ybnormal

all emphasis is mine...

uncircumcised (adjusted odds for what? six or more sexual partners?

I don't know why our good doctor, rbochnermd, feels exempt from providing links which he demands of everyone else... reckon it's one of those doctor-knows-best things...

Here's a link to the above study which he's used as actual proof several times now.

The controlling doctor was "Castellsague"

*sigh*

Dr Rick

Here's what the <a href="http://www.cancer.org/eprise/main/docroot/NWS/content/NWS_1_1x_New_Study_Shows_Benefit_of_Male_Circumcis ion" target="_blank">American Cancer Society</a> had to say about a recent study demonstrating a reduced risk of cervical cancer in female partners and other health issues of circumcision:

"Women are less likely to develop cancer of the cervix if their partners are circumcised men rather than men who are not circumcised, said a report in The New England Journal of Medicine (Vol. 346, No. 15: 1105-1112).

Experts believe a penis that has been circumcised is less likely to harbor human papilloma virus (HPV), a virus associated with almost all cases of cervical cancer.

According to the American Academy of Pediatrics, about 1.2 million male babies or about 65% percent of all male newborns are circumcised each year in the US. Only about 20% to 25% of male babies worldwide are circumcised.

To Cut or Not to Cut

Circumcision has become controversial in recent years. Its advocates in the medical community argue that it prevents urinary tract infections in male babies. It also lowers sexually transmitted infections with HPV that cause genital warts in men. Finally, penile cancer arises less often in men who were circumcised as babies.

Those who do not support the use of circumcision believe that these reasons don’t make up for the pain and possible “mutilation” it causes, as well as the occasional complications.

Now a group of international researchers, led by Xavier Castellsagué, MD, of the Llobregat Hospital in Barcelona, Spain, have uncovered another reason to favor circumcision. They found that women whose partners were uncircumcised were more likely to develop cancer of the cervix.

The researchers studied the male partners of women with cervical cancer.

Castellsagué and his colleagues questioned whether the male partners of women with cervical cancer were circumcised. In addition, they studied male partners of women without cervical cancer. To be as accurate as possible, they only studied male partners in monogamous relationships (males with one sexual partner).
Uncircumcised Men Twice as Likely to Have HPV

The researchers also tested for HPV infection in the males by taking specimens from their penises. The results were matched with whether the men were circumcised.

The first discovery was that men who weren’t circumcised were more than twice as likely to be infected with HPV. In both groups, the chance of HPV infection increased with high-risk sexual activity such as unprotected sex, early age of first sexual activity, and number of partners.

But even more striking was the effect on their partners. Women whose male partners were uncircumcised and had high-risk sexual behavior were two to five times more likely to develop cervical cancer. This high rate of cancer was almost certainly caused by the high rate of HPV infection in these men."

Rick

Dr Rick

...and here's the <a href="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=119482 77&dopt" target="_blank">The New England Journal of Medicine</a> editorial.

By itself, the study is not a justification for circumcison, but it adds to the growing body of recent evidence that circumcision has health benefits including significant reductions in cancer risks and decreased transmission of serious infections.

Rick

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

alek0

RbochnerMD,

can you explain how does reduction of risk for conditions which are preventable by avoiding risky behavior justify performing unnecessary surgery which has risks and complications on unconsenting minors?

Also, since you have called my claim that condoms are, unlike circumcision, proven means of risk reduction for HIV and STD transmission please back it up and prove that circumcision is more effective than condoms. And don't forget to explain how come that all studies agree that condoms reduce the risk, while there are studies showing that circumcised men are more at risk (see my previous post for refs)?

And I am also waiting for enlightment on what does the fact that HIV can be transmitted via activities other than sexual intercourse have to do with circumcision? Or maybe you share the beleifs of your profession from about hundred years ago that circumcision is a magical cure to just about anaything, from paralysis to insanity?

Corwin

Again Dr Rick.... the study is bogus.

That's right, you heard me. Bogus. Misleading. Invalid.

