An Interesting Australian Study

[Fellow Traveler]

The news blurb of a new from the Australian and New Zealand Journal of Public Health:

http://www.6minutes.com.au/articles/z1/view.asp?id=515210


Circumcision does not seem to be justified in the Australian context because it has no protective effect against STIs and does not reduce sexual difficulties, a major new study has found.


Thoughts?

[Father]

I would have to read the entire study. But that doesn't seem to be out.
It is self-reporting, which is a big limitation.


They say findings from a previous Australian survey that showed higher rates of sexual difficulties among uncircumcised men had been used in support of the procedure. However, the new study showed no such differences.

I wonder why???


author Dr Juliet Richters

I guess this is why. She is a vocal intactivist. Obviously her 'study' is going to point in the direction of her opinion. If you doubt her 'bias'. here is a quote of hers:


Yet circumcision can be seen rather as a sociocultural intervention with post hoc medical justification. As a form of body modification, it serves to exaggerate the visual difference between male and female. Reducing the ambiguity and untidiness of the penis turns it into a neat phallus more specifically fitted for what is seen as its purpose in a gendered sexual culture focused on coitus.

From her article "Circumcision and the Socially Imagined Sexual Body".

Using only the abstract, this statement screams issues:


reported lifetime experience of selected sexually transmissible infections (STIs)

Apparently, the study didn't even include HPV! Enough said.

[sockstealingpoltergeist]

Father innactivist is a non term. Fail.

It is the most laughable term used by pro cicers.

Try again.

[Fellow Traveler]

I would have to read the entire study. But that doesn't seem to be out.

It is available through the article.



It is self-reporting, which is a big limitation.


It is self reporting, and that can be a limitation but that would mean that either:

1. Individuals lied about an STD and receiving treatment.
2. Not realize they were infected and thus not reported it.
3. Misreport the infection they had.

1 could certainly happen but since it is over the phone I suspect it would be less likely than a face to face interview. 2 is not very likely most of these STDs make themselves known though some don't which is why men can't report on HPV. 3 is also possible, perhaps more than any other. For all of these things to hide a protective effect one population would have to do much more of lying, not recognizing, and misreporting. I find it difficult to believe that this would be the case. But it is true that there are limitations to self reporting.

On the other hand, it was a very large study. Not as large as the 10,000 man study in 2006 which made similar conclusions but respectable.



I wonder why???

Good question, any ideas?



I guess this is why. She is a vocal intactivist. Obviously her 'study' is going to point in the direction of her opinion. If you doubt her 'bias'. here is a quote of hers:


And Father would never accept research or read the websites of those with bias opinions on circumcision. :rolleyes:



From her article "Circumcision and the Socially Imagined Sexual Body".


That was very insightful and it's one I've never read. I'll have to check it out.



Using only the abstract, this statement screams issues:


To save you the suspense they were:
Genital Warts, Chlamydia, Genital herpes, Gonorrhea, non-specific urethritis, Penile candidiasis, and pubic lice. Not sure what issue there is there.



Apparently, the study didn't even include HPV! Enough said.

Why is that, enough said? What do you mean?

[Father]

To save you the suspense they were:
Genital Warts, Chlamydia, Genital herpes, Gonorrhea, non-specific urethritis, Penile candidiasis, and pubic lice. Not sure what issue there is there.

Thanks for providing that.

Great selection. Lets go through them:

Warts - no argument
Chlamydia - no argument
Herpes - has been some argument, but not much in it
Gonorrhea - no argument
NSU - yep, less likely in the uncircumcised
Candidiasis - yep, less likely in the circumcised
Pubic lice - whatever. Glad they researched that one:)

It seems like a bit of a waste of those 4300 blokes time if you ask me. All the information was out there already. eg. this meta-analyses
http://www.ncbi.nlm.nih.gov/pubmed/16581731



This first systematic review of male circumcision and ulcerative STI strongly indicates that circumcised men are at lower risk of chancroid and syphilis. There is less association with HSV-2. Potential male circumcision interventions to reduce HIV in high risk populations may provide additional benefit by protecting against other STI.


