Uckister wrote a detailed point by point rebuttal of Michael's nonsense in another alt.circ thread where Michael had dumped the same post. I hoped Uckisgter would post his rebuttal here too but he hasn't so I've copied and pasted it below.
It's devasting! See how he shows up Michael's total ignorance of science!
Here you go.
Here we go indeed. Michael has posted this identical statement several times now under two different topics in alt.circ. Although practically everything in it is misinformation copied from amateurish foreskin lover websites, he is very proud of it. He seems to think it's his finest hour in this debate -- that he has hereby "torn apart" the scientific evidence for the protective effect of circumcision on HIV. So let's take a look.
"You seem fixated on the role of foreskin in HIV transmission. I'm wondering what this is based on.
I'm sure you are wondering, as you have obviously not read a single original research report.
Is it the studies that were done in Africa,
Dozens of international studies have shown a link between foreskins and HIV.
[For a list see for example Wamai et al, J Law Med. 2012 Sep;20(1):93-123.]
the same ones that WHO bangs on about? If so, then I can reassure you that your concerns are unfounded.
Ah, the WHO, the world's leading epidemiological organization. The one that is humanity's guardian against epidemic disease. The one whose expertise eliminated smallpox and has almost eliminated polio. The one that stopped SARS and Ebola in their tracks. The one we rely on now to stop typhoid in Haiti and Yellow fever in Central Africa. The one that is coordinating the research and international response to Zika. That one. The organization you have called "an idiot" because it recognizes and acts on the overwhelming scientific evidence about foreskins and HIV.
Read on, we will see who is an idiot.
I'm sure we've all heard the 60% figures, which I'll admit sound impressive when taken at face value. 'Circumcision can reduce the risk of HIV transmission by 60%? Wow!'
Yes it is impressive.
Here we go!
- the men in the study were not representative of the larger population.
Aha! Right here we have the crux of Michael's naive misunderstanding of the science. He doesn't know the difference between a SURVEY, which draws on a representative sample of the population at large, and an EXPERIMENT, which draws on volunteers who are then randomly divided into two groups, one of which is subjected to the experimental procedure while the other serves as the control for comparison.
If you THINK about it you can see how ludicrous the demand for a study "representative of the larger population" would be. Among the larger representative population would be:
-- men who couldn't be included because they were not sexually active (sick, dying, too old, etc);
-- men who couldn't be included because they were already circumcised.
-- men who couldn't be included because they were already HIV positive.
-- men who couldn't be included because they were not remotely interested in undergoing a surgical procedure just because some researchers call them up and ask them to join their project (whether its for circumcision or a hip replacement or a nose job or a hearing implant or artificial lenses or anything else).
So, by the time you have thrown out all the people you can't use who are "representative of the larger population" what do you have left? An UNREPRESENTATIVE sample of course -- DUH!!! What a stupid objection.
They were men from nearby
OF COURSE they were from nearby (in one case, a city, in the second, a suburban area, and in the third, a rural community). The experiments were conducted at local hospitals or clinics which the men were expected to attend regularly for counseling, free condoms, HIV testing etc. Why on earth would the clinics want all the inconvenience (travel time, cost, poor attendance) of having them from somewhere else??? What a stupid objection.
who, due to the fact that they chose to participate freely, were more concerned with sexual health that people generally are.
OF COURSE they were concerned with sexual health. Who do you expect to show up for a circumcision study -- men concerned with poor eyesight or rheumatism? If you run an experiment on a kidney or heart procedure, you expect and WANT people who are motivated about hearts or kidneys to show up don't you? What a stupid objection.
- the group of men who were circumcised were told to refrain from sex for six weeks to allow their penis to heal. In addition, they were also encouraged to use condoms and were given sex ed lessons.
OF COURSE they were. They had just had surgery and might have open wounds that would make them highly susceptible to HIV infection, thereby ruining the experiment! What a stupid objection.
The men who were left intact received no condoms or sex ed
False. Both groups were advised right from the start that they should practice safe sex, both were given the same sex counseling, and both got free condoms, right through the end of the experiment. Try reading the originals?
and had no six-week restriction on sexual activity.
