The British labour movement is poorly informed

On their website, the British Trades Union Council appears to support male genital mutilation for HIV prevention. I assume that they are poorly informed, rather than actually being MGM supporters, so I sent them the following message:
I am very disappointed that the TUC appears to support male circumcision for HIV/AIDS prevention.
The procedure is very painful, permanently mutilating, and seriously affects sexual function. The WHO/UNAIDS justification is based on poorly-controlled investigations which will in the future be discredited, as have all studies purporting to show that circumcision protects against other sexually transmitted diseases.

I would like to point out that it was a British pioneer (Dr. Douglas Gairdner) who in 1949 demonstrated that male circumcision was a useless procedure which caused significant harm and even death, and whose work led to the discontinuation of its routine practice in the National Health Service and throughout Britain.

Please see the following web sites:


Male genital mutilation will be proved to be as useless as telepathy

After following the male circumcision and HIV debate for some time, and trying to make sense of the published scientific literature, I happened upon an article by Susan Blackmore in the Guardian which should clarify the situation.

To me it is just basic common sense that natural, intact anatomy does not cause disease or other health problems. Indeed, all the published scientific articles which purport to show that circumcision reduces the incidence of sexually transmitted infections other than HIV have been discredited or are based on outdated information and invalid statistics. Which leaves the three published randomized trial studies which WHO/UNAIDS is basing its current pro-circumcision policy on. Although these studies were unethical and poorly controlled, and have been severely criticised, they have not yet been formally rebutted, which leaves us with lingering doubts.

Fortunately, Blackmore gives us a good reason to believe that the studies will ultimately be discredited or found to be quite irrelevant. She used to believe in the effectiveness of extra-sensory perception (ESP), and was
an active researcher in parapschycology for a number of years. Finally, after conducting numerous studies, none of which showed statistically significant positive results, she convinced herself of its ineffectiveness. A description of the process she went through is given in her 1987 article in the Skeptical Inquirer, The Elusive Open Mind: Ten Years of Negative Research in Parapsychology

Quoting from her article:
However, I did have an idea. There were still things in which I did believe. I could test the Tarot. In my preoccupation with everything occult, I had been reading Tarot cards for about eight or nine years. They really did seem to work. People told me that I could accurately describe them using the cards, and this was, naturally, gratifying. I even thought it might have a paranormal basis. So I set about testing the cards, doing readings for ten people, keeping the procedure as close as possible to a normal Tarot reading, but isolating myself, as the reader, from the subjects. They then had to rank all ten readings to see whether they picked their own more often than chance would predict (Blackmore 1983).

It worked! The results were actually significant. You can imagine my excitement--perhaps I had at last found something. Perhaps there was no psi to be found in the standard laboratory experiments, but something paranormal could appear when the conditions were closer to real life. But then I talked to Carl Sargent. He pointed out that all my subjects knew one another, and if they knew one another their ratings and rankings could not be independent. So I had violated an assumption of the statistical test I was using.

This seemed so trivial. Their knowing one another could not help them pick the right reading, could it? No it couldn't; but this meant that the estimate of probability was inaccurate--and, after all, the results were only marginally significant. So I repeated the experiment twice more with subjects who did not know one another. I expect you can predict the results I obtained--entirely nonsignificant.

So her initial experiment was rendered valueless merely because her subjects knew each other!

We thus see how easy it is to obtain apparently statistically significant results which are entirely spurious. Given the numerous confounding factors, and the motivations of the researchers conducting the circumcision/HIV trials, I am now confident that their "compelling" results will eventually be found to be completely unreliable, and to have a scientific value no greater than that of reportedly "positive" ESP experiments.


Good news from Africa - congratulations to the World Bank

The World Bank has often been criticised for funding large-scale projects (such as hydropower schemes) which do not necessarily benefit the host community. However, for a recent project, whose report has just been published on their web site, the World Bank should be congratulated. Not a single reference to the word "circumcision" appears in it! The project, the Africa Multi-Country AIDS Program 2000-2006 (MAP), concentrated on tried-and-tested methods, such as prevention of mother-to-child transmission, voluntary counselling and testing, distribution of male and female condoms, provision of information and education about AIDS to the population, provision of antiretroviral (ARV) therapy, supporting vulnerable children, and supporting income-generating activities, for example, as alternatives to sex work.

The program certainly appears to have led to successful outcomes. The percentage of persons of age 15-49 with AIDS in sub-Saharan Africa has stopped increasing. In most countries surveyed. the number of people with a comprehensive knowledge about HIV has increased, as has the rate of condom use and the percentage of HIV-infected people on ARV therapy. For example, in Benin, the fraction of young women who reported using a condom in last sex with a nonregular partner increased from under 20 per cent in 2003 to over 50 per cent in 2005, and in Uganda, the percentage of people with advanced HIV infection who are being treated with antiretroviral drugs increased from 7 per cent in 2003 to over 55 per cent in 2005.

There is thus every reason to suppose that education, treatment, and poverty support measures will decrease AIDS incidence in all African countries. The encouragement of male genital mutilation in such countries as Swaziland, with its small population, and Botswana, with a democratic government and relatively well-educated populace, is therefore absolutely scandalous as well as being totally unnecessary. I congratulate the following Africans for standing up to the American-inspired mutilation bandwagon:
The WHO/UNAIDS support for male circumcision is setting the stage for a tragedy similar to the case of South Korea. Before the Korean War, circumcision was unheard of, but it appears to have been introduced under American military influence, and is now inflicted on about 90 per cent of boys.

