Circumcision and AIDS: Harvard Doctors Respond to Criticism

circ.jpg
Could a whole coalition of highly accomplished, super educated doctors and researchers -- the ones who work at and advise the Gates Foundation, the World Health Organization, the American Academy of Pediatrics, and the Harvard School of Public Health -- all be wrong?

Or are their critics hindering them from saving lives?

As described in our recent feature story about circumcision, three studies conducted in
Africa in the past decade generated a whopping amount of press and have been the catalyst for tens of millions of dollars being pumped into campaigns to circumcise African men in an effort to stem the spread of AIDS.  These three randomly controlled clinical trials (the three "African RCTs," as they are sometimes called) were carried out in (I'm linking to the source material here): Uganda, South Africa, and Kenya.

These three famous studies have, in fact, had challenges. John Geisheker, head of an organization called Doctors Opposing Circumcision, says that researchers "did a marvelous job of attracting Gates Foundation money and creating a halo around the organization" and that people are "trying to capitalize on the Africa market. If American medical companies like Allied can get a hold of this money, they can make billions. The Africans don't even realize they're being used like guinea pigs." He said that when he's contacted the Gates Foundation with contradictory research and warned them to slow down, he doesn't even get a response.

The bigwigs in the international health arena have largely ignored criticism and are forging ahead with plans to circumcise 20 million African men by 2015. 

Who's right?

All of the studies and counterstudies on the subject matter are enough to make one's head spin. For those of you interested in going down this rabbit hole, I've linked to the initial studies (above), read through much of the criticism, and contacted people at the Gates Foundation as well as the Harvard School of Public Health to see if they would respond to some of the points made by detractors.

Here is what I found.

First, I contacted the Gates Foundation, but despite the fact that it has invested millions of dollars into this project, I was told that it didn't have anyone who could speak to me about this matter.

Then I contacted Dr. Max Essex, chairman of the Harvard School of Public Health's AIDS Initiative, with the following four questions. I purposely cited articles that have been published rather than link to websites run by anticircumcision activists.

1) The three RCTs say that circumcision reduces risk of HIV infection by 53
to 60 percent.  Critics argue that that is the "relative reduction" as
opposed to the "absolute reduction" and that if the absolute reduction were
used as a comparison, the numbers would be statistically insignificant.
Thoughts? (This article lays out that argument more clearly:
http://www.salem-news.com/fms/pdf/2011-12_JLM-Boyle-Hill.pdf )

2) Education and condoms are far cheaper than circumcision, so why spend
tens of millions of dollars on circumcision rather than direct that money
toward education and condom use? (http://www.icgi.org/Downloads/IAS/McAllister.pdf)

3) Circumcision is sometimes referred to as a "vaccine" (see New York Times
article of January 31 :
http://www.nytimes.com/2012/01/31/health/aids-prevention-inspires-ways-to-simpli
fy-circumcision.html?pagewanted=all
)
Do you find this accurate? Misleading? What is the status of a
vaccine for HIV/AIDS?

4) Some articles have suggested that removing the foreskin prevents HIV
transmission because HIV enters through the Langerhans cells; yet there are
competing articles alleging that the Langerhans cells actually "lap up" the
virus and protect against it. See :
http://www.nature.com/nm/journal/v13/n3/full/nm0307-245.html


Dr. Essex responded: "it seeems to me that male circumcision would be even less expensive than condoms + education.   It only costs 50-75 $ as a one time event.   Hovever the
person in our group who is most knowlegeable on  MC is Dr Rebeca Plank.  I'll cc
heer on this."  [sic]


Dr. Plank then wrote:

"I will defer to Dr. Essex where it comes to prospects for a vaccine against HIV and also about the basic science of Langerhans cells as he knows much more about these topics than I do. I can say, however, that male circumcision is a one-time intervention with life-long benefit. It can be likened to a vaccine in that REDUCES (but does not eliminate) the risk of infection with a particular agent, and also REDUCES the risk of that infection establishing itself in the community (herd immunity), which is one of the public health principles on which all vaccines stand. Male circumcision for HIV prevention is like getting vaccinated PLUS hand-washing, not touching one's face, mask-wearing when appropriate to prevent the flu rather than remaining unvaccinated and trying to rely on hand-washing, not touching one's face, mask-wearing alone to prevent the flu.

As Dr. Essex has indicated, male circumcision is much cheaper than condoms + education (one male circumcision in southern Africa is < U$100 and each condom costs almost U$1.00 -- although circumcised men should still use condoms consistently). The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recently published modeling data that one HIV infection would be averted for every 5-15 men newly circumcised. Compared to other public health interventions male circumcision is extremely effective (please see Nanchen Prev Med. 2011 Feb 1;52(2):159-63. Epub 2010 Dec 3 that estimates 38-92 people would have to be treated for ten years each with cholesterol lowering medicine to prevent one death from heart attack -- and we put a lot of stock in these cholesterol lowering medicines which are much, much more expensive than one circumcision).

http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000109

Another recent publication estimates that to scale-up male circumcision in the areas of Africa that have both 1) very high prevalence rates for HIV and 2) low prevalence rates of male circumcision, it would cost US$2 billion yet would result in net savings (due to averted treatment and care costs) of US$16.51 billion.

