Many of you undoubtedly pay less close attention than I do to news about the ongoing practice of circumcision. There have been several major news items since my previous diary on the subject.
Read on for article links, quotes, and brief commentary on five recent news items.
Item I: Adult male circumcision may increase female HIV risk
Male circumcision may not be the panacea for reducing HIV infections as it appears to increase infections in women. Initial data from the Ugandan study being undertaken to examine the benefits of male circumcision suggests that the procedure may not be the best tactic to fight AIDS.
The study involved 997 HIV-infected men in Uganda. It found that women had increased risk of infection if they had intercourse with a man who had not allowed the healing process to complete after circumcision. Researchers said that the most probable reason was that circumcision caused surgical tears which allowed infected blood to enter the woman's vagina.
Comment: Return to sexual activity before full healing of a circumcision wound appears to increase HIV transmission. Inadvisable sexual activity is very real risk; It is already a major contributor to spread of the disease.
Item II: University Department of Obstetrics and Gynecology Stop Circumcising
"We believe it is no longer appropriate for physicians who specialize in women’s health and related subspecialties to regularly be providing a routine surgical service for male newborns," says a statement distributed to the Department of Obstetrics and Gynecology and other interested parties at the University of Michigan Hospitals and Health Centers, announced, "The Department of Obstetrics and Gynecology will not be providing newborn circumcision services."
However, the profit motive is strong:
In an attempt to find another department to pick up the service, urologists, pediatric surgeons, pediatricians and family medicine were considered. Urologists had no interest in providing the service. Pediatric surgeons, discovering that the reimbursement for routine newborn circumcision was not advantageous, removed themselves from consideration. The nurse midwives refused, as did the pediatricians. Finally, a pediatric hospitalist team showed interest and the Department of Pediatrics undertook the service with the hospitalist service performing the circumcisions.
Comment: Health care providers are increasingly recognizing that their duty is to their child-patient, and that they are ethically bound to refuse surgeries on neonates which are not in the child's interests.
Item III: Unclean Circumcisions May Actually Spread HIV
Devon Brewer is the director of Interdisciplinary Scientific Research, a Seattle, Washington-based company that reviewed data on circumcision in Kenya, Tanzania and Lesotho. The study is published in the March issue of Annals of Epidemiology:
"Virgins and adolescents who were circumcised were much more likely to be HIV infected than their uncircumcised counterparts. Right there is kind of an indication that HIV transmission may be occurring through both male and female circumcision practices," he says.
Comment: This study suggests that extending the numerous campaigns aimed at curtailing traditional cultural practices of female genital cutting to all genital cutting may help curb the spread of HIV.
Item IV: Massachusetts mgmbill finds legislative sponsor
"We call on members of congress to pass the MGM Bill into law without delay so that boys may enjoy the same protection from circumcision as girls."
Resubmitted to Congress and 16 state legislatures in January 2007, the bill has been sponsored in Massachusetts by Democratic State Senator Michael Morrissey. It's Senate Docket #1348.
Comment: Legislation like this can help the American health care industry break it's addiction to the profitable but medically non-indicated habit of routinely circumcising healthy baby boys.
Item V: Bombshell discovery, Foreskin cells produce a protein that "eats up" invading HIV
Researchers have discovered that cells in the mucosal lining of human genitalia produce a protein that "eats up" invading HIV -- possibly keeping the spread of the AIDS more contained than it might otherwise be.
Even more important, enhancing the activity of this protein, called Langerin, could be a potent new way to curtail the transmission of the virus that causes AIDS, the Dutch scientists added.
Langerin is produced by Langerhans cells, which form a web-like network in skin and mucosa. This network is one of the first structures HIV confronts as it attempts to infect its host.
(Original study publication in pdf form here)
(results discussed here)
Comment: What you were led to believe about the male foreskin may have been 200% wrong. 100% wrong that circumcision removes a gateway which is particularly susceptible to HIV infection, and another 100% wrong in not recognizing that the foreskin may be a natural barrier to HIV with the potential to be boosted for even greater protection.
More recent news suggests that those who completely bought the much-hyped "conclusion" that African circumcision is an HIV-fighting tool were insufficiently skeptical.
Smart science is everybody's responsibility. When somebody tells you "my study shows HIV binds to cells in the foreskin," you need to be smart enough to say "well, how do we know those cells aren't capturing and killing HIV?" Even if you weren't clever enough to ask that question (I'll admit, I hadn't thought of it), it's still your job to resist leaping to unfounded conclusions, as often happens somewhere between the raw data and the news headline.
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To help combat the noise, go ahead and post some insightful on-topic commentary and I'll link to it in the diary text: