CIRCUMCISION: BBC Runs Paid PrePex Ad

It was something I would expect to find only on one of those cheesy infomercial channels, but there it was on the BBC website.

In the heading underneath the video, you can see it, as if it were irrefutable fact:

"Male circumcision reduces the chances of men in heterosexual relationships becoming infected with HIV."
This should have been my first clue.

This would more accurately read "horrendously flawed and heavily manipulated "research" suggests that male circumcision *might* be responsible for reducing the chances of sexually promiscuous men in Sub-Saharan Africa with multiple partnerships, who don't wear condoms, from becoming infected with HIV."

I was expecting more from a British, non-American news outlet.

At first glance, you would think that the people portrayed might be genuinely interested in HIV prevention in Africa, but upon closer inspection, you find that it's simply more circumcision propaganda, particularly the promotion of the PrePex circumcision device.

How does circumcision prevent HIV?

It's disconcerting enough to hear a woman mindlessly chant the well-worn line that "circumcision reduces the risk of HIV transmission in men by 60%." (What does this actually mean, anyway? 60% of what?)

Note: The woman that appears is the Health Minister of Rwanda. According to a demographic health survey taken in 2005,  the ratio of circumcised vs. intact men who contracted HIV was 3.8 vs 2.1. (See p. 10) 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 Rwanda. (In America, 80% of the male population is circumcised from birth.) It is disconcerting that the Health Minister is either not aware of the facts, or she is deliberately ignoring them. I suspect she may be receiving a bribe from Bill and Melinda Gates, PEPFAR or whatnot to boldly ignore the situation in her own country.


What is truly disturbing is to see a video on BBC, where a man touts that circumcision reduces the risk of HIV by making the head of the penis tough and callused like the sole of the foot, acting like a "barrier," as if it were matter of fact.

"A person living without shoes, they have very hard skin. They are walking on stone every day, without any wounds. So it's the same thing with the penis."

"Researchers" may claim that circumcision "reduces the risk of HIV transmission by 60%," there is not a single doctor, scientist or "researcher" that can say with certainty that the callused penis acts as a "barrier" against HIV. To be certain, there is absolutely no scientific basis for this claim.

In actuality, this, the theory that the keratinized surface of the penis in circumcised male resists infection, while the tender mucosa of the glans and inner of the intact male are ports of entry, is perhaps the oldest hypothesis on the mechanism whereby circumcision prevents the transmission of HIV.

It has also long been debunked.

One study found that there is "no difference between the keratinization of the inner and outer aspects of the adult male foreskin," and that "keratin layers alone were unlikely to explain why uncircumcised men are at higher risk for HIV infection." Another study found that "no difference can be clearly visualized between the inner and outer foreskin." 

To be sure, while "researchers" insist with skewed statistics that there is a "correlation" between circumcision and a reduction in HIV transmission, there is not a one that can demonstrate precisely how this happens.

Few people know this, but the famous big three "studies" from Africa lack a working hypothesis. The claim that circumcision "reduces the risk of HIV transmission by 60%" is pure speculation; there is not a single doctor, scientist or researcher who can provide a demonstrable causal link between the foreskin and HIV transmission.

And yet, here we have it, a man on a video on BBC, pretending to tell us exactly how circumcision works.

Why the BBC allows such drivel on their website is mind-boggling.

Conflicts of interest
In the video, a particular woman stands out. Her eyes are wide and glowing, and she tells us, grinning like a french poodle, the wonders of circumcision, and how this new device does away with "that unwanted foreskin." "Unwanted" by whom? Why is she so enthusiastic about circumcision? Particularly this new "PrePex" device? And why does it seem like she's more excited about getting millions circumcised, than she is about HIV prevention? Why is the fact that, even if "studies" were correct, circumcision is not "100% effective" an afterthought?