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001132

Furthermore, despite the widespread availability of education + condoms in a country like Botswana for years and years, the HIV incidence and prevalence continued to be extraordinarily high, with the most recent statistics (2008) showing that in certain age groups the HIV prevalence rate reaches 40% (in the US the HIV prevalence is < 2%). It can be likened to obesity or diabetes in the US. People know that a salad is better for their health than potato chips or ice cream: salad is widely available as is education about the dangers of obesity, yet education and availability of healthy food have not been able to control the obesity epidemic in our own country. Human behavior isn't easy to understand and it is even harder to control.

Regarding the salem-news article you sent, those at the highest levels of public health science and implementation (WHO and UNAIDS) have reviewed the methodology, statistics and results of the three randomized trials of male circumcision and they are in full support of scale-up of this service as soon as possible. We are already delayed. There is a lot of highly charged and emotional controversy about male circumcision, despite peer-reviewed data from randomized control trials considered the gold standard in clinical medicine, that sadly is impeding scale-up. Men and their female partners are getting infected with HIV unnecessarily. If this were a vaccine that came in a sterile glass vial it would almost certainly be celebrated and not debated."

So there you have it. Why do I have a feeling this debate is not going to end anytime soon?  I'll update if Dr. Essex gets back to me about the Langerhans cells.
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231 comments
frhodes85715
frhodes85715

New studies show that after circumcision, HIV can still enter through mucosa in the urethra, as an UTI, I guess those African men are going to have to have their whole penis excised if they believe any more of these circumstitions.

RicardoD
RicardoD

Dr Plank: "As Dr. Essex has indicated, male circumcision is much cheaper than condoms + education (one male circumcision in southern Africa is < U$100 and each condom costs almost U$1.00 -- although circumcised men should still use condoms consistently)."  Strange reasoning. Money is being taken away from condom education and distribution to finance circumcisions, yet circumcision neither eliminates nor reduces need for condom use. Condoms are $1. each for mass purchases under competitive bidding? Much more corruption here than first meets the eye. Is this Mutt & Jeff show for real? Drs Plank and Essex are experts about what they speak of? Heaven help the men of Africa whose health and lives are put on the line with such antics.

dreamerleoguy
dreamerleoguy


They didn't really "respond to criticism" given that they dodged the question about langerin (since Largenhans cells are the closest thing they have to a biological plausibility and is being disputed), and she also dodged the question about relative risk reduction rather than absolute risk reduction (which is again public data and anyone can review it).

What she did was appeal to authority (WHO, UNAIDS, rcts, gold standard) to give the impression that there was nothing controversial about the rcts, followed by an appeal to emotion. Two logical fallacies and two dodged questions. Way to go Harvard Doctors.

And of course she acknowledges that even circumcised men still need to use condoms, (and circumcised men need to be educated in the fact that they are not immune).

Now, real world data. Zimbabwe has already seen that the HIV infections reported in 2010-2011 were higher among circumcised men. http://www.zimdiaspora.com/index.php?option=com_content&view=article&id=8811:hiv-infection-rate-higher-on-circumcised-men&catid=96:international&Itemid=342

The problem with these doctors is that they made their minds that this was a reason to promote circumcision and are not willing to discuss it rationally.

concernedcynic
concernedcynic

The fundamental problem with the African clinical trials is that they were cut short after 12-18 months. Hence risk compensation (look it up in Wikipedia) cannot be ruled out. Specifically, we cannot rule out that circumcision only delays the inevitable. Also, the circumcised treatment group were given free condoms and anti-AIDS instruction. The intact controls got nothing. Experimental bias anyone? Would this protocol pass muster with a First World ethics committee??

 

African population data are not consistent with circumcision mattering for HIV positivity, and this fact has yet to be explained. Circumcision is at best an odds changer. Fixating on odds changers when game changers exist, namely condoms and fidelity, is highly misleading. As a Kenyan man said to a journalist "if I still have to wear a condom, what's the point with this circumcision business?"

 

Neither randomised clinical trials nor publication in a peer reviewed journal are guarantees of truth. For more on how the African clinical trials were poorly designed and badly executed, see:

http://www.salem-news.com/fms/pdf/2011-12_JLM-Boyle-Hill.pdf

 

The focus in Africa should be unlimited free condoms in every village. Note that Dr Plank wrote "...circumcised men should still use condoms consistently." If First World governments can purchase condoms in bulk for 3 cents apiece, I maintain that this objective is feasible.

