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Medical Forum / Diseases and Disorders / AIDS / November 2005Circumcision
These are pretty dramatic data. I'm no fan of circumcision and I think adult versions should be done with great care. Traditional healers, should they be seen, should have the necessary tools and knowledge to prevent spreading HIV and other infections. George M. Carter ** NATAP http://natap.org/ _______________________________________________ Circumcision 'reduces HIV risk' Circumcision can reduce the rate of HIV infections among heterosexual men by around 60%, a study suggests. The South African study, reported in Public Library of Science Medicine, found it had a protective effect for some of the 3,280 young men involved. Cells under the foreskin are vulnerable to infection Circumcision is thought to help protect against HIV because cells under the foreskin are vulnerable to the virus. UK experts warned some circumcised men in the study still became infected and condoms offered the best protection. HIV infection rates are lower among groups in Africa who practise circumcision, but it was not known if this was due to cultural differences. There is a danger that people who have been circumcised will feel that they are fully protected from HIV when they are not Deborah Jack, National Aids Trust When the foreskin is removed, the skin on the head of the penis becomes less sensitive and so less likely to bleed, thereby reducing the risk of infection. Studies in Uganda and in Kenya are also investigating the link. Trial stopped The South African trial, conducted by a team of French and South African researchers and sponsored by ANRS (the French National Agency of Research on Aids), took place in the Orange Farm area near Johannesburg, where male circumcision in adulthood is a common but not universal practice. Just under 3,280 young, sexually active, uncircumcised, heterosexual men who took part in the study were offered the chance to be circumcised and then monitored for HIV infection. Just under half chose to be circumcised. The researchers planned to test all participants for HIV at three, 12 and 21 months, to see whether there was a difference in the rate of new infections between the two groups. However, after 18 months, the number of new HIV infections in the control group was 49, compared with 20 in the treatment group. The researchers decided at this point it would be unethical to continue the study. It was stopped and the uncircumcised men were offered circumcision. UNAids has said the trial found promising results, but more work needs to be done to confirm its findings and "whether or not the results have more general application." 'Not a condom substitute' Keith Alcorn, of the National Aids Manual, said: "Although this study showed that men who were circumcised were less likely to become infected with HIV, it must be stressed that circumcised men did become infected in this study, and that circumcision does not provide total protection against HIV. "I don't think that any country will be moving towards promotion of circumcision for HIV prevention on these results alone. "Two further studies in Kenya and Uganda have yet to be completed, and will give us more information." Deborah Jack, chief executive of the National Aids Trust, added: "There is a danger that people who have been circumcised will feel that they are fully protected from HIV when they are not. "We need more research and clear guidance, as circumcision can never be a substitute for condom use." Story from BBC NEWS: http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/4371384.stm > These are pretty dramatic data. I'm no fan of circumcision and I think > adult versions should be done with great care. Traditional healers, > should they be seen, should have the necessary tools and knowledge to > prevent spreading HIV and other infections. > > George M. Carter The study has been published: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/jour nal.pmed.0020298 > ** > NATAP http://natap.org/ [quoted text clipped - 83 lines] > Story from BBC NEWS: > http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/4371384.stm > > These are pretty dramatic data. I'm no fan of circumcision and I think > > adult versions should be done with great care. Traditional healers, [quoted text clipped - 4 lines] > > The study has been published: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/jour nal.pmed.0020298 and posted here weeks ago. that shows how current Carter is in his information. > These are pretty dramatic data. I'm no fan of circumcision and I think > adult versions should be done with great care. Traditional healers, > should they be seen, should have the necessary tools and knowledge to > prevent spreading HIV and other infections. > > George M. Carter Another study was presented at the same conference, and it found that female circumcision seems to have a similar prophylactic effect vis-a-vis HIV. http://www.ias-2005.org/planner/Abstracts.aspx?AID=3138 The cultural and sexist biases in scientific journalism were seldom more starkly apparent than in the recent coverage of the HIV conference in Rio. These two studies were presented on the conference website together yet the female circumcision study was invisible to the western medical press. One