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The blunt truth about new circumcision device

By Ilham Rawoot

Circumcision is a touchy business. And writing about it has proven to be even touchier, especially when nobody wants to talk about it.

When the KwaZulu-Natal health department decided to go ahead with using the TaraKLamp (a device that strikes me as the penile equivalent of a nail clipper) to circumcise men as part of an HIV-prevention project, a few questions arose.

Firstly, why is the department using a device that has not been approved by the World Health Organisation and which some doctors have warned against citing the higher risk of complications involved compared with standard surgical procedure?

On a deeper note, who is making money out of this device?

Once the Mail & Guardian discovered it was being promoted by a company that didn’t have an office, and that no one had heard of before, we decided to dig a little bit.

We found that no tender process was followed in obtaining the Malaysian-made device even though there are competing versions.

We found that the Zambian man in charge of the company that has the local distribution rights had once been accused — mentioned in a Zambian high court judgement — of dealing in Mandrax, though he was never charged and protests his innocence.

Surely the KZN health department should thank us for our hard work, for helping them make informed decisions that will help find the best option for South Africans. But that’s not what happened.

Instead they called us “disingenuous” for asking for tender documents and expenditure values in relation to the TaraKLamp.

Here’s KZN’s health spokesperson, Chris Maxon: “In the first instance; we wish state that we find it disingenuous for you to ask for these documents without providing reason. These are contract document that are kept to protect their authenticity. We therefore cannot release them with proper procedure being followed and, above all, to a person who is not honest about the reasons for requesting these.”

Even when we explained that the reasons were quite simple — public money is used to pay for these devices and we have a right to know how much is spent and why it is going into the pocket that it is. Obvious, one might say.

This wasn’t a good enough reason for them and they subsequently chose to ignore further requests for information.

When we called the supplier to ask him questions he threatened to take us to court for defamation. We just want to understand things, really.

If people are acting in good faith, then answering questions should be a simple and professional process. But that rarely happens.

The TaraKLamp saga seems to carry some echoes of Virodene, the controversial Aids “cure” that caused a ruckus in the 90s. That case was marked by dodgy science and political meddling from former president Thabo Mbeki and the ANC. The drug was totally rejected by the scientific community.

It seems we don’t learn from history. The decision to use the TaraKLamp seems similarly marked by closed doors and politicking, but the government doesn’t want to acknowledge that. They’d rather cover their ears when probed on new health methods, always wanting to be pioneers and highly advanced in the field, with no room for criticism.

And, as with Virodene, it’s once again only the taxpayers and the men who may suffer complications under the device, that will pay the price.

40 Responses to “The blunt truth about new circumcision device”

  1. It blows my mind that there are men willing to get their penis mutilated instead of just using a condom, which is a thousand percent safer than unprotected sex with or without a foreskin.

    October 4, 2010 at 3:17 pm
  2. Mark Lyndon #

    There are a lot of problems with the Tara KLamp, and the M&G is right to be asking these questions.

    In a controlled trial of the Tara KLamp at Orange Farm in Gauteng, 35 men were circumcised using the Tara KLamp, and there were “adverse problems” with 37% (13 of them). There were 34 men circumcised using the standard technique, with “adverse events” reported for just 1 of them.

    Greater pain was also reported with the TK, and 97 men refused to participate in the trial, with 94 saying they didn’t want to use the TK.

    October 4, 2010 at 3:30 pm
  3. Ash #

    Good grief, please don’t give up trying to find out about this.

    KZ-N? Zuma, Sutcliffe & Shaik territory? Charming, simply charming …

    October 4, 2010 at 4:19 pm
  4. Lux Occulta #

    And just think, once the new (dis)information Bill is in place, this will be classified information and your journalist arrested.

    One can already see the attitude of officials with more and more simply refusing to give out information that should be in the public domain.

