I would have to agree with you, LittleRay. The Derby this year had another annual walk of survivors of breast cancer. For the first time, we had a male walking hand in hand with his wife. Everyone dressed in shades of pink to represent the Susan G. Komen Foundation. They took the opportunity of the male's appearance to remind everyone that anyone can get breast cancer.Quote:
Originally Posted by littlerayofsunshine
WTF?!?!?!?!?!?!?!?!?!?Quote:
Originally Posted by lizard-lix
lizard... I have never seen any valid medical data showing that African American slavery was harmful to the slave...
I have never seen any valid medical data showing that female circumcision is harmful...
I have never seen any valid (by NAZI doctors) medical data that any atrocity committed by NAZIs was harmful...
do you 'get it' yet? Your logic is flawed mostly by it's complete inversion.
"Prove the destruction is harmful"?!?!?
Wait for it...
missing logic/morality link coming...
It's not for the caring people to prove double negatives... this is the common vortex of those who do evil "you can't prove that to me (that my actions are wrong)". Lizard, you're spouting no new defense, has been used as an excuse by many offenders throughout history... to the present. Serial killers who blame the victim for doing the wrong thing, looking the wrong way, shouldn't have been there... it was the victim's fault.
Intro to morality and personal responsibility 101: It's your total responsibility... as the active destructive protagonist... to totally prove... on all levels... beyond any medical, ethical question...
Lizard lix....
"Prove beyond any medical and ethical doubt that male and female circumcision is absolutely necessary, and does no harm to the victim."
You can't do it.
It's great you can manipulate argumentative tactics to try to reverse ethical and medical responsibility. People come into this world okay as they are. You want to violently change them. You are the protagonist. You want to harm babies. By reversing the logic you manipulate the argument; the folks who say "you shouldn't hurt babies" you respond by "it's never been proven to me the babies were hurt, you can't prove that to me!!" Excellent tactic! You would have been a great asset to a debate team in your high school.
But I have razed your argument.
Did you have any VALID point?
I find it hypocritical and interesting that women are flipping out about female circumcision all while claiming that male circumcision is perfectly fine and somehow is not mutilation at all and can't be compared to female circumcision.
These women are in some serious denial and are clearly not for equality for both men and women and I've noticed how they're all American or from the United States and they're just telling themselves this because they had their own sons' penises mutilated because some doctor claimed it was the best thing to do and they didn't do their own research but just wanted to help the doctor or surgeon make more money from mutilation which is what happens with circumcision in hospitals and when a doctor or surgeon performs male genital mutilation.
Useless, and possibly unconstitutional law. Even more useless thread. But it has made a decision easier. From now on, every time Tenni uses someone's gender or sexual orientation as a reason to attack them or publicly attempt fo invalidate them or rhewir words, I will report him.
His lack of tolerance and his obvious mysoginy have gone on for too long. I encourage many of you to join me in this.
Pasa
Having read many of tenni's numerous posts on the subject of women and heterosexuals I see no evidence that he is particularly either a mysoginist or anti heterosexual. He does have particular views about heterosexual women and people being members of this site and being able to express their points of view on forums and that is a point of view which is quite valid if somewhat misplaced. I do believe him to be foolish in his attitudes on these matters but it is surely not a hanging offence to be foolish.Quote:
Originally Posted by Pasadenacpl2
Tenni does seem to have a personal grudge against several people on site, but from what I have read, the feeling is mutual but we can't be compelled to like or love everyone. Personal animosity is not hanging offence either.
If either foolishness or personal animosity were capital offences, many of the regular posters in forums would be long gone.
I find it incredible that a community who screams for acceptance of diversity can be so divisive on the appearance of a dick. It is so petty. There are so many more important injustices going on in this world and everyone seems fixated on the possible performanve of another's body part. Pretty stupid.
......................................
Circumcision Doesn't Reduce Sexual Satisfaction And Performance, Says Study Of 4,500 Men
ScienceDaily (Jan. 8, 2008) — More than 98 per cent of men who are circumcised can enjoy the same levels of sexual satisfaction and performance as men who are not, according to a study of nearly 4,500 males published in the January issue of the UK-based urology journal BJU International.
The randomised trial, carried out by researchers from Uganda and the USA, was undertaken because previous studies showed that the procedure -- which is now recommended as an efficient way to reduce HIV transmission - showed conflicting results.
"Previous studies have been problematic and shown contradictory results" points out co-author Professor Ronald H Gray from the Bloomberg School of Health at Johns Hopkins University, Baltimore, USA.
"Studies focusing on men circumcised in adulthood were highly selective, because there were medical indications for surgery, circumcised infants can't provide before and after comparisons and in most studies sample sizes were small and follow-up was short.
"This study, carried out as part of an HIV prevention initiative, enabled us to compare two groups of men with the same demographic profiles and levels of sexual satisfaction and performance at the start of the study."
The research team looked at 4,456 sexually experienced Ugandan men aged from 15 to 49 who did not have the HIV virus. 2,210 were randomised to receive circumcision and 2,246 had their circumcision delayed for 24 months.
They followed up both sets of men at six, 12 and 24 months and then compared the information on sexual desire, satisfaction and sexual performance for the circumcised men and the control group.
Their research showed that:
•98.6 per cent of the circumcised men reported no problems in penetration, compared with 99.4 per cent of the control group.
•99.4 per cent of the circumcised men reported no pain on intercourse, compared with 98.8 per cent of the control group.
Sexual satisfaction was more or less constant in the circumcision group -- 98.5 per cent on enrolment and 98.4 per cent after two years -- but rose slightly from 98 per cent to 99.9 per cent in the control group. This difference was not felt to be clinically significant.
At the six-month visit there was a small, but statistically significant, difference in problems with penetration and pain among the circumcised group, but this was temporary and was not reported at subsequent follow-up visits.
There was considerable consistency between the men in each group when it came to age, religion, marital status, education and number of sexual partners in the last year. The majority of the men were Catholic, married, had one sexual partner and were educated to primary school level.
"Our study clearly shows that being circumcised did not have an adverse effect on the men who underwent the procedure when we compared them with the men who had not yet received surgery" concludes Professor Gray.
"Other studies have already shown that being able to reassure men that the procedure won't affect sexual satisfaction or performance makes them much more likely to be circumcised."
"BJU International was very keen to publish this large-scale study as there has been a lot of conflicting evidence about the effects of circumcision" says the journal's Editor, Professor John Fitzpatrick from University College Dublin, Ireland.
"We believe that these findings are very important as they can be used to support public health messages that promote circumcision as an effective way of reducing HIV transmission."
The effect of male circumcision on sexual satisfaction and function, results from a randomized trial of male circumcision for human immunodeficiency virus prevention. Rakai, Uganda. Kigozi et al. BJU International. Volume 101, pp 65-70. January 2008.
:2cents:
now that is a good study...
it uses people that can give full and active feedback in a study, not babies....
it covers the aspect of sexual performance and experiences
it covers a good range of males that have differing sexual experiences.....
and it beats the hell out of the * I know many guys that say * argument....
thanks for posting that mikey.....
More levity about the issue for you to peruse. You may believe it flippant but with a little thought, it can be seen that sometimes flippancy does send us a thought provoking message.
http://www.iraresoul.com/circumcision.html
the choice for me is one like the choice for immunization, sammie, there are pros and cons and the best I can hope for is to make the right decision at the right time
as a parent ( I am a legal listed parent which means its on paper, there is no factual proof of paternity ) I would view my role as a person that would have to weight up my options...
with immunization, there is a risk of side effects that can be servere in rare cases and its the same with circumcision, there can be side effects that are servere in rare cases.....
what is the right choice to make, the health and wellbeing of the child is paramount, and in both cases, my choice can result in issues for the child....
well it is easy to say that circumcision is wrong yadda yadda yadda... we have to bear in mind that there are issues that can arise in children that are not circumcised......
the thread is about a petition to push a personal agenda to ban circumcisions cos people do not believe in them... well, if circumcisions are so wrong, why are they performed on adults for medical reasons, which flies in the face of the argument that there is no medical need for a circumcision....
so as a parent, I would have to look at that aspect of things and not the tunnel vision view that circumcisions are wrong and should be banned.... and make a informed choice, knowing that only time will tell if I have made the right choice.....
medical science is not perfect, nor are parents..... but they are both expected to be, by many people that have a one eyed view of a issue.....
