Talk:Medical analysis of circumcision/Archive 1

message: Even though the article is disputed, having read it in full, I would say that it reflects current medical thinking. Where is the bias? --Dumbo1 14:34, 20 Sep 2004 (UTC)
thread_title:  Looks ok to me 

message: Please indent your comment on the next indentation level respectively using a ":" before the paragraph. The disputed paragraph is always on the first level in italics.
Recent studies from Europe demonstrate the prevalence of balanitis and phimosis due to the low rate of circumcision. 
: This phrasing is not neutral. First, it generalizes studies with conflicting data. Second, as I have already explained, phimosis is a condition of the foreskin -- it is obvious that it will all but disappear with routine neonatal circumcision.—Eloquence
Doctors at Royal Liverpool Children’s Hospital diagnosed over 100 cases (a 4% rate) of balanitis in a 3 ½ year survey of English boys. (Source: Escala JM, Rickwood AMK. Balanitis. Brit J Urol 1989;63:196-197).
: This is now summarized under the heading "Balanitis".—Eloquence
Doctors from the Children’s Hospital, Sheffield found a prevlance of phimosis among uncircumcised English boys. (Source: Rickwood AMK, Hemalatha V, Batcup G, Spitz L. Phimosis in Boys. Brit J Urol 1980;52:147-150).
: Not only is this duplicated, it is also wrong. The study, which can be found here, examines 23 boys suffering from phimosis to determine the actual pathology of the condition. It makes no claims of frequency whatsoever. Instead it states that, "The findings of a previous survey (Rickwood, 1977) confirm that phimosis in the pathological sense is rarely seen in pre-school boys. Its aetiology remains obscure." Rickwood at al. have repeatedly criticized routine circumcision, including in their 1980 paper, as a method to prevent phimosis. But this study is of no relevance at all to the circumcision question -- it is only relevant to the aetiology of phimosis.—Eloquence
From the quoted study abstract:
All patients with Zoon balanitis, bowenoid papulosis, and nonspecific balanoposthitis were uncircumcised. Lichen sclerosus was diagnosed in only 1 circumcised patient. Most patients with psoriasis, lichenplanus, and seborrheic eczema (72%, 69%, and 72%, respectively) were uncircumcised at presentation. The majority of men with penile infections (84%) were uncircumcised.
: While this is interesting data, it is only relevant when related to the sociodemographic data of the community. What is the circumcision rate in the area of referral? We know that the majority of men in the UK are uncircumcised by now, so it should not be surprising that the majority of men with penile infections are uncircumcised. The study works with a control group to obtain its odds ratio, but the data above does not work with the control group. Only the actual odds ratio is statistically relevant, and the abstract does not show if they examined confounding variables like genital washing habits, sociodemographic status, sexual behavior etc. -- which is all different depending on circumcision status. I'll say this many times so you remember it: Circumcision is not performed randomly. If you examine circumcision status, you always have to examine for tons of confounding variables. I can't really judge the scientific value of the study without looking at it, but they want 12 dollars for the DRM protected full text. If you have a copy of the full text, let me know.—Eloquence
A study conducted in Denmark examined 9,545 Danish boys between 6 and 17 years of age, and found that 4% had phimosis, (incidence of 8% among 6 year olds), 33% had preputal adhesions (63% among 6 year olds), and 5% had smegma. (Source: Øster J. Further fate of the foreskin. Arch Dis Child 1968; 43:200-203.)
: I have already accurately summarized this study. It does not claim that these are actual medical conditions. Both preputial adhesion and smegma are part of the natural development of the foreskin, and as Øster himself states, these problems disappear at a later age. You are distorting Øster's conclusions by not reporting this.—Eloquence
In "Medical Department, United States Army, Surgery in World War II, Urology", links observed by clinicians in the field were surveyed and compiled. In it, the author notes that “hospital admissions for paraphimosis, phimosis, balanitis, and condyloma acuminata during 1942-1945 totaled 146,793.&;#8221; (Source: JF Patton, Medical Department, United States Army, Surgery in World War II, Urology, p. 145).
: The numbers themselves are uninteresting unless they are correlated with circumcision status and checked for confounding variables. Patton's assessment itself is not entirely irrelevant, but mostly outdated (chancroid is of little relevance today, and the beliefs about phimosis as well as treatment methods have been largely superceded by modern knowledge). I have summarized it in the article.—Eloquence 02:05, Aug 30, 2003 (UTC)
Statement by Dagher
Despite overwhelming evidence from urological surgeons that neoplasm of the penis is a lethal disease that can be prevented by removal of the foreskin, some physicians continue to argue against routine neonatal circumcision in a highly emotional and aggressive fashion.
: This is pure opinion. Irrelevant.—Eloquence
'Schoen's claim on penile cancer
The evidence that circumcision protects against penile cancer is overwhelming. In the US, incidence of penile cancer in circumcised men is essentially zero (about one reported case every five years)
: This is so misleading as to make Schoen completely unreliable. Hitchcock only mentions this briefly in her response but at least on the talk page it deserves greater emphasis. He claims that penile cancer in circumcised men is essentially zero based on the number of published case reports! This is of course nonsensical and fraudulent. Cases will only be reported by doctors who find them interesting and unusual -- most of the time it simply does not matter whether the person in question is circumcised or not, the cancer is treated and the patient either dies or is released. Regardless, I have always included Schoen's claim in my revisions, including the response from Hitchcock.—Eloquence
Circumcision as an indication of elite status
Circumcision is fast becoming a mark of the elite – a status it enjoyed prior to the 19th Century.
: Followed by a list of "famous circumcised men". This is not only completely unrelated to the medical analysis of circumcision, it is also extremely silly. Of course you can list many famous and important Americans and Jews here because circumcision is so prevalent in the United States and a Jewish ritual. Anti-circ advocates can list countless famous Europeans, and Americans who were born before circumcision became popular in the US. Indeed, it should not come as a surprise that a nine-page "gallery of famous intact men" can be found on one of the genital integrity websites. Many of these are/were of course part of the elite of their time, refuting the allegation that circumcision is a defining feature of elite status (although it is true that in certain regions, at certain times, it is or was such a feature). As such, this list is completely pointless, here or elsewhere, as it proves nothing and will only lead to similar lists from the other side.—Eloquence 02:13, Aug 30, 2003 (UTC)
Schoen's claims about UTI
On his website, Dr. Schoen, a circumcision advocate, states: 
Uncircumcised boys are about 10 times as likely to get serious kidney infections in the first year of life as are circumcised infants; uncircumcised older boys and men are more likely to get UTIs as well. These kidney infections are most dangerous in the first 3 months, during which time they often lead to hospitalization and can result in overwhelming blood infection and other serious infections. Kidney scarring has been shown to occur later. There is concern that future kidney failure and high blood pressure may follow infantile UTIs. Abnormal kidney function and hormonal secretion can occur with infant UTIs. Fecal contamination of the moist inner foreskin layer with bacterial attachment leads to these kidney infections.
:These claims are Schoen's interpretation of the present research. Schoen is of course highly biased and unreliable, as we have seen above, and he picks the highest estimates for UTI incidence in intact males instead of the one with the best methodology. Because this is a summarizing statement that does not come from a medical group nor from a methodologically impeccable meta-analysis, it is of no relevance to the article. The cohort study by To et al. is the best designed one I have found so far.—Eloquence 07:33, Sep 8, 2003 (UTC)
Twentieth century doctors once believed that circumcision has no effect on sexual intercourse. That belief, however, is weakening as new evidence of sexual effects accumulates. Medical historians have shown that nineteenth century doctors introduced male circumcision as an intentional sexual injury with the intent of making masturbation impossible. The medical evidence on the effects of circumcision on sexuality are somewhat contradictory. Nevertheless, a pattern is beginning to emerge as more research becomes available.
:Can we substantiate any of this?  If not, this comes across as POV — the nineteenth-century doctors were maliciously chopping off foreskins, and that only recently has medicine seen the light.  Also, this phrasing implies that ALL DOCTORS EVERYWHERE believed whichever; this is  a rather absurd generalization that needs some clarification.  Finally, the last two sentences are duplicated; we'll need to either remove them from this paragraph or remove the intro paragraph from the "Sexual Effects" section. - jredmond 00:23, 18 Sep 2004 (UTC)
replies: text: I believe that much of the quoted passage above can be substantiated. However, it would need to be phrased in more neutral language and recast in chronological order. I would start off by referring to the Nineteenth Century doctors who introduced circumcision as a way of curbing masturbation. Then, when circumcision became established doctors began to claim that it had no effect on sexual performance, e.g., as in the Masters and Johnson study. Lately, however, new evidence has been accumulating that suggests that circumcision does have an impact on coitus for both the male and the female. At this point, to give it credibility, every example of impact should be substantiated with a link to further information or studies. Such information should be expressed in neutral language. Now where this could or should be done is a question that I would leave to others.  Michael Glass 03:32, 19 Sep 2004 (UTC)
thread_title:  Disputed paragraphs and comments 