    October 4, 2010 at 9:09 pm
  5. Jon Story #

    Ladyfingers
    Right: one skin off, another skin on, albeit temporarely. Always!!!

    October 5, 2010 at 8:24 am
  6. Glenn #

    With the proposed new silencing of the media by the ANC, this would obviously be one of those messy little subjects that would simply be declared “secret” and all debate would be silenced.

    October 5, 2010 at 9:02 am
  7. David Brown #

    Is it true that the ANC leadership who are in need of it have all agreed to be Taraklamped so its Johnny Walker and the TaraKlamp that our new brand leaders?Were these brands all in the business lobby at the NGC? Is it true that Mike Sutcliffe has used one of these devices and says its OK? Hey guys –You drink large quatities of Johnny Walker if the device does not work well its called a chaser. In a country where condom use is still being debated and where traditional circumcision causes many deaths. This is one more example of tenderitis!

    October 5, 2010 at 9:05 am
  8. Robin Bownes #

    Democracy (definition):-

    “Government OF the people, BY the people, FOR the people.”

    OUR government (those appointed by US, as OUR representatives), actually has no right whatsoever to deny US (their employers) access to any information concerning any aspect of the governance of OUR country.

    Democracy supposedly means that all people are equal – including those elected to government. Those in government should in fact only have more responsibility, not more power.

    WE the people, need to get up on OUR hind-legs and re-assert our democratic right to ownership & control of OUR country by means of completely open & transparent governance.

    As Ilham says,
    “If people are acting in good faith, then answering questions should be a simple and professional process.”,
    - particularly when the people asking for the information are those that are employing you.

    October 5, 2010 at 10:02 am
  9. spindoctor #

    I attended one of the initial workshops that involved introducing hospital managers and other stakeholders from around Durban to the idea of the TaraKlamp and the proposed initiative by the Department of Health. The meeting was chaired by a woman adept at waffling but with obviously no medical training at all, who simply sought to ram the concept down everyone’s throats. Concerns raised by some of the doctors who had detailed knowledge of the trials involving the device and the complications reported were brushed aside – the predominant motivation was the announcement by the King, and supported by the Premier, calling on men to be circumcised to reduce the risk of HIV transmission. Complementary interventions including improving on existing (dismal) campaigns were likewise brushed aside. So the King now determines medical policy for KZN.. My surgical department was requested to perform the procedures, which we promptly refused to do.. We left the meeting with the clear impression that this was just another tenderpreneurial scheme to be used as a vehicle to redirect public funds into the pockets of politicians and their relatives.. the subsequent revelations in the media have come as no surprise at all.. The planning of medical intervention should be left to adequately-funded and supported PUBLIC HEALTH experts who are trained on public health initiatives and their implementation, NOT to clueless politicians who have absolutely no idea what they are doing but are only too willing to extend their plunder of the taxpayer to the public healthcare system..

    October 5, 2010 at 10:45 am
  10. MLH #

    Do ask for a rabbinical opinion…those chaps probably have about the most experience available. But there’s little doubt that male circumcision is best done at birth plus a few days; it doesn’t confuse the emotional with the physical and leaves no memory.

    October 5, 2010 at 11:21 am
  11. Reg #

    Regardless of culture, mail and female genital mutilation is unnecessary, counter-evolutionary, and when practised on helpless infants and children, a violation of human rights.

    October 5, 2010 at 11:27 am
  12. Peter Joffe #

    Culture, It’s part of their ‘culture’ to be circumcised so its must also be part of their ‘culture’ for many young men to lose their lives in the process? So this is what they want so why should we care just like many wives and many children are also part of their ‘culture’ as is slaughtering defenceless bulls to make a man. I would be more appreciative if one man killed one bull with his bare hands, than 25 of them pounce on a hapless bull.I wonder if 25 ‘surgeons’ pounce on the hapless victim and remove a chunk of his manhood. Why cutting off of a foreskin should make a ‘man’ when more often than not it ‘destroys’ the man is totally nonsensical.
    Viva Culture Viva

    October 5, 2010 at 11:53 am
  13. Ginny #

    It seems strange that someone should criticise the method by which these people are proposing to remove parts of men’s penises, rather than criticising the fact that they’re proposing to do this at all!