The enthusiastic woman in the video is Tzameret Fuerst, CEO of Circ MedTech, the company marketing the PrePex device. If my presumptions are correct, she is the wife of Oren Fuerst, co-inventor of this device. Millions of men circumcised means that millions of PrePex devices will be bought and used. She's cashing in on the HIV gravy train, and that's why she's smiling.

It is difficult to get a man to understand something when his job depends on not understanding it.
~Upton Sinclair

But this would not be the only conflict of interest this woman has. PrePex was invented by Israeli researchers Oren Fuerst, Ido Kilemnick, and Shaul Shohat.

Why do I mention this fact?

I find it increasingly disturbing, the idea that there are Israelis, and Jewish people intent on evangelizing circumcision to other parts of the world. Shusterman Foundation paid Neil Pollock, a professional mohel and child circumcisor by trade, to promote infant circumcision in Rwanda. The Jerusalem AIDS Project (JAIP) created Operation Abraham, which is an organization whose sole purpose is to promote circumcision any which way it can. They've gone as far as Africa, Mexico, and even America to do just this.

A disproportionate number of "researchers" and outspoken members of medical organizations just "happen" to be Jewish. Aaron J. Fink, the very inventor of the idea that circumcision might prevent AIDS was Jewish. Stephen Lewis, former head of UNAIDS, is Jewish; he founded AIDS-Free World in 2007, and he uses this organization to gather funding for male circumcision programs. Daniel Halperin, a lead circumcision "researcher" is Jewish (his grandfather was a mohel). On May 28th 2010, at the UNC School of Medicine, Halperin lectured on "Moyels without Borders?: Barriers to Scale-up of Circumcision."

The list goes on.

So in the end, what's this all about?

Is it really about HIV prevention?

Is it about cashing in on the opportunity? Striking while the iron's hot?

Or do people's intentions on spreading circumcision run deeper than that?

Is this really about HIV prevention? Or is it about popularizing and safeguarding a religious and cultural tradition that has come ever under scrutiny? (Cases, in point, the San Francisco Ban, efforts by the Dutch to discourage circumcision etc.)

All I've gotta say is, there's something fishy going on around here.

This video on the BBC website is nothing more than a paid advertisement for the PrePex device. It's rubbish "as-seen-on-TV" telemarketing that isn't even fit to be on infomercial channel, and the BBC ought to be ashamed for publishing it.

Disclaimer:
The words in this blog belong strictly to Joseph4GI, and do not necessarily reflect the views of other intactivists. Please do not conflate my pointing out of conflicts of interest with anti-Semitism. It is simply matter-of-fact that circumcision is an important and indispensable religious custom to Jews, one that they have historically fought to defend for centuries. Being both Jewish and a circumcision "researcher" presents a conflict of interest, because it places one in the awkward position of reporting accurate findings, and questioning the propriety of what, for Jews, has been a historically controversial and ethically problematic religious practice.

Other posts of interest:
Where Circumcision Doesn't Prevent HIV

The "Anti-Semite" Card No Longer Washes

Doctors Against the SF Circ Ban: Who Are They?

So joining in with religious groups against the circumcision ban in San Francisco are physicians. It seems only obvious that physicians would join against the ban; circumcision is performed routinely in the US, and doctors that do it don't want to get in trouble for it.

Says Brian McBeth MD: "Clearly it affects physicians -- the proposed ban -- is suggesting physicians be jailed for performing what's a routine, commonplace medical procedure."
http://abclocal.go.com/kgo/story?section=news%2Flocal%2Fsan_francisco&id=8205170&status=ok

Ostensibly, the physicians involved are concerned about public health. To defend the circumcision of infants, they spout off a laundry list of supposed "medical benefits" that are supposed to make the practice indispensable.

The problem is, however, that circumcision is not necessary in healthy children. Doctors that circumcise healthy children routinely aren't providing a service that is a requirement for public health. Nor would the ban forbid circumcision if there is actual medical necessity. If this were true, then this ban would clearly be stifling medical practice, and would indeed be placing physicians in an ackward position.