message: It is quite curious how massively the "circumcision prevents HIV/AIDS" fallacy is promoted, particularly by Halperin and Bailey. Here is a map of HIV adult prevalence in Africa:
As you can see, AIDS is clearly most widespread in sub-Saharan Africa. Curiously enough, circumcision rates are higher in the northern countries -- but more importantly, if AIDS had a single epidemiological source in southern Africa, then it would be expected that the disease is most concentrated in the south. It has nothing to do with circumcision -- and it probably has little to do with sex at all. Recent research indicates that heterosexual transmission only accounts for 25-35% of HIV infections -- the majority is from unsafe medical care. Circumcision obviously has nothing to do with it. But that does not prevent charlatans from making outrageous claims about circumcision -- whenever there's a new disease, there's a new disease that circumcision can cure. I will update the article to reflect the flaws in the research.—Eloquence 03:15, Sep 4, 2003 (UTC)
: Hmm, that might make a good map for an AIDS-related article. Shame it's only fair use.
: Doesn't look like 12.24.47.10 is coming back. Martin 09:02, 4 Sep 2003 (UTC)
thread_title:  AIDS in Africa 

message: As this article is so long, perhaps it would be the time to consider dealing with matters such as phimosis, paraphimosis, penile cancer. AIDS and circumcision in their own articles and reducing this article to a summary of  findings with links to the other articles.
What do other contributors think?
Michael Glass 16:34, 4 Sep 2004 (UTC)
thread_title: Length of the article