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208 comments on DrumBeat: December 13, 2006

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Leanan on December 13, 2006 - 10:45am Permalink | Subthread | Comments top
Something we've discussed previously here....

Health officials back circumcision in AIDS fight

Circumcising adult men is the most effective way to stop transmission of the virus that causes AIDS. NBC News has learned that the National Institutes of Health will announce at Noon ET today that two clinical trials in Africa have been stopped because an independent monitoring board determined the treatment was so effective that it would be unethical to continue the experiment.
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smekhovo on December 13, 2006 - 11:07am Permalink | Subthread | Parent | Comments top
Always a solution in search of a problem.
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neon9 on December 13, 2006 - 11:30am Permalink | Subthread | Parent | Comments top
Um, ADULT men? Can't they do it when they are children?
Ouch!
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Leanan on December 13, 2006 - 11:34am Permalink | Subthread | Parent | Comments top
The study was on adult men.  

But doing it when they are children is probably better, for the same reason the cervical cancer vaccine is best given to girls: the best time to protect them is before they are sexually active.

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b3NDZ3La on December 13, 2006 - 5:35pm Permalink | Subthread | Parent | Comments top
Leave infants' bodies alone.

If a man decides he wants to be chopped, let him decide.

this is barbarism!

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pickyreader on December 13, 2006 - 8:25pm Permalink | Subthread | Parent | Comments top
If circumcision offers such significant protection from HIV, why does the USA have such a high rate of infection? I have heard that we have the highest rate of HIV infection of any first world nation, but I can't find a source at the moment.
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Darwinian on December 13, 2006 - 9:01pm Permalink | Subthread | Parent | Comments top
For starters Pickyreader, you should be a little more pickey in your reading. The vast majority of AIDS in the US is either from homosexual sex or from the use of dirty needles by drug addicts.

Only a tiny fraction of US AIDS infection comes from hetrosexual sex. And I would not be surprised to if circumsion dramatically reduces the chances of hetrosexual AIDS infection.

Ron Patterson

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pickyreader on December 14, 2006 - 2:39am Permalink | Subthread | Parent | Comments top
OK, so the important vectors are MSM and needles. In this case, wouldn't our resources be better spent on a 'free clean needles' and a 'free condoms' campaign than on a "free cut off part of your unanesthatised child's penis" campaign?

Besides, are we really going to have the resources post-peak for everyone to have an elective surgery of questionable value in a sterile environment? How much energy is needed to keep a Hospital sterile?

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Leanan on December 14, 2006 - 8:04am Permalink | Subthread | Parent | Comments top
In this case, wouldn't our resources be better spent on a 'free clean needles' and a 'free condoms' campaign than on a "free cut off part of your unanesthatised child's penis" campaign?

Yes, if you live in a wealthy nation and are assuming things will continue as they are now, for the entire life of your child.

But consider peak oil.  Even if it doesn't result in a Mad Max collapse, it may mean we cannot afford to give away clean needles or condoms.  It may even mean ordinary folk can't afford to buy them.  

Besides, are we really going to have the resources post-peak for everyone to have an elective surgery of questionable value in a sterile environment? How much energy is needed to keep a Hospital sterile?

Those of the Jewish faith have practiced circumcision without hospitals for millennia.

Circumcision is actually pretty low-tech - far more so than condoms.  As anyone who has seen Roots knows, it's something they've been doing in Africa for centuries.  Indeed, that's what led to the research to begin with.  It was noticed that AIDS was much more of a problem among some groups than others in Africa.  The difference, it turns out, was that some practiced circumcision, and some did not.

Right now, this research is seen as applying mainly to Africa and other Third World areas.  But if you believe that the U.S. is on its way to becoming a Third World country...it's something to keep in mind.

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Franz on December 14, 2006 - 7:48am Permalink | Subthread | Parent | Comments top
Why wouldn't you be surprised? I'd be very surprised. Via what mechanism?

Has anyone read this study? Anyone got a critique of its design? Maybe it's complete rubbish.

