REAL WORLD EVENT DISCUSSIONS

Circumcision

POSTED BY: FREDGIBLET
UPDATED: Friday, March 30, 2007 23:29
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Wednesday, March 28, 2007 9:52 AM

FREDGIBLET


http://www.newscientist.com/article/dn11481-who-hails-circumcision-as-
vital-in-hiv-fight.html


I remember reading something about this a while ago and wondering why there wasn't more pushing for circumcision. I guess I read about it when they were just starting the studies.

P.S. This obviously proves that HIV is a Jewish conspiracy right?


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Wednesday, March 28, 2007 9:58 AM

GRIZWALD


"Newly circumcised men should also avoid sex for at least six weeks, until they’re healed."

Ummmm, well, yeah...

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Wednesday, March 28, 2007 10:27 AM

KHYRON


Quote:

Originally posted by Grizwald:
"Newly circumcised men should also avoid sex for at least six weeks, until they’re healed."

Ummmm, well, yeah...

I once saw an interview with somebody whose NGO organised free circumcisions in an African country, and they explicitly told the men who were operated on to not have sex until they've fully healed. So naturally, the next morning one of the people operated on came back because the wounds started bleeding out while he was having sex the night before.

The advice may seem obvious to you and me, but not everyone is blessed with a brain.



"The best argument against democracy is a five minute conversation with the average voter."

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Wednesday, March 28, 2007 11:06 AM

SIGMANUNKI


I'm going to call bullshit on this one. HIV is about exchange of bodily fluids and circumcision doesn't exactly restrict fluid exchange to any real degree. Personally, I think that there is a cultural thing going on here that reduces HIV infection rates that is coupled to circumcision rather than circumcision itself doing any real good. Stats can be very misleading in this way.

Then again, the linked article doesn't give any real information regarding why circumcision has this effect.

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Wednesday, March 28, 2007 11:10 AM

CHRISISALL


I'm totally with ya Sig, it's a load, but that's what we get from number jockeys as opposed to real scientists.
"and men must realise that it doesn’t provide full protection," HOW ABOUT LIKE, NO PROTECTION?
WTF?

GRRRChrisisall

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Wednesday, March 28, 2007 11:13 AM

FREDGIBLET


IIRC (and this is going off of an article I read a few years ago), the foreskin acts like a little cup and holds some of the fluids inside of it where they get in via small cuts and tears in the skin.

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Wednesday, March 28, 2007 11:21 AM

KHYRON


Here's an explanation.

http://news.bbc.co.uk/2/hi/health/4371384.stm



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Wednesday, March 28, 2007 11:22 AM

FREDGIBLET


I googled "circumcision hiv" and skimmed the first few pages of results. There is a couple anti- sites and most of the pro- sites are simply repeating the same story. It seems that the split of unique information on the sites is roughly 50-50.

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Wednesday, March 28, 2007 11:23 AM

CHRISISALL


Quote:

Originally posted by fredgiblet:
IIRC (and this is going off of an article I read a few years ago), the foreskin acts like a little cup and holds some of the fluids inside of it where they get in via small cuts and tears in the skin.

Yeah, and mosquitos can't transmit the AIDS virus. And dry-humping can't get you pregnant. And margerine is more healthy than butter. I know cowpatties when I smell 'em .

Doc Chrisisall

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Wednesday, March 28, 2007 11:26 AM

KHYRON


Quote:

Originally posted by fredgiblet:
I googled "circumcision hiv" and skimmed the first few pages of results. There is a couple anti- sites and most of the pro- sites are simply repeating the same story.

The first one that comes up (the one I linked) says: "Circumcision is thought to help protect against HIV because cells under the foreskin are vulnerable to the virus."



"The best argument against democracy is a five minute conversation with the average voter."

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Wednesday, March 28, 2007 11:29 AM

CHRISISALL


"When the foreskin is removed, the skin on the head of the penis becomes less sensitive and so less likely to bleed, thereby reducing the risk of infection."
Oh puhleeze. How many times have you shagged until bleeding? Less sensitive indeed. Like uncircumcised dudes never play with themselves.
And if they float, they're witches.

BS Chrisisall

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Wednesday, March 28, 2007 11:34 AM

KHYRON


Quote:

Originally posted by chrisisall:
Oh puhleeze. How many times have you shagged until bleeding?

On a completely unrelated note, I think it's really cool how more and more Americans are using the word 'shag' these days.



"The best argument against democracy is a five minute conversation with the average voter."

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Wednesday, March 28, 2007 11:36 AM

CHRISISALL


Quote:

Originally posted by Khyron:
I think it's really cool how more and more Americans are using the word 'shag' these days.


It's a Spike thing, mate.

Souled Chrisisall

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Wednesday, March 28, 2007 11:51 AM

SIGMANUNKI


Quote:

Originally posted by fredgiblet:

IIRC (and this is going off of an article I read a few years ago), the foreskin acts like a little cup and holds some of the fluids inside of it where they get in via small cuts and tears in the skin.




Although that /is/ certainly true, the same fluids are *far* more abundant where they originate, where they must be acquired from in the first place. It is because of this that I see no benefit in circumcision as a way to lower the risk of contracting HIV.

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Wednesday, March 28, 2007 11:56 AM

SIGMANUNKI


Quote:

Originally posted by Khyron:

The first one that comes up (the one I linked) says: "Circumcision is thought to help protect against HIV because cells under the foreskin are vulnerable to the virus."




One term to counter this: urethral orifice.

EDIT: From the same article, "HIV infection rates are lower among groups in Africa who practise circumcision, but it was not known if this was due to cultural differences."

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Wednesday, March 28, 2007 12:00 PM

KHYRON


Quote:

Originally posted by SigmaNunki:
Although that /is/ certainly true, the same fluids are *far* more abundant where they originate, where they must be acquired from in the first place. It is because of this that I see no benefit in circumcision as a way to lower the risk of contracting HIV.

As I understand it, uninfected males get the virus from infected females because the vaginal fluids carry it. So if the tissue in the penis that's most receptive to the virus is removed, and this tissue also acts as a "cup" that possibly holds small quantities of vaginal fluid even after the penis has been removed (thereby increasing the exposure to the virus), theoretically it should decrease the risk of infection.



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Wednesday, March 28, 2007 12:05 PM

GRIZWALD


The things we talk about here.

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Wednesday, March 28, 2007 12:05 PM

BIGDAMNNOBODY


Besides, what does the W.H.O. and UNAIDS know about the subject, eh SigmaNunki? Who cares about Africans anyways.

Posting to stir stuff up.

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Wednesday, March 28, 2007 12:09 PM

KHYRON


Quote:

Originally posted by Grizwald:
The things we talk about here.

This is important stuff! If we here in RWED don't solve the world's problems, who on Earth will!?



"The best argument against democracy is a five minute conversation with the average voter."

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Wednesday, March 28, 2007 12:09 PM

SIGMANUNKI


@BigDamnNobody:

Read what I quoted from the BBC article. It seems as though they don't know much.

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Wednesday, March 28, 2007 12:14 PM

BIGDAMNNOBODY


Quote:


Originally posted by SigmaNunki:
Read what I quoted from the BBC article. It seems as though they don't know much.



I've heard the same thing said about man-made global warming. Should we stop investigating that as well?

Posting to stir stuff up.

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Wednesday, March 28, 2007 12:19 PM

SIGMANUNKI


@Khyron:

But, that's only the exterior. What about the fluids that *will* enter through the urethral orifice. Seems to me that the interior of the body will be more vulnerable to a virus than something on the exterior.


Also, from reading the article, there is a fatal flaw with this study: they didn't control the number of sexual experiences nor did they control the number of females that they had sexual contact with that were infected with HIV. If only because of this, this study has absolutely no validity at all.

IMO this study was ill conceived and is quite amoral.

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Wednesday, March 28, 2007 12:19 PM

KHYRON


They say it's not certain that it'll be an effective solution. They also say it's worth a shot. Should one risk not doing it just because it might not work (keeping in mind that it doesn't harm the indivduals... unless they do something really stupid like have sex before it's healed)?



"The best argument against democracy is a five minute conversation with the average voter."

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Wednesday, March 28, 2007 12:27 PM

SIGMANUNKI


Quote:

Originally posted by BigDamnNobody:

I've heard the same thing said about man-made global warming. Should we stop investigating that as well?




Sophistry.