So my point. They have chosen STI's that suit their ant-circ argument. I am surprised that they included candidiasis though.

Since you obviously have faith in this study, I guess then you will acknowledge their conclusion:



Circumcision was unrelated to any of the sexual difficulties we asked about (after adjusting for age) except that circumcised men were somewhat less likely to have worried during sex about whether their bodies looked unattractive (OR=0.77, p=0.04). No association between lack of circumcision and erection difficulties was detected.


This destroys some regular anti-circ comments that are thrown around here. I'm sure Opinionated won't agree with their conclusion.

[MotherNurture]

Apparently, the study didn't even include HPV! Enough said.

Um, if genital warts are included it *did* address HPV; Genital warts are caused by HPV.

[Fellow Traveler]

Thanks for providing that.

Great selection. Lets go through them:

Warts - no argument
Chlamydia - no argument
Herpes - has been some argument, but not much in it
Gonorrhea - no argument
NSU - yep, less likely in the uncircumcised
Candidiasis - yep, less likely in the circumcised
Pubic lice - whatever. Glad they researched that one:)


Ok. I am surprised they got to P.L. first though.



It seems like a bit of a waste of those 4300 blokes time if you ask me. All the information was out there already. eg. this meta-analyses
http://www.ncbi.nlm.nih.gov/pubmed/16581731

So my point. They have chosen STI's that suit their ant-circ argument. I am surprised that they included candidiasis though.


So which additional ones were you looking for that would not satisfy their argument? I am sure they could have ask about Chancroid. They did look at syphilis and HIV but found to few respondents; those diseases are too rare among heterosexuals. We do know that one of the "big" trials from Africa found no significant difference in rates of syphilis, it was rare there too. I am not surprised about candidiasis though, why wouldn't they include it?



Since you obviously have faith in this study, I guess then you will acknowledge their conclusion:

This destroys some regular anti-circ comments that are thrown around here. I'm sure Opinionated won't agree with their conclusion.

That sure is one of their conclusions but their most important conclusion is that there is no practical health benefit for Australians, and in all likelihood any first world country. And if there is no benefit of substance how can one justify it ethically?

I'll reiterate my previous question since you missed it, why is not including HPV a "big" deal?

[Fellow Traveler]

Um, if genital warts are included it *did* address HPV; Genital warts are caused by HPV.

Good pick up MotherNurture.

[MummaBear03]

There's such a thing as pubic lice??? :eek:

[Father]

Um, if genital warts are included it *did* address HPV; Genital warts are caused by HPV.

A random google link for you:

http://www.cancerhelp.org.uk/type/cervical-cancer/about/cervical-cancer-risks-and-causes


Some HPV types are called the ‘wart virus’ or ‘genital wart virus’ as they cause genital warts. The types of this virus that cause warts are not the same types that increase the risk of cervical cancer. But some types of HPV are considered 'high risk' for cancer of the cervix - they include types 16 and 18. If you have persistent or frequent infections with these 'high risk' types, you are more at risk of developing pre-cancerous cervical cells (http://www.cancerhelp.org.uk/type/cervical-cancer/about/ssLINK/cervical-cancer-screening) or cervical cancer than people who have not had these infections.



I'll reiterate my previous question since you missed it, why is not including HPV a "big" deal?

Because all their statements talked about STI's in a generic sense as though they studied them all......when they did not look at the most commonly transmitted STI. Rather convenient coming from an intactivist.

[Fellow Traveler]

A random google link for you:

http://www.cancerhelp.org.uk/type/cervical-cancer/about/cervical-cancer-risks-and-causes

Because all their statements talked about STI's in a generic sense as though they studied them all......when they did not look at the most commonly transmitted STI. Rather convenient coming from an intactivist.

Of course it would be difficult to ask about HPV since it doesn't really present itself. But wouldn't it be an even greater waste of time to ask about a disease for which we have a vaccine that provides in excess of 95% protection?