There are many 'scientific studies', badly designed, poorly controlled, etc., cited as proving this, that and the other. And all of them wrong. Medical literature in particular is replete with such stuff, perhaps more so than anywhere else.

A bit of scepticism, please, folks.

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Leanan on December 14, 2006 - 8:05am Permalink | Subthread | Parent | Comments top
They have been studying this for years.  It's for real.    
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pickyreader on December 14, 2006 - 1:59pm Permalink | Subthread | Parent | Comments top
They have been studying this for years, yes. There have been many studies, some poorly designed, some less so. The problem is that there hasn't been consensus among the studies; some show circumcision as reducing HIV infection and some show the opposite. This is why there have been calls for more research. The problem is that the MSM latches on to the studies that show circumcision in a good light, in this case, writing about a study that has not been published.

I realse that Americans have been conditioned not to question circumcision, but I would ask that you refrain from promoting circumcision until there are benefits attributed to it(that have been accepted by mainstream medicine) that outweigh the fact that it is mutilating.

Also,

Those of the Jewish faith have practiced circumcision without hospitals for millennia.

Yes, and jewish newborns have been dying of infections and bleeding for millennia, not to mention the lack of anesthesia!

This website is about energy, not medicine. Please promote your unneccessary surgery elsewhere.

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Noisette on December 14, 2006 - 9:54am Permalink | Subthread | Parent | Comments top
I would question the results of the study that showed that circumsion of adult men reduces the proliferation of AIDS.  

One guesses there is a powerful X factor at work, i.e. that adult men who agree to circumcision, which is not a trivial thing, will be `richer' (more secure, stable, reachable to the services in question, etc.), more responsible, more health aware, more community minded, more submissive, and generally less `wild' (married vs. single for example.)  All such characteristics (one or many combined or others along the same line) would make these men less sexually active in the `multiple partners' sense.

I haven't read the original study, but it is certain that the factors I mentioned were not controlled for, simply because it is too much work.  

This is just BS, junk science. It all comes from an old correlation between the spread of Aids / circumcision in Africa. That correlation is not causation never found a more illustrative example.

It looks very much like some will go to any lengths to stop people using condoms.  Btw, castration leads to a 0 infection rate for the castrati.

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Franz on December 14, 2006 - 11:24am Permalink | Subthread | Parent | Comments top
Yes, I agree completely with this.

Did they actually take circumsized / uncircumsized males and then get them to have sex with HIV-positive women and see what happens? Of course not. (An ethics problem, at the least). The circumsized fellows are obviously having less or less risky sex for some reason that correlates with, but may not caused by, circumcision, ergo they turn up with lower infection rates. It is not as if the mere fact of being circumsized alone has any effect on HIV spread (again, how could it? Mechanism, please).

One other factor: maybe many of them regret submitting to the chop and feel mutilated afterward. Just conjecture, that. I'd feel that way. Also, being circ'd is supposed to decrease a male's sexual sensitivity - maybe they just don't enjoy it as much as before. (Of course, if you got the chop at birth you'll never know what you are missing anyway, so that takes care of an argument that appeals to promiscuous circ'd US males).

It's correlation. That's all.

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Leanan on December 14, 2006 - 11:32am Permalink | Subthread | Parent | Comments top
Sorry, I've been following this story for so many years it hadn't occurred to me that the mechanism wasn't widely understood.

Here's a brief blurb from Discover:

Circumcision removes mucosal tissue and cell types in the foreskin that contain special "receptors" for HIV. Some estimates suggest that circumcision may cut a man's risk of contracting HIV by 70 percent. If true, this would mean that male circumcision may prove more effective than any of the HIV vaccines undergoing clinical trials. It would also be much cheaper, carry few side effects, and require no booster shots. Randomized, controlled trials of circumcision for HIV prevention are under way in South Africa, Kenya, and Uganda, and the results should be known within three years.

As we found out yesterday, said trials were ended early, because circumcision was so obviously beneficial it was deemed unethical to withhold it from the control group.

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Leanan on December 14, 2006 - 11:25am Permalink | Subthread | Parent | Comments top
One guesses there is a powerful X factor at work, i.e. that adult men who agree to circumcision, which is not a trivial thing, will be `richer' (more secure, stable, reachable to the services in question, etc.), more responsible, more health aware, more community minded, more submissive, and generally less `wild' (married vs. single for example.)  

