Circumcision page 6

146 posts

Flag Post

It goes from 5 in 10,000 to 2.5 in 10,000. Whoopdy do.

I disagree with this reasoning. If your chances of infection drop by 50%, so does everyone else you have sex with (roughly). It compounds itself, which is why 50% (or sometimes even less I think) can be sufficient to act as a vaccine if used over a number of years.

I agree with that, though condoms should be next on the list to take there.

Oh, absolutely, and there are groups that are actively trying to both bring condoms over there and convince people to use them (which apparently takes effort as well).

 
Flag Post

Bobo, you should have read my link more thoroughly. Although the first couple of paragraphs in the first link talk about the old “cornification” theory, it is primarily not about the method, but about the statistics. Lagerhans cells do not matter if the statistics say otherwise.

Yes thankyou i did, and came to the conclusion that it was a very biased literature review. This type of review should probably be taken in conjunction with a meta-analysis of all available data over a set period of years and also compared to other literature reviews. Whislt the article states many references they are carefully selected, this is the case with the majority of this sort of literature review and are normally done in such a manner as the person writting them has done some degree of work on the area themselves and so choses not to include information which would directly go against their findings/conclusions on the subject. A further point – statistics, well I actually had a look not only at the stats in the review article but also at those in the referenced articles. Most of them have performed very basic calculations, there seems to be a lack of Odds ratios/confidence intervals/power calculations any really any form of in depth statistcal analysis without which I’m afraid a lot of the stats become meaningless.

The way you would do it is by forming a monogamous relationship with someone you trust, at which point you can probably trust them when they tell you they’re not HIV positive.

Uh huh, but like i said, for a lot of people that’s simply not how they do things and it’s not something that’s likely to change any time soon.

Is that not more an argument against circ in countries where the incidence of AIDS is low compared to other diseases?

It may well be, i wasnt really putting it as an argument for either, just trying to get some of the facts out there.

You could make a thread on that, whether making bad decisions for your children can be considered as abuse to the same degree as physical harm.

Agreed this is kinda becoming a topic on its own so I’m just going to let this one lie and agree to differ on the matter :p

Ok, will you let me get away with saying most Jewish families will circ their sons only because the Torah says so?

I’ll settle for it if you change ‘most’ to ‘some’ :p

For phimosis, stretching is a treatment (cure?).

It can be but for some it is not an option.

oh and the link for circ/pain/CNS

 
Flag Post

I disagree with this reasoning. If your chances of infection drop by 50%, so does everyone else you have sex with (roughly). It compounds itself, which is why 50% (or sometimes even less I think) can be sufficient to act as a vaccine if used over a number of years.

What do you mean? Circumcision doesn’t affect the amount of virus in semen, so women and anyone receiving anal sex has a higher risk of infection regardless of their partner’s circumcised status.

Yes thankyou i did, and came to the conclusion that it was a very biased literature review.

Yeah, it’s biased. Why do people say that “it’s biased” like it means something? Does the fact that most climate scientists are biased towards global climate change mean it’s false?

I’ve presented my evidence; you shouldn’t dismiss it just because it’s advocating the same thing I am. If you have arguments against the statements made, feel free to bring them up.

A further point – statistics, well I actually had a look not only at the stats in the review article but also at those in the referenced articles. Most of them have performed very basic calculations, there seems to be a lack of Odds ratios/confidence intervals/power calculations any really any form of in depth statistcal analysis without which I’m afraid a lot of the stats become meaningless.

… all of the sources cited in this last paragraph (the one about cross-sectional studies of the effect of circumcision on STDs) state their confidence intervals and odds ratios.

And here’s a (presumably) unbiased literature review from 2003. Their results:

We identified no completed randomized controlled trials. Three randomized controlled trials are currently underway or commencing shortly. We found 34 observational studies: 16 conducted in the general population and 18 in high-risk populations. It seems unlikely that potential confounding factors were completely accounted for in any of the included studies. In particular, important risk factors, such as religion and sexual practices, were not adequately accounted for in many of the included studies.

We found insufficient evidence to support an interventional effect of male circumcision on HIV acquisition in heterosexual men. The results from existing observational studies show a strong epidemiological association between male circumcision and prevention of HIV, especially among high-risk groups. However, observational studies are inherently limited by confounding which is unlikely to be fully adjusted for. In the light of forthcoming results from RCTs, the value of IPD analysis of the included studies is doubtful. The results of these trials will need to be carefully considered before circumcision is implemented as a public health intervention for prevention of sexually transmitted HIV.