[Father]

But wouldn't it be an even greater waste of time to ask about a disease for which we have a vaccine that provides in excess of 95% protection?

You've already done this lap with Gana. I really can't be bothered with it all again.

But a couple of points:

http://www.cancercouncil.com.au/editorial.asp?pageid=253


HPV are a group of over 100 different viruses. Some HPV types are more likely to lead to the development of cancer than others. At least 14 types of HPV have been found to cause cancer however the vaccine only protects against two out of the 14.


For all other people, the cost of the vaccine is around $460; this does not include the cost of the visit to the GP who must prescribe the vaccine.


Studies are still being conducted on the effectiveness of the vaccine in males. Until such studies have been completed and the results analysed, we do not recommend the vaccine for males.

This article was an interesting read.

http://www.purehealthsolutions.com.au/main/index.php?option=com_content&view=article&id=60:hpv-vaccine-article-&catid=1:articles&Itemid=18

[Father]

Just found this Indian article from last week.

http://www.dnaindia.com/india/report_cancer-vaccine-programme-suspended-after-4-girls-die_1368681


The Indian Council of Medical Research (ICMR) has told Andhra Pradesh and Gujarat to immediately suspend the cervical cancer control vaccination programme for girls.


The programme was marred by controversy after four deaths and complications among 120 girls were reported after vaccination. The girls complained of stomach disorders, epilepsy, headaches and early menarche. Women activists fear the vaccine may impact the mental health of girls who have shown no signs of distress so far.

[Fellow Traveler]

But wouldn't it be an even greater waste of time to ask about a disease for which we have a vaccine that provides in excess of 95% protection?
You've already done this lap with Gana. I really can't be bothered with it all again.



But a couple of points:

http://www.cancercouncil.com.au/edit...asp?pageid=253

Originally Posted by :
HPV are a group of over 100 different viruses. Some HPV types are more likely to lead to the development of cancer than others. At least 14 types of HPV have been found to cause cancer however the vaccine only protects against two out of the 14.

An important point, most just say there are 100s of types without noting that few are of actual concern, see that in he previous conversation. It is also important to note that while it protects fully against against two types, those two are thought to cause >70% of cancers. It has also been demonstrated that there is partial efficiency against 10 others strains and even as we speak, Merck is testing a broad spectrum version that will cover the remaining strains.



Originally Posted by :
For all other people, the cost of the vaccine is around $460; this does not include the cost of the visit to the GP who must prescribe the vaccine.
Originally Posted by :
Studies are still being conducted on the effectiveness of the vaccine in males. Until such studies have been completed and the results analysed, we do not recommend the vaccine for males.

Isn't 460$ worth the potential protection? On the issue of efficiency in males, this has been demonstrated several tines but let's assume that it hasn't been. If women are protected nearly 100% how would the men then get infected? So even if they ultimately decided not to vaccinate men, it's hard to see why any one would still care about this any more, unless they wanted to promote circumcision for its own sake.



This article was an interesting read.

http://www.purehealthsolutions.com.a...cles&Itemid=18


I don't see what this contributes. I will say that it is interesting to see examinations of this issue where it relates to boys and men. Many say that despite the >90% protection demonstrated, it doesn't seem to be worth the trouble to get the vaccine. Yet when circumcision is discussed in conjunction with HPV, you would think they curred all the ills of the world and it becomes an imperative.



Just found this Indian article from last week.

http://www.dnaindia.com/india/report...ls-die_1368681

Originally Posted by :
The Indian Council of Medical Research (ICMR) has told Andhra Pradesh and Gujarat to immediately suspend the cervical cancer control vaccination programme for girls.
Originally Posted by :
The programme was marred by controversy after four deaths and complications among 120 girls were reported after vaccination. The girls complained of stomach disorders, epilepsy, headaches and early menarche. Women activists fear the vaccine may impact the mental health of girls who have shown no signs of distress so far.