could hardly open any newspaper in the U.S. without seeing the headlines: "Male Circumcision Prevents HIV". Yet not a peep about the conference's other paper dealing with female circumcision and HIV. Where are the calls to make this practice a public health measure like it's urged for male circumcision? It is not surprising that no one has made such a ridiculous call. Perhaps this is because the West does not have a lobby for female circumcision unlike that for male circumcision. >>These are pretty dramatic data. I'm no fan of circumcision and I think >>adult versions should be done with great care. Traditional healers, [quoted text clipped - 24 lines] > a ridiculous call. Perhaps this is because the West does not have a lobby > for female circumcision unlike that for male circumcision. Female circumcision is an issue in the US? snip... >Where are the calls to make this practice a public health measure like it's >urged for male circumcision? It is not surprising that no one has made such >a ridiculous call. Perhaps this is because the West does not have a lobby >for female circumcision unlike that for male circumcision. Thanks for the abstract, cut-and-pasted below http://www.ias-2005.org/planner/Abstracts.aspx?AID=3138 I don't think female circumcision is viewed by most as anything more than something anatomically unnecessary and often cruel. It is far more destructive than male circumcision, isn't it? I don't particularly advocate either practice. But the reduction in transmission rates seem pretty significant. What do you think the alternatives should be? George M. Carter ** Abstract Female circumcision and HIV infection in Tanzania: for better or for worse? Stallings R.Y.1, Karugendo E.2 1ORC Macro, Calverton Maryland, United States of America, 2National Bureau of Statistics, Dar es Salaam, United Republic of Tanzania Introduction: It has been postulated that female circumcision might increase the risk of HIV infection either directly, through the use of unsterile equipment, or indirectly, through an increase in genital lacerations or the substitution of anal intercourse. The authors sought to explain an unanticipated significant crude association of lower HIV risk among circumcised women [RR=0.51; 95% CI 0.38,0.70] in a recent survey by examining other factors which might confound this crude association. Methods: Capillary blood was collected onto filter paper cards from a nationally representative sample of women age 15 to 49 during the 2004 Tanzania Health Information Survey. Eighty-four percent of eligible women gave consent for their blood to be anonymously tested for HIV antibody. Interview data was linked via barcodes to final test results for 5753 women. The chi-square test of association was used to examine the bivariate relationships between potential HIV risk factors with both circumcision and HIV status. Restricting further analyses to the 5297 women who had ever had sexual intercourse, logistic regression models were then used to adjust circumcision status for other factors found to be significant. Results: By self-report, 17.7 percent of women were circumcised. Circumcision status varied significantly by region, household wealth, age, education, years resident, religion, years sexually active, union status, polygamy, number of recent and lifetime sex partners, recent injection or abnormal discharge, use of alcohol and ability to say no to sex. In the final logistic model, circumcision remained highly significant [OR=0.60; 95% CI 0.41,0.88] while adjusted for region, household wealth, age, lifetime partners, union status, and recent ulcer. Conclusions: A lowered risk of HIV infection among circumcised women was not attributable to confounding with another risk factor in these data. Anthropological insights on female circumcision as practiced in Tanzania may shed light on this conundrum. ..The Muslim population in Africa represents about 65% of all the African people. anyway a big part is muslim. they practice circumcision, but still africa is the biggest continet with "aids" apadamic. if circumcision is that great why are then also so many muslims affected. or do muslim dont practice there religion as the should. > ..The Muslim population in Africa represents about 65% of all the African > people. anyway a big part is muslim. they practice circumcision, but still [quoted text clipped - 3 lines] > > or do muslim dont practice there religion as the should. When one reads shyte like this one wonders what agenda is at play here. Studies out of Africa found that there was a marked difference in HIV infection rates between circumcising and non-circumcising groups and communities. Read this: Male circumcision and HIV infection: 10 years and counting http://www.circumcisioninfo.com/halperin_bailey.html And after 30 odd studies which indicated a protective effect for male circumcision the results of the first of three RCT's have been published. Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/jour nal.pmed.0020298 The evidence is clear. Progress has been made, George, a known foreskin fetishist has decided to leave his foreskin fantasies in the mens-room and take a belated responsible approach to the mounting evidence. Why not take take a leaf out of George's book? Leave your foreskin fantasies in the mens-room and bedroom, millions of lives in Africa and Asia are at risk from HIV/AIDS. snip >Progress has been made, George, a known foreskin fetishist has decided >to leave his foreskin fantasies in the mens-room and take a belated >responsible approach to the mounting evidence. LOL...no, dearest peachkins. I looked at the data and changed my mind. Foreskins are not a fetish of mine. On some men, they are quite beautiful. On others, a cut cock is gorgeous. On most, that dangling dingus just looks like a turkey neck.... But you're right--I have had my concerns about circumcision as a means of reducing the risk of HIV transmission. And important caveats remain about when and among whom to undertake them--who does them, how, etc. Caveats notwithstanding, these data look compelling. And thus my mind has changed about supporting or encouraging men to make that choice to be circumcized. George M. Carter > But you're right--I have had my concerns about circumcision as a means > of reducing the risk of HIV transmission. And important caveats remain [quoted text clipped - 5 lines] > > George M. Carter Ah, the caveats (aka the devil is in the detail). The history of this all makes interesting reading. Thirty odd studies and an RCT was demanded before anything would be considered. Now they have one RCT, they need three. When they have three there will be the caveats. I am trying to understand who gains from these additional infections, who benefits from the deaths, who derives enjoyment from suffering of the families and next of kin? Can you help me understand this George? >> But you're right--I have had my concerns about circumcision as a means >> of reducing the risk of HIV transmission. And important caveats remain [quoted text clipped - 7 lines] > >Ah, the caveats (aka the devil is in the detail). Isn't it always? >The history of this all makes interesting reading. Thirty odd studies >and an RCT was demanded before anything would be considered. Now they >have one RCT, they need three. When they have three there will be the >caveats. There are always caveats, dear. >I am trying to understand who gains from these additional >infections, who benefits from the deaths, who derives enjoyment from >suffering of the families and next of kin? Can you help me understand >this George? I have no idea what you're babbling about. Who benefits from a botched circumcision? Or one in which a practitioner reuses it? Indeed, THESE data are DIFFERENT in that older data suggested that the benefit of circumcision waned after about age 15. And maybe they should be replicated! ;) George M. Carter >>>But you're right--I have had my concerns about circumcision as a means >>>of reducing the risk of HIV transmission. And important caveats remain [quoted text clipped - 31 lines] > > George M. Carter Wrong answer George. It is Big Pharma who benefit from more rather than less HIV infections. What are your connections to Big Pharma? snip >Wrong answer George. It is Big Pharma who benefit from more rather than >less HIV infections. What are your connections to Big Pharma? Oh for god's sakes. Go f.ck yourself dipshit. I have no connections to pharma. And pharma could give a RAT'S a.s about Africans getting circumcised or not. They'd rather defend their IP rights and let millions die than give a flying f.ck about that. Why do I bother with a.sholes like you? George M. Carter "GMCarter" <fiar@verizon.net> wrote in message > Why do I bother with a.sholes like you? Isn't that how you got aids, (bothering) with a.sholes ? does hiv cause aids? no- faggot a.sholes cause aids. >"GMCarter" <fiar@verizon.net> wrote in message >> >> Why do I bother with a.sholes like you? >> >Isn't that how you got aids, (bothering) with a.sholes ? I am queer as a $3 bill. I do not have AIDS. >does hiv cause aids? no- faggot a.sholes cause aids. HIV causes AIDS. Sexual activity spreads it. Hate, like yours, spreads violence and death. And--you will no doubt cling to it til you die. Bad karma, dear. And you're the one who will suffer with it. Too bad. You could choose to be healed from that easier than someone can be cured of AIDS. But you will choose to embrace your bigotry and hate. And it will eat you alive. George M. Carter It' not very often that Mr. Carter and I agree on something. That's why I take such pleasure in making this comment. Mr. Carter says he's no fan of circumcision. Well, neither am I. It's a barbaric ritual from ancient times. Besides, it is usually perpetrated on young defenseless children who are unable to express their own preferences on the subject. I read that a similar study was done on circumcised females. But female circumcision is not politically correct in the Western world, so only the study on circumsized males landed on our plate. But in spite of not being a fan of circumcision, Mr. Carter finds the data compelling... Good grief! It's the same bullshit again, just like the infamous study of nevirapine by Laura Guay and her band of thugs. People with an agenda: "If you want to be happy and healthy, get cicumsized!" Well, I'm all for allowing everybody who really wants it to get circumsized. But these data suck. "However, after 18 months, the number of new HIV infections in the control group was 49, compared with 20 in the treatment group. The researchers decided at this point it would be unethical to