 

A number of American investigators involved in the African clinical trials have argued that the African clinical trials are evidence in favour of circumcising Americans at birth; this is blatantly unscientific. During the 1980s and 90s, about a quarter million gay men died of AIDS in those countries. A large majority of those men were circumcised. Circumcision is also completely irrelevant to AIDS resulting from unsterile medical practices and contaminated blood.

 

A committee of European and Australasian epidemiologists should review this controversy.

 

The rest of this comment addresses two assertions by Dr Plank to which I take firm exception. A vaccine that can be administered only once, that would be only partly effective at the outset, whose partial efficacity would fade over 5-10 years, and that would sometimes have a permanent adverse effect on sexual pleasure and functionality for one or both genders, would NOT be celebrated.

 

"The WHO and UNAIDS recently published modeling data that 1 HIV infection would be averted for every 5-15 men newly circumcised."

The outcome of a modelling exercise is NOT data, nor is the "estimated number required to treat." These are only numerical estimates, ones requiring a host of assumptions about the underlying data and model. If the African clinical trials are flawed, the "estimated number required to treat" derived from those trials is equally flawed.

Frank
Frank

Rebeca Plank has received almost half a million dollars to go to Botswana and promote circumcision.  http://search.engrant.com/rese...  How many condoms is that?  She's lying through her teeth that in bulk it would be one dollar a conom, but nevertheless even at that rate it would be half a million condoms.  By the way, I pray that African cultures don't learn about the langerhans cells hypothesis.  Do you know why?  They're all over the labias and clitoris of women!  We're playing with fire and noone even knows.

HNA
HNA

If it were a vaccine that came in a sterile glass vial, it wouldn't be genital mutilation. 

Cheryl
Cheryl

According to an article in 'The Columbus Dispatch' today, circumcision remains enormously popular in the Midwest, particularly in Ohio, which has an 84% circumcision rate.

Zombie Woof
Zombie Woof

Deidrdra it looks like you have hit journalistic pay dirt. You have Dr. Plank saying that condoms cost nearly $1.00 each. There is only two reasons that Dr. Plank would be say something so fabulously false (in bulk for public health clinics condoms cost about 3¢) and both of them should you prompt you to dig further. Either she knows that she is lying or she doesn't know what she's talking about. If she is being actively deceptive, you should work to find out why she is lying. If she is ignorant, you should work to find out how someone in in her position doesn't know how much condoms cost. The extrapolation of this is if Dr. Plank doesn't know how much a condom costs, can we believe anything the experts tell us.

I hope you planning some follow-up on this, because asking people who are being to promote circumcision about circumcision would be like asking Rumsfeld in 2002 if Iraq had weapons of mass destruction.

Kacii Humanrightsactivist Hame
Kacii Humanrightsactivist Hame

Circumcision is a HUMAN RIGHTS issue. It's NOT your body, it's NOT your choice! For those who are pro-choice - how can you say her body her choice but not say the same for boys? For those who are pro-life why is it the child has the right to live but not the right to its own body! Would you circumcise your daughters? All it can be is just removal of the clitoral hood! Except woman have LESS nerve endings than boys! The foreskin is there to PROTECT the penis. Not harm it. When intact, don't retract, only clean what is seen! The foreskin will naturally retract eventually and all you do is rinse with water! Check out The Whole Network on facebook! Drmomma.org. Please get informed! God and Nature do NOT make mistakes!

Shelly
Shelly

Please talk to David Gisselquist, author of Points to Consider, and check out his blog: Don't get Stuck. His recent blogs/articles discuss the real issue of HIV being transmitted non-sexually through contaminated needles and unsafe medical practices. He also dissects the RCT's and points out the flaws including how HIV is actually being transmitted through circumcision. Also, Simon Collery's blogs: HIV in Kenya, discuss many of these same  issues. This is also done in the article by Van Howe and Storms published in the Journal of Public Health in Africa: How the Circumcision Solution in Africa will Increase HIV Infection. Dr. Robert Van Howe is a biostatistician and pediatrician who has published widely on this topic. He was a consultant to the AAP task force on circumcision in 1997 and to the WHO and CDC.  Those organizations are dominated by pro-circ zealots. Also, check out Boyle and Hill in Journal of Law and Medicine on methodological flaws of the African trials. Talk to the Dutch and Finlanders and Swedes (who recently have called for a ban on male circumcision of children through the Swedish pediatric society.) Do some research and get some balance to your articles. The RCT's would never have been allowed in the U.S. for obvious ethical reasons. That is why they were done in Africa. Tuskegee lives! Wawer's study showed an increased transmission of HIV to women by circumcised males, but she did not even step back to consider not advocating in favor of circumcision. This is outrageous, unprofessional, non-evidence based science.  Physicians in the real world do not seriously consider circumcision a "vaccine". That is ridiculous. Does that also mean mastectomies and hysterectomies are vaccines? The excision or amputation of tissue is not a vaccine.

