Science Based Medicine?

iVillage Member
Registered: 06-16-2009
Science Based Medicine?
17
Mon, 02-08-2010 - 6:04am

Hello. I lurk many of the debate boards here and post at a few.  Please forgive me if I end up being a fly by poster. Anyway, to my point.  I read quite frequently on a website called science based medicine and I came across this article and thought I would post it and see what the response would be. The author is an OB GYN. If you visit the link you can read the commented response (of which at this post was numbered nearly 650) if that is something you are interested in. 


http://www.sciencebasedmedicine.org/?p=3310


The case for neonatal circumcision


Imagine if we could save lives from a dread and often fatal disease simply by performing a minor surgical procedure. People would hail this simple victory and rush to adopt it… Not exactly. The disease is HIV and the simple surgical procedure is circumcision and anti-circ activists oppose it under almost any circumstances.


In this month’s edition of the Archives of Pediatrics and Adolescent Medicine, Tobian, Gray and Quinn present a compelling case for neonatal circumcision. The paper is entitled Male Circumcision for the Prevention of Acquisition and Transmission of Sexually Transmitted Infections. The authors report:



The American Academy of Pediatrics (AAP) male circumcision policy states that while there are potential medical benefits of newborn male circumcision, the data are insufficient to recommend routine neonatal circumcision. Since 2005, however, 3 randomized trials have evaluated male circumcision for prevention of sexually transmitted infections. The trials found that circumcision decreases human immunodeficiency virus acquisition by 53% to 60%, herpes simplex virus type 2 acquisition by 28% to 34%, and human papillomavirus prevalence by 32% to 35% in men. Among female partners of circumcised men, bacterial vaginosis was reduced by 40%, and Trichomonas vaginalis infection was reduced by 48%. Genital ulcer disease was also reduced among males and their female partners. These findings are also supported by observational studies conducted in the United States. The AAP policy has a major impact on neonatal circumcision in the United States. This review evaluates the recent data that support revision of the AAP policy to fully reflect the evidence of long-term health benefits of male circumcision.


The AAP had long recommended male circumcision for prevention of urinary tract infections in young boys, but backed down in 1999, partly in response to pressure from anti-circumcision activists. According to circumcision.org:



Based on a review of medical and psychological literature and our own research and experience, we conclude that circumcision causes serious, generally unrecognized harm and is not advisable.



Anti-circ activists have employed inflammatory language to express their opinion. Circumcision is “mutilation” and parents who choose to circumcise their sons are “mutilators”. But the benefits of circumcision are real and clinically important. As Tobian, et al. explain:




The biological mechanisms whereby circumcision could reduce viral STIs may be due to anatomic and/or cellular factors. The foreskin is retracted over the shaft during intercourse and this exposes the preputial mucosa to vaginal and cervical fluids.61 It has been hypothesized that viral infections may enter the mucosa through microtears in the preputial mucosa. The moist subpreputial cavity may also provide a favorable environment for viral survival. The inner mucosa of the foreskin is lightly keratinized compared with the epithelium of the shaft, coronal sulcus, and glans, which may facilitate mucosal access of HIV, HSV-2, or HPV. The mucosa of the foreskin also contains a high density of dendritic (Langerhans) cells, macrophages, and CD4_ T cells, which are all targets of HIV …


Anti-circ activists are convinced that circumcision reduces sexual satisfaction. Until recently, it was difficult to study that claim because very few men were circumcised after becoming sexually active, making it almost impossible to determine the sensory effect of circumcision. But recent studies make it clear that sexual satisfaction is not affect by circumcision:



… here were no reported differences in sexual satisfaction in the randomized study arms in either the Ugandan or Kenyan male circumcision trials or among men before and after they were circumcised. In addition, it has been hypothesized that behavioral disinhibition may counteract any protective effects of male circumcision. However, there was no consistent or substantial evidence of change in sexual behavior after circumcision in the Kenyan or Ugandan randomized controlled trials.


Tobian et al. call on the AAP to revise its policy to reflect the latest scientific evidence:



The World Health Organization/Joint United Nations Program on HIV/AIDS has concluded that “the research evidence that male circumcision is efficacious in reducing sexual transmission of HIV from women to men is compelling … and has been proven beyond reasonable doubt.” In 2007, the American Urological Association revised their policy to state that “circumcision should be presented as an option for health benefits.” However, the AAP, American College of Obstetricians and Gynecologists, and American Medical Association are likely to have the greatest influence on parental decisions and insurance coverage for neonatal circumcision in the United States. With the mounting evidence that male circumcision decreases viral STIs, genital ulcer disease, and penile inflammatory disorders in men, and bacterial vaginosis, T vaginalis infection, and genital ulcer disease in their female partners, it is time for the AAP policy to fully reflect these current data.


The AAP should heed the authors’ call.