 
Flag Post

What do you mean? Circumcision doesn’t affect the amount of virus in semen, so women and anyone receiving anal sex has a higher risk of infection regardless of their partner’s circumcised status.

Sorry, what I meant is that it compounds beause each person that doesn’t get HIV also can’t transmit it. This doesn’t apply in monogamous relationships, but I don’t think that’s the population we’re looking at.

I’m going to run a quick simulation and report the results in a few minutes.

 
Flag Post

>Does the fact that most climate scientists are biased towards global climate change mean it’s false?

Well, it certainly casts doubt when scientists are funded by a government that has one of its major platforms for both party being global climate change, combined with the fact that certain data is never mentioned when it is against global climate change (such as the fact that natural disasters haven’t increased over the past 30 years). But that is a different topic.

Basic point: If a source is funded by somebody pro-whatever conclusion, has personal convictions based about one conclusion, uses unreliable data (usually a mistake of correlation/causualty), or omits any data that is against them, you can’t use that source alone to prove your point.

EDIT: Also, Einar, what is the study you cited now supposed to prove? All it shows is that they are commencing studies and don’t have adequate data to prove that a lack of circumcision increases HIV and that they have data that highly suggests that circumcision is effective, but is limited by the study group and uncontrollable factors. The study doesn’t prove much, but it certainly doesn’t help your point (at least from what you quoted).

 
Flag Post

Basic point: If a source is funded by somebody pro-whatever conclusion, has personal convictions based about one conclusion, uses unreliable data (usually a mistake of correlation/causualty), or omits any data that is against them, you can’t use that source alone to prove your point.

I don’t see how this can be true. If I reference papers that were properly researched, then the only way to disprove them is to provide further, contradictory research or to provide valid criticism of the original methods. There is no inherent fault in being funded by an interest group, though it does mean that other people will be more likely to closely examine your research. There is no inherent fault in having personal convictions.

Indeed, it is the “circumcision provides STD resistance” camp that seems to be arguing from their personal convictions; consider for instance the part about psycho-cultural factors in the page I keep on posting.

The study doesn’t prove much, but it certainly doesn’t help your point (at least from what you quoted).

My point is that there are no are valid medical reasons for circumcision. The current argument for male circumcision is that it provides STD resistance, specifically resistance to HIV. The study I cited says:

We found insufficient evidence to support an interventional effect of male circumcision on HIV acquisition in heterosexual men.

Thus, the study supports my point; it found no evidence that circumcision intervenes in HIV acquisition. Of course, no evidence of valid medical reasons is not the same thing as evidence of valid medical reasons, but we’ve had this debate before – and I personally believe that, lacking evidence that doing so provides actual health benefits, it is better to not cut off bits of little boy’s.

 
Flag Post

>The results from existing observational studies show a strong epidemiological association between male circumcision and prevention of HIV, especially among high-risk groups. However, observational studies are inherently limited by confounding which is unlikely to be fully adjusted for. In the light of forthcoming results from RCTs, the value of IPD analysis of the included studies is doubtful. The results of these trials will need to be carefully considered before circumcision is implemented as a public health intervention for prevention of sexually transmitted HIV.

It seems that studies show that they were going to look into this. Considering it was in 2003, the follow up research is probably out (or at least a further report has been issued) so the validity of your report is questionable by age and the fact they obviously intended to do more studies.

 
Flag Post

Yes, mils, that survey happened in 2003 and there’s been further research. That further research is what this page, that I’ve posted before, critiques. There’s a heading named “randomized controlled trials” that’s about the results from the RCTs mentioned in the 2003 survey.

One of them finished in 2005 and published, the other two were terminated and not published.

About that one, I quote:

The Auvert study reported that young circumcised males in Orange Farm become infected more slowly than non-circumcised young males. This paper has received a large amount of attention in the worldwide media, but also was subject to extensive scientific criticism, which has been published at the PLoS website.

This is one of the more interesting criticisms; apparently, there’s also been studies done that indicate that circumcised men are more likely to transmit HIV to women.

 
Flag Post

Yeah, it’s biased. Why do people say that “it’s biased” like it means something?

Um…because a good literature review shouldnt be???

