JAMA: Lead Article is a "Study" on Bribing Men to Get Circumcised

So a friend contacts me about a recent "study" published in the current issue of the Journal of the American Medical Association (JAMA).

"You've got to blast it on your blog!" he says.

So I skim through the article and my first thought is "meh."

I mean, so what. Yet another junk "study" that adds nothing of any actual value to science or medical literature, and serves as nothing more than another chance to repeat the same dubious claim, as always, that "circumcision prevents HIV transmission by 60%," and tries to pretend as if it were bygone conclusion. (Researchers can't actually prove that circumcision prevents HIV transmission AT ALL, let alone by 60%.)

What can I say about one more trash "study" that I haven't already said about all the rest? Only just two or three posts ago I posted about promoters using football to coerce teenagers into getting circumcised. They were using bribery as far back as 2011. So what's new to be seen here?

And then he points to the fact that this so-called "study" was actually the lead article in the latest edition of JAMA.

I look again and think "Holy smokes, he's right!" So I decide to take a closer look. (Readers can read the abstract here.)

The "study" is titled:

"Effect of Providing Conditional Economic Compensation on Uptake of Voluntary Medical Male Circumcision in Kenya: A Randomized Clinical Trial"

The title tries very little to hide the fact that the article is only extremely remotely related to medicine. The long and the short of it is, they're trying to see if bribing men will get them to go get circumcised. I've already said this, but the only reason this can be is because "circumcision prevents HIV by 60%" simply isn't selling. African men aren't stupid.

"Gee, if I still have to wear condoms, what's the whole point? NO THANKS!"

More from the abstract:

Objective  To determine whether small economic incentives could increase circumcision prevalence by addressing reported economic barriers to VMMC and behavioral factors such as present-biased decision making.

Translation: Let's see how many men we can bribe into getting circumcised.

It should be noted here that the "researchers," if they can even be called that, are not actually interested in any behavioral factors that matter. They're not interested in seeing if the men are diligently using condoms, for example. (Or if they are not, and hope not to following their circumcisions.) They're not interested in how many sexual partners they have on a weekly or monthly basis, or if they are faithful to one partner or their spouse. Maybe the men feel that since they are faithful, and/or use condoms consistently, they don't feel they ought to be circumcised. And, they would be right.

Also not important to the "researchers," and this would actually be relevant from a "how many men can we dupe into getting circumcised" standpoint; what background were the men from? Did they come from Muslim or tribal backgrounds where circumcision is a social norm, if not expectation? How many were from tribes where NOT being circumcised is important? This is a very important factor; it's not "news" if men who would be circumcised at an initiation school anyway agreed to get circumcised for money in a clinical setting. How many men were actually convinced to get circumcised by financial incentive? How many were already going to get circumcised, but joined the program for the cash?

Only one behavioral factor seems to be important here: What will get the men to comply with having part of their penis cut off?

Design, Setting, and Participants  Randomized clinical trial conducted between June 22, 2013, and February 4, 2014, among 1504 uncircumcised men aged 25 to 49 years in Nyanza region, Kenya. VMMC services were provided free of charge and participants were randomized to 1 of 3 intervention groups or a control group.

"Randomized clinical trial" for what, exactly? What drug or form of medical treatment was being tested for efficacy? It seems the only thing "clinical" about this so-called "trial" was the fact that it was conducted by doctors at clinics, and the only thing "random" about it was what group the men would land in. All of them were offered circumcision.

Interventions  Participants in the 3 intervention groups received varying amounts of compensation conditional on undergoing circumcision at 1 of 9 study clinics within 2 months of enrollment. Compensation took the form of food vouchers worth 200 Kenya shillings (≈US $2.50), 700 Kenya shillings (≈US $8.75), or 1200 Kenya shillings (≈US $15.00), which reflected a portion of transportation costs and lost wages associated with getting circumcised. The control group received no compensation.

In short, groups were offered different amounts of money in increasing increments; the control group was there to see how many men could be conned into needless surgery for nothing.

Main Outcomes and Measures  VMMC uptake within 2 months.

That men would submit for circumcision was an expected outcome; the study was not conducted to measure "whether or not" financial incentive worked in convincing men to get circumcised, but "how well."

