Human Anatomy at Colby

Anonymous Student: Circumcision

February 23rd, 2015 · Comments Off on Anonymous Student: Circumcision

 

Dr. Peter Millard recently came in for a talk about HIV and preventative measures in Africa, specifically discussing circumcision and its effects in nations severely affected by HIV within Africa. Dr. Millard actively supports circumcision and has equated the procedure with vaccination. There are serious issues with this claim. Circumcision and vaccines can not be equated. The amount of mental acrobatics it requires to compare a quick needle stick with a 15-minute unanesthetized surgical alteration of the genitals is ridiculous. Unlike vaccinations, botched circumcisions are common. Immunization prevents disease but circumcision is 100% chance of mutilation (Rebecca Grey). Vaccination also does not deprive an individual of any functional body parts. The foreskin is not just skin as Dr. Millard alluded. It is composed of mucous membrane, also called a prepuce, analogous to the eyelid or the inside of the mouth. People designated female at birth have a foreskin equivalent called the clitoral hood which evolved from the same tissue as the foreskin. Circumcision within US history has been tied to various fleeting reasons. The procedure was popularized by Dr. Kellogs during the Victorian era (the same person who co-invented corn flakes) to curb masturbation. He said:

“ The operation should be performed by a surgeon without administering an anæsthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment.”

This masturbation hysteria was then replaced by fear of sexually transmitted infections followed by prostate cancer, and now urinary tract infections. Parents believe that circumcision helps with cleanliness, but they do not realize that there is something called a bath or a shower. Taddio et al. performed a meta-analysis observing the pain responses to subsequent vaccinations of circumcised infants and uncircumcised infants. They found that circumcised infants showed a stronger pain response than uncircumcised infants. The trauma of circumcision has lasting effects on these children. This logic of removing a functional body part to prevent disease is the same as selling a car to prevent a car accident (Men’s Health). Safe sex practices are what stops HIV transmission.

Dr. Millard mentioned that circumcision decreased transmission of HIV by 50-60%, but did not mention that a vaccine has essentially a 95% efficacy rate. Vaccination is about immunization, circumcision is not about immunization. The US has the highest HIV transmission of all the westernized countries and the highest circumcision rates. Evidence points to insufficient education about safe sex practices. In 1992, 410,00 cases of chlamydia was reported, 20 years later, 1.3 millions cases were reported. In 2000, there were 31,618 cases of syphilis, 10 years later, 45.834 cases were reported. It seems sex education among the general population is low. Instead, doctors are telling parents to circumcise their children instead of teaching children safe sex practices. Media now takes over where various sitcoms commonly have circumcision as a plot device which actively shames those who are not circumcised. Circumcision has become naturalized and not questioned.

Within the US, infant circumcision is still endorsed and is now supported by the WHO and the CDC which is backed by data from adult circumcisions in African countries performed on “consenting” adults. Infant circumcision forcefully separates the fused foreskin from the glans which results in the tearing of the synechia (the tissue that connects the foreskin to the glans) and keratinization of the affected areas. Circumcision is commonly used as treatment for phimosis, but infants can not get phimosis as their foreskins are not naturally retractable. The loss of protective mucosal membranes and various nerves denies the child of their own bodies and decisions. Before a child can even consent to having sex, they have their bodies permanently altered.

The voluntary medical male circumcision in African countries which is backed by the WHO is packaged with connecting men to health care, access to safe sex education, condoms, HIV testing, counselling services, and links to HIV care and treatment. These incentives behind the procedure drive safe sex practices which prevent HIV transmission. Proper habitual condom-use alone prevents HIV transmission by 95%. Circumcision can not be considered voluntary when access to safe sex tools and practices that prevent HIV are contingent upon this procedure. The institutionalized industry of circumcision is backed by ministers of health, policy makers, program managers, health care providers, and donors (e.g. PEPFAR and the Bill and Melinda Gates Foundation) who fund supporting programs. HIV transmission can also be transmitted through circumcision if the tools are not sterilized. Stopping circumcision means stopping access to health care. Of course the HIV transmission rates decrease when patients are educated on safer sex practices. The studies done in Africa were decided to be unethical after two years, but did not mention the unethical issues behind the actual circumcision itself. Long term follow-up should be required for these patients.