For the sake of all of the world's male population, I therefore implore WHO/UNAIDS to change their stupid policy!


First step: identify the network

Since the WHO/UNAIDS policy on circumcision and HIV is said to be based on the results of scientific studies, we should identify the assumptions made behind the relevant published articles, and the scientific record of the participants in the publication process.

I see that certain journals provide public access to the reviewing process for articles. See, for example, http://www.biomedcentral.com/1471-2334/7/16/prepub, which traces the publication process for the article Modelling the public health impact of male circumcision for HIV prevention in high prevalence areas in Africa by Nagelkerke et al. One of the reviewers of the article was Catherine Hankins, the UNAIDS chief scientific adviser, who has been vocal in supporting her organization's encouragement of male circumcision. None of the reviewers appear to have raised problems with regard to the ethics of genital mutilation.

I congratulate the journal BMC Infectious Diseases on its open review policy, which aids the community in understanding the development of science and science policy, and how networks of scientists contribute to this process. The anti-MGM community would benefit from a study of such networks.


We need to define a strategy

As I mentioned in my previous post, the voice of the circumcision lobby seems to be very loud. If you search for "circumcision HIV" on Google you get lots of references to pages which claim that it has been "conclusively proved" and "good news" that removing the male prepuce protects against HIV infection. The fact that removing the female prepuce is totally abhorrent seems to be thought irrelevant, and there are a good few hate messages around directed at those who suggest that male and female circumcision are in any way comparable.

The expressed support from UN agencies for male circumcision campaigns is a serious setback for common sense and human health, and in my opinion our first priority should be to get this decision reversed as soon as possible. So at once we are forced to launch a political campaign, and we need to direct our attention to opinion makers, and those scientists and medical professionals who have influence in the appropriate circles.

So is there anybody out there who can give advice or suggestions on strategy and tactics?


Guys - your anatomy is in danger!

The great majority of men, women, and children in this world are anatomically intact. Lopping pieces off them, stunting their growth, and other such practices, are rightly thought of as perversions not to be tolerated in any rational, humane society. The binding of the feet of Chinese women was banned nearly a century ago. This consideration also extends to the treatment of other animals - in many countries the docking and cropping of tails and ears of dogs, for example, is regarded as distasteful.

Nevertheless, in some cultures there persists a view that the complete human body is in some way incorrect, and needs pieces taken off it. In parts of northern Africa it is still not uncommon to remove parts of the sexual organs of young girls, a practice now termed Female Genital Mutilation and strongly discouraged in international campaigns of exhortation and education. For boys, Muslim and Jewish tradition appears to demand the removal of the prepuce or "foreskin", about half the surface area of the penis, containing its most sensitive portion. This painful practice, termed "circumcision", is of course also regarded with horror by 80 per cent of the world's population. It is just common sense that the human body, when kept as nature intended, will perform better, and have fewer health problems, than when it has been wounded in a part vital to its proper function and the procreation of the species.

For some reason, in the 19th century the Jewish/Muslim practice of circumcision (and also female genital mutilation) was spread by certain members of the medical profession into social groups where it was previously unknown. It seems to have first been introduced to restrict sexual activity, of course to no effect! Once the practice had spread, additional excuses for it were made, such as limiting the spread of sexually transmitted diseases and certain cancers. These alleged benefits have also been completely discredited. Condoms and clean water are always much more effective.

Nevertheless, circumcision of young boys and even day-old infants has persisted, at a rate of more than 50 per cent in the USA and South Korea, and at a lesser rate in Canada and Australia. For the rest of the world's non-Muslim and non-Jewish population the circumcision rate is negligible, except by cultural tradition in the Philippines, Polynesia, and some African ethnic groups.

However, myths do persist, particularly amongst some doctors who should know better. Now that HIV/AIDS has proved to be intractable and expensive to treat, and so far impossible to vaccinate against, people are desperately trying to find "quick fixes". In parts of Africa the human immunodeficiency virus (HIV) infection rate is extremely high, and it is often believed that there is popular resistance to the use of condoms, or even that condom use is immoral. So from some quarters the idea has risen that male circumcision could reduce female-to-male HIV transmission, even though the epidemiological evidence is very poor. Moves are afoot to cut off foreskins in non-circumcising societies such as in Botswana and in Swaziland. Results from a few poorly-controlled experiments are said to be "convincing", even though they cannot be proper double-blind trials, since the subjects all know what their penis looks like.

Although cutting body tissues in regions with poor medical services will increase infection (including HIV), spokesmen for the World Health Organisation and UNAIDS are now calling for mass circumcision in high-HIV areas.

And there are even calls in Western countries, particularly the USA, for mass circumcision of infants to be encouraged or reintroduced!

The voice of the circumcision lobby appears to be very loud, and voices of moderation are relatively silent. Maybe the knives will be coming for you, your infant son, or other young relative ...

[Useful web sites: www.circumcisionandhiv.com, www.icgi.org, and links therein]