    Circumcision causes lots of problems, and doesn’t actually help with anything that can’t much more easily be solved by safe sex and good hygiene! My only hope is that people in regions where this insane practise is being promoted have the sense and courage to say “no”, whatever fearmongering they’re subject to.

    October 5, 2010 at 1:12 pm
  14. The Creator #

    Yes, the whole circumcision-cures-AIDS thing is a big fat scam. However, I suppose you could argue that if you really need to get your foreskin lopped off, you’d be better off having it lopped with a machine which doesn’t actually do major damage, than by a half-drunk psychopath, as we do in the Eastern Cape all too often.

    October 5, 2010 at 3:29 pm
  15. Well, I agree with those who think this must be investigated further. On the same token, I don’t think riduculing cultural practices will really to bring respect for each other. For instance, I have seen Spaniards tormenting a bull in Spain and the event is widely televised and it enjoys a heavy attendance and positive reaction from many Europeans but it is probably out of unidirectional respect that there has never been a single African let alone European who has ever criticised or denigrated those who practice this act. Let’s not conflate issues

    October 5, 2010 at 4:14 pm
  16. johnsimonsy #

    @Ginny on October 5th, 2010 at 1:12 pm

    My dear it appears its too late, look around the region politicians are competing to have the most men cut, and what disturbs me are two issues

    1-the countries advocating this are not cutting their people save for those doing it on religious grounds and

    2-our fellow politicians advocating for this wont volunteer to go under the knife nor do they wish their siblings too but want others and their kith?

    October 5, 2010 at 5:54 pm
  17. @MLH, I corrected your spelling: “But there’s little doubt that male circumcision is best done at death plus a few days.” The main reason for doing it a few days after birth is that he can’t stop you.

    @spindoctor: Bravo!

    October 5, 2010 at 11:15 pm
  18. fatti #

    wow.reading some comments,i’m not surprised a lot of my fellow black folk don’t bother with tolerating the opinions of people who don’t practise this. I was circumsised, as per my culture – and I would have insisted on it regardless-I spent a month in the bush my younger bro,and it was awesome! And to those that seem to “know it all” with their (let’s call a spade a spade here) highly ignorant comments, should reserve their opinions until they’ve actually done even some form of research. Not a single male in my entire family (even Clan for that matter) has EVER had problems during or after their circumsision.And the act of circumsision doesn’t make you a man-this misconception can be laid firmly at the feet of the media, as well as irresponsible parenting, moreso the latter in my opinion. The culture of being a “man” begins BEFORE you go the bush, during, and obviously after, where most stress is laid. Just because you’ve been doesn’t mean your “passage” is over. But this tool, they propose to use – I completely agree with the author – it’s going to cause more problems, than solutions, whatever the reasoning behind the circumsision itself. Just wish you hadn’t used the nail clipper analogy – it made me cringe :) But I say keep asking questions, and keep some bail money handy..

    October 6, 2010 at 9:46 am
  19. Kit #

    Thokozani, your statement on bullfighting in Spain is propaganda of the cheapest sort. No European has ever spoken out about their revulsion about bullfighting? Not even the Spanish Queen? No one speaking up must be why the Catalans have banned it, instigated by an animal rights group (http://www.bbc.co.uk/news/world-europe-10784611) and because popular support for bullfighting is from only a minority, not only in Catalonia but throughout Spain as a whole. (See http://www.columbia.edu/itc/spanish/cultura/texts/Gallup_CorridasToros_0702.htm ).

