Full Text of Circumcision Rate Falling News

This is the full text. Good news that the rate is in free fall, frightening and sickening that 6.5 million innocent American boys were mutilated between 2006 and 2009. Gloria

By Mitchel L. Zoler
Elsevier Global Medical News
http://www.imng.com

Breaking News

VIENNA (EGMN) – Circumcision rates for newborn boys in the United States
dropped steadily and markedly over the past 4 years, based on the largest
review of U.S. rates ever done.

Circumcision rates fell from 56% in 2006 to 33% in 2009.

The review, which included more than 6.5 million U.S. newborn boys during
the period, also showed that adverse event rates following newborn male
circumcision were “extremely low,” and that the most common adverse events
were “mild and easily corrected,” Charbel El Bcheraoui, Ph.D., said at the
18th International AIDS Conference.

“Severe male circumcision-related adverse events are extremely rare,” said
Dr. El Bcheraoui, an epidemic intelligence service officer in the division
of HIV/AIDS prevention at the Centers for Disease Control and Prevention.

The dramatic decline in circumcision rates during 2006-2009 continued a
trend that began in the United States earlier in the decade, although the
fall appeared to accelerate recently, he said. He attributed the drop to a
1999 statement by the American Academy of Pediatrics that said existing data
were not sufficient to recommend routine newborn male circumcision
(Pediatrics 1999;103:686-93).

Another factor may be that following the AAP statement, several states
withdrew Medicaid coverage of newborn male circumcision, Dr. El Bcheraoui
said. An earlier report by him and his CDC associates documented that during
1979-2006, the U.S. newborn male circumcision rate was relatively stable,
with an average rate of 61%.

The recent fall in U.S. circumcision rates coincided with reports from three
African-based randomized controlled trials in 2005-2007 that showed
circumcised men had a 50%-70% reduced risk for acquiring HIV infection,
compared with uncircumcised men. These findings led the World Health
Organization and the Joint United Nations Programme on HIV/AIDS to recommend
male circumcision as an important intervention to reduce the risk for
heterosexually acquired HIV infection in 2007. The CDC and AAP are now
independently interpreting the application of these recent findings on HIV
transmission to the United States based on U.S. prevalence rates of HIV and
circumcision, he said.

The new study also analyzed 90-day outcome data on 258,189 boys and men aged
1 or older who underwent circumcision during 2006-2009, and found that
adverse events occurred much more frequently in this age group, “an
important new finding,” Dr. El Bcheraoui said.

His study used data from the largest U.S. consolidator of electronic health
care reimbursement claims, which included data on 117 million unique U.S.
patients annually undergoing short hospital stays, and data from more than
800,000 unique U.S. health care providers. In this database, 6,571,500
newborn boys underwent circumcision during 2006-2009. To estimate the
incidence of circumcision-associated adverse events, the researchers tallied
the rate of any of 41 different ICD-9 and CPT codes that could be such
events during the 90 days following circumcision. They also compared these
rates in 18,330 infants circumcised within the first month of life with a
matched set of uncircumcised infants.

The data showed that the rates for a range of adverse events, such as
mishaps, correctional procedures, and infections were substantially lower in
boys less than 1 year old, compared with boys aged 1-9 years, and with boys
and men aged 10 years or older. For example, mishaps occurred in none of the
boys aged less than 1 year or aged 1-9 years, but in 158/100,000 boys and
men aged 10 years or older. The rate of correctional procedures was
58/100,000; 2,544/100,000; and 1,709/100,000 in the three age groups,
respectively. Infections occurred at a rate of 154/100,000; 5,664/100,000;
and 4,527/100,000 in the three age groups.

The case-control analysis identified only two types of adverse events that
were more common in circumcised newborn boys, compared with matched
uncircumcised infants: repair for incomplete circumcision, and lysis or
excision of penile adhesions. All other adverse events tallied either
similar rates among the cases and controls, or were significantly more
common among the controls.

“This is the largest study to examine the incidence of male circumcision
adverse events to date. It is highly representative [for the United States],
with a large data set” and with a large number of potential adverse events
tracked, Dr. El Bcheraoui said. One of the strengths of the study was its
longitudinal design, which followed subjects for 90 days following
circumcision.

Dr. El Bcheraoui and his associates said they had no disclosures.
http://www.mdconsult.com/das/news/body/213521005-2/mnfp/0/220621/1.html

Circumcision makes the penis smaller

Like it or not, we have to face the awful truth about what has been done to North American males.
The International Symposium on Genital Integrity has just wound up in California and this report has come out of the presentations.
http://www.icgi.org/2010/07/circumcision-makes-the-penis-smaller-says-doctor/

Circumcision Makes the Penis Smaller says Doctor

July 31st, 2010 by ICGI

Circumcising babies in America always causes disfigurement in men, a family physician told an international conference this afternoon.