Newsflash: when you run an experiment, the experimental group gets the variable (circumcision in this case) and the control group doesn't. The two groups can never be the same in that respect. In this case it means the control group had a potential, unavoidable, six week lead to get infected. If that had actually happened, it would show up in the regular HIV testing results, with the circumcised group showing the same infection rate six weeks later throughout the study. But that didn't happen so the six week lead obviously wasn't long enough to make a difference. Why bring it up then? Ignorance?
-the final results did not take personal differences into account; there was no information on individual hygiene or sexual practises, i.e. no information on whether participants were having regular sex with one or two people, or whether they were much more promiscuous than that, or even whether they visited sex workers. Who was encouraged by their church to be faithful to their wives? In other words, there was no context to the results.
Utter nonsense, and this where your scientific illiteracy really shows! These studies were RCTs. Let me explain. RCT stands for Randomized Controled Trial. It means the subjects are RANDOMLY divided into two groups so that whatever characteristics they have are RANDOMLY distributed between the two groups and so cancel each other out. There were approx 15000 subjects in these trials. Whatever their characteristics -- promiscuity, big dicks, religious belief etc -- it's practically a statistical certainty that half ended up in one group and half in the other. So the "personal differences" DON'T MATTER. DUH. What an ignorant, inane objection.
Now Michael before you write some tirade against RCTs, you should know that they are the experimental basis for just about every medical procedure or drug you use. If you use statins or blood pressure pills or viagra or heartburn meds or HIV antivirals or asthma meds -- they were ALL tested in RCTs just like these which "did not take personal differences into account". In each case researchers in hospitals or clinics got local volunteers, randomly divided them to even out their differences, and got the results you and the rest of us rely on in our daily lives.
- there was significant attrition, i.e. lots of people dropped out of the study.
No there wasn't significant attrition. You have no idea at all what "significant" attrition is, so let me tell you. In all RCTs some people drop out for various reasons (they get sick, get bored, move away, lose interest, etc). In an RCT like these an attrition rate of 5 percent would be meaningless, while an attrition rate of 20 percent might warrant investigation if some unusual reason was suspected. In these RCTS the attrition rate was below 10 percent (8 percent in the SA study that you focus on). That's not significant, in fact it's quite normal and can be ignored.
(By contrast, the RCTs for the HIV antivirals that you keep touting had much higher attrition rates, from 13 percent to over 40 percent... but I don't see complaining about THAT!)
Also, researchers anticipate attrition and so enroll more subjects than they need to compensate. You didn't know that, did you? What a stupid objection.
How many of the circumcised men contracted HIV and became disillusioned with the study?
This is a stunningly dishonest argument. One might as well ask, "how many of the uncircumcised men contracted HIV and became disillusioned with the study?" The number in both groups who dropped out was almost exactly the same. You are getting really desperate now! What a stupid objection.
- there is little correlation between circumcision and HIV rates in Africa.
Nonsense. Clear and consistent correlations have been demonstrated repeatedly and already pointed out to you as in this list from the US Centers for Disease Control:
"International Observational Studies
"Multiple cross-sectional, prospective, and ecologic
(population-level) studies have identified lack
of male circumcision as a risk factor for HIV
infection.
"A systematic review and meta-analysis that
focused on heterosexual transmission of HIV in
Africa was published in 2000 [6]. It included 19
cross-sectional studies, five case-control studies,
three cohort studies, and one partner study. A
substantial protective effect of male circumcision
on risk for HIV infection was noted, along
with a reduced risk for genital ulcer disease.
After adjusting for confounding factors in the
population-based studies, the relative risk for HIV
infection was 44% lower in circumcised men. The
strongest association was seen in high-risk men,
such as patients at sexually transmitted disease
(STD) clinics, for whom the adjusted relative risk
was 71% lower for circumcised men.
"A review that included stringent assessment of 10
potential confounding factors and was stratified
by study type or study population was published
in 2004 [7]. Most of the studies were from
Africa. Of the 35 observational studies included
in the review, the 16 in the general population had
inconsistent results. The one large prospective
cohort study in this group showed a significant
protective effect, with the odds of infection being
42% lower in circumcised men [8]. The remaining
nineteen studies were conducted in high-risk
populations. These found a consistent, substantial
protective effect, which increased with adjustment
for confounding. Four of these were cohort
studies: all demonstrated a protective effect, with
two being statistically significant .
