Corwin

Dr Rick.... you have to remember that most of are familiar with Kellogg's original work promoting circumcision as a curative for the evils caused by masturbation, including insanity, crippled hands, blindness, moral depravity, enjoyment of sex, etc. That would be the interests from a hundred years ago that have been referred to.

Originally doctors were quite blunt about their reasons for circumcising. Over time, society developed and realized that the Victorian stereotypes regarding sexuality and specifically masturbation were all just so much bullshit. As a result, the medical establishment has put a lot of effort into finding medical 'benefits' to circumcision. The claims fall flat on analysis.

By the way Dr Rick... I don't suppose you have any real studies to back up your argument? Yes... I know, we're talking about medical doctors here... and most of you know all jack shit about research. This conclusion is borne out by the simple fact that you can't make a meaningful conclusion from the studies you've listed. Medical doctors are, unfortunately, somewhat notorious for exactly this problem. (I understand, you're bowing to necessity. That doesn't change the fact tho.) Bottom line. Your sample is just too small to draw a meaningful conclusion. Your statistical significance is so low you'd be laughed out of any sociological review. When you have a survey size in the range of four digits, AT LEAST, then we might be able to think about starting to talk. (Five digits is preferable... four is usually doable... three is bad. Less than 250? Is right out.)

Dr Rick

The last bit is true true, but the rest of your evalutation of this study and the others is wrong.

The evidence that there is a protective effect from circumcision against the maladies I have cited in my posts has been confirmed by numerous epidemiologic studies, and the statistical analysis's have shown that the relationship in most of the studies is not just coincidence and is independent of numbers religious practices and other confounfding variables.

One does not have to prove cause and effect to demonstrate a statistical relationship between a variable and an outcome.

Most of the circumcision studies, similar to most population-based observational studies of heart disease and diabetes, do not prove cause and effect

But the circumcison studies still show that you are less likely to get or give cervical cancer, penile cancer, HIV, gonorrhea, syphillis, and UTIs if you or your partner is circumcised, and this protection is independent of other variables and the "protection from HIV, HPV, Syphilis and other sexually transmitted diseases [that] can be gained from a wonderful new invention... it's this tube of laytex rubber.... amazing things they can do these days.

Furthermore, I have posted a study that addresses the cause and effect issue oon this this page; since it's already here, I won't repost the whole thing but just paraphrase it for you:

Just as an aside, I'm curious about something. The New England Journal of Medicine is one of the most prestigious medical journals in the world. It draws editors, reviewers, and contributors from around the world. That study was not published without input and peer-review by some of these internationally acclaimed and recognized medical and statistical experts. How does a social sciences student convince himself that he is so informed and smart that he can just dismiss the and the work and opinions of these experts as "bogus. Misleading. Invalid...It's bullshit."?

Rick

[ September 09, 2002: Message edited by: rbochnermd ]</p>

Corwin

Because this social sciences student actually knows a thing or two about statistics. Doctors tend to not be terribly careful about sample size. (Admittedly, frequently you don't HAVE access to a huge sample size... but this unfortunate fact doesn't change the mathematical rules in question.)

Dr Rick

Well, we try; but please remember, it's not like we have the intellectual benefits and rigourous training of a social studies student...

Since both you and alekO have asked but haven't bothered to look; I'll repost the studies from the previous 6 pages of this thread and a couple of more.

Here's a brief review of some of the international medical literature on circumcision, most of it over the past 36 months. These recent studies speak directly to some of the older, and at the times they were made appropriate but nonetheless now out-dated, criticisms along the lines of "there is no good evidence" that circumcision has any benefit.

From Sweden, a study documenting the protective effects of circumcision against penile carcinomas:
Scand J Urol Nephrol 2000. Etiology of squamous cell carcinoma of the penis. Dillner J, von Krogh G, Horenblas S, Meijer CJ. Microbiology & Tumor Biology Center, Karolinska Institute, Stockholm, Sweden.


quote:
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...circumcision neonatally, but not after the neonatal period, was associated with a 3-fold decreased risk [of penile carcinoma]...
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From Spain, the decreased risk of cervical cancers in women and the decreased risk of human papilloma virus infections in men associated with male circumcision:
N Engl J Med. 2002 Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. Castellsague X, Bosch FX, Munoz N, Meijer CJ, Shah KV, de Sanjose S, Eluf-Neto J, Ngelangel CA, Chichareon S, Smith JS, Herrero R, Moreno V, Franceschi S; The International Agency for Research on Cancer Multicenter Cervical Cancer Study Group. Servei d'Epidemiologia i Registre del Cancer, Institut Catala d'Oncologia, Hospitalet de Llobregat, Barcelona, Spain.