“By any cosmetic or surgical-outcomes criteria, their penises are harmed—twisted, bent, or scarred,” Christopher Fletcher, MD of Santa Fe said, “And though it is counter-intuitive, they are smaller and skinnier than those of intact men.”

Assistant clinical professor of family and community medicine at the University of New Mexico School of Medicine, Dr. Fletcher’s conclusions arise from a study of men 18 years and older seeking medical care. The vast majority of the circumcisions had been done soon after birth for non-medical reasons.

Dr. Fletcher told the 11th International Symposium on Genital Integrity at the University of California, Berkeley, that these men are almost universally unaware of their disfigurements and think of their penises as completely normal.

“This obvious physical damage is universally ignored by the patient, his parents, and physicians,” he said.

Another study found that the adult penis of men circumcised as children is 8mm (3/8″) shorter.

Dr. Fletcher has delivered more than a thousand babies and dissuaded the parents of all but 10 of the boys from having them circumcised.

Speakers have come to the symposium from Australia, Brazil, Canada, Egypt, England, Ireland, Italy, and New Zealand.

For more information: Marilyn Milos, RN, www.nocirc.org

Do Babies Feel Pain? This one does

This photo says more than any doctor, nurse, or parent could about the human rights violation that male genital mutilation entails.

Prior to this awful device crushing the foreskin, the other clamp that is hanging off to the side was used to ream around inside the foreskin to separate the skin from the glans. The newborn foreskin is adhered to the glans like your fingernail is adhered to the finger. That procedure is pure torture, too.

http://www.flickr.com/photos/42409142@N07/4074019691/

Midwives make a difference, ending male genital mutilation

My blog talk radio program this week is on the subject of ending male genital mutilation. 20 mins long.

Listen to internet radio with waterbirthinwoman on Blog Talk Radio

You can download the program to iTunes free.

2010 Gay Pride Parade, San Francisco



IMG_2055, originally uploaded by endenizen.

Intactivists turn out to take the genital integrity message to the streets. More than a million people watch the S F Gay Pride Parade so it’s a chance to get the message out loud and clear. Thanks to all the marchers and sign creators. Speaking up for baby boys who can’t speak for themselves—the work of decent people.

Do Pediatricians Care About Newborns?

Some definitely do. They got into medicine because they love children and want to do everything they can to give each child a chance at a full, healthy life. I’ve met these men and women and I know they must be acutely embarrassed to belong to the American Academy of Pediatricians at this time in history. In a reactive backlash, the AAP seems to actually be entertaining the idea of turning back progress 20 years and allowing the genital cutting of girls in America. As it becomes more and more difficult to argue with the fact that boys need the same protection under law that girls have been granted, the genital cutting committee at the AAP has chosen to think like dinosaurs and reduce the protection to girls so that things can be more fair.

It really sounds to me like the babies need a good lawyer.

Today, the “attorneys for the babies” have put the AAP on notice. Attorneys for the Rights of the Child (ARC) issued this statement today:

Below is the text of our letter today to the American Academy of Pediatrics (AAP) in response to its recent position statement on female genital cutting (FGC), which condones minimal forms of FGC. The AAP position statement is available at http://aappolicy.aappublications.org/cgi/content/abstract/pediatrics;125/5/1088.

Dear AAP:

We have reviewed the AAP’s latest policy statement on female genital cutting (FGC) and we are shocked to see such an ethically and medically incoherent document issue from your venerable organization. What truly is paradoxical is for the nation’s leading organization of doctors treating children to weaken its opposition to a practice proven to cause substantial, irreparable, lifelong harm to children.

Moreover, your proposed, seemingly innocent “ritual nick” almost certainly violates the Federal Prohibition of Female Genital Mutilation Act, whose criminal provisions became effective in March 1997.

We trust that lightening your opposition to female genital cutting is not being done to help set up a parallel move toward diluting your 1999 statement on male circumcision (MGC). Flawed as the latter statement was, it did acknowledge the lack of medical benefit to the procedure on males. It is imperative that both statements be maintained or strengthened.

The AAP has no business brokering cultural procedures, even those that may support future revenue streams for some of its members. In this time of reduced resources, more than ever, it is imperative that medical organizations such as the AAP focus on what matters most—promoting the safety of our children, and working to eradicate—not condone or justify—harmful, non-beneficial, unethical practices such as FGC and MGC.