continue the study." The last sentence is a dead give-away. Whenever a study is not going well, they end it "for ethical reasons" They just couldn't stand by idly while these poor uncircumsized men were getting infected with HIV. (Sob!) So they were all circumsized after all. Mission accomplished. Read the article. Note how vague they are about the numbers. There were over 3000 men in the program. "Just under half chose to be circumcised." Yeah, sure... What was their incentive to let themselves be mutilated? Were they paid? Of these thousands of men only 69 were diagnosed with HIV after 18 months, 20 in the "Yes Massa, cut me" group, and 49 in the sane control group. Knowing how wacky those serological tests are (you can get any result you want), what's so compelling about these data? If they had been compelling, they would not have stopped the study. AIDS researchers in Africa are not known for their strong ethics. But take a look at the underlying theory: " Cells under the foreskin are vulnerable to infection" Eh... Hahahahahahahaha! So by baring those cells permanently (haw! haw! haw!) you protect them? I also read something about uncircumsized men bleeding more easily during intercourse... Good Lord! If you start thumping so hard that you start bleeding, you wear out your welcome with any woman. This theory is so totally devoid of any plausibility and so patently ridiculous that it should tickle anybody' funnybone. > It' not very often that Mr. Carter and I agree on something. That's why > I [quoted text clipped - 21 lines] > The last sentence is a dead give-away. Whenever a study is not going > well, they end it "for ethical reasons" So in your mind a 59% better result from case A in comparison to case B means the record for case A is a failure? In other words if you were crash testing two cars of different makes and model, and car A had 59% less damage in a standard 35 mile per hour collision test then did car B. Yet according to you the manufacturer of car A has failed in there attempt to produce a more crash worthy car then car B's manufacturer produced. What kind of logic is that Claster the world wonders? Gary Stein > What kind of logic is that Claster the world wonders? > > Gary Stein He displays any _logic_? >"So in your mind a 59% better result from case A in comparison to case B means the record for case A is a failure?" Hm, very amusing. The nice thing about these percentages is that they make it so easy to cheat with statistics. I have no idea where your 59% comes from, but it must be 59% from some small number. The total number of participants was something like 3200. The difference in percentages was then [(49 - 20) / 3200] x 100%, which comes out to something a lot smaller than 59%. But if you're in the car sales business, there must be a way to get this number up to something compelling. >People with an agenda: >"However, after 18 months, the number of new HIV infections in the control [quoted text clipped - 6 lines] >while these poor uncircumsized men were getting infected with HIV. (Sob!) >So they were all circumsized after all. Mission accomplished. The article you responded to said: "It was stopped and the uncircumcised men were OFFERED circumcision." [Emphasis added.] Nothng there justifies your implication that this was some kind of foreskin holocaust. If the experimenters' "mission" was to produce a pre-determined verdict that circumcision is beneficial, how can you say this study was not going well for them? It was showing less than half the rate of new HIV infections in circumcised men as in uncircumcised men. Your suggested unethical motivation for ending the study early is contrary to the facts. >Read the article. Note how vague they are about the numbers. There were >over 3000 men in the program. "Just under half chose to be circumcised." This vagueness would only be relevant if it somehow allowed the experimenters to conceal fakery. "Just under half" is nowhere near vague enough to give the experimenters the wiggle-room to fake a results ratio of 20:49. Your vague implication of dishonestly is not justifiable from the facts you cite to support it. >Yeah, sure... What was their incentive to let themselves be mutilated? >Were they paid? Does the paper describe how study subjects were recruited? Did you bother trying to find out, or do you just want to imply something without justifying it? >Of these thousands of men only 69 were diagnosed with HIV after 18 months, >20 in the "Yes Massa, cut me" group, and 49 in the sane control group. >Knowing how wacky those serological tests are (you can get any result you >want), what's so compelling about these data? Unsupported implication of manipulated results noted. If they were doing this, what purpose would be served by also being vague about the numbers? You seem not to care about the sensibility or mutual consistency of your accusations, as long as they damage the reputations you want or need to damage. Dr. Lecter might ask, "Doesn't this random scattering of accusations seem *desperately* random, like the elaboration of a bad liar?" >If they had been >compelling, they would not have stopped the study. AIDS researchers in >Africa are not known for their strong ethics. If the results were compelling why would any researchers, ethical or otherwise, continue the