Circumcision Just Keeps Getting Better!!!

[Asher]

It may be more relevant in that the New Zealand's society is more similar to America or Canada than Ugandan society is. This doesn't change the fact that the design is poorer and the results are therefore less convincing.

It's a better design. It's a 40-year longitudinal study in a Western society vs a couple year study in Uganda, which is completely poverty-stricken with people who will do or say anything for money.

If the experiment is properly randomized, self-selection bias doesn't matter.

This also doesn't matter.

Wrong. You can easily assign men willing to be circumcised to randomized treatment and control groups. This is just as good.

It's too bad they didn't do that. You should do more research before making these kinds of assumptions:

Both trials randomised adult, HIV-negative heterosexual male volunteers either to be circumcised by a medical profesisonal at a clinic, or to no intervention (no circumcision). All participants were extensively counselled in HIV prevention and risk reduction techniques.

You either volunteer to be circumcised, or you volunteer not to be circumcised...

[ricketyclik]

On the issue of aesthetics, an erect, uncircumcised penis normally bares its glans in full glory, so really, being uncircumcised is the best of both worlds on this front

What's more, the glans of the uncircumcised penis is brighter, redder and shinier than that of the circumcised one. I would have thought that would be more attractive to a non-conditioned viewer (ie, a lusty wench of the non-US variety).

[MikeH]

As always Cochrane sums it all up nicely. And you're both kinda right, as in the evidence does appear to show there's some evidence it protects, but there are major issues with the studies that might not be solveable.

http://www.cochrane.org/reviews/en/ab003362.html

Male circumcision for prevention of heterosexual acquisition of HIV in men

Circumcision in heterosexual men is associated with lower rates of HIV infection. This association is strongest in groups at high-risk of HIV infection. However there are no trials to show whether male circumcision as an intervention reduces HIV infection.

Male circumcision is the surgical removal of the foreskin of the penis. It is a common religious or traditional ritual, and is sometimes done for medical reasons. It is not known if the foreskin affects sexual transmission of infection. Circumcision may be an indicator of men affected by other religious or traditional practices which lower the risk of HIV. The review found that men who have already been circumcised have lower rates of HIV infection than uncircumcised men. However, there is no strong evidence of the effects of male circumcision to try to reduce the spread of HIV/AIDS. Trials are underway.

[Arrian]

Wrt AIDS, I'm with the folks who say wear a damn condom.

I'm circumcised, and I don't mind, but of course how would I know if I'm missing something? What I've got is normal to me. :shrug:

-Arrian

[Naked Gents Rut]

You either volunteer to be circumcised, or you volunteer not to be circumcised...

That's not what it says at all. Try again.

[Asher]

Also, Drake, it's not just the New Zealand study. Every study in the Western, developed world on the matter has shown no difference in HIV rates between circumcised and uncircumcised males. There was a recent study in the US on the matter specifically about Black and Latino heterosexual males, and it found no difference as well.

[Naked Gents Rut]

There was a recent study in the US on the matter specifically about Black and Latino heterosexual males, and it found no difference as well.

Was this one randomized? Or just another observational study?

[Asher]

They were observational. In fact I just found another one on homosexual Americans about cut vs uncut, and it's the same deal again.

You need to understand there is no true "randomized" results. There are massive flaws with each of the Ugandan studies that are fundamental to the studies. For one thing, adult circumcision is known to change behaviour and sensation and sexdrive.

The problem with these Ugandan studies is they don't take into account circumcision as a child (which usually does not impact behaviour and sexdrive), nor does it take into account Western culture.

I couldn't care less if they make circumcision mandatory in Uganda. I'm talking about the Western world, where statistics show there's no difference between circumcised and uncircumcised males in HIV/STD transmission, with the notable exception that circumcised men have almost twice the prevalence of genital warts.

[Asher]

Here's an example of the problem with these Ugandan studies:

http://www.newvision.co.ug/D/8/459/643823

A recent study in the US titled: “Circumcision status among Black and Latino men,” that examined heterosexual unions found no statistical difference in HIV rates among circumcised and uncircumcised males.

Darby RJL, in his work: The demonisation of the foreskin and the rise of circumcision in Britain, also brings to the fore what he considers information that the respective supervisors of the three randomised trials should not have ignored. Apparently, the three trials were terminated early, arguably before the incidence of HIV-infection in circumcised males caught up with the incidence of infection in uncircumcised males.

The argument is that uncircumcised males got infected faster than their circumcised friends because the circumcised males required a period of abstinence after circumcision. It is, therefore, likely that if the studies had continued as initially scheduled, the difference in infection incidence between the two groups would have been small.

In the Kenya trials, the reported initial protective effect of circumcision seemed to disappear after 18 months so that in the 18-24-month follow up period, eight circumcised and nine uncircumcised males got infected with HIV (www.futuremedicine.com). The early termination of the trials raises methodological-related challenges that may have biased the results and the subsequent conclusions.

A recent study demonstrates that the Langerhans cells in the foreskin have a protective effect against pathogens, including HIV, by producing the protein Langerin. According to the study, Langerin transports HIV-1 to locations within the Langerhans cells where the virus is destroyed.