J. Steven Svoboda
Attorneys for the Rights of the Child

CIRCUMCISION: A surgery looking for a disease

WHAT WE NEED TO KNOW ABOUT HIV/AIDS STUDIES AND CIRCUMCISION

This blog post is a collection of writings, scientific references and explanations of how the world has been duped into pursuing yet another disease for which circumcision might be a cure. One of the best quotes I’ve seen about the unrelenting quest to find a good use for this irreversible, mutilating surgery is this:

“Dr Colm O’Mahony, a sexual health expert from the Countess of Chester Foundation Trust Hospital in Chester (UK), said the U.S. had an “obsession” with circumcision being the answer to controlling sexually transmitted infections.” http://news.bbc.co.uk/2/hi/health/7960798.stm

In order to combat the media attention given to claims of benefits to male genital mutilation, I’ve put together these posts, articles and citations that show the “behind the science” mis-steps that have been taken in trying to find a ‘quick fix’ for the AIDS tragedy in Africa.

The following is taken from discussions with Robert Hettinger:

“The mucosa contains Langerhans cells that produce a protein called Langerin that destroys HIV. Cut off the foreskin and you cut off part of the body’s immune system.

The African studies are fraudulent. They are unethical, have flawed methodology and manipulated data. They are contrived

– by requiring cut men to wear condoms for one third of the study – to create a lower infection rate for cut men. And then, for “ethical” reasons that are really unethical, all men are circumcised early to eliminate the possibility of any long term studies. This is poor science. Those who cite these “studies”, have not looked deeply enough at the flawed methodology.

The USA has the highest HIV infection rate in the developed world and has the highest circumcision rate. In the U.S., we have a circumcision experiment that involves 300 million men over 30 years. The statistics speak for themselves and blow the conclusions of the fraudulent African studies right out of the water.

The hygiene argument is trivial. The health prophylaxis arguments are a completely fraudulent cultural cliché–everything from cancer prevention to STD prevention to UTI prevention to HIV prevention. The arguments are wrong. Better statistics and examples from around the world refute these arguments.

HIV did not get entrenched in the sub-Saharan population primarily through sexual contact, but , more likely, through inoculating up to 50 or more school children for any number of childhood diseases with one of these veterinary guns using a single needle in the 1980s. http://tinyurl.com/y8fht9q The photo below shows a German made pistol grip automatic syringe of the type used.

German made pistol grip auto syringe
Sexual encounters are not sufficient to explain the exponential growth of HIV in this region. Sex is not an efficient way to transmit the virus. Needles are the most efficient method. Those children that were vaccinated in an unsafe way have grown and become sexually active. This is a far more likely hypothesis of the cause of the AIDS problem in modern day Africa.”

* * * * * * * * * * * * ** * * * * * * * *

HEALTHDAY, Monday, March 5, 2007.

Scientists Discover ‘Natural Barrier’ to HIV By E.J. Mundell .

HealthDay Reporter Mon Mar 5, 2:02 PM ET

MONDAY, March 5 (HealthDay News) — Researchers have discovered that cells in the mucosal lining of human genitalia produce a protein that “eats up”

invading HIV — possibly keeping the spread of the AIDS more contained than it might otherwise be. Even more important, enhancing the activity of this protein, called Langerin, could be a potent new way to curtail the transmission of the virus that causes AIDS, the Dutch scientists added.

Langerin is produced by Langerhans cells, which form a web-like network in skin and mucosa. This network is one of the first structures HIV confronts as it attempts to infect its host. However, “we observed that Langerin is able to scavenge viruses from the surrounding environment, thereby preventing infection,” said lead researcher Teunis Geijtenbeek, an immunologist researcher at Vrije University Medical Center in Amsterdam.

And since generally all tissues on the outside of our bodies have Langerhans cells, we think that the human body is equipped with an antiviral defense mechanism, destroying incoming viruses,” Geijtenbeek said. The finding, reported in the March 4 online issue of Nature Medicine, “is very interesting and unexpected,” said Dr. Jeffrey Laurence, director of the Laboratory for AIDS Virus Research at the Weill Cornell Medical College, in New York City. “It may explain part of the relative inefficiency of HIV in being transmitted.” Even though HIV has killed an estimated 22 million people since it was first recognized more than 25 years ago, it is actually not very good at infecting humans, relatively speaking. For example, the human papillomavirus (HPV), which causes cervical cancer, is nearly 100 percent infectious, Laurence noted. That means that every encounter with the sexually transmitted virus will end in infection. “On the other hand, during one episode of penile-vaginal intercourse with an HIV-infected partner, the chance that you are going to get HIV is somewhere between one in 100 and one in 200,” Laurence said.