Now... I freely admit to not being a doctor. I'm not in fact looking at this from a medical perspective, but from the perspective of a social scientist with a background in? You got it, statistics and methodology.

As a social scientist with said background... let me establish the validity of this study.

It's bullshit.

If you assume the data are accurate, and that there were no serious errors in gathering it, you still only prove correlation. Correlation does not prove causation!!!!! Others have said it because it's one of the most fundamental rules of statistics and research science. Just because two things happen at the same time does not mean one of them is caused by the other. It would be nice if the world worked like that sometimes.... and it would make research a hell of a lot easier. But it just ain't so.

Now.... let's assume that the data are correct. Hell let's assume that the entire study is correct...

Even better protection from HIV, HPV, Syphilis and other sexually transmitted diseases can be gained from a wonderful new invention... it's this tube of laytex rubber.... amazing things they can do these days.

But then we're looking for a surgical solution here aren't we? (Because where's the fun if it doesn't involve cutting on someone?)

Well hell... why stop with circumcision? I mean clearly, the reason we're doing neonatal circ is that if we don't do it when they're babies, the stupid bastards won't get cut themselves as adults... so why give them the choice? But if we really want to stop the spread of disease why don't we take all these morons and just castrate them? Then they won't be having sex at all and we can stop several diseases from spreading in one fell swoop? Gee that sounds great! We'll just have to do whatever we have to to protect these ignorant people from themselves. This whole 'free will' thing is a nice idea on paper... but it just doesn't work in the real world where we consider a .5% reduction in infection rates to be a huge thing... huge enough to warrant whacking off parts of someone's body without their consent...

By the way Dr Rick.... how's the skin on your fingers looking? You might want to start worrying about skin cancer...

*glances over at the cigar cutter*

It's just a thought. I mean it would save everybody a lot of trouble....

Amen-Moses

Originally posted by rbochnermd:
The first discovery was that men who weren’t circumcised were more than twice as likely to be infected with HPV.

Which came from where exactly?

Women whose male partners were uncircumcised and had high-risk sexual behavior were two to five times more likely to develop cervical cancer. This high rate of cancer was almost certainly caused by the high rate of HPV infection in these men."

Damn, what a pesky little "and" in there.

Amen-Moses (Wondering if the English cervical cancer rates are really several times, at least, higher than the US?)

[ September 09, 2002: Message edited by: Amen-Moses ]</p>

Ted Hoffman

&lt;wipes away tears of laughter&gt;

Corwin, that was beautiful.

Rick,
About HPV, there are other factors involved, the most important of which is:

A man who has unprotected sex with a woman having HPV is liable to getting infected with HPV whether he has the hood on or not.

An uncircumcised man who is faithful to one sexual partner who does not have HPV can NOT get infected with HPV.

Period!

Its who you have sex with, NOT the cut, that gets one to be infected with HPV.

Why cant you get that through your head?

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

alek0

Concerning NEJM study, here is an interesting quote from it:

"Male circumcision was associated with a moderate, but nonsignificant, decrease in the risk of cervical cancer in the men's female partners "

Another interesting item from the study: visit to prostitutes 570 answered yes and 274 answered no for uncircumcised, 154 answered yes and 138 unswered no for circumcised. Out of those, 380 uncircumcised reported never or occasional condom use with prostitutes, while only 33 circumcised reported never or occasional condom use with prostitutes. Hhhhmmmmmm....

And since the study also found that relative risk for women who had sex after age 19 is 0.84, while for those who had sex before age 18 is 0.54, Maybe we should encourage teenagers to have sex? It reduces cervical cancer risk! Isn't that marvellous? Also, those with lifetime number of sexual partners &gt;=2 had RR 0.55 while those with only one partner had RR 0.75? So as long as partners are circumcised, we should encourage girls to have sex young and have sex with many to lower further their cancer risk? Does this make sense?