I think the coalition of doctors with religious groups is an intriguing one. Here you have religious groups, many who see the circumcision of children as a religious requirement, and then you have physicians, who, at least on the surface, are concerned about public health. What does one have to do with the other? To people who see the circumcision of children as a religious obligation, how are "health benefits" relevant? Would they consider abandoning the practice if better ways to prevent disease were discovered? And since when do doctors perform surgical procedures to comply with the religious requirement of a patient's parents?

Do doctors honestly care about "public health" and protecting "religious freedom" and "parental choice?" Or do they have other interests to protect under the guise of medicine?

I always ask the following questions: Without medical or clinical indication, can a doctor be performing surgery on a healthy, non-consenting child? Let alone pretend like he can be giving his parents any kind of a "choice?" Doesn't charging to perform non-medical procedures on healthy, non-consenting individuals constitute medical fraud? And, in performing it in healthy, non-consenting children, professional abuse of the child and his parents? If the child is healthy and not in need of any kind of surgery, isn't offering circumcision to his parents the epitome of charlatanism?

Those are questions that I hope would be addressed this November. It seems, though, that doctors like McBeth and religious organizations are working hard to make sure this debate never happens:
http://joseph4gi.blogspot.com/2011/06/cutters-trying-to-silence-debate.html

Brian D. McBeth MD is a voice from the medical field who has joined forces with religious groups against the circumcision ban, including the Jewish Community Relations Council, and the so-called "Committee for Parental Choice and Religious freedom." On June 6th of this year, he wrote to these organizations with a sensationalized anecdote which reveals that the doctor is either extremely biased, he is deliberately misinforming with an intention to deceive, he really is that uninformed when it comes to the proper development of male anatomy, or all of the above.

The following are excerpts from that letter which can be found here:
http://stopcircban.com/downloads/letter_circumcision_ban.pdf

"...I am an emergency physician, and wanted to describe a brief anecdote from the world of emergency medicine that demonstrates the medical value of circumcision and preventable medical illness."

Or so he hopes...

"I practice in a community with a generally low prevalence of infant circumcision. Frequently, I see young boys with urinary tract infections, balanitis and balanoposthitis – infectious conditions seen much more frequently in uncircumcised boys."

Actually, due to a short urinary tract, urinary tract infections are much more common in girls. They're also easy to treat with anti-biotics in boys as they are in girls, and circumcised boys also get UTIs, but this is not mentioned here. It is true, that balanitis and balanoposthitis is much more seen frequently in uncircumcised boys; that's because only uncircumcised boys are capable of getting these conditions. He fails to mention however, that even among uncircumcised boys, these conditions are rare and easily treatable. The fact is he sees ONLY THOSE BOYS who come to him with these conditions, because he is a doctor; he does not see the rest of the boys who don't develop problems with their penises. It's like appendicitis; people with appendices tend to get it. And only people who get it have to see the doctor.

Observe the way he tells his story:

"Two nights ago, I took care of a six year old boy who came in with a case of balanoposthitis, inflammation of the tip of his penis and foreskin which we typically treat simply with an antibiotic or antifungal cream."

Good so far...

"However, his parents had pulled back his foreskin to try to clean underneath, and the foreskin had become stuck in a retracted position, a condition called paraphimosis."

This condition is real and can happen if parents or physicians try to forcibly retract the foreskin of a child.

"The foreskin and glans penis had become markedly swollen and they were unable to bring it back down – the child was in considerable pain, and this condition – if not emergently treated – can result in compromise of blood flow to the penis and necrosis or loss/death of that tissue."

True so far.

"In short, we were able to treat him aggressively with pain medication, sedation and compression techniques, that over a few hour period were successful in relieving the swelling and restoring his foreskin to a safe position. In this case, an emergent surgery was not required, though it sometimes is necessary in these situations."