Experts have long puzzled why HIV is relatively tough to contract, compared to other pathogens. The Dutch study, conducted in the laboratory using Langerhans cells from 13 human donors, may explain why. When HIV comes in contact with genital mucosa, its ultimate target — the cells it seeks to hijack and destroy — are immune system T-cells. But T-cells are relatively far away (in lymph tissues), so HIV uses nearby Langerhans cells as “vehicles” to migrate to T-cells. For decades, the common wisdom was that HIV easily enters and infects Langerhans cells. Geijtenbeek’s team has now cast doubt on that notion. Looking closely at the interaction of HIV and Langerhans cells, they found that the cells “do not become infected by HIV-1, because the cells have the protein Langerin on their cell surface,”
Geijtenbeek said. “Langerin captures HIV-1 very efficiently, and this Langerin-bound HIV-1 is taken up (a bit like eating) by the Langerhans cells and destroyed.” In essence, Geijtenbeek said, “Langerhans cells act more like a virus vacuum cleaner.” Only in certain circumstances — such as when levels of invading HIV are very high, or if Langerin activity is particularly weak — are Langerhans cells overwhelmed by the virus and infected. The finding is exciting for many reasons, not the least of which is its potential for HIV prevention, Geijtenbeek said.

“We are currently investigating whether we can enhance Langerin function by increasing the amount of Langerin on the cell surface of Langerhans cells,”
he said. “This might be a real possibility, but it will take time.

I am also confident that other researchers will now also start exploring this possibility.” The discovery might also help explain differences in vulnerability to HIV infection among people. “It is known that the Langerin gene is different in some individuals,” Geijtenbeek noted. “These differences could affect the function of Langerin. Thus, Langerhans cells with a less functional Langerin might be more susceptible to HIV-1, and these individuals are more prone to infection. We are currently investigating this.” The finding should also impact the race to find topical microbicides that might protect women against HIV infection.

Choosing compounds that allow Langerin to continue to work its magic will enhance any candidate microbicide’s effectiveness, the Dutch researcher said. Laurence did offer one note of caution, however. “In the test tube, this is a very important finding,” he said. “But there are many things in the test tube that don’t occur when you get into an animal or a human.

Having said that, though, this is a very intriguing finding.”

Citation:
1 E.J. Mundell. Scientists Discover ‘Natural Barrier’ to HIV.
HealthDay, Monday, March 5, 2007.
2 de Witte L, Nabatov A, Pion M, Fluitsma D, de Jong M, de Gruijl T, Piguet V, van Kooyk Y, Geijtenbeek T (2007). “Langerin is a natural barrier to HIV-1 transmission by Langerhans cells”. Nat Med 13 (3): 367–71.
http://www.ncbi.nlm.nih.gov/pubmed/17334373

March 29, 2009 Press Release from NOCIRC-SA

A South African human rights group urges government to halt male circumcision adoption, calling the plan dangerous and unethical.

“The promotion of male circumcision is sending the wrong message, creating a sense of false protection, and placing women at greater risk for HIV. Males are already lining up to be circumcised so that they no longer need to wear condoms (v). Women may be the most harmed by the promotion of male circumcision (vi),” says Dean Ferris, director of the National Organisation Information resource Centres – South Africa (NOCIRC-SA).

New studies released since the three randomized control trials (RCTs) on HIV and circumcision show that RCT results cannot be applied to the general population of Sub-Saharan Africa or anywhere else (i).

Two studies published in 2008 concluded that male circumcision is not associated with reduced HIV infection rates in the general sub-Saharan population. The study specifically analysing circumcision rates and HIV in South Africa found that, “Circumcision had no protective effect on HIV transmission (ii).”

Infection rates between both groups leveled off at the end of all the RCTs and circumcision may only delay HIV infection, but does not affect overall rates.

In South Africa, the Zulus do not practice circumcision, while the Xhosas do practice circumcision. The HIV rates of each group are statistically the same.

“Especially troubling is the extraordinarily high rate of complications from male circumcision in Africa. A 2008 WHO bulletin reported an alarming 35% complication rate for traditional circumcisions and an 18% complication rate for clinical circumcisions (iii).