I’ve presented my evidence; you shouldn’t dismiss it just because it’s advocating the same thing I am.

I’m not, i was criticising the sources because they were bad sources not because you were the one that found them! (and i did actually say that most of the papers didnt have the required stats, not all) In actual fact this meta-analysis/review you have found does indeed seem to be a more even approach. However there is a very important note when talking about the whole population studies in the results section of the paper – “The 14 cross-sectional studies…(various references)… had inconsistent findings. Eight studies were in the direction of benefit whilst six were in the direction of harm, with point estimates of odds ratios varying between 0.28 and 1.73.” Inconsistent findings do not necessarily mean that the results cancel each other out – one of the problems with performing meta-analyses in general.

 
Flag Post

Yeah… I seriously can never understand what Bobo is saying when he goes into geneticist mode. But uhh… I agree with him. I think.

 
Flag Post

lol sorry (and its her by the way).

Basically what the review said was that they had found some studies which said X and some which said -X. The problem with the type of review looking at these studies is that if you add X to negative X then you get 0 – i.e. no result. However for a lot of these studies it is not always the best way of looking at things to do it in that manner as you could say have 4X and -4X but 3 studies were biased/wrong/not statistically significant/too small a group of people were looked at etc. so when you lump them all together some of the real results get lost as they are cancelled out by the ‘false’ ones. (this isnt saying that the wrong studies were either the pro or the against ones, they could be a mix of both, there could be none at all! just that this is a common problem in this type of study).

 
Flag Post

That explains it.

And wouldn’t it be She in the sentence I posted? But anyway, I had no clue you wre a girl. I should pay more attention to these things.

 
Flag Post

But uhh… I agree with him. I think.

You had a “him” in there too. ;)

 
Flag Post

Why can’t you ever let me win, Phoenix! WHY!

;-)

 
Flag Post

lol i love how a dicussion about an inherently male surgery has got on to dicussing the fact that i am a girl :p

 
Flag Post

I’ll settle for it if you change ‘most’ to ‘some’ :p

You said only some religious people make their own decisions! :P

But ok, can we agree that Jews are more likely than other people to circ their sons, because of the Torah?

It can be but for some it is not an option.

In these cases, I would advocate surgery as a last resort (probably my stance for anything with a sharp knife). How common is phimosis though? I doubt it’s common enough to use as a reason to circ someone at birth.

oh and the link for circ/pain/CNS

I’m lost in the findings paragraph. I think the ‘Interpretation’ says uncirced babies don’t scream or complain as loudly when they have a needle stuck in them compared to circed babies, and if you are circing your son, use a painkiller when doing so to stop him screaming as loudly when he is vaccinated later. Relevant to this topic, I’d say it was reason not to have your son circed because he’d find vaccinations more painful. It is a small study though.

 
Flag Post

But ok, can we agree that Jews are more likely than other people to circ their sons, because of the Torah?

lol ok i’ll go with that :p

How common is phimosis though?

10% of men – i can’t link to the article as it requires subscription (and i can’t find one that doesn’t!) but if anyone wants to go looking its B J Morris 2003 giggles at the bj in the name very childishly

The CNS study (and there have been others with both similar and different findings i just didn’t want to bore people with lots of scientific articles) basically implies that circumcision has an effect on the central nervous system. The thinking is that circumcision can cause a permenant change in the pain tolerance/pain perception of the individual. This study claims that circumcision makes the boys more sensitive to subsequent pain but there are others which counter this finding. It was really just another layer to the possible effects of circumcision implying that they may go deeper than just loosing a piece of skin.

I also found this study (which hopefully is available to people without athens accounts – sorry im on a permenant connection so i can’t always tell, let me know if it’s not viewable). Scroll down to page 2 to see a very intersting table (table 1) Circumcision

 
Flag Post

10% of men – i can’t link to the article as it requires subscription (and i can’t find one that doesn’t!) but if anyone wants to go looking its B J Morris 2003

That concurs with the 2007 article you linked to, so I guess I’ll believe you :P

Do you know how common phimosis is such that it must be treated with surgery?

giggles at the bj in the name very childishly

How many times did you giggle ‘randomly’ watching Bridget Jones’ Diary?

The CNS study (and there have been others with both similar and different findings i just didn’t want to bore people with lots of scientific articles) basically implies that circumcision has an effect on the central nervous system. The thinking is that circumcision can cause a permenant change in the pain tolerance/pain perception of the individual. This study claims that circumcision makes the boys more sensitive to subsequent pain but there are others which counter this finding. It was really just another layer to the possible effects of circumcision implying that they may go deeper than just loosing a piece of skin.