"Ecologic studies
"Ecologic studies also indicate a strong association
between lack of male circumcision and HIV
infection at the population level. Although links
between circumcision, culture, religion, and risk
behavior may account for some of the differences
in HIV infection prevalence, the countries
in Africa and Asia with prevalence of male
circumcision of less than 20% have HIV-infection
prevalences several times higher than countries
in those regions where more than 80% of men are
circumcised [9].
"International Clinical Trials
Three randomized, controlled clinical trails have
been undertaken in Africa to determine whether
circumcision of adult males will reduce their risk
for HIV infection. The study conducted in South
Africa [10], was stopped in 2005 and those in
Kenya [11] and Uganda [12] were stopped in 2006
after their interim analyses found that medical
circumcision reduced male participants’ risk of
HIV infection.
"In these studies, men who had been randomly
assigned to the circumcision group had a 60%
(South Africa), 53% (Kenya), and 51% (Uganda)
lower incidence of HIV infection compared to men
assigned to the wait list group to be circumcised
at the end of the study. In all three studies, a few
men who had been assigned to be circumcised
did not undergo the procedure, and vice versa.
When the data were reanalyzed to account for
these deviations, men who had been circumcised
had a 76% (South Africa), 60% (Kenya), and
55% (Uganda) reduction in risk of HIV infection
compared to those who were not circumcised.
"References
"1 Fink AJ. A possible explanation for
heterosexual male infection with AIDS. N
Engl J Med. 1986 Oct 30;315(18):1167.
2 Alanis MC, Lucidi RS. Neonatal
circumcision: a review of the world’s oldest
and most controversial operation. Obstet
Gynecol Surv. 2004 May;59(5):379-95.
3 Patterson BK, Landay A, Siegel JN, Flener
Z, Pessis D, Chaviano A, et al. Susceptibility
to human immunodeficiency virus-1
infection of human foreskin and cervical
tissue grown in explant culture. Am J Pathol.
2002 Sep;161(3):867-73.
4 Szabo R, Short RV. How does male
circumcision protect against HIV infection?
BMJ. 2000 Jun 10;320(7249):1592-4.
5 Weiss HA, Thomas SL, Munabi SK, Hayes
RJ. Male circumcision and risk of syphilis,
chancroid, and genital herpes: A systematic
review and meta-analysis. Sex Transm Infect.
2006 Apr;82(2):101-9; discussion 10.
6 Weiss HA, Quigley MA, Hayes RJ. Male
circumcision and risk of HIV infection in
sub-Saharan Africa: a systematic review
and meta-analysis. AIDS. 2000 Oct
20;14(15):2361-70.
7 Siegfried N, Muller M, Volmink J, Deeks J,
Egger M, Low N, et al. Male circumcision
for prevention of heterosexual acquisition of
HIV in men. Cochrane Database Syst Rev.
2003(3):CD003362.
8 Gray RH, Kiwanuka N, Quinn TC,
Sewankambo NK, Serwadda D, Mangen FW,
et al. Male circumcision and HIV acquisition
and transmission: cohort studies in Rakai,
Uganda. Rakai Project Team. AIDS. 2000
Oct 20;14(15):2371-81.
9 Halperin DT, Bailey RC. Male circumcision
and HIV infection: 10 years and counting.
Lancet. 1999 Nov 20;354(9192):1813-5.
10 Auvert B, Taljaard D, Lagarde E, SobngwiTambekou
J, Sitta R, Puren A. Randomized,
Controlled Intervention Trial of Male
Circumcision for Reduction of HIV Infection
Risk: The ANRS 1265 Trial. PLoS Med.
2005 Nov;2(11):e298.
11 Bailey RC, Moses S, Parker CB, et al. Male
circumcision for HIV prevention in young
men in Kisumu, Kenya: a randomized
controlled trial. Lancet 2007; 369:643-656.
12 Gray RH, Kigozi G, Serwadda D, et al. Male
circumcision for HIV prevention in men in
Rakai, Uganda: a randomized trial. Lancet
2007;369:657-666."