study? What unethical motivation are you implying here? Or does it even matter? All of these pseudo-arguments of yours are nothing but contrived opportunities to imply unethical behaviour without having to support the accusations. >But take a look at the underlying theory: " Cells under the foreskin are >vulnerable to infection" >Eh... Hahahahahahahaha! So by baring those cells permanently (haw! haw! >haw!) you protect them? Nice exploitation of ambiguity, Lord Haw Haw. "Some researchers in early studies have said they believe cells in the foreskin may be particularly susceptible to infection." http://groups.google.com/group/misc.health.aids/msg/d82c5fdcc2854757?hl=en "Increased risk of HIV-1 infection in uncircumcised men is likely caused by the presence in foreskin of large numbers of HIV-1 target cells, especially T-cells and LCs, expressing primarily CCR5." "CD4+ T-cells and LCs in the inner, mucosal surface of the foreskin had a 7-fold greater susceptibility to HIV-1 infection than did cells in cervical tissue infected under the same conditions." http://groups.google.com/group/misc.health.aids/msg/0744e6905a40529a?hl=en It is not cells in the glans but cells in the foreskin that are vulnerable to infection. Removing the foreskin reduces risk by removing vulnerable tissue. You have no excuse for pretending not to understand that -- the quotes above are from articles you responded to. >I also read something about uncircumsized men bleeding more easily during >intercourse... Sometimes, during winter cold spells, my foreskin gets chapped...  SignatureDavid Canzi "I am not denying anything." -- Celia Farber >" It was showing less than half the rate of new HIV infections in circumcised men as in uncircumcised men." It was not. Numbers of 49 and 20 out of a total of about 3200 are a drop in a bucket. Just experimental noise. Tell me, what was the standard deviation of the complete sample? I presume they used Poisson statistics. This kind of experiment with highly variable biological data is really so silly. >"Does the paper describe how study subjects were recruited?" Hell, no! They know better than that. >"If the results were compelling why would any researchers, ethical or otherwise, continue the study? What unethical motivation are you implying here? Or does it even matter?" That's the point. The results were anything but compelling. as I explained in my answer to Mr. Stein. The mere mention of "ethical reasons" are a dead give-away that some hanky panky was going on. They just quit when they were ahead. What unethical motivation am I implying? That these researchers wer crooks with an agenda, that's what. If, at the point where they ended the study, the balance of the numbers had pointed the other way, they would have continued the study. People are that way. Especially if they have a preconceived idea what the outcome must be. >"It is not cells in the glans but cells in the foreskin that are vulnerable to infection. Removing the foreskin reduces risk by removing vulnerable tissue. You have no excuse for pretending not to understand that" No excuse, I agree. But I must admit I set you up there. So it is the foreskin that has the "vulnerable cells"? Well, I assume you're familiar with the anatomy of the penis. Where exactly does the foreskin end and the shaft begin? Is there a histological difference between the cells? How does "HIV" know (in the heat of the sex act) which part is rolled-up foreskin and which is not? Funny that they compared the cells of the foreskin with (unrelated)cervical cells, not with cells from the remaining part of the penis. Maybe they didn't think a proper control sammple would prove their point? No, the whole theory is ridiculous. I think I'll keep the foreskin for myself, and give you the shaft. >>" It was showing less than half the rate of new HIV infections in >circumcised men as in uncircumcised men." > >It was not. Numbers of 49 and 20 out of a total of about 3200 are a drop >in a bucket. Just experimental noise. The probability of the circumcised group getting 20 or fewer of 69 infections purely by chance is 0.00032. "Experimental noise" that distributes itself in such a highly significant manner is not noise. >>"It is not cells in the glans but cells in the foreskin that are >vulnerable to infection. Removing the foreskin reduces risk by removing [quoted text clipped - 5 lines] >with the anatomy of the penis. Where exactly does the foreskin end and the >shaft begin? [snip] >Funny that they compared the cells of the >foreskin with (unrelated)cervical cells, I included this quote in my article and the last sentence of yours above proves that you read it: "CD4+ T-cells and LCs in the inner, mucosal surface of the foreskin had a 7-fold greater susceptibility to HIV-1 infection than did cells in cervical tissue infected under the same conditions." I didn't include this quote because of the comparison of foreskin and cervix, but because it stated more clearly than any other quote I have seen, what part of the foreskin is prone to infection: "the inner, mucosal surface". Your question about where the foreskin ends and the shaft begins relies on the outer surface of the foreskin being identical to the skin of the shaft to imply that the foreskin can't be especially vulnerable to infection. This argument depends on the