The Langerhans cells had been considered to be a key entrance point for HIV-1 in previous theories. “Strategies to combat infection must enhance, preserve or, at the very least, not interfere with the Langerin expression and function,” concludes the book titled: “Langerin as a natural barrier to HIV transmission by Langerhans cells.”

Some individuals and groups promoting condom use argue that circumcision reduces condom usage.

[Asher]

http://www.aidsportal.org/News_Details.aspx?ID=6769

Study: Circumcision Does Not Protect Black, Latino Gays From HIV

Despite the positive results obtained from circumcision studies of heterosexual men in Africa, findings of a study published in the December 15 issue of the Journal of Acquired Immune Deficiency Syndromes show no evidence that being circumcised protects against HIV infection among U.S. black or Latino men who have sex with men (MSM), even among those who said they also had sex with women and/or practiced insertive intercourse only.

The Centers for Disease Control and Prevention conducted its "Brothers y Hermanos" study between May 2005 and April 2006, recruiting 2,235 black and Latino MSM in New York City, Philadelphia, and Los Angeles. Participants were asked, "Is your penis circumcised or cut?" The black participants were more than twice as likely to be circumcised as the Latinos: 74% versus 33%. Circumcised black MSM were more likely to be older, have a higher level of education, have a higher income, and identify as gay than were uncircumcised black MSM. There were fewer differences between circumcised and uncircumcised Latino MSM.

Investigators concluded that there was no statistically significant association between circumcision and HIV status among both groups. Investigators then compared men who reported recent male sex partners only with men who reported recent male and female sex partners and again found no significant association between circumcision and HIV status.

"If the results from the African circumcision trials were directly applicable to the MSM in our study, we would have expected to observe a significantly higher prevalence of HIV infection among uncircumcised men," investigators told AIDSmap.com. "Circumcision conferred neither risk nor protection among black men or Latino men in our study, however, and was unrelated to seroconversion among MSM who reported that their last HIV test was negative. Further, there was no evidence that circumcision was protective among men who had only engaged in unprotected insertive anal sex in any of the models."

[Naked Gents Rut]

You need to understand there is no true "randomized" results.

Why would you want randomized results? You randomize assignment in order to get an unbiased estimate of the average treatment effect. The best you can do in an observational study is approach the robustness of the ATE estimate provided by a properly randomized experimental design.

[chequita guevara]

^ This.

Circumcision is primarily a matter of personal preference. (I was going to say "personal taste" but then I realized it might be misconstrued as ribaldry.) STDs are a matter of health and common sense.

Actually, ma'am, it isn't. It's usually something done to us without our consent, as we are infants. While some men do need to have adult circumcisions, in countries where infant circumcision isn't practiced, adult males tend not to choose to have them.

What is frightening to me is the level of medical ignorance Docfeelgood displays. I sure as hell would not want him as my medical practitioner.

[Asher]

You need to understand there is no true "randomized" results.

Why would you want randomized results? You randomize assignment in order to get an unbiased estimate of the average treatment effect. The best you can do in an observational study is approach the robustness of the ATE estimate provided by a properly randomized experimental design.

But the problem is these controlled experiments with "random" assignments are not "random". There is a self-selection bias inherent to the kind of people who are willing to be circumcised as an adult. Further still, these are all short-term studies that don't even seem to mention the obvious that sexual practices change in the short-term after surgery on one's penis. As one of my articles indicates, after the 2 year period the difference seems to disappear in the African studies (as one's sexlife normalizes again).

If you force a man to be celibate for a significant period of the trial then compare him to men who are not celibate at all for the trial, of course the STD rates will differ -- particularly when you take into account HIV can take months to show up in screenings as well.

Every single study, without exception, comparing circumcised vs uncircumcised males in the United States, Canada, and UK show no difference at all. You can't discount that, it's a clear result.

[Naked Gents Rut]

The Centers for Disease Control and Prevention conducted its "Brothers y Hermanos" study between May 2005 and April 2006, recruiting 2,235 black and Latino MSM in New York City, Philadelphia, and Los Angeles. Participants were asked, "Is your penis circumcised or cut?" The black participants were more than twice as likely to be circumcised as the Latinos: 74% versus 33%. Circumcised black MSM were more likely to be older, have a higher level of education, have a higher income, and identify as gay than were uncircumcised black MSM. There were fewer differences between circumcised and uncircumcised Latino MSM.

Investigators concluded that there was no statistically significant association between circumcision and HIV status among both groups. Investigators then compared men who reported recent male sex partners only with men who reported recent male and female sex partners and again found no significant association between circumcision and HIV status.

I'm having trouble detecting the study here. Sounds like they just gathered some descriptive statistics and performed some cross-sectional data analysis.

There is a self-selection bias inherent to the kind of people who are willing to be circumcised as an adult.

Again, this doesn't matter. If self-selection bias couldn't be corrected for by random assignment, medical trials wouldn't work.

[chequita guevara]

Drake doesn't care, he's just trolling Asher. Very successfully I might add.