Laura
Laura

I wonder if circumcision will start becoming more common again in certain Western & European countries? The rates were very low for a long time, but in recent years because of the large influx of Muslim immigrants, there are now many circumcision clinics that were not in existence before. One of the things I was reading in the recent articles is that these circumcision clinics in Western countries are not just circumcising Muslim boys, but many non-Muslim boys as well. Many Christians in the UK, Canada & Australia are now having their boys circumcised and it is becoming more popular again.

Roger Desmoulins
Roger Desmoulins

"Human behavior isn't easy to understand andit is even harder to control."

That is why the belief that circumcision will reduce AIDS in Africa is hopelessly naive. If the clinical trials are correct, that means that in eastern and southern Africa, circumcised healthy men are less likely to acquire HIV from A SINGLE ACT OF UNPROTECTED SEX with an infected women than intact men are. What is the likely outcome? Circumcised men will engage more freely in unprotected casual sex! Ruling out this possibility would have required that the clinical trials run for at least 5 years, and better yet for 10 years. But all trials were cut short in as little as 6 months, thus making it impossible to understand what is really going on.

"scale-up male circumcision in theareas of Africa that have both 1) very high prevalence rates for HIV and 2) lowprevalence rates of male circumcision, would cost US$2 billion yet wouldresult in net savings (due to averted treatment and care costs) of US$16.51billion."

$16bn of "savings" are impossible, because African nations simply do not have the money or health care system needed to treat; people with AIDS effectively march to their deaths. The "costs" of circumcision do not include the cost of the occasional botch, and the problems with sexual satisfaction that very gradually emerge over time. The real cost of AIDS is the loss of future income from morbidity and death. The sad truth is that most Africans who die of AIDS are likely to die before age 50 of other causes, and their present value of expected future lifetime income is quite low

Heather
Heather

I saw the article and since I live in Columbus myself, I will try to shed some light on why I believe the rate is so high: ignorance and herd mentality. As the article itself stated, most parents here still circumcise to match Daddy and/or other boys in the locker room. Many parents I have talked to are not even aware that it is an option NOT to circumcise, and the biggest L&D hospital in the area has a policy of trying to coerce parents into it here. I was asked with my oldest son at least 6 times even though I had it in my chart that we would not be circumcising, and I was even erroneously billed for the circumcision. When my second son was born, the resident implied that we could not be discharged from the hospital until he was circumcised. I tried to advise a close friend not to circumcise, and she agreed that there is no reason to do it, but her husband insisted that they "match". I am embarrassed to live in a region that is still so culturally invested in mutilating their babies, but that is still the reality here. My husband is a physician, and we have found that most of his colleagues did not circumcise their sons, so we are hopeful that the trend will change.

I
I

“If the decision was left only to men, fewer babies would be circumcised,” she says. “I think it’s better if I decide.” (Rebeca Plank, circumcising MD and public policy specialist)

"Plank is studying the feasibility of a large-scale infant circumcision program in Botswana. She believes that infant circumcision is the next sensible step in the fight against AIDS in this part of the world."

“The moms, in the end, just have the baby circumcised and inform their partner later,” says Rebeca Plank.

Shelly
Shelly

Can you use proper sentence structure and english please?

I
I

"Many professionals have criticized the studies claiming that circumcision reduces HIV transmission. They have various flaws. The absolute rate of HIV transmission reduction is only 1.3%, not the claimed 60%. Authorities that cite the studies have other agendas including political and financial. Circumcision causes physical, sexual, and psychological harm. This harm is ignored by circumcision advocates. Other methods to prevent HIV transmission (e.g., condoms and sterilizing medical instruments) are much more effective, much cheaper, and much less invasive." (Ronald Goldman, PhD, author of Circumcision: The Hidden Trauma.)

Erica
Erica

Women should not be doing circumcisions.  One of the things I have always found very contradictory and hypocritical is hearing about female doctors circumcising boys.  At a time when we are trying to teach men & boys to respect the bodily integrity of women, we have female doctors (and some female mohels) thinking it's fine to circumcise boys.  What type of message does this send?