premise that it's the outer surface of the foreskin that is claimed to be vulnerable. But a quote that you have *provably* read clearly says otherwise. So the implied argument your question leads to is based on a false premise, and you knew this before you asked it. You have no excuse. SignatureDavid Canzi "I am not denying anything." -- Celia Farber >""CD4+ T-cells and LCs in the inner, mucosal surface of the foreskin had a 7-fold greater susceptibility to HIV-1 infection than did cells in cervical tissue infected under the same conditions." OK, so it's the inner mucosal surface of the foreskin that's so special. I can see that now. What I can't see is why they had to use cervical cells as a control. Maybe they just happened to have that lying around... But why not some other tissue, from the same donor? >"The probability of the circumcised group getting 20 or fewer of 69 infections purely by chance is 0.00032. "Experimental noise" that distributes itself in such a highly significant manner is not noise." Based on the small number of 69 it isn't noise. But the 69 "infections" are not set in stone. They are in turn a random subset of the 3200 population. And as fractions of the total polpulation, the difference between 49 and 20 is insignificant. You can mimic the result by a Monte Carlo simulation, if you drop a mixture of 1600 red balls and 1600 green balls on a sheet that has 69 holes which can accomodate one ball each. You can get widely different red/green distributions that way. But I leave that exercise to you. >>""CD4+ T-cells and LCs in the inner, mucosal surface of the foreskin had a >7-fold greater susceptibility to HIV-1 infection than did cells in [quoted text clipped - 4 lines] >What I can't see is why they had to use cervical cells as a control. >Maybe they just happened to have that lying around... Maybe you're right. If the study was done in a hospital setting they'd have cervical biopsies to experiment with ... >But why not some >other tissue, from the same donor? ... and they'd have foreskin samples from circumcision patients who hadn't consented to have anything else removed. >>"The probability of the circumcised group getting 20 or fewer of 69 >infections purely by chance is 0.00032. "Experimental noise" that [quoted text clipped - 5 lines] >population. And as fractions of the total polpulation, the difference >between 49 and 20 is insignificant. These numbers are based on only about a year of observation. Multiply by 10 or 20 to get a rough idea of the lifetime risk. >You can mimic the result by a Monte Carlo simulation, ... Or I can calculate the probability of the observed results, and find that they'd be very unlikely if circumcision didn't reduce risk. SignatureDavid Canzi "I am not denying anything." -- Celia Farber >"Or I can calculate the probability of the observed results, and find that they'd be very unlikely if circumcision didn't reduce risk." Yes, you could do that, of course. But you have to start with the complete sample of 3200. That 69 out of that large number wound up "positive" reflects a probability by itself. Then you end up with very small probabilities for each group, and then the difference is not all that impressive. > Good Lord! If you start thumping so hard that you start > bleeding, you wear out your welcome with any woman. I would not have thought that this was your area of _expertise_ so why comment on it? >"I would not have thought that this was your area of _expertise_ so why comment on it?" Ah, but that's where you're completely wrong, Mr. Jordan! It is indeed one of my areas of expertise. Iconoclaster once again shoots his mouth off before he puts his brain in gear. Here we are talking about a study which shows a reduction in incidence of HIV aquisition following circumcision. Does claster bother to read the paper? - No. Does he try to understand what the foreskin consists of? - No. Does he criticise the study without even looking at the methodology, the data, the statistical methods? - Yes. Jordan posted a link to the study at the begining of the thread. Later, Claster comes up with these gems: "Read the article. Note how vague they are about the numbers. There were over 3000 men in the program. "Just under half chose to be circumcised." Yeah, sure... What was their incentive to let themselves be mutilated? Were they paid? " Clearly Claster hasn't even bothered to read the article itself, just a sound bite publication about it. In the article numbers are quite specific - "A total of 3,274 men participated in the trial. There were 146 (prevalence 4.5%) HIV-positive participants at randomization. The difference in size between the intervention and control group was 34 (1,620 versus 1,654)." A cursory look at the methodology will demonstrate exactly how much trial participants were paid, and what recruitment entailed. Go on, Claster, read it - surprise us all. For someone who professes to be a scientist of sorts, he knows nothing about trial methodology. Studies are stopped on ethical grounds by independent Data Safety Monitoring boards. They scrutinise interim trial results, and if a clear benefit or detriment is evident, they recommend the trial is halted. This is quite standard. In this case, the trial was stopped because it was felt unethical to continue to study groups of individuals