Now lets look at the results according to characteristics of men. Men with 1-5 partners, relative risk for monogamous women is 1.4! For over 6 partners is reduced, 0.42. Sexual intercourse with prostitutes: No RR=1.39, Yes RR=0.52. Low risk sexual behavior, RR=1.61, high risk sexual behavior RR=0.50.

So, circumcision has protective effect only in cases of large number of sexual partners and sexual intercourse with prostitues. For low risk behavior, circumcision has the opposite effect.
So how does this add to the welath of data supporting circumcision?

Dr Rick

I have no interest in doing so; I have been arguing that there are medical benefits to circumcision; and your defense of the counter-proposal that there are not is an absurd one that flies in the face of reality. You are trying once again to create a strawman to deflect discussion away from your untenable position that there are no medical benefits to circumcision.

The ACS report posted here is notable for what it does not include; it provides reasons to oppose circumcision but doesn't even acknowledge the ridiculous claim made by you and others that "there is no evidence" of benefit. Those who believe this are simply ignoring or are ignorant of the medical literature. It's foolish of you to continue to hold that position.

It's long past the time for you to demonstrate some intellectual honesty and acknowledge that there is evidence that circumcison provides medical benefit.

<strong> It's simply not enough that your data does not back-up your unsubstantiated assertion that "...if circumcision plays any protective role it is a lot smaller than simply using a condom" as nothing you posted compares the two; you still want to side-track the topic, again.

Since you insist, may I offer the following advice: Use the word "all" carefully in medicine.

1: Ann Pharmacother 2001 Sep;35(9):1135

Condoms and sexually transmitted diseases.
Rudd G.

Many of our patients and colleagues will be surprised and disturbed by the latest revelation from the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC). For more than a decade, the NIH and CDC have been promoting "safe sex," a message apparently based solely on the hope that condoms are effective in prevention of sexually transmitted diseases (STDs). This hope was discredited in mid-July when the NIH released the "Scientific Evidence on Condom Effectiveness for STD Prevention," commissioned in June 2000 by then-House member, Dr. Tom Coburn (R-OK). The report disclosed that the body of medical research shows no evidence that condoms protect against most STDs. I refer to the NIH and CDC's "hope" because their recommendations have not been based on good science, but rather on theoretical models, possibly unduly influenced by a strong bias that condoms would prove to be effective.
Sex Transm Dis 2002 Jun;29(6):344-9

The role of disease-specific infectivity and number of disease exposures on long-term effectiveness of the latex condom.
Mann JR, Stine CC, Vessey J.
Medical Institute for Sexual Health, Austin, Texas 78716-2306, USA. jmann@medinstitute.org
BACKGROUND: Condom use is a primary prevention strategy for sexually transmitted infections (STIs). Consistent condom use substantially reduces the risk of HIV infection. Similar levels of effectiveness for reducing the risk of other STIs have not been established. Differences in disease-specific infectivity and the number of exposures to an infected partner may explain differences in condom effectiveness. GOAL: The goal was to examine the impact of differing infectivities and increasing numbers of exposures on theoretical condom effectiveness. STUDY DESIGN: Mathematical modeling using estimated disease-specific infectivities and condom failure rates. RESULTS: Condom effectiveness decreases as disease-specific infectivity and the number of exposures to infection risk increase. CONCLUSIONS: Condom effectiveness for decreasing STI risk is influenced by disease infectivity and the number of exposures. Generalizations from studies of relatively uninfectious STIs to highly infectious STIs or from short-term studies to longer-term situations will overestimate condom effectiveness.