You should have dug deeper (http://toi.timesofindia.indiatimes.com/india/Four-deaths-not-due-to-flawed-cervical-cancer-vaccine-trial/articleshow/5776065.cms).

Director general of Indian Council of Medical Research Dr V M Katoch told TOI on Thursday that he was certain that the four deaths were not due to the vaccine. "It has been confirmed that while two deaths were due to poisoning, one died of drowning and another due to pyrexia of unknown origin," Katoch said.

[Father]

An important point, most just say there are 100s of types without noting that few are of actual concern, see that in he previous conversation. It is also important to note that while it protects fully against against two types, those two are thought to cause >70% of cancers.

So you could say it's only 70% effective against cervical cancer?

Sounds pretty similar to the 60% HIV circumcision number.



Isn't 460$ worth the potential protection?

"Potential". The most commonly floated word when intactivists talk about the benefits of circumcision. See the double standards?


If women are protected nearly 100% how would the men then get infected?

I haven't looked into transmission between homosexuals.



You should have dug deeper.

Yeah. I guess I should have. Thanks for that.

[Father]

It has also been demonstrated that there is partial efficiency against 10 others strains and even as we speak, Merck is testing a broad spectrum version that will cover the remaining strains.


This partial protection is only about 15% right?

Not sure where you are floating these 90-95% protection from cancer figures from. The Gardasil website doesn't say anything like that.

http://www.gardasil.com/

[Fellow Traveler]

So you could say it's only 70% effective against cervical cancer?

Sounds pretty similar to the 60% HIV circumcision number.


Not really primarily because the vaccine provides that protection against those strains no matter how they are acquired. Keep in mind that HPV is very easily communicable, this is why it's so common. For HIV, the 60% figure relates to only a single, and one of the least common modes of transmission.


"Potential". The most commonly floated word when intactivists talk about the benefits of circumcision. See the double standards?

I am not sure I do, you'll have to explain that.



I haven't looked into transmission between homosexuals.

I haven't deeply either but IIRC there is demonstrated efficiency with MSM in the neighborhood of 85%. Though the disease they are primarily concerned with, anal cancer, is very rare.


This partial protection is only about 15% right?It depends on the type. There has been demonstrated (http://www.medscape.com/viewarticle/563089) cross protection for at least 10 additional types starting at about 40%. However, as I noted in the previous thread, Merck has a supplemental broad spectrum (http://www.merck.com/newsroom/news-release-archive/financial/2008_1209.html) (look for V503) vaccine currently in Phase III trials; they expect licensing in 2012.



Not sure where you are floating these 90-95% protection from cancer figures from. The Gardasil website doesn't say anything like that.


Well, here (http://www.medscape.com/viewarticle/563089) against the strains it was designed for. But as we can see its current limitations are set to expand. Which is exactly what I would expect.

[serendipity22]

MummaBear said

There's such a thing as pubic lice???

Its also called crabs. Quite itchy from what ive heard. A similar one is scabies which is caused by mites.

[Opinionated]

This destroys some regular anti-circ comments that are thrown around here. I'm sure Opinionated won't agree with their conclusion.

Actually, being a self reported study, I wouldn't refute it. The vast majority of men were circed as babies. The only function they have ever known is the way they are. The way they see it, there is no problem.

It is people like me that has seen the contrast that could report differently. Seen the circ's that have cut too much, seen the scarring and the areas with loss of sensation.

My ex boyfriend had a circ where too much was taken, had scarring on his glans which affected sensation, insufficient skin to cover his erection which caused bending in one direction. He would report his penis as perfect. After we broke up and I came into contact with men with totally different anatomy, I could recognise how his was damaged and function was affected. Sure, he and I still greatly enjoyed what he had, but uncirced, he would have been absolutely amazing.

So Father, to respond to your assumption, I actually do agree with their conclusion. They conclude that men report no issues due to circumcision. This is not surprising. I have never known a man to admit that their penis was less than perfect, even when it is. (boy could I tell some stories about that;))