What I'm talking about is the irresponsibility of publicizing positive results when it is far from conclusive (which /is/ admitted in the BBC article). When there is no control over the experiment (which /is/ implied in the BBC article).

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Wednesday, March 28, 2007 12:38 PM

SIGMANUNKI


Quote:

Originally posted by Khyron:

They say it's not certain that it'll be an effective solution. They also say it's worth a shot. Should one risk not doing it just because it might not work (keeping in mind that it doesn't harm the indivduals... unless they do something really stupid like have sex before it's healed)?




Although, circumcision itself doesn't harm the individual (pretty much), this will install a false sense of security in the majority of people. I believe it is this that must be understood.

Also, this experiment does seem to be a *very* poorly designed one. e.g. Did they control how many times these men had sex? Did they control how many times they had sex with someone who was HIV positive? Did they control how many men were infected walking in (HIV can stay undetectable for some time after infection)? etc.

Basically, there doesn't really seem to be any scientific controls on this experiment. And until an experiment comes along that does, I'll call bullshit. Especially given the fact of the urethral orifice.

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Wednesday, March 28, 2007 1:14 PM

FREDGIBLET


Quote:

Originally posted by SigmaNunki:
Especially given the fact of the urethral orifice.



The urethra orifice is controlled for by the fact that everyone has one.

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Wednesday, March 28, 2007 2:35 PM

KHYRON


Quote:

Originally posted by SigmaNunki:
But, that's only the exterior. What about the fluids that *will* enter through the urethral orifice. Seems to me that the interior of the body will be more vulnerable to a virus than something on the exterior.

Although I never bothered to check afterwards (hey, I'm a guy, I'm already fast asleep ), I think it's reasonable to assume that there are still some fluids inside the tract which prevent vaginal fluids penetrating too far into the penis. Aside from that, it's only been said that this treatment may reduce the risk of infection, not eliminate it. The risk of infection through the urethral orifice is still present, but overall risk of infection is reduced.
Quote:

Also, from reading the article, there is a fatal flaw with this study: they didn't control the number of sexual experiences nor did they control the number of females that they had sexual contact with that were infected with HIV. If only because of this, this study has absolutely no validity at all.
3,280 sexually active men took part in the study, just less than half of which decided to get circumcised, so that's more than 1,500 men for either case. This is quite a large sample size, and it's justified to assume that in the case of such large sample sizes environmental factors such as number of sexual experiences and number of infected females will be very similar (law of averages). So in my opinion the study is valid. Whether it's conclusive is another question, but I find no reason to dismiss this study out of hand because I don't regard your criticisms of it as valid.
Quote:

IMO this study [...] is quite amoral.
Participation was voluntary, in which case it can't be immoral.
Quote:

What I'm talking about is the irresponsibility of publicizing positive results when it is far from conclusive (which /is/ admitted in the BBC article).
In which case the media wouldn't be allowed to report on any science news.
Quote:

When there is no control over the experiment (which /is/ implied in the BBC article).
Where was it implied? The sentence "The South African trial, conducted by a team of French and South African researchers and sponsored by ANRS (the French National Agency of Research on Aids)" implies that there was a controlling body.
Quote:

Originally posted by SigmaNunki:
Although, circumcision itself doesn't harm the individual (pretty much), this will install a false sense of security in the majority of people. I believe it is this that must be understood.

All media reports that I have heard and read on this say that it at best reduces the risk of infection, it doesn't eliminate it. The BBC article itself has a mini-headline 'Not a condom substitute', and we can, I think, assume that the researchers will have told the participants the same. Whether the participants follow this advice or not is out of the researchers' control, but seeing as condoms are widely available even in rural African areas and yet hardly used, trying to reduce the risk of infection through other means shouldn't be dismissed simply because these alternative methods aren't fool-proof.



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Wednesday, March 28, 2007 2:38 PM

FREDGIBLET


Quote:

Originally posted by Khyron:
Quote:

IMO this study [...] is quite amoral.
Participation was voluntary, in which case it can't be amoral.



It can be immoral if the participation was based off of false premises.

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Wednesday, March 28, 2007 2:54 PM

KHYRON


Quote:

Originally posted by fredgiblet:
It can be immoral if the participation was based off of false premises.

How so? For one thing, in general, if the premise isn't known to be false at the start of a study, the study can't be immoral. Even if the premise turns out to be false, it still doesn't make the study immoral. Testing on willing participants is common practice in many medical fields, for instance new drug treatments are tested on volunteers. If the new treatments don't work, does that mean conducting the test was immoral?

Secondly, "The South African trial [...] took place in the Orange Farm area near Johannesburg, where male circumcision in adulthood is a common but not universal practice.". Chances are many of those circumcised would have been circumcised anyway. All the researchers did after administering the circumcisions (which, again, were voluntary) was monitor the number of HIV infections in both groups.

In fact, circumcisions in rural communities in South Africa aren't done very well and quite a number of people die due to infection. We can assume that the researchers did the circumcisions in a medically safe way and therefore indirectly saved a couple of lives (in those cases where the men wanted to get circumcised anyway).



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Wednesday, March 28, 2007 3:30 PM

SIGMANUNKI


Quote:

Originally posted by fredgiblet:

The urethra orifice is controlled for by the fact that everyone has one.




The plethora of other factors that I mentioned above are _not_. Which means that the urethra orifice factor isn't necessarily accounted for either.

Basically, this experiment doesn't have a control group because it doesn't control either group. This invalidates the findings no matter how "logical" they are (we all know that just because something is logical doesn't mean it's true).

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Wednesday, March 28, 2007 3:37 PM

KHYRON


Quote:

Originally posted by SigmaNunki:
Basically, this experiment doesn't have a control group because it doesn't control either group.

It controls both groups as much as it needs to. Don't forget, this is supposed to monitor the rates of infection amongst circumcised and uncircumcised men when they go about their lives naturally. If the reseachers had said: "Okay, you have sex with only these three chicks for the next year, and you over there, you only get to have sex with these three, etc.", people would (rightly) be complaining that the study was artificial. In THAT case it wouldn't have been valid.



"The best argument against democracy is a five minute conversation with the average voter."

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Wednesday, March 28, 2007 3:52 PM

STINKINGROSE


nurse says:

Oh for crying out loud, just wear the damned condom.

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Wednesday, March 28, 2007 3:57 PM

KHYRON


Nurse and everyone else too. But in some parts of the world, safe sex is seen as uncool and unmanly, or people just can't be bothered.



"The best argument against democracy is a five minute conversation with the average voter."

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Wednesday, March 28, 2007 4:16 PM

SIGMANUNKI


Quote:

Originally posted by Khyron:

Although I never bothered to check afterwards (hey, I'm a guy, I'm already fast asleep ), I think it's reasonable to assume that there are still some fluids inside the tract which prevent vaginal fluids penetrating too far into the penis. Aside from that, it's only been said that this treatment may reduce the risk of infection, not eliminate it. The risk of infection through the urethral orifice is still present, but overall risk of infection is reduced.




Although there /may/ still be "man fluid" in the penis that /may/ restrict further flow of "woman fluid" this does _not_ account for fluid exchange during sex. Also, although the "man fluid" tends to be fairly viscous it is still a fluid. By definition, fluid exchange is still more than just likely.

I must also point out that toughening the skin on the outside of the penis by circumcision is only one possible attack vector for HIV. First off, it doesn't prevent infection through this skin and it certainly doesn't even remotely stop fluid exchange through the urethral orifice.

Thus, I am seriously skeptical of the validity of this so called study i.e. for this logic to work, it must be shown that the skin "under the hood" is a primary infection vector for HIV. And given how this study was done, IMO this hasn't even remotely been established.


Quote:

Originally posted by Khyron:

3,280 sexually active men took part in the study, just less than half of which decided to get circumcised, so that's more than 1,500 men for either case. This is quite a large sample size, and it's justified to assume that in the case of such large sample sizes environmental factors such as number of sexual experiences and number of infected females will be very similar (law of averages). So in my opinion the study is valid. Whether it's conclusive is another question, but I find no reason to dismiss this study out of hand because I don't regard your criticisms of it as valid.




Actually your law of averages doesn't apply as the sample size /is/ quite low; it is _not_ a representative sample (~3,280 vs a population size of 45.3 million). Thus, your "law of averages" remark does not apply.

Also, having sex with a infected woman is a crap shoot. One just doesn't know.