Hugh x
Hugh x

 Of course the circumcision clinics talk up the number of customers they have. Since there is no good reason for doing it, the only thing they can do to build custom is get people to think it's fashionable and they should go with the crowd.

rickyB
rickyB

There is a lot of pro-circumcision literature out there that always says Europe is "finally coming around." It is not true, never was. Muslim circumcision of boys in Europe is extremely controversial, causing revulsion and disgust among the indigenous population forced to coexist with its existence. Finland has a law against it, and is now considering an update as a judge has read into it a "religious exemption." In Sweden and Netherlands the medical associations are urging laws to prohibit it (they are "fixing" the botches they did not cause; in US doctors fix their own botches and cover up what happened). When Dr Edgar Schoen wrote letters to medical assn journals in Europe, he got blistering responses from the membership there, in effect telling him to keep his US preference for mutilating boys' penises in the US. So the old lie comes back around in new clothes: "Europe is now circumcising. Europe is now circumcised. Now everyone MUST circumcise." Sorry, that dog won't hunt. Won't bark either. But he will lick his delicious, non-mutilated genitals. Dogs are humankind's best friend. We can learn a lot from them.

SteveB954
SteveB954

Many people are starting to recognize male genital cutting of children as a violation of a man's basic human rights. Every person has a right to decide what permanent body modifications are done to his or her own body.

TomTobin
TomTobin

Then why are the rates dropping like a rock in Canada, Australia, and the UK?How many Christians do you know, who take their kids to a Muslim holy man for their circumcision?The circumcision rate has dropped so low in the US, that the medical societies are circling the wagons, and pumping out an amazing number of uninformative, just-do-it kinds of articles.  I know that Johns Hopkins has Drs. Gray and Tobian putting out cheerleading papers, which the press delights in publicizing.  This is a sure sign that cash flow is down.  It's a little sickening to watch.  The medical equivalent of big tobacco's Joe Camel campaign, when too many people started quitting, and they needed some younger smokers.It doesn't take a lot to see that circumcision is a hoax.  How can you read this article, with one Harvard person pointing to another, and the other person pointing back, and believe what they say.  Circumcision is not a vaccine.  It does not prevent HIV. If it did, the US and Ethiopia would be AIDS-free.  Instead, they have some of the highest HIV infection rates in the world.  The US' infection rate is 10 times that of France or Denmark, two countries where routine infant circumcision is non-existent.Tell me, Laura, should girls be circumcised?  I hear it's pretty popular, in some Muslim countries.  Or is it just male genitals for which you favor surgery?  Why?

Joseph Lewis
Joseph Lewis

You sound a lot like a certain Australian circumcision advocate that says exactly this same thing.

'Fraid not very many Western/European countries are buying the circumcision crock. Outside of the US, it's usually only Muslims and/or Jewish families that get their children circumcised.

Regarding the influx of Muslim immigrants, according to the news, in a lot of Western/European country there is a *resistance* by doctors, to demands that they should circumcise children to appease these immigrants. Circumcision clinics are usually run by Muslims or Jews who perform, you guessed it, circumcision for Muslims and Jews.

Where precisely did you read that non-Jewish/Muslim boys were being circumcised and circumcision was "on the rise?" Cir cl is t? Cir cin fo maybe? Check your sources. That's not happening any time soon, except in the minds of disgusting circumcision fetishists.

TomTobin
TomTobin

It's actually worse than that.  In Southern Malawi, the newly circumcised Muslim boys are encouraged socially to go out and have sex (unprotected), before they are fully healed.Their HIV infection rate is considerably higher than that of their uncircumcised countrymen of the same age.You see the same kinds of behavior in other countries.

Hugh x
Hugh x

 I wonder if you mean, "Would you please use proper English sentence-structure?"

Shelly
Shelly

If you are implying that I perform circumcisions, let me state that I do not do them. I was trained in residency to do them. I quit after residency and am a strong advocate against circumcision male or female. Regarding medical care, I do not believe that males are unable to care for females or vice versa, as long as they are providing actual needed medical care. I strongly object to infant circumcision being performed by any physician because it is not truly medical care. That is what bothered me in residency and made me stop. No male physician should do infant circumcision either.

Laura
Laura

They aren't building up the numbers.  Many circumcision clinics which have been established initially to serve Muslim parents end up attracting many non-Muslim (eg. Christian) parents who have had trouble accessing circumcision in the past on the NHS etc.  There have been numerous articles written by journalists who have gone to these clinics and observed this trend in person.  They have written that many of these clinics, whether in the UK, Australia or Canada, are circumcising more Christian boys now than they are Muslim boys.  There are about a dozen circumcision clinics in London alone.

Craig
Craig

I don't think people are saying that Europe is going to engage in mass circumcisions.  I don't think it's going to become as popular there as it is in America.  What people are saying is that there are now many circumcision clinics in the Western countries that were set up to circumcise Muslim boys, and that they are also attracting many Christian clients.  There are about a dozen circumcision clinics in the UK alone, several in Australia and several in Canada.  Dr. Malik's circumcision clinic in London circumcises many Christian boys, as does Neil Pollock's clinic in Vancouver, and Dr. Jesin's clinic in Toronto.

Craig
Craig

I'm not sure how legally sustainable your argument is.  I don't think people are going to allow you to outlaw male circumcision.