The exporting of circumcision results in growing acceptance of this procedure “in communities, among men and their partners, adolescents and parents” (WHO). Although studies have been done on adult men, the WHO supports influence on adolescents who are not given complete informed consent especially when their parents and the institutions manipulating the conditions favor circumcision. Many nations curtail to the US when it comes to health policies. Circumcision has become tool to normalize and impose Western standards of bodies on peoples that can not fully consent.

Circumcision in African countries are funded by western imperialism which exports this practice outside to different nations only to import the “results” back into their own countries to continue non-consensual practice of genital mutilation. This dangerous cycle impacts bodies in very specific ways to normalize cognitive dissonance. Babies do not have consent over circumcision. Continued practice of circumcision normalizes a dangerous environment for those designated male at birth. Why must this procedure be made by doctors paid to cut off foreskin? The infant has no agency over their bodies. Circumcision is a practice that attempts to manage disease, but does not answer the question of how disease can best be managed. Cultural bias coming from Dr. Millard reflects normative nontherapeutic circumcision sentiments within the US.

 

Sources

  1. https://www.psychologytoday.com/blog/moral-landscapes/201109/more-circumcision-myths-you-may-believe-hygiene-and-stds
  2. http://www.ncbi.nlm.nih.gov/pubmed/9057731
  3. http://pediatrics.aappublications.org/content/early/2013/03/12/peds.2012-2896.full.pdf
  4. http://www.parenting.com/blogs/pop-culture/shawn-parenting/circumcision-vaccine-against-bad-parenting
  5. http://www.cbsnews.com/news/circumcision-rates-declining-health-risks-rising-study-says/
  6. http://www.who.int/hiv/topics/malecircumcision/male-circumcision-info-2014/en/

 

Tags: Guest Speakers · Human Health

Rebecca Gray: Sociology of Epidemiology

February 23rd, 2015 · Comments Off on Rebecca Gray: Sociology of Epidemiology

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Today, I met an epidemiologist. He spoke about disease control: how germs traverse continents, how we respond to global health crises, and how we can prepare for future epidemics, because, “after all,” he said, “they are inevitable.” To begin, he offered a bit of a crash course on HIV in America; while the subject matter was grim, the bottom line felt overwhelmingly hopeful. In a nutshell, we learned that HIV, at one time the leading cause of death for men ages 25-40 in the U.S., is now a condition well-controlled with proper medication. So yes, while HIV remains a gravely serious diagnosis, and continues to spread rapidly in underdeveloped regions of Africa, the vibe of this speech was uplifting, full of the promise of research, breakthrough, and medical revolution.

But I am skeptical. I am skeptical because this crash course glossed over the very gritty history of HIV in America. It glossed over they way AIDS (Auto-Immune Deficiency Disorder) used to be called GRID (Gay-Related Immune Deficiency). It skipped the years that HIV drugs (AZT and others) spent in gridlock, waiting to be clinically tested, because policy makers refused to fund medical initiatives for “perverts” with “homosexual tendencies”. It did not mention that the decline of HIV-related deaths in the U.S. correlated exactly with the mobilization of the gay rights movement. In short, it did not admit that disease control intersects with issues of social justice on nearly every level: race, class, gender, and sexuality.

The outbreaks we hear about, the drugs we are sold, the preventative measures we are asked to take, are carefully calculated. Information can be manipulated to reassure or scare us, to rile us up or calm us down. Our recent preoccupation with the ebola virus is a textbook example of this. As midterm elections drew near, political candidates used a health crisis occurring in Africa as ammunition in an American political debate. Articles citing the ways in which ebola can be contracted, pictures depicting its unsavory symptoms, and bold political promises to end this epidemic pervaded our lives. Then, suddenly, voting season passed, effectively closing the door on ebola discussion. This happened because government officials, now secure in their jobs, could no longer bank on public fear. In fact, our speaker did acknowledge this, and made admirable efforts to include social discussion in his lecture. It is not my intention to discredit him; I understand that in a single hour, it’s impossible to cover the field of epidemiology and all its intersections with sociology entirely. I found his presentation to be smart, well researched, and engaging. Rather, I just hope to use this blog post as a means to discuss the social implications of epidemiology in a way that we were not quite able to in class. Medicine cannot function outside the realm of social intersectionality. To say that medical information and technology are the only roadblocks, or even the largest roadblocks between ourselves and global health solutions is to be sadly mistaken. As important and exciting as medical advancement is, we must also tackle poverty and discrimination when taking on issues of global health. Class, race, gender, sexuality, age, and ableism all affect a person’s access to proper healthcare and health education.

Tags: Guest Speakers · Human Health