Now, if the guys were all sexually active in the exact same place and only had sex with woman in the exact same place, and those woman only had sex with the woman in the exact same place, then we'd have something. But, the fact of the matter, is that in any given area, these factors are going to be different, which makes the risk factor different.

Basically, there are *many* non-scientific aspects to this study.

But, let's say that your criticisms of my criticisms are valid. Tell me, what was the exposure rate? After all, knowing this is critical of knowing whether this study is valid or not.


Quote:

Originally posted by Khyron:

Participation was voluntary, in which case it can't be immoral.




You're assuming that the participants are educated and have full awareness of the consequences of the possible outcomes. This is a very bad assumption given the region of the world we are talking about.

IMO, these "researchers" are taking advantage of uneducated people by getting them to be involved in *very* high risk behaviour.

To use some hyperbole, an equivalent study might be to get people to play Russian Roulette seeing if wearing a hockey helmet would help in preventing there grey matter from being splattered on the wall.


Quote:

Originally posted by Khyron:

Quote:



What I'm talking about is the irresponsibility of publicizing positive results when it is far from conclusive (which /is/ admitted in the BBC article).




In which case the media wouldn't be allowed to report on any science news.




LOL. It's the researchers that think that this study is valid and then tell the media. The media then trusts the researchers and publishes an article. Even by what is contained in the BBC article it it stated:

"""
UNAids has said the trial found promising results, but more work needs to be done to confirm its findings and "whether or not the results have more general application."
"""

I question the ethics of people who would even think to ask people to have unprotected sex.

Buddy, we're talking literally about life and death here. This isn't some new drug that seems promising. It's about getting HIV.


Quote:

Originally posted by Khyron:

Quote:



When there is no control over the experiment (which /is/ implied in the BBC article).




Where was it implied? The sentence "The South African trial, conducted by a team of French and South African researchers and sponsored by ANRS (the French National Agency of Research on Aids)" implies that there was a controlling body.




I'm _not_ talking about oversight for the researchers. I'm talking about having a reliable control over factors that the researchers are not testing for. That way by the pigeon hole, they can say what the mitigating factors are. This just isn't in this study. There is basically no control.


Quote:

Originally posted by Khyron:

Quote:

Originally posted by SigmaNunki:

Although, circumcision itself doesn't harm the individual (pretty much), this will install a false sense of security in the majority of people. I believe it is this that must be understood.




All media reports that I have heard and read on this say that it at best reduces the risk of infection, it doesn't eliminate it. The BBC article itself has a mini-headline 'Not a condom substitute', and we can, I think, assume that the researchers will have told the participants the same. Whether the participants follow this advice or not is out of the researchers' control, but seeing as condoms are widely available even in rural African areas and yet hardly used, trying to reduce the risk of infection through other means shouldn't be dismissed simply because these alternative methods aren't fool-proof.




Again, it takes someone who is somewhat educated to understand such things no matter how carefully things are explained. And rural South Africa is hardly the heart of academia.

Also, for the study to have any validity the participants would have to have had unprotected sex. So, any number of participants using condoms would be fatal to the study.

I'm also not dismissing out of hand other ways to control infection. What I'm dismissing is this study as it doesn't really provide many things required in scientific study. IMO, of course.

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Wednesday, March 28, 2007 4:20 PM

SIGMANUNKI


Quote:

Originally posted by Khyron:
[It controls both groups as much as it needs to. Don't forget, this is supposed to monitor the rates of infection amongst circumcised and uncircumcised men when they go about their lives naturally. If the reseachers had said: "Okay, you have sex with only these three chicks for the next year, and you over there, you only get to have sex with these three, etc.", people would (rightly) be complaining that the study was artificial. In THAT case it wouldn't have been valid.




Actually no. This study was meant to see if circumcision reduced the infection rate. Or at least that is what they are looking for based on the conclusion. Because if they were going through there natural lives, then the use of condoms would invalidate the study.

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Wednesday, March 28, 2007 4:33 PM

KHYRON


It's the middle of the night over here and I don't have time to respond to the whole thing now, but I need to ask:
Quote:

Originally posted by SigmaNunki:
I question the ethics of people who would even think to ask people to have unprotected sex.

Where is it written that they did that? The research was never about "have unprotected sex", it was "go about having sex as you usually do" - which, in many cases, happens to be unprotected. That's the way I understood it, if I'm wrong then please show me the relevant quote so that I can retract my statement that the study wasn't immoral.

More tomorrow.



"The best argument against democracy is a five minute conversation with the average voter."

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Thursday, March 29, 2007 1:36 AM

STINKINGROSE


This thread has taken on the tone that they tend to get just before someone calls someone else "poopy head".


You know, discussion becomes heated discussion, becomes:

"Poopy head"
"aardvark breath"
"mango hoarder"
"illegitimate rat purchaser"
"neener neener neener, you ain't got no weiner"


One (admittedly uncontrolled, possibly bad to run, and relatively small) study does not a medical revelation make. Just because it's the only data out there to look at this particular (questionable) variable does not mean it's good data.


Additionally I do not see anywhere in the article where it states that the subjects were only having sex with women.
Blood and bodily fluids is the usual vector for the HIV virus.

Just a thought: anyone having sex enough to form a serious callus on the glans is doing a whole lotta rubbin' babe. I've seen many penises (professionally and a few privately) and the difference between circumsized vs. not is minimal.

Total abstinence and lack of IV drug use is the only 100% effective means of reducing transmission.. but this is the real world where people have sex, do not always follow directions given to them by researchers (who may not have been taught basic statistics and how to design and run a good experiment), and either do not understand or do not care what risk they put themselves and others at by their behavior.

Someone briefly touched on the whole "already positive but testing negative at the beginning of the study" issue. It is commonly accepted that there is a 3 month window period (some argue closer to 6) where the virus may not have triggered an immune response large enough to cause a positive reaction on a test.

Both circumsized and uncircumcised males contract the HIV virus. Period. Fact. Really.

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Thursday, March 29, 2007 2:48 AM

KHYRON


Quote:

By definition, fluid exchange is still more than just likely.
Right. I question the amount of fluid exchange that occurs in the urethal orifice, but that's irrelevant, because, again, circumcision doesn't claim to eliminate the risk of infection, it claims to reduce it. Of course fluid interchange and infection may still occur, there are no claims to the contrary.
Quote:

And given how this study was done, IMO this hasn't even remotely been established.
The study was about rates of infection, not establishing how exactly circumcision seems to reduce the risk of infection. There's no reason to dismiss the study just because one isn't sure why the results might be true.
Quote:

Actually your law of averages doesn't apply as the sample size /is/ quite low; it is _not_ a representative sample (~3,280 vs a population size of 45.3 million). Thus, your "law of averages" remark does not apply.
The size of the population is irrelevent.

For statistical results to have some credibility, the sample size needs to be large enough, and most researchers (in almost any field) would be quite happy with a sample size of around 1500 for each case. Factors such as the mean and variance play a role, but in general, for a sample size of 1000, the chances are 95% of coming within +/- 3% of the actual values that one wants to measure, and for 1500 this would be slightly improved. Under these conditions statistical results apply, amongst other things "my" law of averages.
Quote:

Now, if the guys were all sexually active in the exact same place and only had sex with woman in the exact same place, and those woman only had sex with the woman in the exact same place, then we'd have something.
We'd have something, but something that's an artificial result. In epidemiology, if one looks at the rates at which a disease spreads inside a population one can't take infected and uninfected members of the population out of it and then only look at the consequences of their interactions, one has to let the population go about its usual ways and take representative samples to tell one what's going on.
Quote:

But, the fact of the matter, is that in any given area, these factors are going to be different, which makes the risk factor different.
If you're talking about differences inside the geographical area in which the study was conducted, it's fair to assume that the participants were well-mixed, i.e. it's uinlikely that out of 3,280 people, 90% of those who lived in the Eastern half wanted circumcisions and 90% on the Western half didn't. If you're talking about wider regional differences, this was a relative measure, not an absolute one, so these differences shouldn't play a role.
Quote:

Basically, there are *many* non-scientific aspects to this study.
IMO if one dismisses the methods used in and results from this study, one should also dismiss a plethora of other studies that were conducted in a similar way (and are accepted). This sort of research doesn't give exact results, it only gives an indication of what the exact results might be.
Quote:

But, let's say that your criticisms of my criticisms are valid.
Okay!
Quote:

Tell me, what was the exposure rate? After all, knowing this is critical of knowing whether this study is valid or not.
Do you mean number of times the participants had sex with an infected person on average? If you mean this, I have no idea, nor do I think the researchers would have such statistics. Once again, I think the sample size is large enough to assume that such factors would be very similar.
Quote:

You're assuming that the participants are educated and have full awareness of the consequences of the possible outcomes. This is a very bad assumption given the region of the world we are talking about.
Many people in that area would have been circumcised anyway, and aside from the circumcisions all that the researchers did was monitor the rates of infection afterwards. As long as the circumcised participants understood that they should wait until their wounds are healed before having sex, which doesn't take much education, I don't see how the level of schooling plays a role.
Quote:

IMO, these "researchers" are taking advantage of uneducated people by getting them to be involved in *very* high risk behaviour.
I suppose the high risk comment stems from you thinking the researchers encouraged the participants to have unprotected sex, which I don't think was the case...
Quote:

To use some hyperbole, an equivalent study might be to get people to play Russian Roulette seeing if wearing a hockey helmet would help in preventing there grey matter from being splattered on the wall.
...on the other hand, if it were the case, I would completely agree with your hyperbole and your assertion that the research was immoral. But I think in this case every human rights society in the world would be on the researchers' ass for unethical conduct, and that that would be a bigger story than the results themselves.
Quote:

I'm _not_ talking about oversight for the researchers. I'm talking about having a reliable control over factors that the researchers are not testing for. That way by the pigeon hole, they can say what the mitigating factors are. This just isn't in this study. There is basically no control.
When looking at population dynamics, everything needs to be taken into account. The best way to do this is to let the population do what it does and monitor what happens.
Quote:

Also, for the study to have any validity the participants would have to have had unprotected sex. So, any number of participants using condoms would be fatal to the study.
Once again, the sample size is large enough to make the assumption that such things as condom use would be very similar on both sides. And there's no guarantee that participants who generally use condoms will always use them.

I want to emphasise that nobody is taking this study as conclusive proof that circumcision reduces the risk of infection, it's seen as a (scientifically justified, btw) study that indicates that this might be the case, and that more studies into this need to be conducted.



"The best argument against democracy is a five minute conversation with the average voter."

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Thursday, March 29, 2007 3:13 AM

KHYRON


Quote:

Originally posted by stinkingrose:
This thread has taken on the tone that they tend to get just before someone calls someone else "poopy head".

Sigma seems to be a level-headed guy, so I can't see that happening. I can't even see this discussion becoming heated, it's just a discussion.
Quote:

One (admittedly uncontrolled, possibly bad to run, and relatively small) study does not a medical revelation make.
It was controlled enough and large enough (we have no means of judging how well-run the study was), and it's not supposed to be a medical revelation, the results are an indication that there might be something to these circumcision claims and that the link needs to be explored further.
Quote:

Additionally I do not see anywhere in the article where it states that the subjects were only having sex with women.
Blood and bodily fluids is the usual vector for the HIV virus.

Sigma and I were talking about heterosexual intercourse because, well, it's more common and 'vaginal fluids' are easier to talk about that the other stuff. Doesn't mean that homosexuality was excluded.
Quote:

Both circumsized and uncircumcised males contract the HIV virus. Period. Fact. Really.
That's not in doubt and not what's being discussed.



"The best argument against democracy is a five minute conversation with the average voter."

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Thursday, March 29, 2007 5:01 AM

KANEMAN


Sig you should have stopped as soon as you realized Khyron's argument is much stronger than yours. Common sense would suggest that if the skin is damp and more sensitive there is a greater risk of viral infection. Is this the most scientific study? No. Is it even possible to do a controlled experiment about the most random act(sex)...No. What this study did was allow nature to take it's course, and reported the results. There is no claim of HIV elimination, just a reduction in risk. Have you noticed your cronnies on this board have jumped ship? They leave you here alone to sound like a jack-ass.

Secondly, all men should be circumcised. The uncircumcised pecker looks ridiculous, smells funny, and is as sanitary as the underside of long fingernails on a hand that digs in cow shit. Now, not that I care or anything, because the more guys that walk around this planet with a smelly , ridiculous looking noodle, the less competition I have when it comes to shagging bitches. (Women feel free to chime in here. You girls agree with me... I know you do.) I have many girlfriends that talk openly about this. They all laugh at uncircumcised men, find it ugly, and unsatisfying. If you are one of the unfortunate guys with a hilariously scary looking snail-driver...sorry.

So Sig, if your parents left you to walk around this planet with a funny looking and smelly pecker, be mad at them...not the world. You can always go get it done now. Just remember to not have sex for 6 weeks...

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Thursday, March 29, 2007 5:14 AM

SIGNYM

I believe in solving problems, not sharing them.


What about personal hygiene? Oh that's right... most guys don't believe in it...

---------------------------------
Reality sucks. Especially when it contradicts our cherished ideas.

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Thursday, March 29, 2007 6:36 AM

FREDGIBLET


Quote:

Originally posted by Khyron:
Quote:

Originally posted by fredgiblet:
It can be immoral if the participation was based off of false premises.

How so? For one thing, in general, if the premise isn't known to be false at the start of a study, the study can't be immoral. Even if the premise turns out to be false, it still doesn't make the study immoral. Testing on willing participants is common practice in many medical fields, for instance new drug treatments are tested on volunteers. If the new treatments don't work, does that mean conducting the test was immoral?



I was referring more to the idea of telling people that a test is perfectly safe, thus getting their cooperation, when the test is known not to be. Not saying that it applies here, just that in general a study that includes willing participants that aren't made aware of known dangers of a test is still immoral.

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Thursday, March 29, 2007 6:40 AM

KHYRON


Oh I see. Yes, I agree with you on that.

EDIT: I thought your previous post was referring to this specific case when I responded to it. Thanks for clearing it up, obviously you're right.



"The best argument against democracy is a five minute conversation with the average voter."

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Thursday, March 29, 2007 8:04 AM

SIGNYM

I believe in solving problems, not sharing them.


AFA as testing on human subjects... Tests have been cut short on moral grounds, either because a treatment was found to have negative results (example- beta carotene on smokers) or because the treatment is SO effective that continuing with a placebo is considered immoral.

---------------------------------
Always look upstream.

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Thursday, March 29, 2007 4:41 PM

STINKINGROSE


Like I said...

poopyhead fight in the offing.

(OK that was not only tasteless it was disgusting... sorry.)

So I'll just pop out and let you all continue with a relatively civilized and calm discussion. If I'm lucky the dissonant voices will not follow.

You're on your own, fellas.

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Thursday, March 29, 2007 6:44 PM

SIGMANUNKI


Quote:

Originally posted by Khyron:

Where is it written that they did that? The research was never about "have unprotected sex", it was "go about having sex as you usually do" - which, in many cases, happens to be unprotected. That's the way I understood it, if I'm wrong then please show me the relevant quote so that I can retract my statement that the study wasn't immoral.

More tomorrow.




And where is stated that the study was about people going about there normal business?

Btw, I infer that the men were told that they should have protected sex because in the BBC article it states that "The researchers decided at this point it would be unethical to continue the study." Why would it be unethical to continue a study in which they are only taking blood from time to time?

----
I am on The List. We are The Forsaken and we aim to burn!
"We don't fear the reaper"

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Thursday, March 29, 2007 9:23 PM

SIGMANUNKI


NOTE: I've attempted to proof this, but as you can see, it's rather long. It's also quite late and I'm *very* tired. If anyone that reads this and finds it overly aggressive, etc, please assume that is something that I would have fixed and not be offended by it. And now without further ado, I'm off to zzzzzz...


Quote:

Originally posted by Khyron:

Right. I question the amount of fluid exchange that occurs in the urethal orifice, but that's irrelevant, because, again, circumcision doesn't claim to eliminate the risk of infection, it claims to reduce it. Of course fluid interchange and infection may still occur, there are no claims to the contrary.




A hole shoved into a place where bodily fluids are rather abundant. How exactly do you question the amount of fluid exchange?

But, the question does result in another factor that isn't accounted for; the time of exposure i.e. someone who has sex for 2 hrs is going to stand a far greater chance of getting infected than some that has sex for 10 minutes (or less, poor guy/gal ).

Also, as (I believe) someone above mention, there's the whole IV drug thing. Which isn't stated to be controlled for. Hell, some of these guys could use condoms 100% of the time, yet get HIV through a needle.