The circumcision ban would allow for these situations.

 I do not argue that medically every boy needs a circumcision, but certainly this is one dramatic example of a completely preventable medical emergency that resulted in significant pain, emotional distress for patient and family and significant cost with hours of time in an emergency department as well as the risks of a procedural sedation – none of which would have been necessary had he been circumcised."

Actually, none of which would have been necessary had his parents been PROPERLY EDUCATED to not forcibly retract their son's genitals. McBeth is trying to make a rule out of exception.

Let's ask him what the frequency of these conditions are in countries where normal, natural organs are the norm. And let's ask him what other parts of the body does he recommend we cut off our children "to prevent them from getting infected."

Here is the information this doctor seems to be oblivious to:
http://www.nocirc.org/publish/pamphlet6.html

"Again, I laud your efforts to oppose this unconstitutional ban on an accepted medical practice."

Let's briefly forget that at one point, the genital cutting of girls was "accepted medical practice" in this country, as late as 1996. There was specialized equipment manufactured for it and insurance companies such as Blue Shield paid for it. That it is accepted practice, doesn't necessarily make it constitutional. Questioning "accepted medical practice" is the whole point of the ban.

"The proposed bill is an affront to all who believe in religious freedom, and if implemented, would send a message to Jews, Muslims and others that San Francisco, a city long known for diversity and tolerance, no longer welcomes those with these long standing religious traditions."

What the medical profession has to do with religious practice is beyond me. In 1996, a federal ban on ALL female genital cutting was enstated, without religious exception. Last year, the AAP tried to endorse a "ritual nick" for girls, but was quickly forced to back-pedal after a world outcry. The AAP admitted that the "ritual nick" wouldn't be as severe as male infant circumcision.

The fact of the matter is that there is already a federal ban on female circumcision, and there is no exception for “religious,” “traditional” or “cultural” reasons. Female circumcision is a custom in certain African tribes, and it is observed as “Sunnah” by Muslims all over the world, including different countries in Africa, Egypt, Indonesia, Malaysia and Singapore. The federal ban criminalizes female circumcision in any way, shape or form, and it infringes on the “parental rights” and “religious freedoms” of people from these countries, and yet nobody seems to mind.

I ask, since when is religion relevant to medical science? What is the reason this doctor has decided to side with religious groups against this ban?

"Medically, there is a great deal of research that supports a role for circumcision in preventing the infections mentioned above, as well as penile cancer, cervical cancer and the spread of HIV."

Medically, surgery should only be performed when it is necessary to the physical health of the person on whom it is performed because of a clear, compelling, and immediate medical need where other, less-destructive alternative treatment has failed.

Medically, there is no other part of the body that is cut off to "prevent infection." In most other cases, disease is treated with anti-biotics unless the tissue is damaged beyond repair.

Medically, doctors are supposed to fully inform parents on the proper care of their son's bodies.

Medically speaking penile cancer is already an extremely rare condition which is limited to older men with bad hygiene who smoke, and circumcised men still get penile cancer. Cervical cancer is caused by HPV, which is transmitted by both circumcised and uncircumcised men. Some studies show that circumcision "might reduce the risk" by "up to 28-30%," but even if these claims were accurate, that leaves 60%. In other words, circumcised or not, men would still have to wear condoms.

While we're sharing anecdotes, I'm rather active on Facebook, and I've met quite a few ladies out there who tell me that they got HPV from their circumcised partners. The moral of the story being that circumcision is not effective at preventing HPV transmission. This is just a lame excuse on a laundry list to try and justify infant genital mutilation.

Children are at absolute zero risk for sexually transmitted HIV, and even if the latest "studies" were correct, circumcision would be so ineffective at preventing HIV, that the very authors of the studies themselves cannot stress the use of condoms enough. In light of the fact that there is already better, more effective measures against disease, circumcision is a moot point, especially in children who do not engage in sex, and who, when older, would still have to learn to wear a condom anyway.