    Broadly, Spanish TV no longer carries bullfighting at all because it’s said to be too violent and because it’s unprofitable because advertisers won’t buy space during it. You’re probably confusing the news reports on the running of the bull where people watching newscasts rarely catch sight of the bull and it becomes really newsworthy when the bull gets its own back and gores someone. That’s no more glorifying bullfighting than the international news reports on ukweshwama glorify that ritual.

    The fact that some people interspose what’s a fairly simple debate with their own racial/cultural/superiority issues doesn’t change the fact that a) circumcision is a risky and probably unnecessary procedure and b) this device appears to increase that risk – which is completely unacceptable. SA needs to focus on real issues and stop listening to whining fools with self-image problems on all sides.

    October 6, 2010 at 11:15 am
  20. Kit #

    and that last salvo isn’t at all aimed towards you, Thokozani, just in case I wasn’t clear.
    Where you might be a bit off on the extent of support for torturing bulls, you surely have it totally right about the not conflating issues.

    That’s why there’s hardly ever any progress in discussions; everyone must start raising the same irrelevant complaints and can’t hear the other person’s point of view because in-built prejudices and racial filters, both conscious and subconscious, are so engrained. It’s one of the reasons I barely bother to read the comments here any more, the same drums are banging on and on, the same drivel even when it’s inappropriate to the discussion.

    We shouldn’t even have needed to comment on the bulls, huh? It’s supposed to be about a scary-looking sharp thing to cut off bits of young men’s penises; hopefully the right bits but there’s no evidence to show that – or is there?

    October 6, 2010 at 11:22 am
  21. Mark Lyndon #

    Thekozani: Most Europeans, and many Spaniards are very against Spanish bullfighting, and it was recently banned in Barcelona.

    AIDS is a far more important issue though, and promoting circumcision isn’t going to help. Europeans don’t circumcise (except for about 5% who are mostly Muslim or Jewish), and their HIV rate is lower than north America or Africa.

    In Africa, there are six countries where men are *more* likely to be HIV+ if they’ve been circumcised: Cameroon, Ghana, Lesotho, Malawi, Rwanda, and Swaziland. Eg in Malawi, the HIV rate is 13.2% among circumcised men, but only 9.5% among intact men. In Rwanda, the HIV rate is 3.5% among circumcised men, but only 2.1% among intact men. If circumcision really worked against AIDS, this just wouldn’t happen. We now have people calling circumcision a “vaccine” or “invisible condom”, and viewing circumcision as an alternative to condoms. The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups “believe that circumcised men do not need to use condoms”.

    The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw.

    ABC (Abstinence, Being faithful, and especially Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.

    October 6, 2010 at 11:49 am
  22. Dinileminyanya Sandile Latha #

    It is disgusting that the department that is supposed to ensure the well being of the South African masses is acting in such a reckless manner. We need to take the KZN health department to task on this matter as the society and ensure that the lives of the people are saved before anything happens to the precious penises of fellow South Africans. If this device is not safe, it may unnecessarily lead to loss of many lives. It is disturbing to say the least that the department has approved a device that has not been approved by WHO. We must not let big things to happen before we act, we ought to pressurised the KZN government to account transparently for the good of the South Africans. If we have to take them to court, let it be.

    October 6, 2010 at 2:28 pm
  23. Frank OHara #

    The science in the trials is dodgy at best and documentation is not available to support it. That is probably the best reason the supporting documents are difficult to get. They just can’t provide documentation that clearly supports their agenda to spend government funds to circumcise men.

    AS Mark Lyndon pointed out above, There are six African nations that practice circumcision that have higher HIV rates than neighboring nations that do not adhere to the practice. If the claims of the so called researchers were true, this would be virtually impossible. Those denying documentation probably don’t want you to know this in their agenda to promote circumcision. Apparently, circumciison has a pathological effect on the brain making those who practice it advocates. Simply, they want all men circumcised to conform to their practices.

