Circumsicing Babies

   The focus of this blog has included the application of research to real life and evaluating headlines that are in response to research.  In other words, the "truthiness" of those headlines.
   The American Academy of Pediatrics confirmed its stance and recommendation for male infant circumcision today.  The rationale behind the recommendation is that there are lower rates of certain infections amongst males who have had the procedure.  The outcome that shows a greater difference between circumcised and uncircumcised boys is urinary tract infections.  UTI rate also seems to have the most evidence behind it- it has been studied the longest. Other outcomes that researchers associate with lack of circumcision are HIV, HPV, cancer, and sexually transmitted infections in general.  (associated  meaning the outcomes are higher in one group than the other)
   If I had a male child I would have him circumcised, but not because I believe that it prevents sexually transmitted diseases.  I believe that it may reduce infections in general and to tell you the honest truth - my decision is also aesthetic.
   This morning I heard someone make an argument for circumcision as an HIV prevention strategy using the results of the change in HIV rates in African men, living in African countries who are circumcised as adults.  The person who was using this evidence to support circumcision in infant American boys was challenged.  Can you see why?  How are these two groups similar?  They are not.  The results from the adult study in another country does not translate to these boys.  Even if it makes biological sense, you can't extrapolate to such a different context.
   Another point made in the discussion was that the rate of circumcision in the UK is much lower than that in the USA and UK men HIV is lower in the UK.  This was countered by another who said that the number of new cases was much higher in the UK - or the rate vs the prevalence (chronically ill vs newly ill).  Again - the two groups are not the same and a comparison is suspect. (what else protects against HIV?  Maybe UK men have less sex?  Maybe many are HIV and undiagnosed?  Who knows, but you can't show cause and effect either way.)
  My biggest issue however, is when any of them try to say that circumcision prevents the "disease in question" or that not being circumcised causes it.  The only way to claim that direct link is to have some boys circumsized and others not and then make sure that they are exposed to the same conditions and risks throughout their lives and see if one groups gets more diseases than the others.  That has not been done and it will not be done.
   I imagine that instead, most of these studies are looking at the characteristics of men with a disease.  To determine what those characteristics are, they have to ask questions - either of the men, their physicians or their partners. Or some combination. Whether or not they have been circumcised is observable but the number of sexual partners, the use of condoms with partners, consistent or occasional use of condoms, the risk behaviors of the people the men have sex with... all of those things have to be considered and all of those things have certain biases.  For example, a person might not remember, might not know, or might not want to say.  But, what if boys who are not circumcised have different kinds of sexual partners/experiences on average than the circumcised boys/men do? With all of these things impacting the risk of getting sick, how can one say that circumcision is the determinant?  Maybe a question to ask is whether or not condoms are more or less protective based on circumcision status.
    I am not at all speaking out against the procedure - just the use of studies to make a link between the penis status and the diseases.  I am especially suspect of the circumcision - HPV link.  
   Today I heard someone say that HPV causes penile cancer (they were claiming that circumcision prevents HPV and thus can prevent penile cancer).   That got a reaction from me! I feel certain that if HPV caused a cancer in men Merck (drug company with the HPV vaccine) would be all over it.  Unless of course,  the association is real but the actual cancer incidence is extremely low. 
   I have not reviewed any of the studies, my main point is that there is a great deal to consider and just because someone says it on the radio, doesn't make it true.
   Here is a link to the actual statement from the pediatric organization as published in their leading journal.