from http://groups.yahoo.com/group/PROCIRCORG/
Good morning Ty,
A few comments regarding adverse events following pubescent and adult circumcisions in
Kenya.
For those unaware of the acronym (initialism) including myself, RCT means
randomized controlled studies (should be RCS, but comes out in the
authors’ paper RCT).
This is in no way necessarily related to RIC (ritual infant
circumcision).
The paper talks of two categories of circumcisions, one traditional
and the other medically supervised. Of course the complication rate
for traditional is alarmingly high, and considering no suture is used,
etc. not surprising. Yes, I agree because of delayed healing,
sexually active men having received such a circumcision are in fact
even more prone to HIV acquisition.
The purpose of my message is not so much to argue for the blessing of
circumcision in Africa, but to agree with you that if it is
done and consented by the patient or responsible adults in an
informed manner, it has to be done properly. And if you feel it
should not be done at all, I and a whole host of health care
committees and providers would still argue that it has to be done
properly.
If this continues, then better “the traditional” not to be done at all. Even
complications rates although less with medical style
circumcisons are not good either. Lots of education is needed here.
The remedy is proper training for circumcision providers, adequate
suture and hygienic conditions. Adequate cautery. There are many missionary
doctors who will train Kenyans to do this properly, but will they listen, will
they attend meetings, will they be properly supervised to be sure the tenants of
good surgery are being followed?
Show and tell sessions are needed taking some of these complication
patients and presenting them and saying, if you do it this way, this is what you
could expect, and if you do it this (other) way, this is what you could expect.
We already know how to put a man on the moon; we already know how to
do a proper circumcision with very minimal risk.
Sincerely,
Harold M. Reed, M.D.
Ty, abtracted word for word from the article.
“As well as exacting significant levels of morbidity in the young male
population, the authors say that poorly-performed circumcision,
although often the result of lack of equipment and money, may end up
costing families more than properly supervised circumcision would. It
also represents a significant HIV risk in itself as 6.3% of the young
men circumcised traditionally and 3% of those circumcised medically
had already engaged in sex a mean of 60 days after circumcision even
though in 24% of the traditional cases and 19% of medical cases the
circumcision wound had still not healed properly by this time.
The contrast with the medically-supervised circumcision performed in
the RCTs is most starkly highlighted by the fact that in the RCTs all
but 4% of circumcision wounds had healed by 30 days after the
operation whereas in a directly-observed subset of 12 traditional and
12 medical procedures in this survey, no wound had properly healed by
this time.
The contrast with the medically-supervised circumcision performed in
the RCTs is most starkly highlighted by the fact that in the RCTs all
but 4% of circumcision wounds had healed by 30 days after the
operation whereas in a directly-observed subset of 12 traditional and
12 medical procedures in this survey, no wound had properly healed by
this time.
The main difference between medical and traditional circumcision, in
the 24 operations directly observed, was that all medical ones
featured some form of local or general anaesthesia compared with none
in the traditional circumcisions, and in 75% of cases the wound was
sutured, though often inadequately, whereas in traditional
circumcision it was just left to heal. Not surprisingly bleeding was
a common adverse event with 8% of medical circumcisions featuring
bleeding described as “profuse, requiring IV fluids”. ”
— In PROCIRCORG@yahoogroups.com, L F <frogpond2pad8@…> wrote:
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> John, You state: “The only problem I have with those articles you
cited is that they’re not about whether circumcision reduces the risk
of HIV or not but instead about the procedure itself and how badly
it’s being done.” This comment speaks volumes about you and your so-
called science experts who are responsible for the RCTs and pushing
surgery (circumcision) without understanding the realities that are
AFRICA!
>
> The victims’ reality of these gruesome resullts are REAL! Do you
think they really understood fully about any risk of aids when they
have sex with still open wounds? These study participants endured the
following: “permanent adverse events included torsion (bending) of
the penis, injuries to the glans, loss of penile sensitivity caused
by scarring and erectile dysfunction. Among the 298 boys and men
examined post-operation only 21% of traditional and 10% of medical
circumcisions had fully healed an average of 45-89 days after the
operation.”
>
> Just what number of circumcision victims is ok for Africa, but
wouldn’t be tolerated by us in the U.S.A.?
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> [PROCIRCORG] AIDS conference in Mexico, “a call to action”
>
> Sunday, August 17, 2008 9:50 AM
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> MEXICO CITY (Reuters) - Governments and health communities need to
ramp up male circumcision to prevent HIV infection, particularly in
> vulnerable countries in eastern and southern Africa, researchers and
> advocates said on Monday.
>
> Three studies were cut short in 2006 after they showed strong
evidence that male circumcision could prevent HIV infection, but very
little effort has been made to push for more men to go under the
knife, they told a conference on AIDS in Mexico City.
>
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> Doesn’t the fact that the studies were cut short as soon as
they observed results that fit pre-conceived expectations, raise a
lot of questions about the integrity of the studies? What would the
studies have shown had they been carried out and concluded as
originally planned? (Unsafe sex practices of those
circumcised?) That hardly sounds like a scientific approach. The
fact that the studies were cut short should render the results as, at
least, unreportable as scientific evidence. However, Africa is the
perfect setting for this double speak and hyprocrisy.
>
> Notice THE AREAS OF AFRICA they want to RAMP UP for circumcision
(surgery) at the MEXICAN CONFERENCE in AUGUST and the areas of
concern as reported by AIDS Map News on the 5th of September. THEY
ARE THE SAME! RAMP UP WHAT? THE SUFFERING?
>
> http://www.aidsmap.org/en/news/03B54A29-5328-43FE-80D8-
735C78D21F56.asp
>
> The authors comment: “The levels of morbidity and mortality from
circumstances documented as occurring in this study community are
unacceptable,” and they add that there is sufficient anecdotal
evidence to indicate that Bungoma is not unique, especially in east
and southern Africa where circumcision is performed on adolescents
rather than infants.
>
> They say: “Our results…should serve as an alarm to ministries of
health and the international health community that focus cannot only
be on areas where circumcision is low…it must address the safety of
circumcision in areas where it is already widely practised.
>
> “If the practices in these communities continue to be largely
ignored,” they conclude, “the gains to be achieved by promotion and
provision of circumcision for HIV prevention may well be undermined
by further accounts of unnecessary suffering.”
>
> Well, safe sex with a condom, not requiring surgery, seems to be
the answer to unnecessary suffering. Not convinced, then two condoms
and no surgery. Do this math.
> Any surgery has risks, period. I hear guys, like youself, on this
site DIRECT guys seeking to get circumcised to DR. Reed! You tell
others NOT TO TAKE A CHANCE. WHY?
>
> The economic realities and the amount of money needed for
unneccessary and unsafe surgeries (circumcisions) will soon become a
stark reality world-wide when the money trough is dried up.
>
> TRUE OR FALSE: Many people in Africa lack the necessary sanitation
to prevent infections relating to circumcision, whether adult or
infants.
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> I ask you: What happens when junk science meets real world
implementation?
>
> Ty