Monthly Archives: April 2014

On The Stream: To Cut or Not To Cut – Brian Morris, Richard Wamai on circumcision

Spotting contradictions between circumcision promoters on Al Jazeera’s “On The Stream: To Cut or Not To Cut”

If you are outside the U.S., you can watch the video here: https://www.youtube.com/watch?v=GitOnW-nzck&sns=fb

If you are in the U.S., this link may work: http://bc19.ajnm.me/864352181001/201404/3132/864352181001_3492775214001_FULL-to-BC-AJE-0421.mp4

Richard Wamai

Richard Wamai

At 8:25 Richard Wamai denies risk compensation

Richard Wamai: There is no evidence out of Sub Saharan Africa where male circumcision is being promoted to prevent millions of men from getting infected with HIV that somehow there is disinformation and that men get circumcised and reduce using condoms or change behavior, we don’t have that evidence, it simply does not exist.

At 20:21, after a YouTube blogger argues that we don’t need to amputate every tissue that becomes infected, and calls for “our bodies, our choice”,  Richard Wamai responds:

Richard Wamai: I totally disagree with that. First off all, if we talk about human rights, adult men can determine whether they want to keep their foreskin or not. If I know the benefits of circumcision, then I have the right to make the decision. For somebody to say that it is amputation, that is not quite accurate at all.

[Richard Wamai is co-author of "A snip in time: what is the best age to circumcise?" where he, along with Brian Morris and other circumcision advocates, argues that infancy presents a "window of opportunity" for circumcision. Infants cannot provide informed consent.]

Richard Wamai

Richard Wamai

At 22:25 approximately:

Moderator: I don’t understand if you are circumcised as a man, you are still putting a condom on. Why don’t you put a condom on in the first place?

Richard Wamai: Well, why, you don’t, because, you know what the rate of condom use is in South Saharan Africa?

Moderator: But you have to use it to have protection

Richard Wamai: You know what it is? Very few people ever use a condom consistently so we need to do something, that’s why we are doing studies, that’s why we are doing studies  to test whether there could be a microbicide, a vaginal stuff, gel that women can use…

Moderator: Because men don’t like to wear condoms?

Richard Wamai: Well, that too, but I mean, we know that condom use is very low…

At 23:22 Brian Morris tries to interrupt, I have not been able to figure out what he says. The show goes to a commercial break. Upon return, John Geisheker from Doctors Opposing Circumcision presents his critique of the African circumcision trials.

Brian Morris and John Geisheker

Brian Morris and John Geisheker

John Geisheker: (…)For one thing, the figure of 60% does not rise to the level of immunization, which must, by standard of bioethics, be in the high nineties. A 60% protection of anything is merely a roll of the dice. All that a person is doing who is circumcised and then not bothering to use the usual protection of ABC [abstinence, be faithful, condoms] is playing bio-roulette, Russian roulette. (Continues explaining the real meaning of the 60% figure)

Brian Morris: John is a lawyer, he is not a scientist, he is not a doctor [never mind that Brian Morris is not a medical doctor either], trials are not about following people for ever and ever, trials follow people until they find a statistical difference and in this case the statistical difference happened so soon that the monitoring body stepped in and stopped the trials because it would be unethical to continue them since the evidence showed such a strong protective effect

Moderator interrupts for a back story. Then Brian Morris continues

Brian Morris: I also completely dispute John’s misunderstanding of immunology and vaccines. Vaccines some are quite effective, but look at one of the more common vaccines, the flu vax, the effectiveness of that in the population is about 80%, which is also about the effectiveness of condoms, and with the long, long term follow up of HIV trials and roll out, the protective effect of circumcision has risen over the years, so it’s now approaching that 80% mark, and in public health we advocate [I keep missing this word, sorry] interventions, not just condoms, not just circumcision, but also a behavioral practice, anything else that we can show does work. We don’t say oh let’s just go this way because we like it. We use all of the effective methods and circumcision is one of THE MOST effective [vocal emphasis], and as Richard pointed out condoms cannot be used but once a man is circumcised he is circumcised for life and that is significant. Condoms have to be put on the penis before any sexual contact…

…..