quote:
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...After adjustment for...potential confounders, circumcised men were less likely than uncircumcised men to have HPV infection (odds ratio, 0.37...)Monogamous women whose male partners had six or more sexual partners and were circumcised had a lower risk of cervical cancer than women whose partners were uncircumcised (adjusted odds ratio, 0.42)...
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...ditto from India:
J Indian Med Assoc 2000 Epidemiology of cancer of the cervix: global and national perspective. Shanta V, Krishnamurthi S, Gajalakshmi CK, Swaminathan R, Ravichandran K. Cancer Institute (WIA), Chennai.


quote:
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Cancer of the uterine cervix is one of the leading causes of cancer death among women worldwide...Aetiologic association and possible risk factors...are: Sexual and reproductive factors, socio-economic factors (education and income), viruses e.g., herpes simplex virus (HSV), human papillomavirus (HPV), human immunodeficiency virus (HIV) in cervical carcinogenesis and other factors like smoking, diet, oral contraceptives, hormones, etc...ritual circumcision can undoubtedly reduce cervical cancer incidence.
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From Uganda, evidence that circumcision protects against HIV aquisition:
AIDS 2000 Male circumcision and HIV acquisition and transmission: cohort studies in Rakai, Uganda. Rakai Project Team. Gray RH, Kiwanuka N, Quinn TC, Sewankambo NK, Serwadda D, Mangen FW, Lutalo T, Nalugoda F, Kelly R, Meehan M, Chen MZ, Li C, Wawer MJ. Johns Hopkins University, School of Hygiene and Public Health, Department of Population and Family Health Sciences.


quote:
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...Prepubertal circumcision significantly reduced HIV acquisition (RR 0.49, CI 0.26-0.82), but postpubertal circumcision did not. In discordant couples with HIV-negative men, no serconversions occurred in 50 circumcised men, whereas HIV acquisition was 16.7 per 100 py in uncircumcised men (P = 0.004). In couples with HIV-positive men, HIV transmission was significantly reduced in circumcised men with HIV viral loads less than 50000 copies/ml (P = 0.02)...
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...and the same from other parts of sub-Saharan Africa:
AIDS 2001 Male circumcision and HIV infection in four cities in sub-Saharan Africa. Auvert B, Buve A, Lagarde E, Kahindo M, Chege J, Rutenberg N, Musonda R, Laourou M, Akam E, Weiss HA; Study Group on the Heterogeneity of HIV Epidemics in African Cities.


quote:
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...In Cotonou and in Yaounde, the two low HIV prevalence cities, 99% of men were circumcised. In Kisumu 27.5% of men were circumcised, and in Ndola this proportion was 9%. In Kisumu, the prevalence of HIV infection was 9.9% among circumcised men and 26.6% among uncircumcised men. After controlling for socio-demographic characteristics, sexual behaviour and other sexually transmitted infections, the protective effect of male circumcision remained with an adjusted odds ratio of 0.26 (95% confidence interval = 0.12-0.56)...Male circumcision is one of the factors influencing the transmission of HIV during sexual intercourse, and this study confirms the population level association between HIV and lack of male circumcision...
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From Turkey, an exploration of the mechanisms by which neonatal circumcision protects against urinary tract infections:
Pediatr Nephrol 2001 Circumcision for the prevention of significant bacteriuria in boys. Nayir A. Department of Pediatrics, Pediatric Nephrology Division, Istanbul Faculty of Medicine, University of Istanbul, Tarik Zafer Tunaya sok 2/6, Gumussuyu-Istanbul, 80040 Turkey.


quote:
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...Among the uncircumcised patients, symptomatic UTI was observed in 6 cases..., whereas after circumcision no patient had symptomatic UTI. No complication due to circumcision occurred in any patient...The present study indicated that circumcision in boys decreases the rate of positive urine cultures. Therefore circumcision could be considered as a part of UTI therapy.
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From Tanzania, the association of syphillis with the lack of circumcision:
Sex Transm Infect 2001 Risk factors for active syphilis and TPHA seroconversion in a rural African population. Todd J, Munguti K, Grosskurth H, Mngara J, Changalucha J, Mayaud P, Mosha F, Gavyole A, Mabey D, Hayes R. National Institute for Medical Research, Mwanza, Tanzania.


quote:
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...Among men, prevalence was associated with lack of circumcision (OR=1.89)...
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From the USA, a study linking lack of circumcision to gonorrhea:
Sex Transm Infect 2000 Circumcision and STD in the United States: cross sectional and cohort analyses. Diseker RA 3rd, Peterman TA, Kamb ML, Kent C, Zenilman JM, Douglas JM Jr, Rhodes F, Iatesta M. Kaiser Permanente Research Department, Nine Piedmont Center, 3495 Piedmont Road, NE, Atlanta, GA 30305-1736, USA.