AIDS 2001 Nov 9;15(16):2171-9 Related Articles, Links
 
HIV incidence and sexually transmitted disease prevalence associated with condom use: a population study in Rakai, Uganda.
Ahmed S, Lutalo T, Wawer M, Serwadda D, Sewankambo NK, Nalugoda F, Makumbi F, Wabwire-Mangen F, Kiwanuka N, Kigozi G, Kiddugavu M, Gray R.
Johns Hopkins University School of Public Health, Baltimore, Maryland 21205, USA.
OBJECTIVE: Evidence of condom effectiveness for HIV and sexually transmitted disease (STD) prevention is based primarily on high-risk populations. We examined condom effectiveness in a general population with high HIV prevalence in rural Africa. METHODS: Data were from a randomized community trial in Rakai, Uganda. Condom usage information was obtained prospectively from 17,264 sexually active individuals aged 15-59 years over a period of 30 months. HIV incidence and STD prevalence was determined for consistent and irregular condom users, compared to non-users. Adjusted rate ratios (RR) of HIV acquisition were estimated by Poisson multivariate regression, and odds ratios of STDs estimated by logistic regression. RESULTS: Only 4.4% reported consistent condom use and 16.5% reported inconsistent use during the prior year. Condom use was higher among males, and younger, unmarried and better educated individuals, and those reporting multiple sex partners or extramarital relationships. Consistent condom use significantly reduced HIV incidence [RR, 0.37; 95% confidence interval (CI), 0.15-0.88], syphilis [odds ratio (OR), 0.71; 95% CI, 0.53-0.94] and gonorrhea/Chlamydia (OR, 0.50; 95% CI, 0.25-0.97) after adjustment for socio-demographic and behavioral characteristics. Irregular condom use was not protective against HIV or STD and was associated with increased gonorrhea/Chlamydia risk (OR, 1.44; 95% CI, 1.06-1.99). The population attributable fraction of consistent use for prevention of HIV was -4.5% (95% CI, -8.3 to 0.0), due to the low prevalence of consistent use in the population. CONCLUSIONS: Consistent condom use provides protection from HIV and STDs, whereas inconsistent use is not protective. Programs must emphasize consistent condom use for HIV and STD prevention.

1: J Biomech Eng 2001 Oct;123(5):513-8
Virus transmission through compromised synthetic barriers: part II--influence of pore geometry.
Das B, Myers MR.
Center for Devices and Radiological Health, US FDA, Rockville, MD 20852, USA.
When stressed during normal use, synthetic barriers such as gloves and condoms can develop tears that are undetectable by the user. It is of considerable public-health importance to estimate the quantity of virus transmitted through the tear, in the event of viral contamination of the fluid medium. A mathematical model that accounts for virus adsorption to the barrier material was used to compute the quantity of virus transmitted through defects of various geometries. Slits were modeled as cylinders of elliptic cross section, and upper and lower bounds for the transmission rate of HIV and Hepatitis B virus (HBV) were calculated for barrier-use scenarios such as coitus and gripping of surgical instruments. For a 1-microm high slit, HIV transmission was found to be negligible for all likely use scenarios. HIV transmission became potentially significant for a 5-microm slit. Due to its high titer, HBV transmitted at potentially important levels even through the 1-microm slit. The dependence of the transmission rate upon pore aspect ratio was determined and found to be very strong for high-adsorption situations and near-circular pores. Numerical predictions of virus transport through a laser-drilled hole in a condom matched experimental measurements well, even when the tapered nature of the geometry is ignored.

1: Sex Transm Dis 1992 Jul-Aug;19(4):230-4
Effectiveness of latex condoms as a barrier to human immunodeficiency virus-sized particles under conditions of simulated use.
Carey RF, Herman WA, Retta SM, Rinaldi JE, Herman BA, Athey TW.
Division of Physical Sciences, Center for Devices and Radiological Health, Food and Drug Administration, Rockville, Maryland.
Condoms were tested in an in vitro system simulating key physical conditions that can influence viral particle leakage through condoms during actual coitus. The system quantitatively addresses pressure, pH, temperature, surfactant properties, and anatomical geometry. A suspension of fluorescence-labeled, 110-nm polystyrene microspheres models free human immunodeficiency virus (HIV) in semen, and condom leakage is detected spectrofluorometrically. Leakage of HIV-sized particles through latex condoms was detectable (P less than 0.03) for as many as 29 of the 89 condoms tested. Worst-case condom barrier effectiveness (fluid transfer prevention), however, is shown to be at least 10(4) times better than not using a condom at all, suggesting that condom use substantially reduces but does not eliminate the risk of HIV transmission.