Cheryl
Cheryl

While the majority of Christians in the UK, Canada & Australia do not circumcise, in recent years, there has been a small reversal of this trend.  Because of the large influx of Muslims to the Western countries, there are now many circumcision clinics in England, Canada & Australia that were not in existence a decade ago.  These clinics are not just circumcising Muslim boys - they are circumcising large numbers of non-Muslim (eg. Christian) boys.  Many Christians today are deciding to have their boys circumcised at the new circumcision clinics that have sprung up, and the practice of 'holistic circumcision' whereby Christians have their boys circumcised in a ceremony by a mohel, is also increasing.

Cheryl
Cheryl

Isn't pre-marital sex discouraged in the Muslim religion?

Erica
Erica

I agree that men shouldn't be circumcising boys either.  My point is that I think it's even more hypocritical for women doctors to be circumcising boys since the whole point of the gender equality movement was that the sexes should be treated equally and that men & boys were taught to respect a female's bodily integrity.  We expect male doctors to be guilty of bodily integrity violations because they have a history of that.  I was hoping that female doctors would know better, and yet when I research this topic, I see many women doctors advocating and performing circumcisions.

Hugh x
Hugh x

Laura, please give some source for this information. My search could find only about four circumcision clinics in London. A dedicated circumcision clinic must do at least 700 circumcisions/year (one in the morning, one in the aftternoon) to stay open every weekday, let alone show a profit. For a dozen, that's 8,400/yr. London has a population of 7.5M and a birth rate of 24.5/1000, or 91,800 male births/year. Do you really think the circumcision rate (in dedicated London clinics alone) is 11%? It would need to be more than twice that for the clinics to stay in business.

There is no reason Christian parents in non-circumcising countries might be seeking out circumcision. St Paul says (Gal 5:2) "...if you become circumcised, Christ is of no value to you." A recent poll in the UK found that of the 54% of the population who put "Christian" in the census, only a small minority ever went to church, prayed, believed any of the basic Christian teachings, read the bible or even knew the name of the first book of the New Testament given four to choose from - they ticked "Christian" because they had been christened.

Don't believe everything "they have written".

Hugh x
Hugh x

 My reply to Laura above applies to Craig also. They both appear to be reading the same beat-up articles.

Craig
Craig

RickyB, I will try to explain it again.  Up until recent years, circumcision was not very common in the European countries among non-Jews/non-Muslims.  It wasn't paid for by NHS systems, and it was hard to provide doctors and hospitals willing to do it.  This has changed in the past decade.  With the large number of Muslims immigrants to countries like the UK and Australia, and also places like Canada, there are now circumcision clinics that were not there before.  

As the non-Muslim/non-Jewish populations in these areas began to learn that it was now possible to get boys circumcised at a clinic, those who had previously been unable to do so at the NHS or in regular hospitals, began to take the opportunity to do so.  Many of these clinics originally had predominantly Muslim clientele, but several articles and journalists covering these stories and who went to research the clinics in question, learned that these clinics are now circumcising large numbers of indigenous (eg. Christian) boys.  Who brings them there?  Their parents, obviously.  The articles quote parents who chose to have it done, and quote statistics that some of these places are doing more Christian circumcisions than they are Muslim or Jewish (since obviously Christians are in the majority in the West).  As I previously mentioned, there are now many, many circumcision clinics in the UK, and there are several in Australia and Canada as well.  

There are also several articles you can find that discuss the popularity in the U.S. of non-Jews having their boys circumcised by mohels.  There is not just one, but many mohels who do 'holistic circumcision' (their words, not mine).  There is Cantor Sherman in New York, as well as Cantor Kushner (Pennsylvania?) and Rabbi Rovinsky in Texas.  Rabbi Malka also does it.  So does Rabbi Karesh (Chicago).  And as mohel Joel Shoulston says, the large majority of mohels have non-Jewish clients anyway.

Tom Tobin
Tom Tobin

As long as you brought him up, let's talk about Neil Pollock.Here is a court challenge.  http://www.courtchallenge.com/...And here is some marketing, from when he visited Africa.  http://www.marketwire.com/pres..."When a relatively simple and painless procedure exists that can so dramatically reduce one's chances of contracting AIDS, it seemed tragic that the local doctors in Rwanda were not properly trained to use it," said Pollock. "This was, by far, the most meaningful week I have spent in surgery in my life and I am so grateful to have been given this opportunity to join forces with the BCCDC, FHI and their amazing team." Gee, Doctor, why was performing penile reduction surgery on huge numbers of men the most meaningful week in your life?  What were you doing with your other hand?Not to put salt in the wound, so to speak, he used a Mogen clamp, described as "a virtually painless and bloodless method which takes less than a minute to perform."Sounds so nice, doesn't it?  Not according to these lawyers.The Mogen is no longer manufactured by one company because they were sued out of business.  Children were losing the entire head, or large chunks of it.http://www.ajc.com/news/nation... Family wins $11 million in Atlanta, for head amputation.http://articles.latimes.com/20... kid maimed for life in Los Angeleshttp://ilawyersource.com/blog/... Besides, in case no one noticed, every circumcision clamp is less painful and more bloodless than the last.  There's no marketing campaign without that.

