Audio By Carbonatix
Could a whole coalition of highly accomplished, super educated doctors and researchers — the ones who work at and advise the Gates Foundation, the World Health Organization, the American Academy of Pediatrics, and the Harvard School of Public Health — all be wrong?
Or are their critics hindering them from saving lives?
As described in our recent feature story about circumcision, three
studies conducted in
Africa in the past decade generated a whopping amount of press and
have been the catalyst for tens of millions of dollars being pumped into
campaigns to circumcise African men in an effort to stem the spread of AIDS. These three randomly controlled
clinical trials (the three “African RCTs,” as they are sometimes called)
were carried out in (I’m linking to the source material here): Uganda, South Africa, and Kenya.
These three famous studies have, in fact, had challenges. John Geisheker, head of an organization called Doctors
Opposing
Circumcision, says that researchers “did a marvelous job
of attracting
Gates Foundation money and creating a halo around the organization” and
that people are “trying to capitalize on the Africa market.
If American medical
companies like Allied can get a hold of this money, they can make
billions. The Africans don’t even realize they’re being used like guinea
pigs.” He said that when he’s contacted the Gates Foundation with
contradictory research and warned them to slow down, he doesn’t even get
a response.
The bigwigs in the international health arena have largely ignored criticism and are forging ahead with plans to circumcise 20 million African men by 2015.
Who’s right?
All
of the studies and counterstudies on the subject matter are enough to
make one’s head spin. For those of you interested in going down this
rabbit hole, I’ve linked to the initial studies (above), read through
much of the criticism, and contacted people at the Gates Foundation as
well as the Harvard School of Public Health to see if they would respond
to some of the points made by detractors.
Here is what I found.
First, I contacted the Gates Foundation, but despite the fact that it has invested millions of dollars into this project, I was told that it didn’t have anyone who could speak to me about this matter.
Then I contacted Dr. Max Essex, chairman of the Harvard School of Public Health’s AIDS Initiative, with the following four questions. I purposely cited articles that have been published rather than link to websites run by anticircumcision activists.
1) The three RCTs say that circumcision reduces risk of HIV infection by 53
to 60 percent. Critics argue that that is the “relative reduction” as
opposed to the “absolute reduction” and that if the absolute reduction were
used as a comparison, the numbers would be statistically insignificant.
Thoughts? (This article lays out that argument more clearly:
http://www.salem-news.com/fms/
2) Education and condoms are far cheaper than circumcision, so why spend
tens of millions of dollars on circumcision rather than direct that money
toward education and condom use? (http://www.icgi.org/Downloads/
3) Circumcision is sometimes referred to as a “vaccine” (see New York Times
article of January 31 :
http://www.nytimes.com/2012/
fy-circumcision.html?
Do you find this accurate? Misleading? What is the status of a
vaccine for HIV/AIDS?
4) Some articles have suggested that removing the foreskin prevents HIV
transmission because HIV enters through the Langerhans cells; yet there are
competing articles alleging that the Langerhans cells actually “lap up” the
virus and protect against it. See :
http://www.nature.com/nm/
Dr. Essex responded: “it seeems to me that male circumcision would be even less expensive than condoms + education. It only costs 50-75 $ as a one time event. Hovever the
person in our group who is most knowlegeable on MC is Dr Rebeca Plank. I’ll cc
heer on this.” [sic]
Dr. Plank then wrote:
I can say, however, that male circumcision is a one-time intervention with
life-long benefit. It can be likened to a vaccine in that REDUCES (but does not
eliminate) the risk of infection with a particular agent, and also REDUCES the
risk of that infection establishing itself in the community (herd immunity),
which is one of the public health principles on which all vaccines stand. Male
circumcision for HIV prevention is like getting vaccinated PLUS hand-washing,
not touching one’s face, mask-wearing when appropriate to prevent the flu rather
than remaining unvaccinated and trying to rely on hand-washing, not touching
one’s face, mask-wearing alone to prevent the flu.
As Dr. Essex has indicated, male circumcision is much cheaper than condoms +
education (one male circumcision in southern Africa is
http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000109
Another recent publication estimates that to scale-up male circumcision in the
areas of Africa that have both 1) very high prevalence rates for HIV and 2) low
prevalence rates of male circumcision, it would cost US$2 billion yet would
result in net savings (due to averted treatment and care costs) of US$16.51
billion.
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001132
Furthermore, despite the widespread availability of education + condoms in a
country like Botswana for years and years, the HIV incidence and prevalence
continued to be extraordinarily high, with the most recent statistics (2008)
showing that in certain age groups the HIV prevalence rate reaches 40% (in the
US the HIV prevalence is
Regarding the salem-news article you sent, those at the highest levels of public
health science and implementation (WHO and UNAIDS) have reviewed the
methodology, statistics and results of the three randomized trials of male
circumcision and they are in full support of scale-up of this service as soon as
possible. We are already delayed. There is a lot of highly charged and emotional
controversy about male circumcision, despite peer-reviewed data from randomized
control trials considered the gold standard in clinical medicine, that sadly is
impeding scale-up. Men and their female partners are getting infected with HIV
unnecessarily. If this were a vaccine that came in a sterile glass vial it would
almost certainly be celebrated and not debated.”
So there you have it. Why do I have a feeling this debate is not going to end anytime soon? I’ll update if Dr. Essex gets back to me about the Langerhans cells.