I don't believe that immunisation and circumcision are valid comparisons. One has proven medical benefits without pain or personal injury and the other except in certain rare cases, doesn't.
I think the point that is being made again and again, is that modification of the body, whether it be by tattoos, piercings, augmentation or reduction should be made by the individual concerned, and not by any other person.
It is not as though we are talking about life threatening conditions that require immediate surgery, we are discussing an elective operation in which the patient concerned is not given a say in the matter.
I seem to recall that there was a recent outcry in the US about some mother giving her child botox injections.
If the child on reaching adulthood decides for themselves that they wish to be circumcised, tattooed or pierced, that is entirely their decision. As a society we quite rightly place restrictions on minors buying alcohol or firearms or driving a vehicle. In the UK at least it is illegal for a minor to be tattooed in a tattoo parlour, and yet it is somehow deemed acceptable to cut bits from the penis of infants that are unable to defend themselves.
To my mind, we abrogate the trust reposed in us when we allow such procedures to happen. As I see it, our duty is to nurture and care for our offspring, until such time as they are able to fend for themselves.
I only hope debate on this matter leads more parents to question the validity of the advice they are receiving from doctors. The Chinese once bound the feet of their women, causing deformity and damage in the process. This practice has died out, one can only hope, that circumcision in time, will also be consigned to the dustbin of history.
I would refer everyone to this article regarding circumcision in the US, it makes for interesting reading. I would also suggest they watch the link to the video posted by Sammie, above, showing an actual circumcision being performed on an infant.
It is graphic and disturbing, but perhaps that will help clarify in people's minds what we are actually debating, something that no amount of words could convey.
The article I refer to :-
http://books.google.co.uk/books?id=l...0Union&f=false
No. Mikey, it's a gross oversimplification (and clear manipulation on your part) to state that circumcision is just "the appearance". I could rip apart just "the appearance" if that were your true motivation; but it's not, it's just an argumentative/distractive ploy on your part.Quote:
Originally Posted by mikey3000
No Mikey, I believe you're trying to belittle, in every manipulative way *sigh*Quote:
Originally Posted by mikey3000
1 molesting/mutilating innocent children is not petty, not even by custom.
2 "possible performance", possible Mikey, possible??? WTF? there is no question of circumcision damage, it is intentional, the damage and loss of feeling is the substantiation... the reason for circumcision! Possible performance?!?! Really Mikey?!? Please immediately present this argument if you want to use it again... present it prominently as a principle argument.
3 "of another's body part", same evasive moral angle as "why do those abolitionists cause trouble? They're not the ones being enslaved."
By the way I thought you claimed the center of this matter (in your first sentence) was only about the appearance of a dick...
Forgive me Mikey, I disliked you before, but I quickly get over it. I'd much rather be friends with you, Pasa, Duck, Twyla, ...Quote:
Originally Posted by mikey3000
My opposition to you is entirely because you're maintaining a stance where harsh language required here.
Bullshit 101
How can deliberate destruction of 1/4 to 1/3 (complete destruction by complete removal of nerve paths and nerve endings) and incidental destruction of 1/4 shaft feeling (formerly transmitted via electrical signals through nerves now simply gone), desensitization due to direct glans continuous exposure and kerotinatization of penis glans.
And all of this destruction does NOT reduce feeling of penis? ... Really Mikey? Are you going to tell us "day is night" next?
I expect no less of neurosis.
Everyone would have to be a willful idiot... to wish this (circumcision) destruction into non destruction.
Fertile ground for bias.Quote:
Originally Posted by mikey3000
Isn't homosexualty illeagal in Uganda (death penalty), and isn't the USA pathetically (via cultural tradition) pro-circumcision? (violation of medical standards)
Why is HIV mentioned here, if this is an unbiased article?
These people set out to prove circumcision is okay for HIV prevention... they unashamedly announce it for God's sake!
Double blind medical standards gone (in addition to ethical abandonment)??????????
Yeah, "problematic" inasfar as not solidly supporting circumcision...Quote:
Originally Posted by mikey3000
HELLO! openly declared medical bias!Red flag!!!Quote:
Originally Posted by mikey3000
Wait... WHAT?!?!?!?!?Quote:
Originally Posted by mikey3000
Please note the careful selection and wording of the statistics. This isn't a legitimate medical study with anything to do with the thesis or conclusions (for anyone familiar with the medical ethical standards).Quote:
Originally Posted by mikey3000
Nice vague reference and generalization.Quote:
Originally Posted by mikey3000
Reannouncement of bias.Quote:
Originally Posted by mikey3000
Uganda... Right... The sexually unbiased capital of the world with no other agenda.Quote:
Originally Posted by mikey3000
Mikey, I wish I didn't have to rag you; anger/rebuke takes so much energy from me...Quote:
Originally Posted by mikey3000
But your position, even your proof is very full of holes, bias, and manipulation, all towards sustaining an evil.
Please do not harm any more children than you already have.
I beg you.
This insanity (of harming children) must be resisted and countered by all morally cognizant human beings.
If you simply uttered doubts to your children, they might pick up the torch from there and end family 'tradition/logic' in harming little ones. It might not have to be inflicted on the next generation. It might be stopped.
This is the entire point of personal growth affecting social progression; to stop the stupid crap, the harm, to allow children to grow up and exceed the parents.
I steadily maintain that since circumcision has not, cannot grab medical or ethical high ground in any logical argument that it is doomed by it's very discussion... I am ecstatic San Francisco has taken the initiative. Even if they lose, the question is brought publicly up... and thus will eventually die by logic, reason, and ethics.
To quote the last 20 year stand by the American Pediatric (Association?)...
There is no medical indication for routine circumcision of newborns.
bluebiyou, I have to say, its you that is doing damage to your own argument....
most of what you are using is statements by people that claim etc etc etc.... but at the end of the day, there is no full study that proves your claims and the people that would know best, the effects, are the adult circumcised males, as they have the penises that are being used... and that is the study that mikey provided
your totally hilarious argument against mikeys study, is that its for hiv / aids prevention and so that makes it null and void... and that its in uganda .....
I am sorry, but are you trying to say that penises in uganda are some how not valid penises cos they are not in the US... or that cos homosexuality is illegal over there that any study of penises in uganda is faulty ?
now you make the claim that the findings are faulty, I put it to you bluebiyou, instead of picking apart mikeys post with your hilarious attempt to debunk the study, how about you come up with a study on your terms ( must be in the US, must be where homosexuality is legal etc ) that counters mikeys study... and I am talking about at least 4,500 adult circumcision cases that prove your claims about circumcision
now I am not pro or anti circumcision.. I view it as a medical needed procedure at times..... and most of your argument is on the basis that it hurts children and damages nerve endings....... but I am curious, if you are so anti circumcision as cruel and inhumane.... then what is your stance on cancer treatments etc for kids, that infect a hell of a sight more suffering to children, that can last years.... and often, involves far more pain and suffering than a quick operation to remove a circumcision......
one thing I have noticed in a lot of anti circumcision advocates, is that they will inflict long term pain and suffering on kids ( medical operations ) and use the stance that its in the best interests of the kids, yet accuse others of child abuse cos of a circumcision.....
its a double standard cos no matter what way you look at it, pain is pain, suffering is suffering and kids are kids.... regardless of the reason for taking up a scalpel
I beg your pardon? What kind of absolute dross is this? You are equating the removal of healthy penile tissue with what are considered necessary treatments for children aimed at curing their disease and preventing a lifetime of suffering or even often agonising death?Quote:
Originally Posted by Long Duck Dong
Of course many treatments for terminal and other serious illnesses can themselves cause pain and suffering which people of all ages would not otherwise endure during the normal course of their illness. But that is not out of a sadistic wish to inflict pain on a child or anyone else, but for what is hoped to be and very often is successful in curing the illness which may in the end kill or cause the child permanent disability and sometimes disfigurement. The medical profession uses what knowledge, technology and skills it has to try and cure the sick, and it often will involve pain and suffering from the treatment often over a long period of time. It is the state of the medical technology and knowledge available. Are we to allow children (or adults for that matter) to die needlessly when there is a treatment available even although that treatment will involve much pain and suffering over a long period of time which may in the end save that child's life? Because a treatment itself can cause pain and suffering are we never to allow it even although that is the only hope for the child?