Quote:

Originally posted by Khyron:

The study was about rates of infection, not establishing how exactly circumcision seems to reduce the risk of infection. There's no reason to dismiss the study just because one isn't sure why the results might be true.




Actually from the conclusion given at the New Scientist article:

"""
It may not seem like the kindest cut, but circumcision has been hailed as a vital new way to combat HIV. In a report issued on 28 March, the World Health Organization and UNAIDS issued a series of recommendations to increase rates of circumcision in countries where the HIV problem is most serious.
"""

They have concluded that circumcision reduces infection rates when they also state (BBC article):

"""
HIV infection rates are lower among groups in Africa who practise circumcision, but it was not known if this was due to cultural differences.
"""

Basically, they have _not_ established that circumcision actually helps matters. And that's by there own admission. Yet they are recommending that a great deal of effort be expended to circumcise men because of these "results".

In other words, if these results are cultural, then one does _not_ need to be circumcised to get any benefits. One just needs to have there attitude "re-educated".

These guys are running off of circumstantial evidence and they even admit it!

Basically, these guys are saying things that completely contradict what you're saying here.


Quote:

Originally posted by Khyron:

The size of the population is irrelevent.

For statistical results to have some credibility, the sample size needs to be large enough, and most researchers (in almost any field) would be quite happy with a sample size of around 1500 for each case. Factors such as the mean and variance play a role, but in general, for a sample size of 1000, the chances are 95% of coming within +/- 3% of the actual values that one wants to measure, and for 1500 this would be slightly improved. Under these conditions statistical results apply, amongst other things "my" law of averages.




Ok, let's assume you're right (my wife agrees with you btw). Tell me how this is representative of the population.

The researchers admit that (BBC article):

"""
took place in the Orange Farm area near Johannesburg
"""

To do a study in /only/ one place is rather poor form. When companies do studies in North America, to gain statistical significance, they do the study in several cities across the country.

There are a variety of reasons for doing so, but the one that is most relevant here is difference in lifestyle. Though diet will probably play a strong role as well. Anyone know how rich Orange Farm is? This /will/ play a role as the immune system will be *much* better in one that is _not_ malnourished among other things.

The BBC article also quotes Keith Alcorn as saying, "Two further studies in Kenya and Uganda have yet to be completed, and will give us more information."

Now if those show the same results, then we might have something.

But as it sits right now, all we have is something that indicates that circumcision has something to do with a lower HIV infection rate. What circumcision has to do with it is still very much in the air. Again, this is by these people's own admission. We still know pretty much nothing.


Quote:

Originally posted by Khyron:

We'd have something, but something that's an artificial result. In epidemiology, if one looks at the rates at which a disease spreads inside a population one can't take infected and uninfected members of the population out of it and then only look at the consequences of their interactions, one has to let the population go about its usual ways and take representative samples to tell one what's going on.




Well, if we were talking about how HIV spreads you'd be spot on, but we are _not_ talking about how HIV spreads. What we /are/ talking about is if circumcision itself reduces the risk of getting infected with HIV upon exposure through sex. The conclusion on the article you linked to even states this!

"""
The researchers planned to test all participants for HIV at three, 12 and 21 months, to see whether there was a difference in the rate of new infections between the two groups.
"""

From the beginning it was all about circumcised vs non-circumcised. Does one have a lower rate of infection.


Quote:

Originally posted by Khyron:

If you're talking about differences inside the geographical area in which the study was conducted, it's fair to assume that the participants were well-mixed, i.e. it's uinlikely that out of 3,280 people, 90% of those who lived in the Eastern half wanted circumcisions and 90% on the Western half didn't. If you're talking about wider regional differences, this was a relative measure, not an absolute one, so these differences shouldn't play a role.




The differences /will/ play a role when it's general conclusion time. As it sits, the only thing that we know right now is, in this particular part of South Africa, circumcision itself may or may not reduce the risk of getting infected with HIV. Though the "researchers" say that they /think it/ does. Enough in fact, to recommend based on circumstantial evidence that we should (New Scientist article) "increase rates of circumcision in countries where the HIV problem is most serious."

You seem to be defending an absolute conclusion based on what you call a "relative measure".


Quote:

Originally posted by Khyron:

Quote:



Basically, there are *many* non-scientific aspects to this study.




IMO if one dismisses the methods used in and results from this study, one should also dismiss a plethora of other studies that were conducted in a similar way (and are accepted). This sort of research doesn't give exact results, it only gives an indication of what the exact results might be.




Skepticism is a main stay of science. So, is proper scientific method.

This study uses... questionable methods. In fact, the "methods" that they use indicate that they cannot come to the conclusion that they claim. In fact, there are so many variables that they are _not_ accounting for it isn't funny.

Not to mention that they themselves state (BBC article) "UNAids has said the trial found promising results, but more work needs to be done to confirm its findings". Yet, (New Scientist article) "UNAIDS issued a series of recommendations to increase rates of circumcision in countries where the HIV problem is most serious."

They contradict themselves i.e. in the BBC article, more study is needed, but in the New Scientist article they say that the study has such strong results that they are going to recommend significant policy change.

Basically, this "study", on its own, should be dismissed.


As for your comment that we should discard all studies of this type if we discard this one. Well that bit of hyperbole is just plain wrong. Those other studies have had other more rigorous studies to confirm them. Or other studies that have a different set of variables, that further reduce what could be going on. And after many studies to try to confirm those results, we end up with a logical conclusion.

The main problem with your line of thinking here is that with the studies that we should apparently discard, they have been confirmed time and time again. Whereas this "study" is the *first*. There are two others that are going on /right/ /now/ (BBC article). Again, *if* those studies show the same thing, then we have enough evidence for an actual rigorous study.

Basically, this is only the beginning in a possible long chain of studies regarding circumcision and its chance of reducing the chance of HIV infection.


Quite frankly, I find such pre-mature announcements in rather poor taste. And when it comes to the specific topic here quite dangerous and as such, ethically questionable. This really should have stayed in the literature until at least the other two studies had been completed. But, that would have stolen the thunder of the WHO and UNAIDS (or at least the people involved in this particular study). After all, fame requires one to be first.


Quote:

Originally posted by Khyron:

Quote:



Tell me, what was the exposure rate? After all, knowing this is critical of knowing whether this study is valid or not.




Do you mean number of times the participants had sex with an infected person on average? If you mean this, I have no idea, nor do I think the researchers would have such statistics. Once again, I think the sample size is large enough to assume that such factors would be very similar.




Well, we actually can't.

Sexually active can mean being in a monogamous relationship or having sex once every couple months or a couple times a day or anywhere inbetween or more extreme. And each time one has sex, one rolls the dice to whether they are "getting it on" with someone that is HIV+. If only for these uncontrolled factors, we certainly cannot say that the exposure rate is homogeneous.

But, that's just IMO.


Quote:

Originally posted by Khyron:

Quote:



You're assuming that the participants are educated and have full awareness of the consequences of the possible outcomes. This is a very bad assumption given the region of the world we are talking about.




Many people in that area would have been circumcised anyway, and aside from the circumcisions all that the researchers did was monitor the rates of infection afterwards. As long as the circumcised participants understood that they should wait until their wounds are healed before having sex, which doesn't take much education, I don't see how the level of schooling plays a role.




I was responding to you saying "Participation was voluntary, in which case it can't be immoral."

What I was getting at is that these researchers knew that they were probably going to indirectly cause the infection of a fair number of people. Yet they did it anyway. This I find amoral.

When it comes to the level of education, educated people are *far* less likely to enter such a risky endeavor (especially when they are pretty much guaranteed to contract HIV as a result). These researchers chose a rural community, _not_ a city. An area which is *far* less likely to have educated people in it. Thus "ripe for the picking" when it comes to participants. Which can been seen in the ~3300 males who joined up. I find that number disturbingly high.

But, you bring up an interesting point regarding circumcision. That some would have been already. But, by the BBC article:

"""
Just under 3,280 young, sexually active, uncircumcised,
"""

So, /all/ of the guys had been circumcised by these doctors assumedly at the same time. Which leads into another point. Did these guys have the "full effect" of circumcision? Were the non-circumcised not allowed to have sex during these 6 weeks so that everything was a level playing field?