who may continue to be at more risk than an intervention group. Claster then has to have it explained to him that the foreskin is not a single pathological entity - it has a mucosal inner surface, which is where HIV makes entry via langerhans cells- again something that is generally well known, and would be known to anyone reading the article. He then criticises the statistical conclusions, thinking his comparisons to balls dropping into holes are a valid comparator. Again, the article goes into the statistics in some detail. If Claster cannot understand proportional hazards models, relative risks, incidence rates and incidence rate ratios, he has only himself to blame. Perhaps the next time a study is discussed we will witness the spectacle of Claster entering the discussion after he has read the paper, but I doubt it somehow. >"Does claster bother to read the paper? - No." Wrong conclusion. I just went back to the paper, and it was clear to me that I had read it all before. I usually pay most attention to "Materials and methods", and skim through the rst. So I see now that these poor suckers got the princely sum of 300 Rand. >"Does he try to understand what the foreskin consists of? - No." I think I KNOW what it consists of. I HAVE one. Do you? >"For someone who professes to be a scientist of sorts, he knows nothing about trial methodology. Studies are stopped on ethical grounds by independent Data Safety Monitoring boards. They scrutinise interim trial results, and if a clear benefit or detriment is evident, they recommend the trial is halted. This is quite standard." It may be quite standard, but it is also quite fraudulent. Just waiting till the numbers are in your favor and then quitting while you're ahead may be good market speculation practice (That's probably where they got the idea), but it has nothing to do with proper science. >"...it has a mucosal inner surface, which is where HIV makes entry via langerhans cells- again something that is generally well known, and would be known to anyone reading the article." Generally well known?? For a virus that has never been shown to exist? This is an undocumented assumption, Master David. And then, after reading the article I'm supposed to believe that cutting this "vulnerable tissue" off, there is protection against this virus? I never encountered more obvious circular reasoning. >"He then criticises the statistical conclusions, thinking his comparisons to balls dropping into holes are a valid comparator." Let's face it: The statistical methods suck. After reading this crap (again) I must say that they indulged again in the popular habit of using as much jargon as possible for the sole reason of obfuscating what they're really doing. >"If Claster cannot understand proportional hazards models, relative risks, incidence rates and incidence rate ratios, he has only himself to blame." What did I tell you? Words, just words to impress the unwary. But look at what they really did: They had a large sample, and they based their results (and conclusion) on a very small subsample of 69, produced by a sequence of 3 (very wacky) ELISA tests. This, ladies and gentlemen, is outright fraud! All this gobbledygook about hazard models etc. is political doublespeak. I do know. I've been part of it during my stint in government. > >"Does claster bother to read the paper? - No." > [quoted text clipped - 17 lines] > may be good market speculation practice (That's probably where they got > the idea), but it has nothing to do with proper science. So sayeth his high holiness Iconclaster............ While the practice in question has been standard in medical trials for decades his majesty Iconclaster proclaims that he is the one and only arbiter of science and ethics who's opinion matters. One must ignore the bioethics staffs of every Medical School, government agency, and medical research institution in the western world and take Iconclaster's statement as definitive. And if you believe that he has a bridge in San Francisco that he would love to sell you for a very reasonable price. Gary Stein >"One must ignore the bioethics staffs of every Medical School, government agency, and medical research institution in the western world and take Iconclaster's statement as definitive." That's right. I've been in too many Medical Schools not to know these "ethics boards" are merely a bunch of sanctimonious hypocrites advancing their own agenda. Just because something has been standard for decades doesn't mean it's right. Chasing lepers out of the community was standard for a long time. >>"Does claster bother to read the paper? - No." > >Wrong conclusion. I just went back to the paper, and it fell on the floor.... >Wrong conclusion. I just went back to the paper, >and it was clear to me that I had read it all before. Translation: I had no need to read the paper, because I already had come to my own conclusions about what it would say. >I usually pay most attention to >"Materials and methods", and skim through the rst. If that is a demonstration of what "most of your attention" will yield, I think we can dismiss anything you have to say on virtually any topic as irrelevant. You obviously didn't even notice how they conducted recruitment and how much the participants were paid, by your own admission, and this with you devoting