Studies showing "benefits of circumcision" highly flawed

[JackRiddler]

When bad science kills, or how to spread AIDS
Published May 22, 2012 | By Brian D. Earp

http://blog.practicalethics.ox.ac.uk/2012/05/when-bad-science-kills-or-how-to-spread-aids/

Must read in full. Proceeding from a longer study by Boyle and Hill (2011).

Key excerpts:

A handful of circumcision advocates have recently begun haranguing the global health community to adopt widespread foreskin-removal as a way to fight AIDS. Their recommendations follow the publication of three [1] randomized controlled clinical trials (RCCTs) conducted in Africa between 2005 and 2007.

...

While the “gold standard” for medical trials is the randomised, double-blind, placebo-controlled trial, the African trials suffered [a number of serious problems] including problematic randomisation and selection bias, inadequate blinding, lack of placebo-control (male circumcision could not be concealed), inadequate equipoise, experimenter bias, attrition (673 drop-outs in female-to-male trials), not investigating male circumcision as a vector for HIV transmission, not investigating non-sexual HIV transmission, as well as lead-time bias, supportive bias (circumcised men received additional counselling sessions), participant expectation bias, and time-out discrepancy (restraint from sexual activity only by circumcised men).

...

What does the frequently cited “60% relative reduction” in HIV infections actually mean? Across all three female-to-male trials, of the 5,411 men subjected to male circumcision, 64 (1.18%) became HIV-positive. Among the 5,497 controls, 137 (2.49%) became HIV-positive, so the absolute decrease in HIV infection was only 1.31%.

...

Some major issues with trying to roll-out circumcision in particular include the fact that the RCCT participants—who were not representative of the general population to begin with—had (1) continuous counseling and yearlong medical care, as well as (2) frequent monitoring for infection, and (3) surgeries performed in highly sanitary conditions by trained, Western doctors. All of which would be unlikely to replicate at a larger scale in the parts of the world suffering from the worst of the AIDS epidemic. And of course, circumcisions carried out in un-sanitary conditions (that is, the precise conditions that are likelier to hold in those very places) carry a huge risk of transmitting HIV at the interface of open wounds and dirty surgical instruments. So this is a serious point.

He notes that even accepting these highly flawed studies, condom use has been found to be about 95 times more effective in stopping the spread of AIDS. The propaganda about circumcision is actively dangerous due to "risk compensation," or the effect of alleged protective measures causing people not to bother with real ones. One of the cited reports supports the misconception engendered by the propaganda about the magic powers of circumcision among some Ugandan men. Once circumcised, they believe they no longer need to use condoms.

The full article from Boyle and Hill (2011): "Sub-Saharan randomised clinical trials into male circumcision and HIV transmission," is available in PDF at http://xa.yimg.com/kq/groups/23477339/1441224426/name/JLM_boyle_hill.pdf. This file has safeguards against copy-paste, or I would quote their abstract.

See also my deconstruction in detail of the insupportable Auvert et al. (2005) study that started the new wave of propaganda for foreskin removal.
http://journals.democraticunderground.com/JackRiddler/1093

Here are Earp's credentials, from:
http://oxford.academia.edu/BrianEarp

Brian Earp is a Research Associate in the Oxford Uehiro Centre for Practical Ethics and a Consultant working with the Institute for Science and Ethics at Oxford's Martin School. Brian recently completed his MSc. in experimental psychology as a Henry Fellow of New College, Oxford; and received his undergraduate degree from Yale, where he studied cognitive science and philosophy and was elected President of the Yale Philosophy Society. Serving as Editor-in-Chief of both the international Yale Philosophy Review and the Yale Review of Undergraduate Research in Psychology, Brian also conducted extensive experimental research in a number of areas, generally touching on unconscious or automatic mental processes, and has published refereed work on this topic. Brian's paper on the psychology of free will, co-authored with Professor John Bargh, was published by the Society for Personality and Social Psychology, and is the #2 trending philosophy paper on Academia.edu as tracked by nationalacademies.org. The #1 trending paper, "Can science tell us what's objectively true?" is Brian's as well, originally published in the graduate journal of New College, Oxford. Brian's senior thesis at Yale was awarded the Robert G. Crowder Prize from the Department of Psychology, and was recently covered in over 50 newspaper articles, from the Telegraph and Daily Mail in England to the Sydney Morning Herald and the Times of India. Brian has given interviews on his work with BBC Radio as well as Highland Radio in Ireland. A recipient of the Ledyard Cogswell award, the highest honor bestowed upon a graduating senior in Yale's Calhoun College, Brian is also a professional actor and singer, with nearly 50 leading roles to his credit, and was called "one of the most audaciously talented young actors seen on any Seattle stage in many years" by talkinbroadway.com. With Professor Julian Savulescu, Brian is authoring a book on the neuroenhancement of love and marriage, to be completed this year.