So, let’s point some issues here. In Richard Wamai’s view, condom use rate cannot be increased significantly, so it seems better to go on a crusade to circumcise millions of men, even though men are not running to take the offer. And while Wamai denies risk compensation, he also denies that condom use rate can be increased (which is a risk compensation behavior on its own). And yet he seems to put hopes on hypothetical future gels for women to use, when men cannot (in his mind) be expected to use condoms.

Brian Morris on his end appears to be doing what he usually does: inflating the benefits and overlooking the risks. In his mind the protective effect has been increasing and is close to the 80% mark.

About this increasing protective effect, I’m reminded of this text by Des Spence (BMJ 2010;341:c6368) (we highlighted some keywords):

Study design—Study populations are biased by design. Only high risk, unrepresentative populations are studied because they are the most likely to show an effect. These data are then extrapolated to low risk populations of people who never benefit—statins are studied in Scotland and prescribed in Surbiton. The inverse care effect also means that people at low risk are more likely to seek treatment and comply with it.

The same article indicates:

Statistical trickery—There is systematic and cynical use of statistics to manipulate results [see following paragraph]. This dishonesty—the dark magic of surrogate and composite end points, “validated” questionnaires, the premature ending of studies, the reporting only of relative risks , and the lack of long term follow-up—is just cheating.

The famous 60% figure is a relative risk, a comparison between two very small percentages, as John explained in the debate until Brian Morris interrupted.

One fact often overlooked about the African trials is that the number of individuals lost to follow up was 3 times more than the total number of sero-converted individuals. This alone casts serious doubts over the “statistical significance” of the results.

Trying to listen to Brian Morris and Richard Wamai, we are reminded of the technique known as Gish Gallop: “The Gish Gallop is the debating technique of drowning the opponent in such a torrent of small arguments that their opponent cannot possibly answer or address each one in real time. More often than not, these myriad arguments are full of half-truthslies, and straw-man arguments - the only condition is that there be many of them, not that they be particularly compelling on their own. They may be escape hatches or “gotcha” arguments that are specifically designed to be brief, but take a long time to unravel.

Another important detail, Richard Wamai argued that to call circumcision amputation is wrong because every adult man has the right to decide over his body. John Geishener made clear that he and his organization (Doctors Opposing Circumcision) agree that every adult man has the right to do anything to his own body, and that their opposition is to forceful circumcision of infants and children, and to using the African trials as rationale to push for infant circumcision in the United States (extrapolation).  Brian Morris and Richard Wamai are, however, coauthors of a paper called “A snip in time: what is the best age to circumcise?” where they argue that infancy presents a “window of opportunity” for circumcision. So how would Richard Wamai defend his argument that circumcision is not amputation, after arguing in writing for circumcision during infancy?

But please dear readers, don’t take our word; watch the video, do your best research, evaluate the evidence, evaluate the advocates one way or another, and formulate your own conclusions.

Related News:

ZIMBABWE: Men are not buying circumcision…

ZIMBABWE: …so they’re doing it to babies

UGANDA: Myths about circumcision help spread HIV

ZIMBABWE: Circumcised men abandoning condoms

Evidence that “simply does not exist” – according to Wamai:

Botswana – There is an upsurge of cases of people who got infected with HIV following circumcision.

Zimbabwe – Circumcised men indulge in risky sexual behaviour

Nyanza – Push for male circumcision in Nyanza fails to reduce infections

Introducing CircWatch

It is time for formal introductions, and we are pleased to present CircWatch, a WordPress blog which has been created to replace the CircLeaks wiki website, taking an editorial role to also replace the CircLeaks blog. All content from the CircLeaks blog has already been transferred here.
 
This website aims to keep a close watch on the actions of persons, entities, companies and organizations that support, advocate, purport, profit, or otherwise stand to gain from the promotion and medicalization of circumcision, male and/or female.
 
Articles will be published as we become aware of new and latest developments in the promotion of male and/or female circumcision.
 
In addition to being published here, the latest information will also be archived at the new intactivist wiki database, IntactWiki.
 
We thank the original followers of CircLeaks for their continued viewership and support.
 
CircWatch Staff

Did a Mayo clinic study confirm health benefits on circumcision? Or Brian Morris, and how to manipulate public opinion on circumcision using clever headlines

Recently, circumcision has resurfaced as a hot topic in the media. All last week, numerous articles with misleading titles were published by big name media outlets,  promoting the latest “study,” which supposedly “confirms” the so-called “benefits” of circumcision.