    If male circumcison had an effect as claimed on the transmission of HIV, there would vast diffferences in the infection rates between counties that circmcise (few) and those that don’t (most). Those expected diffences are not seen anywhere in the world. Circumcision just doesn’t work and they don’t want you to know that.

    October 6, 2010 at 2:37 pm
  24. dan #

    Fatti I agree with you that the process of teaching about manhood and womanhood as an initiation or ceremoney is great, and is done all over. I am not in favour or circumcision unless the person wants it, but having a cultural vehicle for transition from adolescent to adult is great. From what I understand some of the cultural material for boys and girls needs updating to include gender equality and parenting, but why not update it and make it available to everyone as a national institution?

    October 6, 2010 at 8:51 pm
  25. Dan #

    Circumcision shortly after birth is the worst time to do it. Beyond deliberately inflicting pain on a child for no good reason, it is not possible to get the cut right and furthermore there is no consent for what is unquestionably unnecessary cosmetic surgery. And anyone who supports it must also support the same carried out on girls. It’s reprehensible that we allow circumcision of babies to continue. The time is long overdue to outlaw circumcision of minors unless it is absolutely medically necessary and all other avenues have been exhausted.

    Now as for it’s AIDS prevention potential the evidence is extremely weak and organisations that continue to promote this make themselves look stupid. If men were properly informed of the extremely limited benefit few would willingly participate. I also wonder if those promoting this are willing to promote the same for women, since that will also give a similar small level of protection.

    October 7, 2010 at 7:15 am
  26. Alan #

    @Frank Ohara: The science is not dodgy. I’ve read 3 large randomised control trials that show an extremely pronounced protective effect of male circumcision. A protection effect of aprox. 60%. If we had a vaccine that produced that level of protection, we’d be crowing from the rooftops.

    People, don’t confuse the issue of this dodgy approach to the procedure with the issue of whether circumcision protects men and their loved-ones from HIV. It does do that. Only the ignorant debate otherwise.

    Why not just advise people to use condoms? Because HIV has always been difficult to prevent because of the situation in which transmission occurs – i.e., not when people are thinking at their clearest but when they are motivated by very strong, irrational drives.

    Condoms are crazy important to the prevention of HIV, but they can’t do it all. There are many people who are not going to be able to benefit. It would be crazy and irresponsible to ignore the very significant protection offered by male circumcision.

    HIV has never allowed us to mess around with our sensitivities. The unproven case of poorer sexual reaction needs to be balanced against the protection from the present and real disaster that is HIV/AIDS.

    October 7, 2010 at 8:27 am
  27. Frank OHara #

    Alan wrote: “@Frank Ohara: The science is not dodgy. I’ve read 3 large randomised control trials that show an extremely pronounced protective effect of male circumcision. A protection effect of aprox. 60%. If we had a vaccine that produced that level of protection, we’d be crowing from the rooftops.”

    I’ve also read the trials and am left . . . unimpressed. Infact, there were not 3 trials but one trial conducted in three locations. The methodology of all “three” trials were exactly the same.

    Alan wrote: “If we had a vaccine that produced that level of protection, we’d be crowing from the rooftops.”

    Well, yes we would but male circumciison has not produced that kind of results anywhere in the world. An intervention with 60% efficacy would show very different results and those results are not observable anywhere in the world. As a matter of fact, there are six African nations where the majority of men are circumcised yet they have higher HIV infection rates than neighboring nations that do not practice male circumcision. If MC were truly effective as claimed, this dichotomy and contradiction would not exist. Areas that practice MC would have significantly lower levels of HIV or insignificant infection rates. We know this because epidemology is an advanced science and can rather accurately predict the courses of diseases and the effects of interventions against them. In actual populations, male circumcision has been shown to be worthless as an intervention against HIV/AIDS.

    October 8, 2010 at 4:08 pm
  28. Frank OHara #

    Alan wrote: “Why not just advise people to use condoms? Because HIV has always been difficult to prevent because of the situation in which transmission occurs – i.e., not when people are thinking at their clearest but when they are motivated by very strong, irrational drives.”