Not true.  It's not like they suddenly decided to try circumcizing men for the heck of it.  They noticed that some groups in Africa had much lower infection rates than others.  They thought at first that it was due to different religious values, or socioeconomic factors, etc.  But it wasn't.  They found that there was no difference in socioecnomic status, number of sexual partners, etc.  That's what led them to circumcision.  

As it turns out, the cells of the foreskin are particularly vulnerable to HIV infection.  They've got a lot of HIV-friendly receptors.

And they've been studying this for a long time now.  This is just the latest study in a long line of them.

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smekhovo on December 14, 2006 - 11:28am Permalink | Subthread | Parent | Comments top
It would be an interesting exercise to control the results of these studies for the researchers' own possession or lack of a foreskin.
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Leanan on December 14, 2006 - 11:38am Permalink | Subthread | Parent | Comments top
Well, the appropriately named Dr. De Cock is from Belgium.  I assume, like most European men, he is not circumcized.
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smekhovo on December 14, 2006 - 2:06pm Permalink | Subthread | Parent | Comments top
Momus must assign these people their names. I remember Dr. Long Dong the penile enlargement surgeon and Thomas Crapper, inventor of the flushing lavatory.
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BrianT on December 14, 2006 - 6:42pm Permalink | Subthread | Parent | Comments top
Smekhovo: You read my mind.
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Squalish on December 14, 2006 - 3:43pm Permalink | Subthread | Parent | Comments top
Although it's somewhat intuitive that the environment created by circumcision is less receptive to HIV than the unscarred, uncalloused natural form of the penis; I still hold that they cannot correct for the major cause of error: You cannot give people a placebo for circumcision in adults.  Half of those in the study had major surgery on their sexual equipment, half did not.  It's unremarkable that this would affect relative tendency towards sexual activity.

How about this: Let's surgically remove an equivalent amount of penile skin that doesn't have said 'HIV-binding mucosal membranes,' and see where it goes.  That would be scientific.  Don't forget to cut off the entire penis of others (don't withhold the ultimate HIV-safety device, the lop shears), as a control group for needles/buttsecks.

To actually do this scientifically, you have to get Mengele on the people you're saving.

Now could we get back to energy?

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pickyreader on December 13, 2006 - 8:12pm Permalink | Subthread | Parent | Comments top
Can't they do it when they are children? Ouch!

Do children not feel pain on your planet? You might want to look into somthing called empathy.

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slaphappy on December 13, 2006 - 8:19pm Permalink | Subthread | Parent | Comments top

Because kids won't be having sex for many years (presumably), so it's hard to do a double blind study in this manner.
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slx on December 13, 2006 - 7:24pm Permalink | Subthread | Parent | Comments top
I bet that castration is even more efficient.
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Franz on December 14, 2006 - 7:57am Permalink | Subthread | Parent | Comments top
"It's not a magic bullet, but a potentially important intervention," agreed Dr. Kevin De Cock of the World Health Organization.

I'm not making that name up. It's from the article...

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GreyZone on December 14, 2006 - 12:19pm Permalink | Subthread | Parent | Comments top
The complete and utter denial in the other responses to your comment here, Leanan, is interesting. Let's imagine this a little differently. Say that instead of circumcision, you were instead talking about some other generally unacceptable concept like, oh... peak oil? Then I read the responses here and they run the gamut of denials from emotional to rationalizations. The irony in the content of these replies has been the best laugh of the entire morning.
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Franz on December 14, 2006 - 10:10pm Permalink | Subthread | Parent | Comments top
I suggest you have an overly-sensitive irony detector, or at the least are very easily amused (though why you would find rational objections funnier than that fellow's name is a mystery...)

It has been pointed out that the research is flawed, indeed must be so for fundamental reasons. So there isn't anything wrong with being sceptical about the conclusions of the study. It's quite appropriate in the circumstances.

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208 comments on DrumBeat: December 13, 2006

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