Here are some of the titles:

Infant circumcision is the healthiest choice, new study claims
Researcher says circumcision should be offered like childhood shots
Circumcision should be offered ‘like vaccines’ to parents of boys
Study determines circumcision comparable to vaccination” (Israel and Stuff)
Call for circumcision gets a boost from experts
Circumcision rates declining in US infants, raising health risks later in life
Circumcision should be seen ‘in same light as childhood vaccination’: study
Circumcision benefits far outweigh the risks, finds study IN MAYO CLINIC PROCEEDINGS (elsevier connect)
MAYO ON MILAH – Mayo clinic study confirms health benefits on circumcision” (The Jewish Press)
New Journal argues circumcision should be mandatory
The benefits of circumcision outweigh the risks 100 to 1
To snip or not to snip – academic claims circumcision should be treated like vaccination

But, is it true? Did the Mayo Clinic perform a new study on circumcision? And, was the study published legitimate?

To the casual observer, these headlines appear to say all they need to know. When they approach a conversation about circumcision, they will remember one of these headlines and quote it or paraphrase it without any real knowledge of what it means or what really happened. And this is exactly what some sectors want.

Now, let’s go step by step:

First off, the Mayo Clinic did not perform a study on circumcision.

The study being discussed is not new, original research, but a literature review of select articles.

The article was not written by unbiased researchers. The three authors have been known to promote circumcision for many years.

To call this article a “Mayo Clinic study” is misleading and manipulative. Independent authors submitted the article to the journal of Mayo Clinic, Mayo Clinic Proceedings. The Editorial Board procured peer reviewers, who then approved the article for publication. This is very different from having actual staff researchers or commissioned experts performing a study at the Clinic’s request. The article was not written at Mayo Clinic’s request or by Mayo Clinic personnel.

Related: Problems with Peer Review

Related: Is peer review broken?

This article (or literature review) was written by Australian retired professor and molecular biologist Brian Morris, and co-authored by Dr. Thomas Wiswell  and psychologist Stefan A. Bailis, both of whom had already co-written other publications promoting infant circumcision with Brian Morris.

Some articles referred to Brian Morris as Dr. Morris. While the fact that Brian Morris has a PhD makes this reference technically correct, it is misleading because it makes it sound like he is a qualified medical physician, when he does not hold a medical degree of any kind. Brian Morris is not a physician or a medical doctor in any way, and the public should know that. He is a professor of molecular science, and does not hold a degree in urology, surgery, pediatrics or epidemiology.

In their last Policy Statement on circumcision (2012), the American Academy of Pediatrics tries desperately to push the soundbite that “The benefits of circumcision outweigh the risks.” Be that as it may, the AAP stops short of the recommendation that circumcision advocates like Brian Morris were hoping for.  In this new review, Brian Morris takes a position far more extrem, going as far as comparing circumcision with vaccines; yet, the implied goal of both papers is to get Medicaid and insurance companies to re-establish coverage for neonatal circumcisions in those U.S. states where they no longer cover it.

This review makes claims that are manipulative and hard to prove, for example that the  “benefits exceed risks by at least 100 to 1” and that “over their lifetime, half of uncircumcised males will require treatment for a medical condition associated with retention of the foreskin”.

Because awareness that circumcision of minors violates human rights has been moving from the “anti-circumcision lobby groups” (as Brian Morris refers to pro-genital integrity organizations on his website) to mainstream organizations such as the Royal Dutch Medical Association, the Parliamentary Assembly of Council of Europe, the International NGO Council on Violence against Children and many others, professor Morris now is trying to manipulate the language to suggest that  “not circumcising a baby boy may be unethical because it diminishes his right to good health“, again a claim hard to substantiate.

Morris’ desired conclusion is that “as with vaccination, circumcision of newborn boys should be part of public health policies” particularly on “population subgroups with lower circumcision prevalence“.

Unsurprisingly,  the same authors, in cahoots with some of the promoters of circumcision in Africa, presented a paper called “a snip in time” two years ago, arguing that infancy is the best time to circumcise and that “by making MC (male circumcision) normative in a community, [...] the prospect of [psychological problems] would be largely eliminated“.

As usual, in this new article Morris references his own previous publications numerous times. Out of 80 references, he is author or co-author of at least 12 of them. On the contrary, the American Academy of Pediatrics in their 2012 Policy Statement did not quote a single publication by Brian Morris.