    This is the best way. Condoms are 99+% effective and could literally stop the infection in it’s tracks. It also leaves responsibility up to the individual to protect him/herself.

    October 8, 2010 at 4:13 pm
  29. Frank OHara #

    Alan wrote: “People, don’t confuse the issue of this dodgy approach to the procedure with the issue of whether circumcision protects men and their loved-ones from HIV. It does do that. Only the ignorant debate otherwise.”

    Alan, appparently you are ignorant of the science of epidemology. If you proposed the situation to any credible epidemiologist, they would clearly tell you that the evidence does not support any efficacy of male circumcision in combatting HIV/AIDS.

    October 8, 2010 at 4:18 pm
  30. maori #

    The randomized clinical trials are a scientific scandal waiting to explode. Much has been written about how these trials are flawed to the point of fraudulence.

    Subjects were not followed long enough, and the trials were ended prematurely. The circumcised men were given condoms and lectures warning about HIV and how it is transmitted. The controls received no condoms and no lectures. In the first world, the nations with the highest rates of circumcised adult men, USA and Israel, are also the first world nations with the biggest AIDS problem.

    The principle investigators in the African clinical trials are American scientists with a long standing enthusiasm for male circumcision. Their real agenda is convincing American public health authorities and mothers to continue circumcising American baby boys, a practice dating to the late 19th century which has never had a sound medical foundation. Tellingly, European and Australian medical authorities have declined to endorse the claimed results of the African clinical trials.

    Fidelity and condoms work. Circumcision merely delays the inevitable.

    October 10, 2010 at 7:03 pm
  31. @maori: “The circumcised men were given condoms and lectures warning about HIV and how it is transmitted. The controls received no condoms and no lectures.” That WOULD be scientific fraud of the first water, but it’s a slight exaggeration.

    All were given access to condoms, but the circumcised groups were given particular warning to abstain from sex for six weeks after their operations, or if they could not, to be sure to use condoms.

    Apart from that, the differences between the two groups were more subtle, but since everyone knew which men were circumcised and which were not, and what outcome was expected, there could have been all sorts of experimenter and experimentee effects, quite sufficient to create the relatively slight difference seen. “60 percent” sounds like a lot but it was actually only 73 circumcised men who didn’t get HIV after less than two years, the difference between 137 non-circumcised and 64 circumcised men who did get HIV – out of 5,400 men circumcised. All much fewer than the numbers of men who dropped out of the trials, their HIV status unknown: http://www.circumstitions.com/HIV-SA.html#loss

    October 12, 2010 at 4:02 am
  32. Keswa #

    The whole situation for black people circumsising old men is messed up, only they will suffer. its basically black on black crime with two consenting individuals. It is part of tradition yes, but it still has bad implications at the end

    October 12, 2010 at 11:51 am
  33. Alan #

    @Frank Ohara

    “The methodology of all “three” trials were exactly the same.”

    Not quite but almost. But since they were all randomised control trials, that’s what you’d expect. Especially when you’re trying to confirm a previous finding.

    “there are six African nations where the majority of men are circumcised yet they have higher HIV infection rates than neighboring nations that do not practice male circumcision. If MC were truly effective as claimed, this dichotomy and contradiction would not exist.”

    No. Because that, of course, takes no account of any other differences between them. Frank, you accuse me of poor epidemiological knowledge, but I think it’s you who needs a refresher. The purpose of conducting an experiment like an RCT is to *reduce* all those unknown factors so that you can see if the specific intervention works (it did).

    “because epidemology (sic.) is an advanced science and can rather accurately predict the courses of diseases.”

    You gave yourself away here Frank. Epidemiology is an amazing science, yet no scientist would make your absurd claim about its near infallibily. An argument from authority is anti-scientific.