In respect of these treatments, there are few parents, pro or anti circumcision who would not grasp the opportunity to give their child a chance of life and good health knowing that a side effect of that treatment may be more pain and suffering, may be over a long period of time and may in the end not do what is hoped of it. Even the most successful treatments sometimes end in death. Even simple surgical procedures end in death. Even a simple surgical procedure such as circumcision of healthy penile tissue.
Use of such treatments to combat disease are not a double standard as you suggest but a beacon of hope for child and family alike.
Your statement is crass and has positively no bearing on the case for or against circumcision.
Quote LDD.
now I am not pro or anti circumcision.. I view it as a medical needed procedure at times..... and most of your argument is on the basis that it hurts children and damages nerve endings....... but I am curious, if you are so anti circumcision as cruel and inhumane.... then what is your stance on cancer treatments etc for kids, that infect a hell of a sight more suffering to children, that can last years.... and often, involves far more pain and suffering than a quick operation to remove a circumcision......
one thing I have noticed in a lot of anti circumcision advocates, is that they will inflict long term pain and suffering on kids ( medical operations ) and use the stance that its in the best interests of the kids, yet accuse others of child abuse cos of a circumcision.....
its a double standard cos no matter what way you look at it, pain is pain, suffering is suffering and kids are kids.... regardless of the reason for taking up a scalpel[/QUOTE]
Children or adults for that matter that don't have cancer are not given cancer
treatment, so I don't really see the point of the above statement.
Medical treatment, as opposed to elective surgery, is given to treat a medical condition, often one that threatens the life or health of the patient. Operations are performed on that basis. Routine circumcision is not performed on that basis.
It is the unnecessary surgery without medical need, on a child that has not given his consent, that forms the argument of this thread, not that people may need surgery at some point in their lives. Or that pain and suffering may be involved.
We don't remove an appendix or gall bladder unless it is causing problems, so there is no medical necessity to remove a foreskin if it is not causing problems.
In my opinion, it is fine for adults to consent to elective surgery on their own bodies if they so wish. It is not alright for adults to consent to elective surgery on the bodies of someone else, especially if that someone else is too young to give their consent.
We ask our children their preference for breakfast cereal, why not leave them to decide if they wish to be circumcised or not? Why rob them of the choice? They will have to make many decisions for themselves in later life, one more decision will not hurt. At least they will have made it for themselves, it will not have been foisted upon them without their consent.
In answer to DD, as to feeling like a freak in a shower room, I have never felt this. As an uncircumcised male, I have been in shower rooms all over the World, with people who were circumcised and those who were not, I have never in my life heard any disparaging remarks on whether anyone was circumcised or not.
Boys from puberty upwards are only interested in size and comparing their endowment with those of their friends or class-mates, who could attract the most girlfriends, who was smartest, who could fight the best and who was best at sport.
For those less endowed, it spurred them on to attract girls by their personality and by their prowess in other areas, by being funny, or good at sports.
To suggest that young males with foreskins in the school locker/shower room would be regarded as freaks is simply not true and is no different from someone else in this thread mis-labelling you a monster, or child-molester.
Labeling people as freaks, monsters or child-molesters is wrong. It does not do anything for the debate and only serves to detract from an honest, and thoughtful consideration of the points at issue. That is the only basis on which any debate can be won or lost.
The whole "circumcision protects against HIV and STDs!" argument does not hold water at all.Quote:
Originally Posted by Long Duck Dong
If it did then why did an entire generation or two of bisexual and gay men who were all cut at birth and born in the United States get infected with HIV and other STDs and die from AIDS?
Circumcision is not something magical that's going to prevent you from getting infected with HIV or other STDs if you're not having safer sex and using condoms correctly to begin with. This is what people are going to believe in Africa that circumcision somehow prevents the transmission or infection of HIV and that condoms do not have to be used and safer sex does not have to be done if someone is circumcised.
Male circumcision offered no protection to women, and male circumcision actually increased the risk to women. Women also are placed at greater risk from unsafe sex practices when they, or their circumcised male partners, wrongly believe that with circumcision they are immune to HIV and therefore they choose not to use condoms.
In the latest Uganda study it is 56 circumcisions to prevent one HIV infection per year. They fail to mention that more than a third of the circumcised men were infected before the study started, and hence were not admitted to it.
Caution must be exercised in applying the results of this study to individual risk-reduction strategies. For example, the result that no circumcised men seroconverted during the course of the study might be casually interpreted to mean that a circumcised man cannot be infected with HIV through heterosexual sex. This conclusion is illogical, as the relatively small sample size (50 circumcised seronegative men) and short duration of follow-up (median less than 2 years) allow for a significant possibility that infection of circumcised men would be observed in a larger population or over a longer period of time. The fact that over one-third (29/79) of the circumcised men in this study were HIV-positive on entry demonstrates that transmission to circumcised men occurs in this population, and it seems extremely unlikely that heterosexual transmission did not contribute.
the point I was making, darkside, is that one form of suffering is deemed unacceptable, another is not... we can inflict severe suffering on kids in the name of wellbeing and say that its acceptable ( surgical operations ), while decrying the suffering of children with a circumcision cos its unneeded suffering.... yeah we can in effect be setting them up later in life for a adult circumcision any way
do the children have a choice ??? no, we make the choice for them.... yet mention circumcision, and then the stance becomes *right of the children to decide *... funny how we play the double standards.....
what is my point ?? its simple,.... mutilation, child molestors etc surrounding circumcision.... yet parents that sign the consent for prolonged suffering on children, using surgical procedures, are seen as loving parents......
if I circumcised a child with the intent of avoiding a possible adult circumcision, I am deemed a cruel person... but not if I say ok, do any number of ops on my child so they have a bright / better future....
lil hint, juliana wetmore.... google her..... and the pain and suffering of circumcision becomes very mild compared to what we can put kids thru...
read back to my post.... I was talking about the effects of adult circumcision in mikeys study post... I was not arguing validity of circumcision to prevent aids / hiv.....Quote:
Originally Posted by BiDaveDtown
now where is your link to your study..... where is the scientific references and study location..... its all good and well to talk about your study... where is it so I can read it.....
References in next post.Quote:
How the circumcision solution in Africa will increase HIV infections
Robert S. Van Howe, Michelle R. Storms
Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Marquette, MI, USA
Correspondence: Dr. Robert S. Van Howe, Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, 413 E. Ohio Street, Marquette, MI 49855, USA.
Tel. +1.906.2287454 - Fax: +1.906.4852726. E-mail: rsvanhowe@att.net, vanhowe@msu.edu
Key words: circumcision, HIV infection, risk compensation.
Conflict of interest: the authors report no conflicts of interest.
Received for publication: 25 October 2010.
Accepted for publication: 9 December 2010.
This work is licensed under a Creative Commons Attribution 3.0 License (by-nc 3.0).
©Copyright R.S. Van Howe and M.R. Storms, 2011
Licensee PAGEPress, Italy
Journal of Public Health in Africa 2011; 2:e4
doi:10.4081/jphia.2011.e4
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Abstract
The World Health Organization and UNAIDS have supported circumcision as a preventive for HIV infections in regions with high rates of heterosexually transmitted HIV; however, the circumcision solution has several fundamental flaws that undermine its potential for success. This article explores, in detail, the data on which this recommendation is based, the difficulty in translating results from high risk adults in a research setting to the general public, the impact of risk compensation, and how circumcision compares to existing alternatives. Based on our analysis it is concluded that the circumcision solution is a wasteful distraction that takes resources away from more effective, less expensive, less invasive alternatives. By diverting attention away from more effective interventions, circumcision programs will likely increase the number of HIV infections.