Sure, 6 weeks to heal. But, that's just the cuts due to the circumcision! The whole thought is that the tougher skin on the penis would provide better protection against HIV. Is 6 weeks enough time to get the full "benefits" of circumcision?

IMO this isn't enough time. IMO years of being circumcised is going to produce a tougher more protective skin than a couple weeks. IMO this further invalidates the study, but brings up another good question. How long before you get the full "benefits" of circumcision?


Quote:

Originally posted by Khyron:

I suppose the high risk comment stems from you thinking the researchers encouraged the participants to have unprotected sex, which I don't think was the case...




How would circumcision play a role if they were using condoms?


Quote:

Originally posted by Khyron:

...on the other hand, if it were the case, I would completely agree with your hyperbole and your assertion that the research was immoral. But I think in this case every human rights society in the world would be on the researchers' ass for unethical conduct, and that that would be a bigger story than the results themselves.




I'm not sure I agree. If the study was about if circumcision affected infection rate (which it is), and the researchers chose people who engaged in unprotected sex already, then I don't see any human rights org shitting on these guys. Especially since there work is all about reducing the spread of HIV.

Getting human rights people after you because you're doing research to prevent the spread of HIV. Now there's irony


Quote:

Originally posted by Khyron:

Quote:



I'm _not_ talking about oversight for the researchers. I'm talking about having a reliable control over factors that the researchers are not testing for. That way by the pigeon hole, they can say what the mitigating factors are. This just isn't in this study. There is basically no control.




When looking at population dynamics, everything needs to be taken into account. The best way to do this is to let the population do what it does and monitor what happens.




But, when trying to see if one specific factor is a determining factor, one must mitigate all other factors to negligible.

Here, they are trying to determine if circumcision is a significant factor in the risk of contracting HIV. And it looks like they haven't even tried to mitigate /any/ factors.


Quote:

Originally posted by Khyron:

Quote:



Also, for the study to have any validity the participants would have to have had unprotected sex. So, any number of participants using condoms would be fatal to the study.




Once again, the sample size is large enough to make the assumption that such things as condom use would be very similar on both sides. And there's no guarantee that participants who generally use condoms will always use them.

I want to emphasise that nobody is taking this study as conclusive proof that circumcision reduces the risk of infection, it's seen as a (scientifically justified, btw) study that indicates that this might be the case, and that more studies into this need to be conducted.




Really? (New Scientist article):

"""
circumcision has been hailed as a vital new way to combat HIV.
"""


You're right that /no-one should/ take this study as conclusive proof (IMO not anywhere close to it).

You're also right that the question posed here is an interesting one. I'd like researchers to figure out just how well skin protects us from HIV infection. But, there's gotta be a more ethical way of determining this.

Perhaps getting some blood samples from HIV+ people (or other "stuff") and growing some skin of various thicknesses. Then exposing one side of the skin to the fluid and waiting for a bit. A sample to be tested for HIV can be taken from the non-exposed side of the skin to variable depths seeing how far the HIV got.


EDIT: Does anyone here have access to the article? Because I can't really see this discussion continuing much further without access to it i.e. everyone here (myself included obviously) is already relying on implications made by two (or more) short articles that lack any real detail.

EDIT:
Quote:

Originally posted by Khyron:

Sigma seems to be a level-headed guy, so I can't see that happening. I can't even see this discussion becoming heated, it's just a discussion.




Thanks, and right back at you

----
I am on The List. We are The Forsaken and we aim to burn!
"We don't fear the reaper"

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Friday, March 30, 2007 12:09 PM

KHYRON


I don't have a lot of time today, so my answers are pretty short, terse and to the point. That's actually my preferred debating style, but I've been told a couple of times before that it comes across as impatient, condescending and aggressive. It's not meant to be like that, but for that reason I almost always expand my arguments here in RWED a bit. However, I don't have the time to expand the arguments today, and the post is long enough as it is, so if I come across as aggressive and condescending at times, I'm not trying to be.
Quote:

Originally posted by SigmaNunki:
And where is stated that the study was about people going about there normal business?

Seems a bit unrealistic to assume the researchers thought they could control the sex lives of 3,280 horny young men.
Quote:

Btw, I infer that the men were told that they should have protected sex because in the BBC article it states that "The researchers decided at this point it would be unethical to continue the study." Why would it be unethical to continue a study in which they are only taking blood from time to time?
It would have been appropriate to also quote the sentence that follows it:

"The researchers decided at this point it would be unethical to continue the study.

It was stopped and the uncircumcised men were offered circumcision. "


It seems like the researchers were convinced enough that circumcisions do lower the risk of infection and therefore to refuse circumcisions to the uncircumcised because the study was ongoing would be immoral, hence they broke off the study and offered these men circumcisions, since being circumcised might help prevent HIV infection. In principle it's similar to something that SignyM correctly pointed out above:
Quote:

Originally posted by SignyM:
AFA as testing on human subjects... Tests have been cut short on moral grounds, either because a treatment was found to have negative results (example- beta carotene on smokers) or because the treatment is SO effective that continuing with a placebo is considered immoral.

Alright, we're not dealing with a placebo here, but the applicability of the latter case he mentioned is clear.
Quote:

Originally posted by SigmaNunki:
Quote:

Originally posted by Khyron:
Right. I question the amount of fluid exchange that occurs in the urethal orifice, but that's irrelevant, because, again, circumcision doesn't claim to eliminate the risk of infection, it claims to reduce it. Of course fluid interchange and infection may still occur, there are no claims to the contrary.


A hole shoved into a place where bodily fluids are rather abundant. How exactly do you question the amount of fluid exchange?

Stick a garden hose into a muddy hole in the ground and turn it on. How much muddy water is going to flow into the hose?

Even before ejaculation there are fluids excreted by the penis (for lubrication - this is why sex is bearable even if one didn't bother with foreplay or the missus is in one of her 'I can't be aroused until you take out the garbage' moods), making it difficult for fluids to flow into it.
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But, the question does result in another factor that isn't accounted for; the time of exposure i.e. someone who has sex for 2 hrs is going to stand a far greater chance of getting infected than some that has sex for 10 minutes (or less, poor guy/gal ).

Also, as (I believe) someone above mention, there's the whole IV drug thing. Which isn't stated to be controlled for. Hell, some of these guys could use condoms 100% of the time, yet get HIV through a needle.

You can come with all of these different factors, my counter-argument will always be the same: the sample sizes are large enough so that no significant difference in environmental factors between the two groups should be present.

But let's turn it around. Tell me, why would an uncircumcised man (say) be more likely to be infected by a needle than a circumcised man? Why would a circumcised man (say) be more likely to use a condom? Why would an uncircumcised man (say) be more likely to have sex for two hours than a circumcised man?

Please give me the reasons why you think there would be such significant differences in probability for each of these factors (and whatever others you've mentioned previously).
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Originally posted by Khyron:
The study was about rates of infection, not establishing how exactly circumcision seems to reduce the risk of infection. There's no reason to dismiss the study just because one isn't sure why the results might be true.


Actually from the conclusion given at the New Scientist article:

"""
It may not seem like the kindest cut, but circumcision has been hailed as a vital new way to combat HIV. In a report issued on 28 March, the World Health Organization and UNAIDS issued a series of recommendations to increase rates of circumcision in countries where the HIV problem is most serious.
"""

They have concluded that circumcision reduces infection rates when they also state (BBC article):

"""
HIV infection rates are lower among groups in Africa who practise circumcision, but it was not known if this was due to cultural differences.
"""

Basically, they have _not_ established that circumcision actually helps matters. And that's by there own admission. Yet they are recommending that a great deal of effort be expended to circumcise men because of these "results".

In other words, if these results are cultural, then one does _not_ need to be circumcised to get any benefits. One just needs to have there attitude "re-educated".

These guys are running off of circumstantial evidence and they even admit it!

Basically, these guys are saying things that completely contradict what you're saying here.

Hmmm... where to start on this one. Alright, let us look at this:

"HIV infection rates are lower among groups in Africa who practise circumcision, but it was not known if this was due to cultural differences."

As I understood it, the uncertainty expressed here is part of what motivated the South African case study. Scientists weren't sure if cultural factors were the reason, so they started a study in South Africa to investigate it on a sample that is large enough to be statistically valid and yet small enough to ensure some measure of cultural homogeneity amongst the participants.

The conclusion in New Scientist is evidently based on three such studies.