It did seem counter-intuitive to me at first, I’d have thought the circ would have toughened the boys up, so to speak. (Not that putting them through pain so they wouldn’t mind lesser pain later is an argument for circ, mind.) I suppose if the circ really hurt, the baby would cry more loudly the next time he was hurt because he felt his parents ignored him the first time.

I also found this study (which hopefully is available to people without athens accounts – sorry im on a permenant connection so i can’t always tell, let me know if it’s not viewable). Scroll down to page 2 to see a very intersting table (table 1) Circumcision

I didn’t have to sign in, so I think it’s publicly available.

The first thing I noticed was urinary tract infection and chlamydia for women. Other studies or articles I’ve read said those were reduced by circ. But I guess these studies will disagree from time to time (though the other studies did suggest a plausible explanation). The second is that there is no mention of alternative treatments. Clearly, if these are all the issues, and the only way to stop those conditions is by circ then go ahead, though I would ignore the less likely 1/100 conditions and focus on those such as prostate cancer (That’s really high, 1 in six uncirced men get it, and 1 in 12 circed men get it – never knew that).

Lastly I’d like to point out (somewhat smugly) that whoever made the table got a bit carried away with their maths skills and put down that you need to circ very, very few people (should be infinite, or some very large number) and someone will die from it. Not that I could do better, but the NNT and NNH is quite confusing.

 
Flag Post

Do you know how common phimosis is such that it must be treated with surgery?

I don’t know off the top of my head but I’ll have a root around and see if it was in any of the papers i looked at. Whatever the number is though it’s likely to be the number who could or perhaps should be treated by surgery as in studies like this there will always be people who either don’t want surgery and would rather live with the problem or who will try alternative methods (with most likely varying sucess). This isnt saying that they don’t need the surgery just that they wont have it.

How many times did you giggle ‘randomly’ watching Bridget Jones’ Diary?

No comment :p

It did seem counter-intuitive to me at first, I’d have thought the circ would have toughened the boys up, so to speak.

It’s more to do with investigating how the internal workings of the body deal with the surgery. Looking at whether it causes cellular or nervous changes which would affect not jsut the childs psychological perception of pain but the actual amount/intensity they feel. Kinda like the butterfly effect i geuss (for those who don’t know the theory is some dumb bug flaps its wings in say China and the ripples end up magnified by things and cause a hurricane in say Scotland).

The first thing I noticed was urinary tract infection and chlamydia for women. Other studies or articles I’ve read said those were reduced by circ

This one was saying the same thing, their data suggested a 10 fold increase in UTIs and a 5 fold increase in chlamydia for uncircumcised.

Lastly I’d like to point out (somewhat smugly) that whoever made the table got a bit carried away with their maths skills

lol just clocked that, dumbass researchers :p

 
Flag Post

It’s more to do with investigating how the internal workings of the body deal with the surgery. Looking at whether it causes cellular or nervous changes which would affect not jsut the childs psychological perception of pain but the actual amount/intensity they feel.

A lot more complicated than I thought then? How would that work, a big pain in the penis area making them feel more pain when a needle is put into their arm?

Perhaps it explains partly why men on average can take less pain than women, or why men allegedly make a bigger deal when ill.

This one was saying the same thing, their data suggested a 10 fold increase in UTIs and a 5 fold increase in chlamydia for uncircumcised.

Sorry, I meant other studies said circ increased (easy typo, the keys are very close to each other) the risk of UTI and chlamydia. The reasoning was the glans was more likely to get swollen with a circ (for UTI) and chlamydia sores would be less noticeable on a tougher, circed penis.

 
Flag Post

A lot more complicated than I thought then? How would that work, a big pain in the penis area making them feel more pain when a needle is put into their arm?

Well kinda. (Ignore the needle in the arm thing by the way, it isnt really that important it was just one method of testing pain response in young children without giving them a painful stimulus that they wernt going to have to have anyway.) To be honest this is quite a long way off my feild and I’m not confident enough about the actual process they think might happen to try and explain it.

Perhaps it explains partly why men on average can take less pain than women, or why men allegedly make a bigger deal when ill.

I’ll reply to that one when i finally stop laughing :p