Introduction
At the XVIII International AIDS conference held in Vienna, there was a strong push to gather funding to circumcise 38 million men in sub-Saharan Africa within the next five years. The belief is that male circumcision provides the best hope of decreasing the spread of HIV infection there. We believe these efforts are misguided.
Although the World Health Organization (WHO) and UNAIDS have supported circumcision as an HIV preventive in regions with high rates of heterosexually transmitted HIV, the circumcision solution has several fundamental flaws that have been glossed over by its proponents within these organizations. These proponents, who have been touting the “benefits” of circumcision for decades, have developed plans to circumcise Africa on behalf of WHO and UNAIDS.1 If their goal is to prevent the spread of HIV in Africa, circumcision will only serve to divert resources away from effective measures.
In this paper, we will expose the lack of scientific evidence, biological plausibility, and epidemiological evidence that provides the foundation for the circumcision solution. We will demonstrate how circumcision will likely increase the number of heterosexually transmitted HIV infections. Finally, we will discuss how poorly circumcision compares with other interventions.
Lack of scientific evidence
The results of three randomized clinical trials (RCTs) are often presented as proof beyond a reasonable doubt that male circumcision prevents HIV infection.2 After all, RCTs are the gold standard of medical experimentation. However, such accolades only apply to well-designed, well-executed trials. The three RCTs were neither.
The trials were nearly identical in their methodology and in the number of men in each arm of the trial who became infected. The trials shared the same biases, which led to nearly identical results. All had expectation bias (both researcher and participant), selection bias, lead-time bias, attrition bias, duration bias, and early termination that favored the treatment effect the investigators were hoping for.3 All three studies were overpowered such that the biases alone could have provided a statistically significant difference.
The common hypothesis for these trials was that male circumcision would decrease the rate of heterosexually transmitted HIV infections. A basic assumption adopted by the investigators was that all HIV infections resulted from heterosexual transmission, so no effort was made to determine the source of the infections discovered during the trial. There is strong evidence that this assumption was not valid.
In the South African trial, men who reported at least one episode of unprotected sex accounted for 2498 person-years and 46 HIV infections during the trial. Among the remaining men, who accounted for 2076 person-years, 23 become infected although they either had no sexual contact or always used a condom. These men, who had infection rate of 1.11/100 person-years (95%CI=0.74-1.67), presumably became infected through non-sexual means. The men at sexual risk of infection had an infection rate of 1.84/100 person-years (95%CI=1.38-2.46). It would be expected that all men in the trial shared the same baseline risk of non-sexual transmission and any additional risk could be attributed to sexual transmission. The infections attributed to sexual contact would be the difference between the total rate and the non-sexually transmitted rate (0.73/100 person-years). Consequently, only 18 (0.0073 infections per person-year * 2498 person-years) of the 69 infections in the South African trial can be attributed to sexual transmission.4
Similarly, in the Ugandan trial, men who consistently used condoms had the same rate of infection as those who never used condoms (Consistent condom use: 1.03/100 person-years; No condom use 0.91/100 person-years; RR=1.13, 95%CI=0.54-2.38, P=0.74). Men who reported no sexual partners for the duration of the trial accounted for 1252.1 patient-years and 6 infections (0.48/100 persons-years, 95%CI=0.22-1.07). If this rate is subtracted from the rate in sexually active men, at most 35 of the 67 infections in the Ugandan trial can be attributed to sexual transmission.5
Finally, in the first three months of the Kenyan trial, five men became HIV-positive who reported no sexual activity in the period before the seroconversion (0.73/100 person-years, 95%CI=0.30-1.76). If this rate is subtracted from the overall rate of infection in the trial, at most 36 of the 69 infections in the Ugandan trial can be attributed to sexual transmission.6 Conservatively for the three trials, 89 of the 205 infections (43.1%) were sexually transmitted. Without knowing which infections were sexually transmitted, it is impossible to test the hypothesis of whether circumcision reduces the rate of sexually transmitted HIV. Basing policy on studies that were unable to answer their own research question is unwarranted.
Lack of biologic plausibility
How does cutting off the foreskin prevent the transmission of HIV? This question remains unanswered. Proponents of the circumcision solution have speculated that the interior mucosa of the prepuce is thinner and more prone to tearing, but mucosa of the inner and outer prepuce have been shown to be of the same thickness.7 Proponents also speculate that HIV is more likely to be transmitted through the foreskin because it has a high concentration of Langerhans cells, which they believe are the entry point for HIV. Research has shown that Langerhans cells are quite efficient in repelling HIV and explains why the transmission rate of HIV is one per 1000 unprotected coital acts.8 The inner foreskin secretes langerin, which kills viruses.9 Langerhans cells also protect against other sexually transmitted infections (STIs), which may explain why circumcised men are at greater risk for getting an STI (unpublished data). In general, mucosal immunity provides a stronger barrier to infection than the skin. Finally, to support their plausibility argument, circumcision proponents have identified the sub-preputial space as a harbor for sexually transmitted viruses. Meta-analyses assessing the susceptibility to genital infections with herpes simplex virus and human papilloma virus have not shown an association with circumcision status.10,11,12 Unfortunately, these speculations have been repeated so often in the medical literature that many physicians and public health officials consider them factual. There is, however, no direct scientific evidence to support the hypothesis that the foreskin is a predisposing factor for infection.
Lack of consistent epidemiological evidence
If the RCTs are to be believed and circumcision provides 50% to 60% protection from sexually transmitted HIV infection, then the impact of circumcision should be readily apparent in the general population. This is not the case. In Africa, there are several countries where circumcised men are more likely to be HIV infected than intact men, including Malawi, Rwanda, Cameroon, Ghana, Zimbabwe, Lesotho, Swaziland, and Tanzania.13,14,15 Even in South Africa, where one RCT was undertaken, 12.3% of circumcised men were HIV-positive, while 12.0% of intact men were HIV-positive.16 If the national survey data that are available from 19 countries are combined in a meta-analysis (Table 1) the random-effects model summary effect for the risk of a genitally intact man having HIV is an odds ratio of 1.10 (95%CI=0.83-1.46), indicating that on a general population level, circumcision has no association with risk of HIV infection. Among developed nations, the United States has the highest rate of circumcision and the highest rate of heterosexually transmitted HIV.17 Within the United States, blacks have the highest rate of circumcision18,19,20,21 and the highest rate of heterosexually transmitted HIV.22 Among English-speaking developed nations there is a significant positive association between neonatal circumcision rates and HIV prevalence (data currently under submission, Scot Anderson). On a population level, circumcision has not been found to be an effective measure and may be associated with an increase in HIV risk.
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Table 1. Meta-analysis of population survey results from 19 countries15,16 comparing HIV prevalence based on circumcision status using fixed-effects and random-effects models on exact odds ratios and confidence intervals.11
Risk compensation
Risk compensation occurs when people believe they have been provided additional protection (wearing safety belts) they will engage in higher risk behavior (driving faster). As a consequence of the increase in higher risk behavior, the number of targeted events (traffic fatalities) either remains unchanged or increases.23,24 When modeling HIV infections in San Francisco, Blower and McLean found that if an HIV-vaccine offered 50% protection, but reduced condom usage, or increased other risky behaviors, it would likely result in higher HIV infection rates.21
Risk compensation will accompany the circumcision solution in Africa. Circumcision has been promoted as a natural condom,25 and African men have reported having undergone circumcision in order not to have to continually use condoms. Such a message has been adopted by public health researchers. A recent South African study assessing determinants of demand for circumcision listed “It means that men don’t have [to] use a condom” as a circumcision advantage in the materials they presented to the men they surveyed.26 If circumcision results in lower condom use, the number of HIV infections will increase.