Basically, you're going about this backwards. You start with the conclusion and say the certainty expressed in it contradicts the uncertaintly in the initial question. It's like reading the end of a Sherlock Holmes novel, then reading the rest of it and concluding that the novel contradicts itself because in the beginning Holmes didn't know who the murderer was and in the end he does.
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To do a study in /only/ one place is rather poor form. When companies do studies in North America, to gain statistical significance, they do the study in several cities across the country.
That's why it's also being done in Uganda and Kenya. Regardless of that, we're dealing with human physiology here, the effects of circumcision aren't going to differ significantly in different places.
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There are a variety of reasons for doing so, but the one that is most relevant here is difference in lifestyle. Though diet will probably play a strong role as well. Anyone know how rich Orange Farm is? This /will/ play a role as the immune system will be *much* better in one that is _not_ malnourished among other things.
If the diet is bad, both groups of participants would be malnourished equally.
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The BBC article also quotes Keith Alcorn as saying, "Two further studies in Kenya and Uganda have yet to be completed, and will give us more information."

Now if those show the same results, then we might have something.

The New Scientist article seems to imply that the studies have been completed:

"Studies in South Africa, Uganda and Kenya have recently shown that circumcised men are on average 60 per cent less likely than uncircumcised men to pick up the virus (New Scientist, 25 November 2006, p 8)."

So this means we might have something, right?
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But as it sits right now, all we have is something that indicates that circumcision has something to do with a lower HIV infection rate. What circumcision has to do with it is still very much in the air. Again, this is by these people's own admission. We still know pretty much nothing.
I wouldn't say it's up in the air, the hypothesis that increased sensitivity in the skin cells beneath the foreskin makes them more receptive to the virus has been addressed at the start of this debate. Apparently this isn't absolutely certain to be the reason, but it's more than nothing and it seems sensible. But I'm glad you've changed your mind, though. Before you said the study was BS, now you say: "all we have is something that indicates that circumcision has something to do with a lower HIV infection rate". Good call.
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Originally posted by Khyron:
We'd have something, but something that's an artificial result. In epidemiology, if one looks at the rates at which a disease spreads inside a population one can't take infected and uninfected members of the population out of it and then only look at the consequences of their interactions, one has to let the population go about its usual ways and take representative samples to tell one what's going on.


Well, if we were talking about how HIV spreads you'd be spot on, but we are _not_ talking about how HIV spreads. What we /are/ talking about is if circumcision itself reduces the risk of getting infected with HIV upon exposure through sex. The conclusion on the article you linked to even states this!

"""
The researchers planned to test all participants for HIV at three, 12 and 21 months, to see whether there was a difference in the rate of new infections between the two groups.
"""

From the beginning it was all about circumcised vs non-circumcised. Does one have a lower rate of infection.

Erm... I'll put your argument here down to your tiredness when you wrote it. Epidemiology is about the spread of contagious diseases in a population (the rate of infection is a part of this; the population may be subdivided as necessary), this study is about the rate of HIV infection in the two cases we're talking about. This study falls under epidemiology. Relevant methods used in epidemiological investigations apply.
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Originally posted by Khyron:
If you're talking about differences inside the geographical area in which the study was conducted, it's fair to assume that the participants were well-mixed, i.e. it's unlikely that out of 3,280 people, 90% of those who lived in the Eastern half wanted circumcisions and 90% on the Western half didn't. If you're talking about wider regional differences, this was a relative measure, not an absolute one, so these differences shouldn't play a role.


The differences /will/ play a role when it's general conclusion time. As it sits, the only thing that we know right now is, in this particular part of South Africa, circumcision itself may or may not reduce the risk of getting infected with HIV.

My guess is a penis in Jo'burg is quite similar to a penis in Durban or Cape Town, and cultural differences don't play a role because the study area was small enough not to be affected be cultural differences. So once you've accepted that the study might be on to something, there's no reason to think the results wouldn't be true in other parts of the world.
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Though the "researchers" say that they /think it/ does. Enough in fact, to recommend based on circumstantial evidence that we should (New Scientist article) "increase rates of circumcision in countries where the HIV problem is most serious."
Read the passage from the New Scientist article I quoted above.
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You seem to be defending an absolute conclusion based on what you call a "relative measure".
What I called a relative measure was comparing the number of HIV infections in circumcised men relative to the number of infections in uncircumcised men.
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Skepticism is a main stay of science. So, is proper scientific method.
Yes, but you're not just being skeptical, or maybe too skeptical. You've already dismissed the study as 'bullshit', dismissed the researchers as quacks (by using quotation marks) and made it clear that circumcision can't work because you don't see how it could work. On the other hand, most scientists, who indeed should be skeptical, would react like this: "Huh, that's interesting. I wonder if further studies would back this up."; quite different from your reaction.

For these types of studies, the scientific methods used here are standard.
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This study uses... questionable methods. In fact, the "methods" that they use indicate that they cannot come to the conclusion that they claim. In fact, there are so many variables that they are _not_ accounting for it isn't funny.
There are only four variables they need to be accounting for: number of participants in each group, and number of new infections in each group.
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Not to mention that they themselves state (BBC article) "UNAids has said the trial found promising results, but more work needs to be done to confirm its findings". Yet, (New Scientist article) "UNAIDS issued a series of recommendations to increase rates of circumcision in countries where the HIV problem is most serious."

They contradict themselves i.e. in the BBC article, more study is needed, but in the New Scientist article they say that the study has such strong results that they are going to recommend significant policy change.

Here's a qualifying statement from the New Scientist article (I quoted this passage before, but it's relevant again):

"Studies in South Africa, Uganda and Kenya have recently shown that circumcised men are on average 60 per cent less likely than uncircumcised men to pick up the virus (New Scientist, 25 November 2006, p 8)."

This indicates the other studies have been concluded and have confirmed the original hypothesis.
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Basically, this "study", on its own, should be dismissed.
Scientists would argue that it should be taken as the basis for further exploration and more studies into that direction.
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As for your comment that we should discard all studies of this type if we discard this one. Well that bit of hyperbole is just plain wrong.
You can take the credit for the hyperbole, I said 'plethora'.
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Those other studies have had other more rigorous studies to confirm them. Or other studies that have a different set of variables, that further reduce what could be going on. And after many studies to try to confirm those results, we end up with a logical conclusion.
Bingo! That's what I'm saying.

You said the methods used in this study were objectionable and hence the study should be dismissed, now you say that other studies done with the same methods are okay because they had back-up studies to confirm them. Do you think the back-up studies in those other cases would've been made had the original study in each case been dismissed out of hand because somebody somewhere was under the impression that the method used wasn't scientific enough?
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The main problem with your line of thinking here is that with the studies that we should apparently discard, they have been confirmed time and time again. Whereas this "study" is the *first*. There are two others that are going on /right/ /now/ (BBC article).
The main problem with your line of thinking is that if we discard the first study, there will be no back-up studies.
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Again, *if* those studies show the same thing, then we have enough evidence for an actual rigorous study.
It seems like they have (read the passage I've quoted twice before).
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Basically, this is only the beginning in a possible long chain of studies regarding circumcision and its chance of reducing the chance of HIV infection.
But that's a good thing. Right? In the meantime, the studies say it could work, and it certainly can't hurt, so let's get chopping away and we might be saving lives.
Quote:

Quite frankly, I find such pre-mature announcements in rather poor taste. And when it comes to the specific topic here quite dangerous and as such, ethically questionable. This really should have stayed in the literature until at least the other two studies had been completed. But, that would have stolen the thunder of the WHO and UNAIDS (or at least the people involved in this particular study). After all, fame requires one to be first.
Yes, the media shouldn't be reporting the latest scientific and medical findings. Informing people what's going on in the world of science and medicine is, uhm, just wrong... for some reason.
Quote:

Quote:

Originally posted by Khyron:
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Tell me, what was the exposure rate? After all, knowing this is critical of knowing whether this study is valid or not.


Do you mean number of times the participants had sex with an infected person on average? If you mean this, I have no idea, nor do I think the researchers would have such statistics. Once again, I think the sample size is large enough to assume that such factors would be very similar.


Well, we actually can't.

Sexually active can mean being in a monogamous relationship or having sex once every couple months or a couple times a day or anywhere inbetween or more extreme. And each time one has sex, one rolls the dice to whether they are "getting it on" with someone that is HIV+. If only for these uncontrolled factors, we certainly cannot say that the exposure rate is homogeneous.