So this is the problem:

In the eyes of the casual observer (and reporter), the fact that this article is being published by Mayo Clinic Proceedings (a publication of the Mayo Clinic) is almost equivalent to saying that the Mayo Clinic performed an original study and/or agrees with it. While this is certainly not true, it is an easy assumption for people to make or believe.

Media headlines are used to manipulate the general opinion by using the more dramatic claims from the abstract to embed them in the collective consciousness. Most people will not read past the headlines, and will reach their conclusions based on this limited information.

Few reporters and authors dare to criticize peer reviewed publications. In this case, one notable exception is Wellington Professor, Dr. Kevin Pringle, who perfectly summarized: “Vaccination is a low-risk intervention to prevent a problem with significant adverse outcomes. Circumcision is an intervention with significant risks (ignored or minimised by the authors of this paper) to prevent problems that will not develop in the vast majority of males; most of which can be simply addressed if and when the need arises.

For those wishing to seriously challenge Brian Morris’ new article, the following is a response from the Editor-in chief of the Mayo Clinic Proceedings journal:

April 4, 2014 at 2:46 am

The article, “Circumcision Rates in the United States: Rising or Falling? What Effect Might the New Affirmative Pediatric Policy Statement Have?” was authored by 3 experts in the subject matter. All 3 have previously authored numerous scientific articles on this topic, and their combined credentials are far more than adequate to allow them to authoritatively address the topic.

Once submitted to Mayo Clinic Proceedings, the aforementioned manuscript was rigorously peer reviewed by other experts in the field, revised, and later accepted for publication. The Journal’s Editorial Board oversaw this process. All of these are typical processes for the review and acceptance of a manuscript. As a result of these processes, the approved manuscript was deemed to provide solid scientific information and appropriate speculative synthesis on the subject matter.

Formal comments regarding this article and other materials published in Mayo Clinic Proceedings should be directed to the journal, in the form of a Letter to the Editor. That communication should be submitted through the journal’s manuscript management portal, http://mc.manuscriptcentral.com/mayoclinproc . There, those wishing to comment will find instructions on the allowable content and other guidelines for formulating a Letter to the Editor. The comments within the Letters must be restricted to the scientific matter under investigation, and will be evaluated by a peer-review process to determine their educational and clinical value to the general/internal medicine readership of the Proceedings. In general, only 15% to 20% of all submissions to the journal are eventually accepted for publication. Ad hominem attacks on the authors, the Journal, or its sponsoring institution, Mayo Clinic, will not be permitted in any published Letters. Further, any letters eventually accepted for publication will be accompanied by a published response from the authors.

William L. Lanier, MD
Editor-in-Chief
Mayo Clinic Proceedings

Why does Brian Morris link his site to a circumfetish page?

The casual observer landing on Brian Morris‘ website (circinfo.net) may believe that it is in fact “an evidence-baised appraisal”. However, as one advances through it, one can’t stop but wonder why Brian Morris includes links on his website to a circumfetish page.

A circum… what?

Yes, a circumfetish website. A page to share circumcision-themed erotica, often involving forced circumcisions, sexual acts during circumcisions, often involving minors, and other similar smut.

Could it be an oversight? A site that changed after Professor Morris initially linked to it?

No. In fact the link has existed for years on Morris’ website, and the page itself has existed for years as it is, known by many who are aware of Morris’ darker links.

The page says it was created for the “benefit of the circlist members” and “not aimed at the general public”. One would wonder why.

We will not reveal the “secret password”, but let’s take a look at this dark side.

Links and resources page, on Brian Morris’ website.

morris1

Notice link #16.

morris2

When we click on link #16, a new tab opens:

morris3

We clicked on the last link (images) and entered the password. (We will not reveal the password at this time)

morris4

We clicked on one of the “stories”. Notice this one is about a 15 year old whose dad “needs” to have him circumcised and then goes on to tell the story of dad’s own forced circumcision during adolescence. We don’t need to see it all. We already feel dirty reading this garbage.

morris5

Now, given how meticulous Brian Morris is with his references, can anyone think that it is an accident that his website has included a link to a password protected circumcision fetish website describing forced circumcisions, sexual acts during circumcisions involving minors and similar trash,  for years?