    Aside from that, the RCTs *are* epidemiology or a more rigorous nature that say different. Efficacy and effectiveness are not identical. Other factors in real life may cancel out a beneficial effect.

    October 15, 2010 at 11:38 am
  34. Alan #

    @Maori

    “The randomized clinical trials are a scientific scandal waiting to explode. Much has been written about how these trials are flawed to the point of fraudulence.”

    By anti-circumcision fanatics perhaps. Scientists have regarded them favorably in general. Is it coincidence that the reports you have read about these “flaws” have left you with so many misconceptions, or have your sources, mislead you on purpose? For e.g.:

    “Subjects were not followed long enough, and the trials were ended prematurely.”

    If you’re doing an experiment on the efficacy of a new drug vs. an old one, what would you do if the death rate on the old drug was three times higher than the new one? Would it be ok to carry on the experiment? No, you ethically have to switch the controls onto the new drug otherwise you’re with-holding effective treatment.

    The circumcision trials were the same – so effective, that they had to stop the trials to offer the controls circumcision. You were mislead.

    “The controls received no condoms and no lectures.”

    Not true. Simple as that. Again, you’ve been mislead.

    “Fidelity and condoms work. Circumcision merely delays the inevitable”

    Now you admit delays? This is not a “magic bullet.” It’s meant to be a complimentary intervention to go along with others, with condoms as the lynch-pin.

    With the low HIV prevalence in the EU, the risks would out weigh the benefits. Not so here.

    October 15, 2010 at 11:50 am
  35. Alan #

    @Hugh7 That foolish website says in response to the fact that equal numbers of controls and intervention subjects dropped out:

    “One objection to this argument is that approximately equal numbers of non-circumcised control-group members dropped out. The answer to that is that a major and very likely motivation for them to drop out would be completely different and inapplicable to the experimental group – to avoid getting circumcised. Thus what needs explaining is why nearly equal number of circumcised men dropped out, and an HIV-diagnosis could be an answer in a significant number of cases.)

    But they were never going to be forced to be circumcised and they knew this! Even the intervention group had to agree to it after randomization before being circumcised. If not, they were simply excluded from the study.

    An HIV diagnosis would have applied to *either* group as a reason for dropping out.

    Statistics are hard for all of us to understand, but they are not made up. The numbers needed, and the acceptable drop out rate to determine statistical significance was determined statistically *before* the studies commenced. The drop out rates in all the trials were comfortably below this pre-determined figure.

    Those numbers of people may not sound huge to you, but they represent a difference between the two groups that it’s almost impossible was due to chance (i.e., it was statistically significant).

    You’re not criticising circumcision in that case. You’re criticisng randomised control trials in general.

    October 15, 2010 at 12:04 pm
  36. Mark Lyndon #

    Actually, those six countries are where men are more likely to have HIV if they’re been circumcised. It has nothing to do with neighbouring countries. If male circumcision worked effectively against HIV in the real world, it would be surprising to find any countries where circumcised men had higher rates of HIV than intact men.

    One clue seems to be in the only RCT investigating male-to-female transmission which showed a 54% higher rate in the group where the men were circumcised. It would apparently be deemed unethical to repeat such a trial. How then can it be ethical to start mass circumcision campaigns?

    Condoms are by far the most effective weapon against HIV. Why then is so much funding being diverted to genital surgery? We wouldn’t have RCT’s investigating even the most minor forms of female circumcision, so why is male circumcision considered ethical?

    Whether you’re for circumcision or not, the TaraKLamp is not the way to go.

    October 17, 2010 at 4:09 pm
  37. @Alan: Only the non-circumcised men could change their minds. It was too late for the circumcised men.

    “An HIV diagnosis would have applied to *either* group as a reason for dropping out.”
    But it would be more of a disillusionment to the circumcised men, because they had expected their circumcision to protect them. The circumcised men would also feel they had let the experimenters down, “failed the experiment”. The non-intervention group had no such expectation or feeling.