Put this onto the list of things you need to explain to me why there'd be a difference with respect to this between the two groups.
Quote:

Quote:

Originally posted by Khyron:
Quote:

You're assuming that the participants are educated and have full awareness of the consequences of the possible outcomes. This is a very bad assumption given the region of the world we are talking about.


Many people in that area would have been circumcised anyway, and aside from the circumcisions all that the researchers did was monitor the rates of infection afterwards. As long as the circumcised participants understood that they should wait until their wounds are healed before having sex, which doesn't take much education, I don't see how the level of schooling plays a role.


I was responding to you saying "Participation was voluntary, in which case it can't be immoral."
{I know, I responded to your response }

What I was getting at is that these researchers knew that they were probably going to indirectly cause the infection of a fair number of people. Yet they did it anyway. This I find amoral.

I assume this is a response to the school of thought that they asked the participants to have unprotected sex, so I disagree with the quoted segment but won't go into details since the motivating argument has already been addressed.
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When it comes to the level of education, educated people are *far* less likely to enter such a risky endeavor (especially when they are pretty much guaranteed to contract HIV as a result). These researchers chose a rural community, _not_ a city. An area which is *far* less likely to have educated people in it. Thus "ripe for the picking" when it comes to participants. Which can been seen in the ~3300 males who joined up. I find that number disturbingly high.
They chose a rural community because rural communities have high rates of infection (making it easier to obtain significant comparative results), because they are more culturally homogeneous due to low levels of immigration to those areas (needed to ensure that not too many those who want circumcisions come from a cultural background where circumcisions are common practice and sexual habits differ), because South Africa's cities, especially Jo'burg, are crime-ridden and many of the participants would have died or fled during the study (for reasons not related to the study), and because it would be easier to keep track of the participants in a rural area than in a big city. Besides, Jo'burg has a large number of slums, the overall level of education (or lack thereof) is just as bad as in rural areas.
Quote:

But, you bring up an interesting point regarding circumcision. That some would have been already. But, by the BBC article:

"""
Just under 3,280 young, sexually active, uncircumcised,
"""

What I meant was that some participants would have been circumcised anyway at some point (I left the underlined part out before because I thought it was clear from the context).
Quote:

So, /all/ of the guys had been circumcised by these doctors assumedly at the same time. Which leads into another point. Did these guys have the "full effect" of circumcision? Were the non-circumcised not allowed to have sex during these 6 weeks so that everything was a level playing field?

Sure, 6 weeks to heal. But, that's just the cuts due to the circumcision! The whole thought is that the tougher skin on the penis would provide better protection against HIV. Is 6 weeks enough time to get the full "benefits" of circumcision?

Excellent and valid questions, I'd like to know the answers to these too. But I suppose some hardening of the skin can happen quite quickly if the skin starts off being very sensitive because of things such as chafing against the fabric of one's underwear.
Quote:

Quote:

Originally posted by Khyron:
I suppose the high risk comment stems from you thinking the researchers encouraged the participants to have unprotected sex, which I don't think was the case...


How would circumcision play a role if they were using condoms?

It wouldn't.
Quote:

Quote:

Originally posted by Khyron:
...on the other hand, if it were the case, I would completely agree with your hyperbole and your assertion that the research was immoral. But I think in this case every human rights society in the world would be on the researchers' ass for unethical conduct, and that that would be a bigger story than the results themselves.


I'm not sure I agree. If the study was about if circumcision affected infection rate (which it is), and the researchers chose people who engaged in unprotected sex already, then I don't see any human rights org shitting on these guys. Especially since there work is all about reducing the spread of HIV.

Getting human rights people after you because you're doing research to prevent the spread of HIV. Now there's irony

I have two avenues of approach in response to this point:

i) either you're saying the HROs aren't saying anything because the researchers chose people who engaged in unprotected sex already, in which case there's no moral dilemma,
ii) or you're saying that the HROs are keeping quiet because the work is about reducing the spread of AIDS, which would be completely out of character for them and against their founding and working principles. "The needs of the many outweigh the needs of the few" has seldom been the guiding mantra of HROs, and many of them even vehemently oppose non-lethal medical tests on no-chance-of-parole, life-sentence serving prisoners.

In today's over-sensitive, overly politically correct Western societies, do you really think that if there were unethical conduct you'd be the only one to say something about it?
Quote:

Quote:

Originally posted by Khyron:
When looking at population dynamics, everything needs to be taken into account. The best way to do this is to let the population do what it does and monitor what happens.


But, when trying to see if one specific factor is a determining factor, one must mitigate all other factors to negligible.

Here, they are trying to determine if circumcision is a significant factor in the risk of contracting HIV. And it looks like they haven't even tried to mitigate /any/ factors.

Of course they haven't, because the correct approach to studies like this is: "All other factors being equal, does this altered factor have a significant impact?". There's no reason to eliminate the other factors from the study, in fact taking the subject of study out of its natural environment has a tendency to lead to artificial (i.e. not necessarily representative) results. How were they supposed to do it anyway, stick some guys into a whorehouse and see which group gets infected first?
Quote:

Quote:

Originally posted by Khyron:
I want to emphasise that nobody is taking this study as conclusive proof that circumcision reduces the risk of infection, it's seen as a (scientifically justified, btw) study that indicates that this might be the case, and that more studies into this need to be conducted.


Really? (New Scientist article):

"""
circumcision has been hailed as a vital new way to combat HIV.
"""

I was, of course, referring to the South African study. Here's a qualifying statement from the New Scientist article (I quoted this passage twice already, but it's relevant once again):

"Studies in South Africa, Uganda and Kenya have recently shown that circumcised men are on average 60 per cent less likely than uncircumcised men to pick up the virus (New Scientist, 25 November 2006, p 8)."

Once again, this indicates the other studies have been concluded and have confirmed the original hypothesis.

Please realise that the New Scientist and the BBC articles weren't reporting on the same thing. The BBC article was reporting on the case study in South Africa, the New Scientist article was reporting on the recommendations made based on three such studies. There. Is. NO. Contradiction.



"The best argument against democracy is a five minute conversation with the average voter."

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Friday, March 30, 2007 1:42 PM

FREDGIBLET


First off I'd like to say thanks Khyron for putting the effort that I'm not willing to into defending this.

Quote:

Originally posted by Khyron:
On the other hand, most scientists, who indeed should be skeptical, would react like this: "Huh, that's interesting. I wonder if further studies would back this up."



This was my exact reaction when I read the article from a few years back.

Quote:

In fact, there are so many variables that they are _not_ accounting for it isn't funny.


Actually because of the number of variables the manner in which the test was conducted makes sense, controlling for every single variable in the course of 2 years of human life would require an extremely regimented system bordering on imprisonment and would have to include absurdly unethical activities such as knowingly and purposefully exposing the test subjects to an incurable disease. The only way that makes any sense is to let them free and see what they do.

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Quite frankly, I find such pre-mature announcements in rather poor taste. And when it comes to the specific topic here quite dangerous and as such, ethically questionable. This really should have stayed in the literature until at least the other two studies had been completed. But, that would have stolen the thunder of the WHO and UNAIDS (or at least the people involved in this particular study). After all, fame requires one to be first.
Yes, the media shouldn't be reporting the latest scientific and medical findings. Informing people what's going on in the world of science and medicine is, uhm, just wrong... for some reason.



Actually Sigma makes a decent point here, too often the media makes scientific announcements before the research is conclusive and then fails to keep up with the story later giving people false impressions about the science in question. In debates on evolution Piltdown Man is frequently brought up. Piltdown Man was widely trumpeted by the mass media but never corroborated by science, eventually being exposed as a fake, but that was never shown by the media. To an outside observer it appears as if the scientists believed in Piltdown Man and to this day it is still used by anti-evolution groups, if the mass media had waited for some sort of consensus to form before rushing off to write their stories then this persistent bit of mis-information wouldn't be around.

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Friday, March 30, 2007 1:49 PM

KHYRON


Regarding the media, just because it doesn't follow up on many of the contentious studies it reports on surely doesn't mean that it shouldn't be reporting them at all. Partial information is better than no information, and those who are interested can follow up on it by doing personal research, and those who don't will at least have heard about the research that's being reported on. As long as the media doesn't report it as fact but as an open question (as, in this case, the BBC article does), I have no problems with it.



"The best argument against democracy is a five minute conversation with the average voter."

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