rickyB
rickyB

Not asking you to do research for me. Asking you to substantiate wild allegations you are making about Muslim circumcision clinics circumcising large numbers of Christian boys. How do those boys get there? Who brings them? Do they want to be there? Do they want to have 30% to 50% of the epithelial tissue of their penises cut off? Is anyone asking them? Who determines whether they are Christian? Really, these are important issues that need to be addressed. Even in Lebanon and Palestine, where Christians and Muslims live in the same neighborhoods, and Muslims tend to be in the majority, there is no such circumcising of Christian boys by Muslim clinics or other practitioners of Muslim circumcision. Yet most Middle East Christians are NOT circumcised . . . only the Copts in Egypt do it. In view of these realities, I find your assertions about Muslims circumcising large numbers of Christian boys in Europe to be doubtful.

Craig
Craig

It's not my job to do all your research for you, and how are we supposed to find private auditing information anyway?  I cited specific cities and clinics.  If only Jewish & Muslim parents are having their boys circumcised, then why are there so many circumcision clinics in Canada, the UK & Australia that are circumcising non-Jewish boys?  Journalists and stories covering these clinics say that some of them circumcise more Christian boys than they do Muslim or Jewish.

rickyB
rickyB

You pass to me alleged events as provided to you by the websites of the clinics in question. Now really, how reliable do you believe such data are? Precise numbers please, when we are having a discussion such as this one about specific places, and alleged events that are against the cultural grain in the places described, and eminently unlikely to be the case. Preferably numbers from an independent polling service or a CPA who has audited the records at those clinics. Get my drift? Sort of a CU type approach to advertising claims from those clinics . . . let's be sure before we foist them onto an unsuspecting public.

frhodes85715
frhodes85715

@Craig Legal prohibition against infant circumcision will be passed by specific wording, separating forced unnecessary ritual, witchdoctor, religious, and routine infant circumcision or on minors, from medically necessary circumcision. Doctors are beginning to be sued for malpractice, negligence and misconduct, for this human rights violation, a sacrificial punishment based on negligence/ignorance and bad sexual practices, resulting in higher malpractice insurance policy costs.

Hugh x
Hugh x

 An age restiction on male genital cutting will (eventually) be passed by exactly the same mechanism that an outright ban on any female genital cutting was passed. (In some jurisdictions, including my own, an adult woman may not even consent to her own cutting - apparently this is to protect her from coercion. Nobody has suggested this for males.)

According to lawyer Peter Adler, male genital cutting should already be considered illegal wiithout any change in the law. Many Chrisians want the right to thrash their children black and blue if they think they need to, too, but the law doesn't let them.

Tom Tobin
Tom Tobin

And if you don't think rickyB is telling the truth, consider this little piece of charity from the author of one of the three major, unfinished African studies which 'proved' that circumcision prevents HIV, Dr. Bailey.“We’re hacking away at it every month,” Dr. Bailey said. “Those foreskins are flying.” This is from a New York Times article.  http://www.nytimes.com/2011/09...Can you imagine your doctor talking about your body that way to someone else?The article itself is a master class in pro-circumcision bias in the media.Dr, Robert Bailey isn't even a medical doctor, but he can say this, just the same as the Harvard doctors above:“With drugs, you have to get people to take a pill,” which may cause side effects or require increasing doses, said Robert Bailey, an epidemiologist at the University of Illinois at Chicago, who helped design Kenya’s circumcision efforts. “Even if we had a vaccine, we’re probably going to need a booster. With circumcision, you don’t need a booster.” No discussion about, if they come out with a real vaccine tomorrow, all those people who had 60% of the nerves of their genitals removed are pretty much out of luck.No mention that condoms actually prevent disease at a much better rate than circumcision, which has not been shown to prevent a single disease.

Hugh x
Hugh x

 Not today, not tomorrow, but eventually. And not "outlaw" - only age-restrict until a person is able to give informed consent on his own behalf. Why not? As matters stand the infant male foreskin is the ONLY normal, healthy, integral, functional, non-renewable body part that anyone can have cut of anyone else's body at their whim. It's just a tiny loophole in the law that will be closed sooner or later.