African men, on average, have coitus once a week,27 and use condoms in 48% of their sexual encounters with women.5 Assume that 20% of sexually active women are HIV-positive, partners were contacted randomly, condoms are 98% effective when used, the baseline circumcision rate is 5%, and circumcision reduced the transmission rate of HIV infection by 50%. Since the transmission rate of HIV from females to males is one per 1000 unprotected coital acts, the HIV infection rate in men in this scenario would be 0.537 per 100 person-years (which is far below the rate reported in the three RCTs). If the circumcision rate increases from 5% up to 75%, the infection rate would decrease to 0.344 per 100 person-years. If in the baseline scenario with a 5% circumcision rate condom use increased from 48% up to 67.9% of sexual encounters, the infection rate would be 0.344 per 100 person-years. Consequently, the impact of a fifteen-fold increase in the rate of circumcision could be accomplished by a relative 41% increase in the use of condoms.
The leap of faith
Interventions and medications that demonstrate efficacy in a research setting are often failures in a clinical setting. Circumcision will provide another example of this. The results from the RCTs are of questionable value, and it is unknown how they will translate to the real world. Numbers gathered from general populations are outside the 95% confidence intervals generated by the RCTs.
Research results often fail to translate to other settings because the research population differs considerably from the targeted population. For example, to save money in a trial of a new antihypertensive medication, participants with the highest blood pressure will be recruited for the trial, because it is easier to show effectiveness in those with more severe disease. The new medication may do well with the participants, but when the medication is released for general use, it may not be beneficial for those with mild hypertension, let alone those who are normotensive.
The men attracted by a free circumcision to enroll in the RCTs are not representative of the general population. The RCT participants were required to want to be circumcised. A faithful monogamous man with a faithful spouse would have little motivation to seek a free circumcision. This selection bias may have resulted in enrollment of men more likely to engage in high-risk behaviors. The free circumcision and financial inducements may have added to the selection bias.
If the selection bias resulted in more men at high risk of infection being in the trial, then the results would apply only to men who engage in high-risk behaviors. This would be consistent with the observational studies finding that the association between circumcision status and HIV infection was present primarily in studies of high-risk men.
Instead of targeting sexually active men at high risk of HIV infection, the circumcision solution proposes circumcising all males (of all ages), which would be equivalent to recommending the above antihypertensive medication to everyone regardless of their blood pressure. In addition to the national survey data (Table 1), observational studies of general populations have for the most part failed to show an association between circumcision status and HIV infection.28,29,30 There is no scientific reason to believe that the RCT results would necessarily apply to the general population. It is quite likely that applying research results from a high risk population to the general population will lead to failure. Using the scenario above, if it is assumed that circumcision has only a 10% protective in the general population then increasing the circumcision rate from 5% up to 75% would decrease the infection rate from 0.548 to 0.509 per 100 person-years. Increasing condom use from 48% up to 51.8% would result in the same gains. So a fifteen-fold increase in the circumcision rate would have the same impact as a 3.8% absolute increase in the use in condoms.
Attractive, less invasive, less expensive, more effective alternatives
Before Africans address sexually transmitted HIV, a concerted effort to eliminate the iatrogenic spread of the virus is needed. As the numbers from the RCTs indicate, most infections can be attributed to non-sexual transmission. While this indictment of the medical system is unsettling, ignoring iatrogenic sources of infection will only allow the African epidemic to flourish.31
When it comes to sexually transmitted HIV infections, proponents of circumcision have consistently failed to compare the effectiveness and cost of circumcision to currently available alternatives, which include condoms, aggressive surveillance and treatment of STIs, and antiretroviral therapy (ART).
ART is a secondary preventive measure. When those infected with HIV are treated with ART, the viral counts can decrease to where the patient is no longer contagious. HIV-infected patients on ART with no currently active STI no longer need to use condoms to protect their partners.32 A recent model predicted that a “test and treat” model in a sub-Saharan setting could reduce the number of new HIV infections by 55-73.2%,33 making this approach attractive in Africa, San Francisco, and Washington, DC.34 This intervention directs prevention at those most likely to benefit: those exposed to the virus. With the circumcision solution, the vast majority of men who are circumcised will not benefit from the procedure (Figure 1). Secondary prevention is a more efficient use of resources and many HIV experts consider primary prevention extremely wasteful and ineffective.8 The “test and treat” approach is effective regardless of whether the infection was sexually or iatrogenically transmitted. Such an approach would not be limited to ART, as the use of other medications proven to decrease viral counts, such as decitabine and gemcitabine, may also become available.35
Aggressive surveillance and treatment of STIs has been shown to reduce the number of HIV infections by 40%36 at a cost of $217.62 per HIV-1 infection averted.37 This is more cost-effective than models for circumcision, which extrapolate the data collected from the 21 to 24 months of the RCTs to over 20 years, have predicted. These models, which incorporated major assumptions of questionable validity, presented circumcision as favorably as possible. In addition to being more cost-effective, aggressive surveillance and treatment of STIs have the advantage of treating and preventing the spread of STIs and avoiding the damage caused by removing the most sensitive portion of penis.38 Part of the success of STI treatment research may be due to a reduction of iatrogenically transmitted HIV, as the STIs were treated in research facilities.
In studies of discordant couples, condoms have been shown to be more than 99% effective in preventing infection.39 Condoms, in a public health setting, cost 2.5¢ each.40 A safe circumcision performed under sterile conditions in Africa using local anesthetic costs approximately $75,41 so for the cost of an adult circumcision, 3000 condoms, at 2.5¢ per condom, can be purchased. The nearly complete protection provided by condoms is a bargain compared with circumcision. In the first hypothetical scenario outlined above, the 0.193 infections per 100 person-years decrease in HIV infection rate brought by circumcision costs $52.50 per person. The cost per person of the additional condoms (at 2.5¢ each) for one year to achieve the same impact on the infection rate would total 25.87¢. To have the same effect for one year, circumcision costs 202.9 times more than condoms. Proponents for circumcision would argue that circumcision is a one-time expenditure, while condoms would be an ongoing expense. Using the scenario above with 3% discounting and assuming an average of weekly sexual contact over 45 years, the lifetime difference in the cost of condoms would be $6.13 per person. With 5% discounting the lifetime difference in cost would be $4.83. If circumcision is only 10% effective, with a 3% discount, the lifetime difference in cost of condoms would be $1.25.
One complaint has been that the 2.5¢ condoms are not attractive, which may explain why they are underused. Based on this analysis, if a man is having sex weekly for 45 years, an upgrade to condoms that cost ten times as much would be cost neutral (assuming a discount rate of 3%). Of course, if sexual contact was less frequent or a man was in a mutual monogamous relationship, further condom upgrades could be justified.
This is, however, a false comparison because, unlike circumcision, condoms can provide nearly complete protection.
Circumcision proponents believe that circumcision is the only proven effective preventive tool for HIV infection and have argued that condoms are ineffective.42,43 Condoms would be expected to be ineffective in regions where the majority of infections are from non-sexual transmission. Abstinence, be faithful, and condoms (ABC) should remain the focus of primary prevention for sexually transmitted HIV, but more resources need to be focused on the non-sexually transmitted infections, which is a much more efficient means of transmission.31
How rational is it to tell men that they must be circumcised to prevent HIV, but after circumcision they still need to use a condom to be protected from sexually transmitted HIV? Condoms provide near complete protection, so why would additional protection be needed? It is not hard to see that circumcision is either inadequate (otherwise there would be no need for the continued use of condoms) or redundant (as condoms provide nearly complete protection). The argument that men don’t want to use condoms needs to be addressed with more attractive condom options and further education that sex without a condom and without a foreskin is potentially fatal, while sex with a condom and a foreskin is safe. No nuance is needed. Offering less effective alternatives can only lead to higher rates of infection.
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. The second tier would be primary prevention that focuses on the ABCs.
Resources are not unlimited. With the push for circumcision, public health workers in Africa are finding that resources that previously paid for condoms are now being redirected to circumcision. With every circumcision performed, 3000 condoms will not be available. For every circumcision performed, a health care provider is prevented from caring for someone in need of medical care. With trained medical providers busy performing circumcisions, patients will be forced to seek medical care provided in settings where sterility of equipment is less likely and HIV is more likely to be spread iatrogenically. For every circumcision performed, there are fewer resources that can be put into ART and other chemotherapies. Male circumcision is an unnecessary distraction that depletes the limited resources available to address the HIV epidemic. It also fails to address the underlying causes for the epidemic in Africa.