Also if you look at this 1996 article by Caldwell in Scientific American. 1996 Mar;274(3):62-3, 66-8. you will see a map of Africa showing the geographical distribution of HIV and lack of circumcision. THEY OVERLAP ALMOST PERFECTLY.
Jump forward to 2016 and look at this article with an additional 20 years of data: https://pophealthmetrics.biomedcentral.com/articles/10.1186/s12963-016-0073-5 You will find two maps, one showing distribution of HIV and one showing lack of circumcision. THEY OVERLAP ALMOST PERFECTLY.
Here is more information in tabular form:
CIRCUMCISION RATES IN AFRICAN COUNTRIES WITH LOWEST HIV RATES
COUNTRY........CIRC %............HIV RATE
Algeria..............98.0.............. 0.1
Benin................98.0...............1.1
Burkina Faso.....89.0...............1.0
Congo DR..........97.0...............1.0
Djibouti..............99.0...............1.3
Egypt................94.6...............0.1
Eritrea...............99.0.............. 0.7
Ethiopia.............92.0...............1.3
Gambia..............98.0...............1.3
Ghana...............96.0...............1.4
Guinea...............99.0 ..............1.7
Liberia...............94.0...............0.9
Libya.................96.6...............0.3
Mali...................99.0...............0.9
Mauritania..........99.1 ..............0.4
Morocco............99.0...............0.1
Niger.................99.0...............0.5
Senegal.............98.0...............0.5
Sierra Leone......94.0...............1.5
Somalia.............99.0...............0.5.
Tunisia..............99.5...............0.1
CIRCUMCISION RATES IN AFRICAN COUNTRIES WITH HIGHEST HIV RATES
COUNTRY........CIRC %...........HIV RATE
CAR................55.0................4.7
Lesotho............48.0 ..............23.1
Mozambique......60.0...............11.1
Tanzania...........69.0................5.1
Uganda.............25.0................7.0
Botswana..........14.0...............23.0
Malawi.............21.0...............10.8
Namibia............21.0...............13.3
South Africa......35.0...............17.9
Swaziland..........8.0...............26.5
Zambia........;...13.0...............12.7
Zimbabwe...;.....10.0...............14.7
I can see a correlation Michael. Are you SURE you can't?
In fact if you examine the sources below, you will find that:
ALL countries with very high rates of HIV -- over 6 percent -- have low circumcision rates -- below 35 percent.
ALL countries with high circumcision rates -- over 95 percent -- have very low rates of HIV -- below 2 percent.
[The sources are: http://www.photius.com/rankings/2015/population/hiv_aids_adult_prevalence_rate_2015_0.html; http://www.photius.com/rankings/circumcised_men_country_ranks.html; http://whqlibdoc.who.int/publications/2007/9789241596169_eng.pdf; circs.org estimate reproduced https://groups.google.com/forum/?fromgroups#!topic/alt.circumcision/H_mYGEYXYPs.
I can't be bothered to look up newer data for you but you can find a more recent estimate of circumcision rates at https://pophealthmetrics.biomedcentral.com/articles/10.1186/s12963-016-0073-5, although the numbers will hardly change. You might get a newer HIV rates at the UNAIDS website, which would no doubt show some decline in newly circumcising African countries.]
Anyway, the final results showed that 2.49% of men left intact had contracted HIV by the end of the study, whereas 1.19% of the circumcised men had contracted it. So yes, there's a difference of around 55%, but it's not at all impressive when seen in this light. When all of the points I've made are taken into account, the effect of foreskin can be seen as, at best, negligible and likely non-existent.
Right now the WHO is sponsoring circumcision campaigns in 15 African countries. Ten million men there have been circumcised as a result, and ten million more are likely to have the procedure. The WHO estimates that this campaign will save several million lives. The WHO gets financial and other support for this campaign from:
The World Bank
The US President's Emergency Plan for AIDS Relief
The US Centers for Disease Control
The United Nations Joint Program on AIDS
The Clinton Foundation
The Bill and Melinda Gates Foundation
It's possible I suppose that the WHO and all of these organizations don't know what they are doing, and that all their statisticians have got their sums wrong. But isn't it much more likely that you just don't know what you're talking about?
Now Michael, who is the idiot? The WHO, or you?