Results  Analysis of data for 1502 participants with complete data showed that VMMC uptake within 2 months was higher in the US $8.75 group (6.6%; 95% CI, 4.3%-9.5% [25 of 381]) and the US $15.00 group (9.0%; 95% CI, 6.3%-12.4% [34 of 377]) than in the US $2.50 group (1.9%; 95% CI, 0.8%-3.8% [7 of 374]) and the control group (1.6%; 95% CI, 0.6%-3.5% [6 of 370]). In logistic regression analysis, the US $8.75 group had significantly higher VMMC uptake than the control group (adjusted odds ratio [AOR] 4.3; 95% CI, 1.7-10.7), as did the US $15.00 group (AOR 6.2; 95% CI, 2.6-15.0). Effect sizes for the US $8.75 and US $15.00 groups did not differ significantly (P = .20).

Conclusions and Relevance  Among uncircumcised men in Kenya, compensation in the form of food vouchers worth approximately US $8.75 or US $15.00, compared with lesser or no compensation, resulted in a modest increase in the prevalence of circumcision after 2 months. The effects of more intense promotion or longer implementation require further investigation.

Or, in short, the more money you shell out, the more men are likely to agree to having part of their penis cut off. (Surprise, surprise...)

Conclusion
There are so many things wrong with this "study," I don't even know where to start.

How can this even be called "research" or a "study?" It's not looking to contribute anything of actual value to science or medicine. This "study" is about nothing, on a topic that isn't even remotely related to medicine, yet it gets the lead spot in JAMA. It proves nothing more than that, the more money you offer men, the more likely they'll be to do what you ask them to, in this case, submit to non-therapeutic surgery.

Is it even ethical to conduct this kind of "study" on financial incentive in a setting where food, water and other supplies are scarce? Wouldn't most men say yes to money in situations where it is scarce, regardless of how they feel about HIV prevention and the proper use of condoms? How ethical is it to exploit the financial situations of people who are already in dire poverty, to offer them a dubious form of "protection" from HIV, which is already far superseded by less expensive, less invasive, more effective means?

They call it "VMMC" which stands for "VOLUNTARY Male Medical Circumcision." How is it "voluntary" if you're continuously looking for ways to put men between a rock and a hard place?

As I've told my friend, what more can I say?

This is just one more in a long line of other "studies" that look for the same thing; "Acceptance. Feasibility. Demand creation."

And it will not stop here.

Circumcision "researchers" are desperately looking for every which way they can to get the men to go circumcise themselves on a supposed "voluntary" basis, I will not be surprised to see "studies" on the "effect" of celebrity endorsement. Sex appeal. Sports. Money. Emasculation. Outright insults. Whatever works.

Because "circumcise to prevent HIV" isn't working.

Be on the lookout for an upcoming onslaught of  circumcision "research."

Watch as the message of "prevent HIV" is slowly replaced with "get yourself circumcised."

The way progress in the fight against HIV should be measured is how many cases of HIV/AIDS have been avoided, but this is slowly being replaced by how many men have been circumcised, and it ought to concern those interested in reducing HIV transmission in Africa.

"Most studies on male circumcision, including the Kenya Aids Indicator Survey 2013 (KAIS), have so far concentrated on the quantity of procedures but none has shown it is achieving its primary objective of reducing HIV infections. Started almost seven years ago, on the promise that it could reduce the risk of infection by 60 per cent, the KAIS report showed a spike in prevalence in places like Nyanza where the circumcision programme is most intense."~Standard Digital

There is something wrong when progress on the HIV front is measured, not by how much HIV infection has decreased in time, but by how prolific the practice of circumcision has become. It is simply mistaken to assume that a mostly circumcised population automatically translates to a lowered HIV transmission rate, as real-world data indicates.

The way so-called "researchers" are trying to pass their brainwashing strategies as legitimate "science" and "research" is a complete disgrace.

It is outrageous, despicable and disgraceful that no one at JAMA sees a problem with this.

How was this "study" approved to go on? Who agreed to fund it? Why hasn't there been any kind of public outcry from respected medical communities around the world deploring this horrendous conduct? Who at the IRB approved this unethical "study?" What was the editor of JAMA thinking when he decided to make this the "lead study?" Is the AMA going to voice any complaint?

Lies are being spread. Garbage is being passed off as "research" and being used to shape public health policy. This is not the first "study" of this kind. They have been going on since the WHO endorsed circumcision as "HIV prevention." Why does it seem respected medical organizations are not concerned that this is going on?