1: Sex Transm Dis 1998 Jul;25(6):273-7
Assessing condom use practices. Implications for evaluating method and user effectiveness.
Warner L, Clay-Warner J, Boles J, Williamson J.
Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
BACKGROUND: Consistent and correct condom use remains important to human immunodeficiency virus (HIV) prevention. Although many studies evaluate consistent condom use, few examine how condoms are used during intercourse. GOALS: Assess how user practices affect exposure to risks of pregnancy and infection during condom use. STUDY DESIGN: A cross-sectional survey on condom behaviors in the past month was conducted among 98 male students attending two Georgia universities. RESULTS: Altogether, 35 of 270 total condom uses (13.0%, 95% confidence interval, 7.4-18.5) resulted in potential exposure to sexually transmitted disease and/or HIV infection or pregnancy. Both consistent and inconsistent users were similarly likely to report potential exposures during condom use. CONCLUSION: These findings suggest condom problems occur among both consistent and inconsistent users. Future studies of condom effectiveness must distinguish whether condoms were used both consistently and correctly.

AIDS 2001 Nov 9;15(16):2171-9 Related Articles, Links
 
HIV incidence and sexually transmitted disease prevalence associated with condom use: a population study in Rakai, Uganda.
Ahmed S, Lutalo T, Wawer M, Serwadda D, Sewankambo NK, Nalugoda F, Makumbi F, Wabwire-Mangen F, Kiwanuka N, Kigozi G, Kiddugavu M, Gray R.
Johns Hopkins University School of Public Health, Baltimore, Maryland 21205, USA.
OBJECTIVE: Evidence of condom effectiveness for HIV and sexually transmitted disease (STD) prevention is based primarily on high-risk populations. We examined condom effectiveness in a general population with high HIV prevalence in rural Africa. METHODS: Data were from a randomized community trial in Rakai, Uganda. Condom usage information was obtained prospectively from 17,264 sexually active individuals aged 15-59 years over a period of 30 months. HIV incidence and STD prevalence was determined for consistent and irregular condom users, compared to non-users. Adjusted rate ratios (RR) of HIV acquisition were estimated by Poisson multivariate regression, and odds ratios of STDs estimated by logistic regression. RESULTS: Only 4.4% reported consistent condom use and 16.5% reported inconsistent use during the prior year. Condom use was higher among males, and younger, unmarried and better educated individuals, and those reporting multiple sex partners or extramarital relationships. Consistent condom use significantly reduced HIV incidence [RR, 0.37; 95% confidence interval (CI), 0.15-0.88], syphilis [odds ratio (OR), 0.71; 95% CI, 0.53-0.94] and gonorrhea/Chlamydia (OR, 0.50; 95% CI, 0.25-0.97) after adjustment for socio-demographic and behavioral characteristics. Irregular condom use was not protective against HIV or STD and was associated with increased gonorrhea/Chlamydia risk (OR, 1.44; 95% CI, 1.06-1.99). The population attributable fraction of consistent use for prevention of HIV was -4.5% (95% CI, -8.3 to 0.0), due to the low prevalence of consistent use in the population. CONCLUSIONS: Consistent condom use provides protection from HIV and STDs, whereas inconsistent use is not protective. Programs must emphasize consistent condom use for HIV and STD prevention.

<strong> So am I; you brought it up when you made this erroneous comment: <strong> <strong> Huh?

Rick

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

Dr Rick

All of what you are saying is irrelevant to your erroneous statement that:

<strong> Other factors certainly play a role in the diseases that are positively impacted by circumcision, but that doesn' t alter the evidence that circumcision has medical benefits. It may change the way you want to apply that evidence to real-life conditions, and you may even ignore it, but the fact remains that your assertion was wrong.

Rick