Here are the references to the study in the previous post.
Quote:
References
1.World Health Organization, UNAIDS. Male circumcision: global trends and determinants of prevalence, safety and acceptability. 2007. Available at: http://www.malecircumcision.org/medi...terminants.pdf
2. World Health Organization, UNAIDS. New data on male circumcision and HIV prevention: policy and programme implications. 2007. Available at: http://www. unaids.org/en/media/unaids/contentassets/dataimport/pub/report/2007/mc_recommendations_en.pdf
3. Halperin DT, Bailey RC. Male circumcision and HIV infection: 10 years and counting. Lancet 1999; 354:1813-5.
4. Auvert B, Taljaard D, Lagarde E, et al. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: The ANRS 1265 Trial. PLoS Med 2005;2:e298.
5. Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet 2007;369:657-66.
6. Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet 2007;369:643-56.
7. Dinh MH, McRaven MD, Kelley Z, et al. Keratinization of the adult male foreskin and implications for male circumcision. AIDS 2010;24:899-906.
8. Chin J. The AIDS pandemic: the collision of epidemiology with political correctness. 2007. Radcliffe Publ., Abingdon, OX,UK
9. de Witte L, Nabatov A, Pion M, , et al. Langerin as a natural barrier to HIV-1 transmission by Langerhans cells. Nat Med 2007;13:367-71.
10. Weiss HA, Thomas SL, Munabi SK, Hayes RJ. Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis. Sex Transm Infect 2006;82:101-10.
11. Van Howe RS. Human papillomavirus and circumcision: A meta-analysis. J Infect 2007;54:490-6.
12. Van Howe RS, Storms MR. Circumcision to prevent HPV infection. Lancet Oncol 2009;10:746-7.
13. Garenne M. Long-term population effect of male circumcision in generalised HIV epidemics in sub-Saharan Africa. Afr J AIDS Res 2008;7:1-8.
14. Demographic and Health Surveys. HIV Prevalence and Associated Factors (Chapter 15). In: Rwanda National Health and Demographic Survey for 2005. Available at: http://www.measuredhs.com/ pubs/pdf/FR183/15Chapter15.pdf
15. Mishra V, Medley A, Hong Ret al. Levels and Spread of HIV Seroprevalence and Associated Factors: Evidence from National Household Surveys. 2009. DHS Comparative Reports No. 22. Macro International Inc., Calverton, MD, USA.
16. Connolly C, Shanmugam R, Simbayi LC, Nqeketo A. Male circumcision and its relationship to HIV infection in South Africa: Results of a national survey in 2002. S Afr Med J 2008;98:789-94.
17. UNAIDS, World Health Organization. Global HIV/AIDS and STD Surveillance Project: Report on the global HIV/AIDS epidemic 1998. Available at: http://www. unaids.org/hivaidsinfo/statistics/june98/global_report/index.html.
18. O'Brien TR, Calle EE, Poole WK. Incidence of neonatal circumcision in Atlanta, 1985-1986. South Med J 1995;88:411-5.
19. Xu F, Markowitz LE, Sternberg MR, Aral SO. Prevalence of circumcision and herpes simplex type 2 infection in men in the United States: the National Health and Nutrition Examination Survey (NHANES), 1999-2004. Sex Transm Dis 2007;34:479-84.
20. Mor Z, Kent CK, Kohn RP, Klausner JD. Declining rates in male circumcision amidst increasing evidence of its public health benefit. PLoS ONE 2007;2:e861.
21. Mansfield CJ, Hueston WJ, Rudy M. Neonatal circumcision: associated factors and length of hospital stay. J Fam Pract 1995;41:370-6.
22. US Centers for Disease Control and Prevention. Racial/ethnic disparities in diagnoses of HIV/AIDS - 33 states, 2001-2005. MMWR Morb Mort Wkly Rep 2007;56:189-93.
23. Blower SM, McLean AR. Prophylactic vaccines, risk behaviour change, and the probability of eradicating HIV in San Francisco. Science 1994;265:1451-4.
24. Richens J, Imrie J, Copas A. Condoms and seat belts: the parallels and the lessons. Lancet 2000;355:400-3.
25. Bonner K. Male circumcision as an HIV control strategy: not a 'natural condom'. Reprod Health Matters 2001;9:143-55.
26. Bridges JFP, Selck FW, Gray GE, et al. Condom avoidance and determinants of demand for male circumcision in Johannesburg, South Africa. Health Policy Planning 2010; e-pub ahead of print.
27. Sawers L, Stillwaggon E. Concurrent sexual partnerships do not explain the HIV epidemics in Africa: a systematic review of the evidence. J Int AIDS Soc 2010; 13: 34.
28. Grosskurth H, Mosha F, Todd J, et al. A community trial of the impact of improved sexually transmitted disease treatment on the HIV epidemic in rural Tanzania: 2. Baseline survey results. AIDS 1995;9:927-34.
29. O'Farrell N, Egger M. Circumcision in men and the prevention of HIV infection: a "meta-analysis" revisited. Int J STD AIDS 2000;11: 137-42.
30. Van Howe RS. Circumcision and HIV infection: review of the literature and meta-analysis. Int J STD AIDS 1999;10:8-16.
31. Gisselquist D. Points to consider: responses to HIV/AIDS in Africa, Asia and Caribbean. 2008. Adonis & Abbey Publ. Ltd, London, UK.
32. Vernazza P. La prévention du sida devient plus simpl, mais aussi plus complexe! Bull Med Suisses 2008;89:163-4.
33. Bendavid E, Brandeau ML, Wood R, Owens DK. Comparative effectiveness of HIV testing and treatment in highly endemic regions. Arch Int Med 2010;170:1357-54.
34. Charlebois ED, Havlir DV. “A Bird in the Hand...”: a commentary on the test and treat approach for HIV. Arch Int Med 2010;170:1354-6.
35. Clouser CL, Patterson SE, Mansky LM. Exploiting drug repositioning for discovery of a novel HIV combination therapy. J Virol 2010;84:9301-9.
36 Grosskurth H, Mosha F, Todd J, et al. Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial. Lancet 1995;346:530-6.
37. Gilson L, Mkanje R, Grosskurth H, et al. Cost-effectiveness of improved treatment services for sexually transmitted diseases in preventing HIV-1 infection in Mwanza Region, Tanzania. Lancet 1997;350:1805-9.
38. Sorrells ML, Snyder JL, Reiss MD, et al. Fine-touch pressure thresholds in the adult penis. BJU Int 2007;99:864-9.
39. de Vincenzi I. A longitudinal study of human immunodeficiency virus transmission by heterosexual partners. European Study Group on Heterosexual Transmission of HIV. N Engl J Med 1994;331:341-6.
40. Shelton JD, Johnston B. Condom gap in Africa: evidence from donor agencies and key informants. Br Med J 2001;323:139.
41. Krieger JN, Bailey RC, Opeya J, et al. Adult male circumcision: results of a standardized procedure in Kisumu District, Kenya. BJU Int 2005;96:1109-13.
42. Potts M, Halperin DT, Kirby D, et al. Reassessing HIV prevention. Science 2008;320:749-50.
43. Klausner JD, Wamai RG, Bowa K, et al. Is male circumcision as good as the HIV vaccine we’ve been waiting for? Future HIV Ther 2008;2:1-7.
---------------------------------------------------------------------------------------Quote:
Originally Posted by Long Duck Dong
Strange, I thought I was making myself abundantly clear. I differentiate between ELECTIVE surgery and surgery of MEDICAL NECESSITY. In the latter one is treating the illness, in the former one is performing surgery for reasons other than medical necessity.
There may well be pain and suffering involved in both. In the latter surgery is performed as a necessity to remove a threat to life, or to prolong life itself.
To use your example of cancer, we give chemotherapy and radiation-therapy to kill the cancer cells in order to prolong the patient's life. The alternative is to allow the patient to die, the patient might well die anyway but we did the best we could to save and prolong their life. The surgery was undertaken for the greater good of saving the life, the attendant pain and suffering was incidental and worth the risk in gaining remission, or extra years of life for the patient. The benefit out-weighed the risk
In contrast routine circumcision, being elective surgery, does not grant the patient any added benefit and as any surgery carries with it a risk, it makes the patient vulnerable to that risk. There is no benefit to outweigh the risk.