Why isn't the WHO concerned that their endorsement of circumcision as "HIV prevention" is resulting in horrendous misconduct on the part of "researchers," circumcision promoters and even amongst African tribes themselves?

It ought to concern respected medical organizations around the world that "research" on what is essentially the financial coercion of men living in poverty to comply with non-therapeutic surgery was published as the leading article in a medical journal of a respected medical organization.

Readers are encouraged to write to representatives at medical organizations in their respective countries, as this is an issue that needs to be addressed. American readers, you are encouraged to write to the AMA and the editors of their JAMA journal. Other medical organizations need to be concerned that this is what passes today as legitimate "research."

I repeat, the WHO must be made aware of this, and respected medical organizations and influential doctors and researchers ought to call for the WHO to withdraw their endorsement of male genital mutilation as HIV prevention.

Human experimentation in Africa must end, and the rights of non-consenting individuals ought to be respected.

How about we give Africans food and water, and not make genital mutilation a condition for not dying of hunger or thirst?

Readers, please express your outrage to the AMA, JAMA and other respected medical organizations about this so-called "research" happening in Africa today. Let them know that this is NOT acceptable conduct for people that call themselves "researchers" and/or medical professionals.

Related Posts:
MASS CIRCUMCISION CAMPAIGNS: The Emasculation and Harassment of Africa

AFRICA: Creating Circumcision "Volunteers"

AFRICA: When Propaganda Fails, Try Bribery

 CIRCUMCISION "RESEARCH": Rehashed Findings and Misleading Headlines

Where Circumcision Doesn't Prevent HIV

Where Circumcision Doesn't Prevent HIV II

UNITED STATES: Infant Circumcision Fails as STI Prophylaxis

A number of "researchers" are on a mission to "prove" that infant circumcision prevents STIs in adults, and therefore children ought to be circumcised as newborns. There are a few problems with this line of thinking, beginning with the ethics of removing normal, healthy tissue in healthy, non-consenting minors who are not sexually active, and therefore at zero risk for STIs, and the fact that even if the above reasoning held any water, condoms would still be more effective at preventing disease.

I recently came across this poster which tells of the sobering reality of STIs in the United States.

If the above poster is to be believed, 65 million Americans are living with an incurable STI. That's one in five of the population. The asterisk following the given 65 million figure indicates that this data is given by none other than the Centers for Disease Control (CDC).

If American circumcision pundit Edgar Schoen is to be believed, well over 80% of US males are circumcised from birth. With an adult circumcision prevalence rate of 80% or greater, the United States should serve as a prime example of the "benefits" of circumcision, or lack thereof. Yet, compared with other countries where circumcision is rare or not practiced, the United States does poorly when it comes to the prevention of STIs.

American doctors, "researchers," medical organizations and charity funds are currently placing much time, effort and precious funds in efforts to circumcise the majority of males in Africa under the pretext of HIV prevention. "Researchers" claim that that circumcision cuts HIV transmission rates by 55 to 65 percent, based on three African trials, and so PEPFAR and several other very well-funded and influential N.G.Os, including the Bill & Melinda Gates Foundation are funding, supporting and administering a multinational effort to circumcise over 28 million men in Sub Saharan Africa by 2015. And yet when it comes to circumcision and HIV prevalence rates, the United States isn't a very good model of reference.

In fact, AIDS rates in some US Cities rival hotspots in Africa. In some parts of the U.S., they're actually higher than those in sub-Saharan Africa. According to a 2010 study published in the New England Journal of Medicine, rates of HIV among adults in Washington, D.C. exceed 1 in 30; rates higher than those reported in Ethiopia, Nigeria or Rwanda. The Washington D.C. district report on HIV and AIDS reported an increase of 22% from 2006 in 2009. According to Shannon L. Hader, HIV/AIDS Administration, Washington D.C., March 15, 2009, "[Washington D.C.'s] rates are higher than West Africa... they're on par with Uganda and some parts of Kenya." (Hader once led the Federal Centers for Disease Control and Prevention's work in Zimbabwe.)