    “Those numbers of people may not sound huge to you, but they represent a difference between the two groups that it’s almost impossible was due to chance (i.e., it was statistically significant).”

    It’s also several times fewer than the number of drop-outs.

    The trials were not (of course) double-blinded or placebo-controlled and hence open to experimenter and experimentee effects.

    They were recruited by snowball techniques so they knew each other, and that’s another problem with the studies – the men were not a random sample of the population, hence the trials were not true RCTs.

    Being circumcised or not could affect sexual behaviour, for example the class of women who would sleep with them, and hence the likelihood of those women being infected.

    I don’t know which if any of those effects is significant, but unconsidered and uncorrected they throw the trials into doubt.

    October 23, 2010 at 4:30 am
  38. @Alan: “Especially when you’re trying to confirm a previous finding.”
    Exactly. Real scientists don’t try to confirm previous findings. On the contrary, science is about trying to falsify previous findings (Popper).

    The three trials were all held in places where it happens that more of the non-circumcised men have HIV than the circumcised. If they had been held in any of the six or more countries where the reverse is the case*, the outcome might have been different.

    * According to the National Health and Demographic Surveys, within each of Cameroon, Ghana, Lesotho, Malawi, Rwanda, Tanzania, parts of Uganda, and in one survey, Swaziland, the HIV rates are higher among the circumcised men of those countries than the non-circumcised. This is a much stronger case against circumcision than the way Frank O’Hara states it.

    October 23, 2010 at 4:58 am
  39. Frank OHara #

    Hugh7 Wrote: “* According to the National Health and Demographic Surveys, within each of Cameroon, Ghana, Lesotho, Malawi, Rwanda, Tanzania, parts of Uganda, and in one survey, Swaziland, the HIV rates are higher among the circumcised men of those countries than the non-circumcised. This is a much stronger case against circumcision than the way Frank O’Hara states it.”

    Hugh, both are equally valid and have equal strength. Both add to the body of evidence that male circumcision is fruitless in the battle against HIV. Both show that there is deception in the claim that MC will have an effect against the disease.

    When a lawyer goes into a courtroom to defend, he will make a list of evidence to show his client is innocent. He builds his case piece by piece and bit by bit. Each piece of additional evidence builds on previous evidence. That is what we are doing here. My evidence builds on your evidence and vice versa.

    Now what has become clear is that the “jury” has not heard our evidence as they still (apparently) are listening to the deceivers. The deceivers have the mantle of medical professionals and apparently that gives them more credibility.

    .

    October 24, 2010 at 4:14 pm
  40. Dalleen Bothma #

    The entire thing on TaraKlamp is a corrupted action between Government and the Supplier, with the middle man – a Zambian, who are secretly doing there thing. THe rightful owners of the rights, Is rightfully Carpe Diem Enterprizes. A “behind the scene” – negotiation has secretly been going on, hidden and protected by Corrupted Government Officials. I wish Carpe Diem Enterprises will rize up and speak…..it is there right! I have seen all their legal documentation. Government officials have been cutting off everyone – even Lawyers. Why does NO ONE in Government stand up for what is right??????? When will the corruption end??????? Carpe Diem Enterprises, holds the rights until 2014 – but GREED made a few people crazy – that includes the Inventor, his Zambian (drug dealing) partner who fraudulantly are using Carpe Diem Enterprises’s name to raise millions for himself……..Can ANYONE in GOVERNMENT PLEASE WAKE UP!!! Government will definitely be guilty of corruption if they do not rize to the occasion very quickly. This Man from Zambia must be stopped, and Government Officials must deal rightfully with Carpe Diem Enterprises – that is the right and justice thing to do. They branded the product over the last 8 years, accross Africa AND other COuntries, and have legal documents to proof their rights!! SOmeone PLEASE do something!!! Dalleen Bothma

    December 5, 2010 at 5:24 pm

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