]

I had to go no further than this: "...all studies to date were observational, and many were of poor quality. In the absence of any experimental evidence, no causal relationship between male circumcision and HIV prevention could be confidently assumed". This "argument" : I've heard before to back circ. Here's my take on the matter: men who would otherwise have zero knowledge of sexual risk-taking are brought into a clinic, circed, and sent home with all sorts of new information. Because of the KNOWLEDGE, NOT the circ, they are better able to avoid HIV infection. Hey! I've got an idea for the "scientists" running these "experiments"- as part of the methods, go ahead and hack off another piece of the person's body, and see if THAT keeps them from getting infected with STDs. So there would be one group that is circed, another group that is missing a pinky finger, a third group that is brought into the clinic but doesn't undergo a knife, and then the population at large with no clinic visit. What do you want to bet that the three groups who have clinic visits all turn out the same numbers???? I'd be willing to wager a lot on that one.

Another way to verify/disprove the "circed = less STDs" nonsense is to simply look at men from anywhere else, just compare numbers... how hard could that be? Of the number of men HIV+, how many are circed? How does that compare to a random sample of HIV- men? Is there a statistical difference? Doubt it.

I can sure get fired up over this issue

[Kim22]

Originally Posted by hummingbear

So these actually seem to support the position that circumcision has no medical benefit. Was your friend trying to prove a point?

Kind of. He knows I'm totally opposed to circ. In my e-mail signature, I have the same link that I have in my MDC sig that you see below. He wrote me with this:

I
definitely understand your stance. The AAP (Amer
Assoc of Peds) doesn't recommend for or against, so
that's pretty much my stance on it, I'll leave it up
to the parents.

As far as the link. There's a section...I'll paste it
here:
(This is from the link in my sig)
Well, at least it's beneficial medically. It's much
healthier to circumcise, right?

"No. There is no medical reason for routine infant
circumcision, and no national or international medical
association recommends it. It doesn't stop urinary
tract infections, it doesn't stop HIV infection, it
doesn't stop cancer of the penis or of the cervix. It
doesn't stop any disease."

They are correct in saying there is no recommendation
for it. They are misleading in saying "it doesn't
stop...". It may not stop UTI's, STD's, HIV, but it
DOES decrease the incidence of these. However, UTI's
(urinary tract infections) are already really rare in
boys, and the complication rate (2%) doesn't really
make it a worthwhile procecure. The only exception is
for boys with urinary tract anomalies/high risk. I've
sent you a link to this article in another email, but
the conclusion is as follows:

"Conclusions: Circumcision reduces the risk of UTI.
Given a risk in normal boys of about 1%, the
number-needed-to-treat to prevent one UTI is 111. In
boys with recurrent UTI or high grade vesicoureteric
reflux, the risk of UTI recurrence is 10% and 30% and
the numbers-needed-to-treat are 11 and 4,
respectively. Haemorrhage and infection are the
commonest complications of circumcision, occurring at
rate of about 2%. Assuming equal utility of benefits
and harms, net clinical benefit is likely only in boys
at high risk of UTI"

I also sent you a paper that was done in South Africa
recently which showed a decreased rate of HIV in
circumcised males (risk dec by 60%).

This being said, It's really more important, as well
as relevant to adopt safe sex practices. You're not
going to get HIV (or STD's) if you go around
practicing unsafe sex (even safe sex for that matter).
So no, I wouldn't recommend the routine practice of
circumcision (we got it from Jews, and is an Israeli
practice as well...another error in the paper as it
said only the USA did it, but not impt)


So, he's taking the AAP's stance of neutral, but then says he wouldn't recommend RIC. I'm happy to hear that he's not going to push circ, but if I could get him to refuse to perform them and to speak out against it, I'd be thrilled! So far I haven't been able to save any little boys (except for my own!) but if I could get him to agree with me, that would be a lot of boys saved! Help me!

[Frankly Speaking]

I definitely understand your stance. The AAP (Amer Assoc of Peds) doesn't recommend for or against, so that's pretty much my stance on it, I'll leave it up to the parents.

If female circumcision were given such a neutral stance, would he leave it up to the parents and circumcise baby girls? Has he ever considered that males have rights from birth just the same as girls have rights from birth and that to circumcise boys is a violation of those rights in the most personal and private way possible? (read rape here)

"Conclusions: Circumcision reduces the risk of UTI.
Given a risk in normal boys of about 1%, the
number-needed-to-treat to prevent one UTI is 111. In
boys with recurrent UTI or high grade vesicoureteric
reflux, the risk of UTI recurrence is 10% and 30% and
the numbers-needed-to-treat are 11 and 4,
respectively. Haemorrhage and infection are the
commonest complications of circumcision, occurring at
rate of about 2%. Assuming equal utility of benefits
and harms, net clinical benefit is likely only in boys
at high risk of UTI"

That is only true if the lowest risk factor is used. What if the risk factor is higher?

I also sent you a paper that was done in South Africa
recently which showed a decreased rate of HIV in
circumcised males (risk dec by 60%).

Yes, that paper was published in a on-line journal that is associated with no medical association. Why was that? It was turned down by The Lancet. Why was that? PLoS was established just 1 year ago to publish studies of dubious value. Was PLoS chosen as a legitimate journal or a journal of last resort? The study was funded by The Bill and Melinda Gates Foundation and they also funded the study. See any conflict there?

The actual numbers of their control group that contracted HIV/AIDS was 3.2% and the circumcised group was 1.9% so yes as a ratio, that is 60% but as a mathematical computation, it was 1.3% or a difference that was insignificant and could be completely off set by a confounder. Certainly 60% sounds impressive unless you look at the real numbers and then it looks insignificant.

But there is another factor in play. How long did it take the circumcised men to heal and resume sexual activity? In a study that only last a year, the 6 to 8 weeks of recovery would have a significant impact on the final results especially with the latency period of HIV/AIDS. Could it be that the study was ended early simply because the infection rate of the circumcised men began to catch up at an alarming rate?

Too many questions here to take this study seriously without some answers. It appears that The Lancet also had some serious concerns as well and maybe many other serious medical journals as well.

(we got it from Jews, and is an Israeli
practice as well...another error in the paper as it
said only the USA did it, but not impt)

Neonatal circumcsions in Israel are for ritual purposes and the medical is not even seriously considered. The US is the only country that routinely circumcises for non-religious purposes. We also did not get it "from the Jews." Circumcision was instituted in the US simply to control the sexuality of males and for no other reason. It was only after it began that all of "the medical reasons" began to crop up. The medical reasons have all been disproven but as a new most dreaded disease pops up, there is going to be someone there to say circumcision will prevent/cure it. Examples of diseases/disorders that have been used are masturbation, blindness, tuberculosis, joint disease, cancer, syphlis/gonorreah and now HIV/AIDS.



Frank

[lise brit]

Hi,

As far as the PLOS study saying the HIV rate is reduced by 60%, see my husbands answer under the "Newsweek article" discussion.

Lise Brit

[baybee]

Please send your medical student friend the links to the video that was produced
to teach med students the anatomy and physiology of the foreskin and request that he share it with his professors.


(WMP, streaming) http://www.doctorsopposingcircumcisi...C/prepuce.html

(WMP, download) http://www.doctorsopposingcircumcisi...TSC_256k_D.wmv

[gottaknit]

Another thing that really really bothers me about that HIV study is that they tested the participants for HIV at the beginning of the study, and then didn't tell them their HIV status. So some of them already had HIV, the Drs knew it, and sent them on their merry way to continue having unprotected sex!! Sick sick sick, wrong, and unethical, IMO.