Craig
Craig

How will such a legal prohibition be passed?  And how would it withstand legal scrutiny?  The medical associations will not support it, and I don't think the politicians will support it.  Usually most politicians won't even touch this subject.  I didn't see any of them voting against the pro-circumcision bill in California last year.  And many Christians will want the right to circumcise their boys if they think they need to.

rickyB
rickyB

Jehovah's Witnesses are no longer allowed to prevent their children from getting blood transfusions when needed. Christian Science parents can no longer withhold medical care from their dying children, in favor of only prayer for their cures. Appalachian Snake handling sects can no longer involve their children in their death defying rituals. It's a matter of religious belief versus religious practice, but restricting practice only to the extent that it involves children. Once at an age of legal consent, the children can then participate in becoming a martyr for the faith, but not before, not because their parents want them to "be together" in perversion of religion, or together in heaven. No Jews, no Muslims stood up for those sects when their "freedom of religion" was being "attacked." Once society recognizes circumcision for what it really is, we will see restrictions placed on exposure of children to death and dismemberment through circumcision, religious or not. Of course, adults will still be free to expose themselves to such risks any time they wish to do so. It's not about restricting religion, it's about protecting children, obtaining for children their full rights under the constitution, to live long enough to decide for themselves what religion they wish to follow.

SteveB954
SteveB954

I am confident that it will be illegal for doctors to cut the genitals of healthy non-Muslim and non-Jewish boys in the future. The fact that Muslims and Jews believe male circumcision is a religious requirement is not a good reason for society to fail to protect non-Muslim and non-Jewish boys for unnecessary and harmful genital cutting.

rickyB
rickyB

Human rights and civil rights never win with popular votes. Don't forget that we had slavery in the US until 1865, racial segregation until almost the end of 20th century. In the US we've only just begun to enforce laws that have long prohibited child sexual abuse, the same laws that also already prohibit what happens during infant/child circumcisions. It will take a few more years, but once the circumcision rate in US has dropped to the levels of Australia and Canada (two one-time Anglophone bastions of male, infant, sexual mutilation remaining after UK and NZ quit cold turkey by the mid 1950s) which is around 10% to 15% now, you will see a huge change in the public perception of what circumcision really is. That's why US "scientists" are hyping their "vaccine" in Africa; they don't care that they will cause millions of deaths with the delusion that circumcision prevents and cures AIDS; their mission is to bring back to the US "evidence" to increase the circumcision rate here, before it gets so low circumcision loses its social cachet.

Hugh x
Hugh x

 Actually, who is to say whether circumcision is or is not "holistic". The word once meant something, but is now just New Age blather. Strictly speaking, "holistic circumcision" would take the whole penis, as in the case of David Reimer.

SteveB954
SteveB954

Please cite a reliable source to support your claims.

Is "holistic male circumcision" like "holistic female circumcision"? Cutting the genitals of a child is never "holistic". Genital cutting is a violation of the child's right to bodily autonomy.

rickyB
rickyB

Circumcision is NEVER, EVER holistic. That is hype from one mohel, stated at his website selling circumcision to anyone who will pay him a fee for it, advertising hype designed to delude the unaware. Circumcision is an invasive surgical procedure. It is brutal and violent. It is a modern day continuation of an ancient, prehistoric blood ritual from the ancient Middle East. It destroys healthy tissue and body parts. It disrupts normal body functioning and causes social and psychic dysfunction in many of its victims. It is absolutely the very antithesis of holism. I am hurt and offended to have your personal preference for child genital cutting slung in my face as I struggle to cope with the mutilation inflicted on my body when I was a day or two old; I am absolutely outraged that you believe I am so stupid as to fall for such drivel about circumcision being holistic.

And there is no "reversal" of non-circumcision trends in Anglophone cultures, no reversal of Europe's millenia of disdain for circumcision and abstention from it. Would you be so kind and so honest as to provide references to the sources for your assertion that Muslim clinics are "circumcising large numbers of . . . (Christian) boys"? You've made the same assertion in another nearby post, and I've given you a more thorough answer there.

rickyB
rickyB

Not sure which culture Tom Tobin is referring to. I have read of one African culture that is NOT Muslim that does what Tom describes. Islam is widespread over parts of sub-Saharan Africa, but it is not overarching in its presence and prevalence. That said, premarital sex is more discouraged of Muslim women than it is of Muslim men, who often cavort with "loose" women of nearby non-Muslim cultures, sometimes becoming infected with HIV (despite their circumcised status). Away from Africa, the border towns of Southern Thailand are prosperous because of sex tourism from Malaysian Muslims who travel there in organized tours.

There are also NO GAY MEN in any Islamic culture, or so they say. Ain't that special? God just does not make any men gay in that religion! But no one has explained why gay Muslim men are often found dead after a family member does an honor killing on them. Oh well, just another ancient Middle East way of dealing with those who deviate from societal expectations . . . sort of an analog to the tribal marking that is circumcision, which may or may not result in a death, God willing.

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