quote:
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...Uncircumcised men were significantly more likely than circumcised men to have gonorrhoea in the multivariate analyses (odds ratio 1.3) and in the cohort analysis (OR, 1.6).
---------------------------------------------------------------Sex Transm Infect 1998 Oct;74(5):368-73
Male circumcision: assessment of health benefits and risks.
Moses S, Bailey RC, Ronald AR.
Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada.
OBJECTIVES: Globally approximately 25% of men are circumcised for religious, cultural, medical, or parental choice reasons...There is substantial evidence that circumcision protects males from HIV infection, penile carcinoma, urinary tract infections, and ulcerative sexually transmitted diseases. We could find little scientific evidence of adverse effects on sexual, psychological, or emotional health. Surgical risks associated with circumcision, particularly bleeding, penile injury, and local infection, as well as the consequences of the pain experienced with neonatal circumcision, are valid concerns that require appropriate responses.

Urol Clin North Am 1995 Feb;22(1):57-65

Neonatal circumcision.
Niku SD, Stock JA, Kaplan GW.
Division of Urology, University of California, San Diego Medical Center.
Circumcision remains the most common operation performed in males in the United States. When performed by an experienced operator, circumcision is usually a safe and simple operation. The medical benefits of circumcision appear to exceed the risks of the procedure.

1: Pediatrics 1999 Mar;103(3):686-93
 Circumcision policy statement. American Academy of Pediatrics. Task Force on Circumcision.

Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided.

American Journal of Pathology 2002 Sep;161(3):867-73
Susceptibility to human immunodeficiency virus-1 infection of human foreskin and cervical tissue grown in explant culture.
Patterson BK, et. al.
Department of Pediatrics, Division of Infectious Diseases, Children's Memorial Hospital, Chicago.

"Numerous studies have indicated a protective effect of male circumcision against acquisition of human immunodeficiency virus (HIV)-1...Circumcision likely reduces risk of HIV-1 acquisition in men by decreasing HIV-1 target cells."

Rick

Corwin

Nice... of course the only study that even lists the sample size, lists a sample of.... 50.

Which is pretty typical for people who are medics instead of researchers.

There's a reason social scientists don't pay attention to these studies. They're useless. Your sample is so small, and has so many variables that aren't being considered, (in many cases can't even be quantified) that you can draw no meaningful conclusions from the study. When your sample size is 50 people, ANY change in a seemingly unrelated variable can throw your entire study off. (Remember the study you got called on before? Where the circumsized men were... gee... all Muslims?)

Again, when you can come up with a realistic study... say a random sample size of 5000.... we might be able to talk.

In the meantime you're just flailing around looking for any possible justification for a brutal, barbaric and useless practice. You've looked and looked, and found one possible benefit that can also be achieved with a piece of rubber... WITHOUT hacking off bits of people.

But then.... the cigar cutter's always ready...

Dr Rick

Your comments belie your self-proclaimed expertise in statistics; if you really understood research of this nature, you would know the significance of odds ratios, confidence intervals, and p values, and how they and not absolute figures determine the adequacy of sample sizes.

Each one of the studies (as opposed to the reviews) posted reached statistically significant conclusions. Some of them have been edited for brevity, but you can certainly look up the materals and methods that were used yourself.

Rick

Mageth

Nice... of course the only study that even lists the sample size, lists a sample of.... 50.

No, it doesn't. The study you refer to says:

It doesn't mention the total number of subjects in the study. I'm no statistics expert, but I recognize that.

I get the impression that Dr. Rick listed abstracts and excerpts from the studies which don't happen to include the sample sizes. Perhaps instead of dismissing out-of-hand all of the studies because they lack sufficient sample size (when you have no idea what the actual sample sizes are), you could ask him to post those numbers if he has them available, or research the studies to find out yourself.

It seems to me that someone who claims to be an expert in statistics would want to have and examine all of the parameters and results of a study before dismissing it out of hand based on shortcomings that you, in reality, don't know exist.

Corwin

I'm well aware of their significance.

I'm also more than well aware of exactly how much they can change when you're using a small, apparently non-random sample.

A sampling of 50 people doesn't give you anything terribly useful, ESPECIALLY not something useful enough to apply to all people.

Again... come back with some real numbers and maybe we can talk... in the meantime... your arguments are mildly interesting, but hardly compelling enough to justify the current practice of 'slice and dice.'

But then we're back to the cigar cutter.... (Which I presume you'd strongly object to.... funny how it's so much more objectionable when it's YOUR body parts someone wants to cut off... most of us would object to such things... even if it isn't a critical organ.)

Corwin

I read that one a bit quickly, I'll admit. Skimming it seemed to say that the sample size was 50.

However, you're just emphasizing my point. Now, with your correction... NONE of the listed surveys report their sample size.

It takes one sentence.... it's also generally accepted practice.

But not here apparently.

Mageth

It's also "generally accepted practice" to know and evaluate the sample size (and other study parameters and results) before declaring the sample size too small, I would assume.