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iVillage Member
Registered: 03-15-2005
Mon, 02-08-2010 - 8:59am

Sadly, the doctor's opinions are not based in science.


Want to know what is more effective than anything at all?

KristiHannahPiperJackson1.jpg picture by itsirkmr


"Belief is not required.  Once you know this story

iVillage Member
Registered: 12-30-2006
Mon, 02-08-2010 - 9:25am

This article was written in a condescending tone that turned me off immediately. I think many of the comments address it very well, pointing out unsubstantiated claims and a definite lack of respect for "anti-circ's" (any one who believes circumcision to be trampling on a baby's rights). Looking over the blog archives this should come as no surprise, as she is rabidly pro-western medicine and anti-alternative health care,

Keep in mind this is a blog. Not a scientific journal. It is simply this woman's opinions which she then argues by finding studies that support them! You know what? Anyone can do that and support any idea the want.

--Wendy
iVillage Member
Registered: 04-27-2009
Mon, 02-08-2010 - 10:57am

".....Keep in mind this is a blog. Not a scientific journal. It is simply this woman's opinions which she then argues by finding studies that support them! ...."


Yes, I noticed that after a while. Initially it appears to have "the look" of a scientific journal, but on further scrutiny it is just a blog.



"...Looking over the blog archives this should come as no surprise, as she is rabidly pro-western medicine and anti-alternative health care...."


True again. I looked her up and she has her own page called the Skeptical OB or something like that and yes, don't get near there if you like your food organic or if, say, acupuncture ever worked for you.



"....I think many of the comments address it very well, pointing out unsubstantiated claims and a definite lack of respect for "anti-circ's" (any one who believes circumcision to be trampling on a baby's rights)..."


Yes, in fact she actually got in to respond to comments herself, and she comes out as just a pro-circ supporter with the usual arguments. At one point, she derailed (I believe deliberately) the conversation towards the Judaism requirement for circumcision, and away from the discussion of the actual issues on circumcision.


And again, as in the case of the radio conversation to which Christopher linked in another thread, I did not read her, or anybody else for that matter, addressing the simple question of how come it is only in the USA that circumcision is performed in a medical setting under the rationale of "medical benefits".


I guess I will never see a simple answer to that question from any circumcision supporter (other than "what is the point of your question?").


Regards,


Federico

iVillage Member
Registered: 01-29-2004
Mon, 02-08-2010 - 12:16pm

LOL Oh, I've seen Amy on the web before, she's the anti-breastfeeding doctor. She's convinced that all the "science" about the risks of formula is also wrong, and that it's just "anti-formula" propaganda, just like she's trying to do here with her "anti-circ activists" crap. She is willing to dismiss the thousands of studies that show risks for these two subjects in favor of pushing her own personal agenda. Sorry, but I don't give her OPINION much credence.

Stephanie
mom to seven sensational kids!!!

iVillage Member
Registered: 04-27-2009
Mon, 02-08-2010 - 9:51pm

"....LOL Oh, I've seen Amy on the web before, she's the anti-breastfeeding doctor. She's convinced that all the "science" about the risks of formula is also wrong, and that it's just "anti-formula" propaganda, just like she's trying to do here with her "anti-circ activists" crap...."

Actually, the funnier part is that she is part of this Science blog of sorts, so she has her own platform for her views.

And yet, I guess she cannot control the posters or their comments. As more and more people called her on her "science", she attempted to derail the debate away from circumcision and towards Judaism (maybe hoping for somebody to say something harsh so that she could play the religious/anti-semitism card?) and when that didn't work, she pulled out of her own debate and stopped answering altogether.

Makes you wonder about American M.Ds willingness to honestly discuss this issue, when they even chicken out in their very own blogs....

Regards,
Federico

iVillage Member
Registered: 06-16-2009
Tue, 02-09-2010 - 3:42am
Oh, believe me, I am well versed in the differences between blogs and scientific literature. Reading SBM is actually a guilty pleasure of mine, purely for entertainment purposes. I guess I like to stay objective by subjecting myself to the

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iVillage Member
Registered: 05-02-2006
Tue, 02-09-2010 - 2:58pm

Sorry, but as soon as I saw that it was written by Amy Tuteur, it lost all credentials in my opinion.

2010 Siggy
iVillage Member
Registered: 06-16-2009
Tue, 02-09-2010 - 6:03pm
Is circumcision considered mainstream? I thought the numbers were fairly equal nowadays in the US with the exception of perhaps the midwest. Perhaps I live in my own little bubble on this topic. I do not consider this a parenting choice.

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iVillage Member
Registered: 12-17-2007
Tue, 02-09-2010 - 7:31pm
Circumcision of infants is still considered mainstream in the minds of many in the USA. The latest
iVillage Member
Registered: 08-07-2008
Tue, 02-09-2010 - 7:51pm
I contributed fairly heavily to that thread.

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