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Jun 27 2011

How big are the health benefits of circumcision?

When Dan had me on as a guest of the Savage Lovecast, one of the questions I fielded was on circumcision. I knew that circumcision had been shown to reduce HIV infection rates in at least one study, but I also knew the reduction wasn’t that huge. And frankly, that’s all I knew about the research, so I didn’t want to assert any more. I hadn’t read the paper, so for all I knew, it could have it’s flaws.

Turns out it does. PZ explains:

Now Salon has followed up with an article that suggests that circumcision may actually have some health benefits. I am not impressed. They cite a couple of incomplete epidemiological studies in African populations for HIV infection, and they come up with some astounding figures: a 50-60% reduction in infection rates. Wow, with that kind of advantage…sign me up.

However, these are deeply flawed studies. None of them were completed: they all abandoned the protocol and stopped the research as soon as preliminary results gave them positive values. This is like shooting craps and announcing that all your dice throws were practice…until you get a good roll, and then, yeah, that was the real deal. That one counts.

They all overstate their results. That 50-60% reduction was in relative rate, in comparison across the two groups. The actual calculated protection in absolute terms conferred by circumcision was a 2% reduction in the likelihood of infection. That doesn’t dazzle me, either, and given that the studies were terminated when they got their best results, I’m not persuaded.

And finally, give me a plausible mechanism for how circumcision would achieve these remarkable gains. Tell me how it is supposed to work. If it’s something to do with hygiene, it seems to me that better sex and health education should have the same or better effect than lopping off bits of skin.

Again, the jury is still out. So don’t be using this questionable study in the name of “science” to justify chopping off foreskin. And frankly, it would take a lot more than a 2% benefit to outweigh the concerns of autonomy in my mind. That’s not even touching on the fact that most people do it thanks to religion (which is bollocks ) or “tradition” (which is also bollocks).

And while I’m against circumcision, I’m also with PZ on his final paragraph:

I also say as I always have that I oppose circumcision, think it is a pointless and petty bit of suffering to put children through and ought to be discouraged, but I also don’t think it’s as hideously damaging as the obsessive nuts want to claim. Also, in the context of the original post, I consider it a prime example of selfish privilege to invade discussions of female genital mutilation, which does cause serious sexual and medical problems, with demands that we pay more attention to the lesser concerns of males getting lightly scarred penises.

What he said.

2 comments

  1. 1
    RD

    The following article explains in meticulous detail why the claim that the randomised clinical trials conducted last decade in east and south Africa “prove” that circumcision is effective against AIDS, is not credible.

    TITLE: Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns.
    AUTHORS: Gregory J Boyle and George Hill

    ABSTRACT
    In 2007, WHO/UNAIDS recommended male circumcision as an HIV-preventive measure based on three sub-Saharan African randomised clinical trials (RCTs) into female-to-male sexual transmission. A related RCT investigated male-to-female transmission. However, the trials were compromised by inadequate equipoise; selection bias; inadequate blinding; problematic randomisation; trials stopped early with exaggerated treatment effects; and not investigating non-sexual transmission. Several questions remain unanswered.

    http://xa.yimg.com/kq/groups/23477339/1441224426/name/JLM_boyle_hill.pdf

    @PZ: The milder forms of FGM are damaging mainly because performed in unsterile conditions. Male circumcision is more damaging than people think, mainly because no one has looked for that damage in a careful way. In Africa, hundreds of teens _of both genders_ die every year because of the appalling sequaliae of genital mutilation. Also, there are men, circumcised routinely or ritually under hygienic conditions, who have serious sexual difficulties, either lifelong or starting in middle age. And when I write “damage,” I have much more than “lightly scarred penises” in mind.

  2. 2
    Rilian

    I think MGM is a big deal. It makes me :( when people say it’s not. Victims of FGM can still have sexual pleasure, so the fact that victims of MGM can doesn’t mean anything. I think both should be talked about together, when it’s a similar violation. That shit where they sew up vaginas is something completely different though.

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