As adults, people make decisions all the time to take the risks of elective surgery, as they believe the resulting larger breasts, or whatever, outweigh the pain and discomfort. That is fine, I don't have a problem with adults deciding what to do with their own bodies.
I do have a problem with them making decisions for elective surgery for others in cases where there is no threat to health or life.
We don't, as a society, amputate a healthy leg on the off chance it may become infected with gangrene and need amputation at some distant point in the future. Why should a healthy foreskin be any different?
If the child reaches adulthood, you can ask them then if they would like their foreskin removed. I believe in most cases they will answer no, in any case it will have been their decision, not one that was made for them.
I appreciate that many parents in the US thought they were making the best decision for their infants at the time the circumcision was performed, on the advice of their doctor. However, as the article I posted the link to stated, the main American Health Associations have clearly stated, for a long time, that routine circumcision as elective surgery is not necessary or beneficial to the infant patient. They do not recommend it.
With all due respect, perhaps those parents should have conducted more research on the matter before giving their consent. If I was able to discover the views of the American Health Associations inside of five minutes, I'm sure they could have too, instead of listening to a doctor that had a remunerative interest in the outcome.
I sincerely hope that this practice of routine circumcision of infants, dies out in America and for this reason I wish the proposed legislation every success.
Thank you, Bidave, for the interesting article, I hope it helps parents arrive at a more informed decision. If, after reading your post, only one parent decides not to put their son through this elective surgery your post will have been worth it. It will have provided, one step in the right direction.
I'm for leaving this as a parental decision. Make all the arguments you want about pro-circumcision or anti-circumcision. How about stop intruding on others' lives and minding your own business? Embark on education campaigns if you must, but please, no more laws.
No one is forced to circumcise their son. It is a choice. Let's leave it that way. This is just another example of some who hold a certain belief (circumcision is bad) and intend to force that belief on others by law if necessary. These are the same people who turn around and complain that others are forcing beliefs on them.
The interesting part of this entire circumcision story is that in another generation it will be all but absent from America. The statistics are trending downward in a dramatic fashion.
No, darling, you are quite wrong. It is not we who force our beliefs on others except in the sense that we believe that it should not be the right of a parent to force theirs upon their sons when that son cannot answer for himself.Quote:
Originally Posted by tristancir
Occasionally someone has to lose in an argument of belief, and this is especially important on issues where one group is making unnecessary decisions about the future of others who are unable to make those decisions for themselves.
People used to believe in slavery and burning witches but were forced by others who believed them to be wrong to think again. Hindu wives were burnt on the funeral pyre of their husbands and this too was a fundamental issue of belief for many. Many wives went to the flames voluntarily but many did not. Many in fact were as young as 6.
Occasionally, we have to put a stop to issues where people take decisions which they really have no right to take. That is in part what this argument is about.
bidived..... ahh I asked for a study reference, what you posted, was a paper talking about randomized studies....
a study is what mikey posted, that laid out who was tested, why, what for, the test groups and the findings....
a paper is something somebody writes about studies that have been done, and selects parts of them, and uses them to point out some aspects of different areas......
now if you can please find the study ( control groups, who did the studies, where why and how, numbers used, methodology etc etc ) I would like that every much... cos all you have posted is the equal to a blog post, its a personal overview of a issue..... and while there are a shitload of references that you have posted with it... its still not a study....
darkside... elective surgery? in most cases it is.... until its required cos of a medical issue... and that is where the issue arises....
the argument is being used that the children should have the right of choice... again, yes, they should, when possible.... unfortunately, there are cases when it is medically required to do a circumcision on a young child...
that places us in the grey area, of do we as parents, say yes or not.....
thats where I keep coming back to, is the grey area and how the issue of circumcision revolves around the right of choice but there are occasions when the right of choice is not possible to do....
the grey area is also the difference between circumcision and invasive surgery on a child... say we have one child, we say no to inflicting pain and suffering on a child by way of circumcision, then we are told that it needs to be done urgently for a medical reason... we then has the dilemma of do we stand by our beliefs, or sidestep them and say, its ok cos its medically needed.....
and that brings me back to the people in the threads that are talking about mutilating kids etc etc... and their one eyed stance that circumcision is mutilation... does that mean that a parent that gives consent for a medically needed circumcision, is guilty of mutilating their child, or acting in the best interests of the child.....
we are parents that are acting in the best interests of our children.... and there are times that we have to stop and say, what we preach, is not always what we practise..... and that is why, darkside, most of the people in the thread are not parents, but telling other people how to bring up their kids and how they are mutilating their kids etc etc.....
that is why I am not judging people on the issue of circumcision.. as they may say no to circumcision and end up saying yes to it anyway......
and regardless of all the studies and statements about how wrong / bad it is.... until we find a way to get rid of all foreskin related issues, circumcision will always be a aspect of life for parents and medical experts......
btw I am still waiting for the anti circumcision crew to come up with a alternative to circumcision in the event that a circumcision is medically essential... and I think I asked them for an alternative solution, 3 years ago in the site and I am still waiting for one..... and that leads me to believe they do not have a alternative, they just wait to preach their beliefs about circumcision and how wrong it is etc etc etc....
lastly, you mention about elective surgery like breast reduction...... we have ladies in NZ that are opting for full breast removal and reconstruction, not cos they have cancer, but cos they have a family history of breast cancer..... ironically, some of the same ladies, are anti circumcision campaigners.... arguing that the removal of healthy tissue from the penis has no basis at all......
quess they have never heard of a non retractable necrotising foreskin....
LDD, most of the issues you raise have been covered ad infinitum in this and other threads. I will concentrate on only two.Quote:
Originally Posted by Long Duck Dong
A foreskin can be partially restored. This can be done surgically or by other means (some quite comical in appearance but no laughing latter to the individual concerned, but quite effective). What cannot be restored are the severed nerves. Just as a severed hand at present cannot (always be) be reattached or restored perfectly we do not have the ability to do so with a severed forskin. But we have the technology and knowledge to compensate in many instances. At present this is the best that can be done for most amputees.
http://www.cirp.org/pages/restore.html
If I may touch on your argument regarding breast removal as a precaution against cancer, this too has been commented upon in several threads on the issue of circumcision including this one and these more than adequately cover your point. One successfully treated cancer sufferer made it quite clear that although she knew that one day the cancer may return to her breast, the option of a full mastechtomy had never entered her head. Some women take the opposite view, including some in high risk groups and even statiscally low risk groups who opt to have their breasts removed as a precaution. That is their choice. Their choice, no one elses. Their choice based on information which they are given once they are mature enough to do so.
Few of us are anti circumcision per se. We are anti needless circumcision performed on the child. Equally we are against needless removal of a child's breast tissue. In both instances, it is they and no-one else, once grown and given the information they require who should be the only ones to make that decision.
what I was asking of the anti circumcision advocates, is a alternative to circumcision,..... if circumcisions are so bad in their eyes, come up with a way that the medical experts can use to avoid having to remove non retractable foreskins... foreskin restoration is a repair job..... not a alternative to circumcision.....
I am sure that a large number of males would love to have a alternative to adult circumcision, and would appreciate having a alternative, rather than hearing that they are mutilated and how the parents of young kids are child molestors
however, like I said, I have been waiting for a few years for a valid answer...
as for the breast cancer thing... I find it ironic that some ladies will have healthy tissue removed and say its a good thing to do and the right thing to do, but if you say the removal of healthy skin such as the foreskin, to avoid future issue, is a good move, they will tell you that there is no reason to remove healthy tissue if there is no issues with it.....
in essense you have a person arguing that the removal of healthy tissue is right, while telling you its wrong ..... and that is what amuses me....
as for the last part..... the right of consent and choice... that works and I agree, untill you have a person that is a adult but incapable of making a informed decision, IE intellectually impaired person.....
then who has the right to decide......??? it comes back to the caregivers, the medical experts etc etc... in the same way a childs circumcision is in the hands of a parent and doctor..... or in both cases, the courts....
lol I threw that one in to show that its not all plain sailing... that we have a viewpoint that people should be allowed to make informed choices for their own bodies... but all too often, we forget that not everybody can.....
so it comes back to a grey area again, not a clear cut ideal......
The alternative to circumcision is non circumcision. Once such a procedure has been done then in time the individual may wish to try and restore that which he has lost as best he is able in accord with the level of technology and knowledge we possess. That is also his choice just as remaining foreskinless is his right.Quote:
Originally Posted by Long Duck Dong
You are right LDD. Some people never have the capacity no matter how old they may be to make such decisions for themselves for the very reasons you mention. In this country mentally impaired adults have been sterilised and evn had abortions for example, not because they have anything medically wrong with them but because it has been considered by responsible adults and guardians (and I use this term 'responsible' guardedly here), medical professionals and the courts that they would never be fit to raise a child, or to know how to say no to advances from unscrupulous individuals and because of the risk of a child suffering the same genetic condition as a mentally impaired parent.
These 'responsible' adults, the medical professionals and the courts felt in the best interests of that adult, that sterilisation was in their best interests. I am not criticising those people, professionals or the courts for those decisions, but remarking upon what is quite a dilemma. It was considered that these people (not all women) could never be responsible enough to make informed decisions on their lives for reasons all of us should be able to understand. Without being party to these considerations I am unable to judge whether the right decision was taken or not and neither is anyone else not directly involved. Such a scenario has also been played out in respect of a very few mentally impaired children.
However, in respect of childhood circumcision we are not talking about such young people who will never be able to make that choice for themselves. In time the vast majority will have that ability if it is allowed them by their parents. Some will not for much the same reasons as exist in respect of the types of cases I have mentioned above. Some may, because of mental impairment never have the ability to make that decision for themselves. In most instances it will never prove necessary.
Informed consent means allowing a person to make such decisions for him or herself. It also means that occasionally there will be an adult who is unable to make such decisions in which case he or she will have a guardian or responsible adult (or adults), medical professionals and courts of law to make that decision for them.
In the case of circumcision of men this will be a very rare necessity usually only taken in times of medical need (normally without recourse to the courts), and while I am unable to envisage a reason why an otherwise healthy man, mentally impaired as he may be, would require to be subjected to the removal of healthy penile tissue and would find it difficult to support such a move without very good reason, I do not entirely rule it out. Even if such a scenario is ever acted out, I would imagine that such cases would be very rare indeed. It would not be, as is now the case of infant boys, an everyday common occurence because that mentally impaired adult has rights of legal protection that a new born or infant child does not.
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Originally Posted by Long Duck Dong
You raise the same point over and over again. It has been answered over and over again. An elective surgery is one that is not medically necessary.
If an adult, in full possession of their faculties, wishes to undergo elective surgery on their own body, I don't have a problem with that, as long as they have been given all the relevant information they need to make an informed decision.
If an adult needs surgery that is medically necessary, then they can have it, if they so wish. Bear in mind here that an adult in full possession of his/her mental faculties, can refuse medical treatment. As long as they do not have some contagious disease that requires them to be quarantined, I don't have a problem with that either.
If an adult that is mentally impaired needs surgery that is medically necessary then they should have it. If they are unable, through the nature of their impairment, to assimilate the relevant information in order to give their informed consent, then their case will be dealt with, (in the UK ) under the Mental Health Act 1983, or such legislation as may replace it.
For the purposes of the above Act, mental illness, incomplete, or arrested development of mind, psychopathic disorder, and any other disorder or disability of mind. A person suffering or appearing to be suffering, from mental disorder can be detained in hospital, either for assessment or for treatment.
Detention for assessment normally takes place on an application for his/her admission made by his nearest relative or approved Social Worker. This is supported in either case by the recommendation of two doctors that it is desirable in the interests of the patient's own health and safety or for the protection of others.
The application authorises detention for up to 28 days. In the case of emergency, however, detention may be for up to 72 hours on an application supported by one doctor only and made by an approved Social Worker or the patient's nearest relative.
The procedure for detention for treatment is the same as the normal procedure for detention for assessment. The application authorises detention for six months, renewable for a further six months, initially, and then for periods of one year on a report to the hospital managers by the doctor in charge.
Discharge of a person detained may be effected by the managers or the doctor in charge and, within certain limits, the nearest relative; in the case of detention for treatment, discharge may also be directed by a Mental Health Review Tribunal.
The National Health Service and Community Care Act 1990, provided for more care in the community for patients who previously may have been treated in secure hospitals.
The above Mental Health Act has safeguards, in the form of a Commission, which is the regulatory body established in 1983 to monitor the operation of the above MHA. Its members, appointed by the Secretary of State for Health, include psychiatrists, nurses, lawyers, members of other clinical professions, and lay people. Commissioners are responsible for regularly visiting patients detained under the Act, reviewing psychiatric care, investigating certain complaints, and advising Government Ministers.
In addition there is the previously mentioned Mental Health Review Tribunal, to which applications may be made for the discharge from hospital of a person detained there for assessment or treatment of mental disorder or under a hospital order or a guardianship order.
When a patient is subject to a restriction order or direction an application may only be made after his/her first six months of detention.
Such tribunals include legally and medically qualified members appointed by the Lord Chancellor and are under the supervision of the Council on Tribunals.
If an adult female, in full possession of her faculties, wishes to have her healthy breast tissue removed in order to remove the chance of getting breast cancer that would be elective surgery. Her body, her decision, I don't think it is a choice many women would opt for, but again it is her body, her decision.
If a child needs surgery as a matter of medical necessity, to prolong their life, or alleviate their suffering, they should have it, it is a matter between the child and his/her parents. Again, I do not have a problem with this.
Medical necessity is where the patient's life or health is at risk and where the benefits of undergoing the surgery outweigh the risks inherent in any surgery.
In my opinion, a child should not be forced by the parent to undergo the risk of surgery where that surgery is unnecessary, or of no medical benefit. It merely serves to put the child at risk for an invalid or inadequate reason. This is an opinion shared by the American Medical Associations.
A parent should wait until the child reaches adulthood and is able to make an informed decision for themselves. Their body, their decision.
I hope this makes my viewpoint clear to you.
Two other points I would address. I have never in this thread or any other, accused anyone, of being a monster, a child-molester, mutilated or a freak.
They are accusations that have been levelled by other people, not by me. I am quite capable of articulating my own beliefs and opinions and do not need to stoop to such a level.
I regard these threads as a medium for the exchange of ideas. Where I believe the views or ideas of other posters are erroneous or unfounded I have sought to persuade them by the logic of my viewpoint. The sole point in doing so, is that they might examine their own ideas and beliefs afresh.
By the same token I have examined my own beliefs and ideas in the light of other poster's arguments. That is the nature of debate and how it should be, a continual process of learning.
We, each of us, have topics that are dear to our hearts. Something we feel passionately about. For me personally, one of those topics is defending those who for whatever reason are unable to defend themselves. It has been the reason I have been willing to expend so much time and energy on this topic, trying to answer each and every dissenting view thrown at me. Despite on occasion, thinking that some posters were being deliberately obtuse.
For the poster who argued that the decision to circumcise or not circumcise should be as a result of education, not law, I would answer this.
Research the opinions of your own countries Medical Associations, they have been stating for many years that the elective surgery of routine circumcision of infants is unnecessary. Although circumcision rates are dropping in the US, the message obviously isn't getting out there quickly enough in the face of vested interests and cultural attitudes.
Female circumcision is illegal in both our countries, it is enforced by law. We owe our sons no less than parity of esteem. If following the debate in this thread, has caused even one parent to change their minds about circumcising their son, I will feel my efforts have been well rewarded.
To those still undecided, look again at the video posted by Sammie showing an infant being circumcised. Listen to the fear and pain in that baby's cries and tell me you are unmoved by his plight. Tell me again that you understand why the child's Father could sit there and allow that to happen to his off-spring. Tell me again, that having witnessed it once, you would consent to it happening again to any of your own children, to your neighbour's children, to any child. The remedy is only a legal act away.