African’s overburdened health care system cannot handle the tens of thousands of circumcision complications that would result from mass circumcision campaigns,” Ferris contends, “A 2008 study found that increased use of condom promotion would be 95 times more cost effective than male circumcision in preventing new HIV infections (iv).”

Ferris goes on to say, ” Studies have shown that the removal of the foreskin results in a less sensitive penis (ix). A less sensitive penis coupled with the reduced sensitivity afforded by condoms, may encourage males not to use them (x). It is unethical for circumcisions to be carried out on adult males unless fully informed consent has been obtained. The number of reports of African males agreeing to circumcision so that they no longer need to use condoms reveals that they are consenting to the surgery and are not being fully informed of its consequences.

Women may be the most harmed by the promotion of male circumcision. In addition to the false sense of security reducing safe sex practices, male circumcision INCREASES the risk of HIV transmission to women before the wound is fully healed [vii]. A 2008 WHO report found that 1 out of 4 circumcised African males still had not fully healed at 60 days post operative [viii].

Of particular ethical concern is the recent increase in advocacy for neonatal circumcision to prevent HIV. Neonatal circumcision places newborns at immediate risk of infection, hemorrhaging, penile damage and in rare cases even death (xi, xii). It is unethical to place newborns in the immediate risk of these complications to potentially reduce their risk, if at all, of acquiring HIV 15-20 years later when other prevention methods may exist.”

Ferris concludes, “the promotion of male circumcision for HIV prevention is fraught with logistical, monetary, ethical and human rights concerns. Proponents of circumcision have yet to suggest a long term monitoring system in order to evaluate failure or success of the exaggerated claims based on the three RCTs which are in contrast with real world population samples. While the world is desperate for a silver bullet to end the HIV epidemic, the use of male circumcision is not the answer that we have been waiting for.”

Wilfred Ascott – NOCIRC-SA: Communications Advisor – wilfred(at)nocirc.sa.co.za
Dean Ferris – NOCIRC-SA: National Coordinator – dean(at)nocirc-sa.co.za

NOCIRC-SA – National Organisation of Circumcision Information Resource Centres – South Africa
www.nocirc-sa.co.za
info@nocirc-sa.co.za

REFERENCES:
[i] Garenne M, Long-term population effects of male circumcision in generalized HIV epidemics in sub-Saharan Africa. African Journal of AIDS Research 7(1), 1–8 (2008).

[ii] Connolly C, et al., Male circumcision and its relationship to HIV infection in South Africa: Results of a national survey in 2002 S Afr Med J 98, 789–794 (2008).

[iii] Bailey RC, Egesah O, Rosenberg S. Male circumcision for HIV prevention: a prospective study of complications in clinical and traditional settings in Bungoma, Kenya. Bull, WHO 86(9), 657–736 (2008).

[iv] McAllister RG, Travis JW, Bollinger D, Rutiser C, Sundar V. The Cost to Circumcise Africa. Int. J, Men’s Health 7(2), 307–316 (2008).

[v] Nyakairu, F. Uganda turns to mass circumcision in AIDS fight. Reuters Africa 13 August (2008). http://www.canada.com/topics/ bodyandhealth/sexualhealth/ story.html?id=2788448d-1b51-44e2-9fef-ab591d723ad7 (March 2, 2009).

[vi] Irin, Swaziland: Circumcision gives men an excuse not to use condoms. UN Office for the Coordination of Humanitarian Affairs 31 July (2008). http://www.irinnews.org/Report.aspx?ReportId=79557 (March 2, 2009).

[vii] Wawer M, Kigozi G, Serwadda D, et al. Trial of male circumcision in HIV+ men, Rakai, Uganda: effects in HIV+ men and in women partners. 15th Conference on Retroviruses and Opportunistic Infections 3–6 February, Boston. Abstract 33LB (2008).

[viii] Bailey RC, Egesah O, Rosenberg S. Male circumcision for HIV prevention: a prospective study of complications in clinical and traditional settings in Bungoma, Kenya. Bull, WHO 86(9), 657–736 (2008).

[ix] Cold CJ, Taylor JR. The prepuce. BJU Int. 83 Suppl.1, 34–44 (1999).

[x] Gusongoirye D. Rwanda: Nothing can fight HIV/AIDS better than discipline. The New Times (Kigali) 12 February (2008).

[xi] Williams N, Kapila L. Complications of circumcision. Brit. J. Surg. 80,1231–1236 (1993).

[xii] Paediatric Death Review Committee: Office of the Chief Coroner of Ontario. Circumcision: a minor procedure? Paediatr. Child Health 12(4), 311–312 (2007).

Website by AboutWebsites.ca