Readers may be interested to know, that the latest "studies" in circumcision and HIV fail to correlate with the real world, the biggest smoking gun being our own country: Circumcision hasn't stopped HIV in the US.
http://data.unaids.org/pub/Report/1998/19981125_global_epidemic_report_en.pdf

And, it hasn't stopped other STDs either.
http://www.reuters.com/article/2009/01/13/us-infections-usa-idUSTRE50C5XV20090113?pageNumber=1&virtualBrandChannel=0

In America, the majority of the male population is circumcised, approximately 80%, while in most countries in Europe, circumcision is uncommon. Despite these facts, our country does poorly.
http://www.advocatesforyouth.org/index.php?option=com_content&task=view&id=419&Itemid=177

One would expect for there to be a lower transmission rates in the United States, and for HIV to be rampant in Europe; HIV transmission rates are in fact higher in the United States, where most men are circumcised, than in various countries in Europe, where most men are intact. It is telling that the HIV epidemic struck in our country in the 1980s, 90% of the male population was already circumcised.

In short, doctors like McBeth are grasping at strings and straws to defend their profession.

"The medical community as well as those who believe religious and cultural freedom of practice and expression should stand united to defeat this proposed ban on circumcision."

It would appear as if Brian McBeth is trying to be an objective voice of reason, and that from his story, he is genuinely concerned for the well being of children, though it boggles my mind why anybody in the medical community would be against the ban, if they would still be permitted to perform circumcision when and if the procedure were medically necessary.

Initially, the only explanation that I could think of was that the ban would affect those doctors who collect a  stipend from performing non-medical circumcisions on healthy, non-consenting infants.

"It's hard to get a man to understand something, when his livelihood depends on his not understanding."
~Upton Sinclair

As it turns out, though, Brian McBeth is in fact Jewish, and a certified mohel at that.
http://www.sfbaymohel.com/About_Dr.html

Brian McBeth, his wife and their son just after his ritual circumcision;

maybe it's my intactivist bias, but that poor child looks like he's in pain...

It is generally well accepted that an "authority" needs to be objective and impartial, and that an audience can only evaluate information from a source if they know about conflicts of interest that may affect the objectivity of the source. Identification of a conflict of interest is appropriate, and concealment of a conflict of interest is a problem.

Upon first impression, most people might actually think that Brian McBeth is indeed an unbiased, objective and impartial doctor who is genuinely interested in public health, and is not in any way connected with the religious groups with whom he has joined forces.

I think that it is dishonest and misleading that this doctor fails to mention the fact that he is in fact Jewish, and a ritual circumciser himself. He fails to mention this in his letter, and he fails to mention this in this interview.
http://abclocal.go.com/kgo/story?section=news%2Flocal%2Fsan_francisco&id=8205170&status=ok

In my opinion, religious groups against the circumcision ban are engaging in a deceptive tactic. It seems to me they're trying to create an illusion of a "coalition" of religious groups and objective medical practitioners, where there is actually not.

I must ask, of the physicians that have banded with religious groups, how many are actually using their medical authority to defend other interests? How many double as Jewish mohels and are trying to come off as impartial medical practitioners? Why have religious groups against the ban deemed it necessary to have, or at least appear to have, the voice of doctors behind them?

My speculation is that even religious groups have come to realize that "religious freedom" and "parental choice" are beginning to fail as rationale for the forced circumcision of healthy, non-consenting infants. "Religious freedom" and "parental choice" simply aren't enough to justify the the circumcision of boys anymore. A pseudo-medical front is necessary to avoid the same scrutiny as female circumcision. The difference between male and female circumcision seems to be "potential medical benefits." "Benefits" which the child may never need nor want, and which can actually already be better achieved by more effective, less invasive means. "Benefits" which are irrelevant to those who view circumcision as a religious requirement.