According to the CIA World Factbook, the United States has a higher HIV prevalence rate than 53 countries where circumcision is rare (e.g. under 20%) or not practiced. The United States has more HIV than:

Colombia, Argentina, Uruguay, Cambodia, Peru, Nepal, Switzerland, Vietnam, Ecuador, France, Chile, Spain, Moldova, Mexico, Italy, India, Iceland, Costa Rica, Canada, Belarus, Austria, Paraguay, Netherlands, Ireland, Denmark, Bolivia, Bhutan, United Kingdom, Belgium, Nicaragua, Laos, Bulgaria, China, Cuba, Cyprus, Czech Republic, Finland, Georgia, Germany, Greece, Hong Kong, Hungary, Japan, Lithuania, Mongolia, New Zealand, Norway, Poland, Romania, Serbia, Slovakia, Sri Lanka, Sweden

One would expect for there to be a lower HIV prevalence in the United States, where the great majority of males are circumcised from birth, and for HIV to be rampant in Europe, where circumcision is rare, if at all practiced. It is telling that the HIV epidemic struck in our country during the 1980s, when 90% of the male population was already circumcised. And not only did it strike, America was the one place in all of the developed world where the disease took root and spread. Somehow, we're supposed to believe that what never worked in our own country, is going to start working miracles in Africa. If ever there was an intervention that failed to prevent HIV transmission (and if this poster is to be believed, the transmission of most any other STI) it is routine infant circumcision.

I've already talked about how the magical 60% prevention figure simply doesn't manifest itself in the real world in other posts (see here and here), and I've already talked about the disgraceful actions that the WHO has given de facto endorsement to, including forced circumcisions in children and adult men (circumcision was supposed to be "voluntary," remember?), and the use circumcision as a condition for participation in sports. I've also already talked about how there is no scientifically demonstrable causal link between the presence of the foreskin and increased HIV transmission, and/or it's removal and decreased HIV transmission, all "studies" being based on correlational hypothesis.

Let's just assume for a moment that all of the science is solid. Let's assume the all too famous 60% figure we are given is 100% infallible (real world data tells us otherwise, but let's press on). Circumcision would still FAIL to prevent HIV or any other STI. It fails so terribly that circumcised men must still be urged to wear condoms. There isn't a single doctor or "researcher" that can deny this fact. At which point it must be asked, why even bother with circumcision?

What male in the right mind would choose to be circumcised given complete information?

Why violate the integrity of a healthy, non-consenting minor, to afford a dubious benefit better afforded by the use of condoms which would be cheaper, less invasive and more effective in preventing STIs?

Again, infant circumcision never prevented anything in our country. The data is staring us right in the face, and not even the CDC can deny it. How is it suddenly going to start working wonders in Africa?

Upworthy presents the above poster under the following heading:

"People Say The Dumbest Things Right Before They Have Sex. Here Are Some Of Them."

This can be added to the poster; "I don't have to wear a condom; I'm circumcised."

Related Posts:
Where Circumcision Doesn't Prevent HIV

Where Circumcision Doesn't Prevent HIV II

MASS CIRCUMCISION CAMPAIGNS: The Emasculation and Harassment of Africa

AFRICA: Creating Circumcision "Volunteers"

CIRCUMCISION "RESEARCH": Rehashed Findings and Misleading Headlines

QUICK POST: "Just a Little Piece of Skin"

It's been a while since I last posted, as life keeps me busy. I still don't have much time to write, but I just saw this picture making the rounds on Facebook, and I decided I'd make a quick post.

It always pisses me off to hear people write off circumcision as "just a little snip" and the foreskin as "just a little piece of skin." Well, I'd like to see them cut off "just a little piece of skin" this size off a little baby girl and away with it...

Just as a point of reference...
If we are to believe a certain blogger from South East Asia who had her baby girl "sunat" to fulfill social obligations, pictured below is the severed clitoris of a little baby girl.

Original Text: "It happens so fast, with a bismillah and a snip,

a little bit blood and that's it, Zahra dah sunat!

She didn't cry even a drop, in fact giggling2 lagi.

I guess it wasn't painful for her, alhamdulillahh.."

(The blog post has been now taken down. Gee I wonder why...)

Come to think about it, you know what else pisses me off?

When people say "Don't you dare compare male and female circumcision. They're not the same!"

Ch' Yah! You're right! They're not.

Related Posts:
Circumcision is Child Abuse: A Picture Essay

CIRCUMCISION: "Just a Little Piece of Skin?"

Male and Female Infant Circumcision: Which One is Worse?

Politically Correct Research: When Science, Morals and Political Agendas Collide

AFRICA: Creating Circumcision "Volunteers"