61 Frames Per Second by John Constantine Today in Nerve's videogame blog: Friedrich Nietzsche, River City Ransom, angry nerds, and the horrors of time. So, you know, business as usual.
The Remote Island by Bryan Christian Veronica Mars returns (maybe), RuPaul is haunting us (definitely), and the Dexter "Pscyho Therapy" quiz (creepy.)
It's said that a little knowledge is a dangerous thing, and there's nothing like a conversation about male circumcision and sexual health to prove the point.
Consider my contribution to the problem. Every time the subject of circumcision has arisen, whether at a wedding, a funeral or a bris, I've always brought up the study they did showing that the female partners of uncircumcised men were significantly more likely to wind up with cervical cancer. I long ago forgot, if I ever knew, who did the study, or when, but nobody ever asks. In casual chit-chat — most people's source of medical information — "they" is an authority beyond
promotion
dispute.
Whoever was behind the research, it served admirably as a conversation stopper. If I were debating a circumcision opponent (which describes most of my friends and acquaintances under fifty), the words "cervical cancer" would fry their argumentative circuits; you could almost smell their liberal pieties about respecting the integrity of the human body being incinerated by their liberal pieties about men's responsibility for protecting their partners' sexual health. As the circumcision opponent fell mute, I'd go on to explain the study results, how nearly all cervical cancers were caused by varieties of the human papillomavirus, or HPV, and that the research demonstrated that intact foreskin played a role in transmitting the lethal virus.
In fact, the research linking HPV infection to intact foreskin is highly controversial and its conclusions muddy. A paper in August's British Journal of Infection looked at sixteen papers on this subject, found serious methodological problems with most of them and concluded from the salvageable data that there was "no significant association between genital HPV infection and circumcision status." So whether or not circumcisions are protecting men and their sex partners from viral infection, I've apparently been spreading something else to my conversation partners over the years: medical misinformation.
The link between circumcision and sexually transmitted disease is a hot topic this year, and, according to circumcision opponents, misinformation is playing a key role in the debate. Three papers published in 2007 claimed to demonstrate that male circumcision significantly reduced female-to-male AIDS transmission in South Africa, in Kenya and in Uganda. The studies instantly became a rallying cry for circumcision proponents around the world, and not just on behalf of African populations. In New York, the health department said it may recommend adult circumcision as a way to help slow the spread of AIDS there.
"The efficacy of male circumcision in reducing female-to-male HIV transmission has now been proven beyond reasonable doubt," the World Health Organization and the United Nations' AIDS program declared this year.
But circumcision opponents fault the African studies on methodological grounds. They say the African subjects and the
"Male circumcision has long been an operation in search of a disease," wrote members of a doctor's group.
researchers studying them had a so-called expectation bias that influenced the results. While researchers told both the circumcision and control groups to practice safer sex, the circumcision group was told to abstain from sex altogether or use condoms while their circumcisions healed, a period of safe sex that study critics say would likely skew the rates of HIV infection. And because the studies were concluded early, after eighteen months, critics say the effect of that lead-time bias would be magnified.
Circumcision opponents complain more generally that the procedure has attached itself to medical justifications with some promiscuity over the years. When circumcision was first promoted in English-speaking countries in the nineteenth century, it was as a prophylaxis against masturbation, which in turn was thought to cause such disorders as TB, epilepsy, insanity and hip dysplasia.
"Male circumcision has long been an operation in search of a disease," wrote members of the group Doctors Opposing Circumcision in the May 12th edition of The Lancet.
In the twentieth century, as claims about masturbation and mental illness started sounding quaint and then downright wacky, circumcision transformed itself into a shield against STDs, urinary tract infections and cancer. "A clear pattern has emerged," wrote circumcision opponents introducing a study in the November 2005 Journal of the Royal Society for the Promotion of Health. "Any incurable disease that happens to be the focus of national attention at any given time will be used by U.S. circumcision advocates as an excuse for the continued imposition of mass circumcision."