most of your attention to this precise section! Your "attention" obviously amounts to very little. >I think I KNOW what the it (the foreskin) consists of. I HAVE one. It is quite obvious you only THINK you know - you admit being unaware until now that the inner surface consists of mucosal cells. Since you have one - go ahead, peel it back and take a look. Trial monitoring by Independent Data and Safety Monitoring Boards is not "fraudulent" as you claim - it is a statutory independent process with no link to those conducting the studies. It provides an important means for stopping trials if the intervention in question is clearly superior OR inferior to the control/standard treatment arm, or if excessive toxicities are apparent. Many trials of HIV drugs have been stopped by this method - the most recent I can think of is Glaxo's CCR5 inhibitor which showed unacceptably high levels of hepatotoxicity. But in your surreal world, discontinuing that study on the basis of an intervention by the Data and Safety board would be classed by you as "fraudulent" >Let's face it: The statistical methods suck. Translation: "I don't understand them, so I'll pretend they are crap since they show the opposite of what I would like to believe" >"It is quite obvious you only THINK you know - you admit being unaware until now that the inner surface consists of mucosal cells." So what? There are mucosal cells in the mouth too. Do we get a study in South Africa next, to show that cutting out your tongue protects you against "HIV infection"? They'll have to come up with more than 300 Rand for that. >"Trial monitoring by Independent Data and Safety Monitoring Boards is not "fraudulent" as you claim - it is a statutory independent process with no link to those conducting the studies. It provides an important means for stopping trials if the intervention in question is clearly superior OR inferior to the control/standard treatment arm, or if excessive toxicities are apparent." Ah! So THAT's how AZT came to be approved so fast! It's trial was monitored by an Independent Data and Safety Monitoring Board... And all those clinical trials that are done without controls... are they also monitored? Say, those Independent Data and Safety Monitoring Boards, are they also active when Weapons of Mass Destruction in some hapless country must be found? Maybe that bridge in S.F., Gary Stein was mentioning... Did you buy it? You are dissembling...... a sure sign you have lost the argument. > You are dissembling...... a sure sign you have lost the argument. Yes take pity on the poor man. The following further explains the infection process in cervical mucosa: HIV binding, penetration, and primary infection in human cervicovaginal tissue http://www.pnas.org/cgi/content/full/102/32/11504 >"You are dissembling...... a sure sign you have lost the argument." Oh, was there an argument? My dear fellas, this whole idea of an ancient barbaric ritual protecting against a non-existing virus is way too ridiculous for anybody to even consider. A scriptwriter for SciFi B-movies would have been laughed out of the studio if he came with a story like that. Just look at the studies done: They use serological tests with a protein kit they don't know the origin of, they test for a virus they can't isolate, but of which they assume it has a preference for mucosal cells of the foreskin. Their statistical methods stink, suggesting that they don't even know the difference between a probabale outcome and an observed fact. And you really want to be taken seriously? >>"You are dissembling...... a sure sign you have lost the argument." > [quoted text clipped - 13 lines] > fact. > And you really want to be taken seriously? Perhaps you need to consider your own question. >"Perhaps you need to consider your own question." Is this your idea of a post, Mr. Jordan? You repeat all of mine (and then some) And you add these 8 words of your own. Is there a point you want to make? >Their statistical methods stink< You have already shown you have no understanding of the statistical methodology used in this study. Perhaps you could be very specific and list your precise objections to the statistical methods? >"Perhaps you could be very specific and list your precise objections to the statistical methods?" I have been specific. On several occasions in this thread I have pointed out that it is not correct to start with a cohort of more than 3000, and basing your conclusions on 69 chance hits, especially when there are so many possible confounding factors. Don't think for a moment, Master David that I'm impressed by the only argument you ever presented: Namely that I don't understand statistical methods. I have participated myself in the epidemiology racket, and I know how uninformed clinical workers are. They don't think, they just follow the cookbook. And you and the other assorted losers on this forum won't convince me otherwise. And one more thing: I have been able to nail your herd down to the point of view that the mucosal cells of the foreskin are the ones vulnerable to "HIV infection. Well, let me spring the trap now: In the paper, kindly furnished by Mr. Jordan in the 2nd post of this thread, it says: "When the foreskin is removed, the skin on the head of the penis becomes less sensitive and so less likely to bleed, thereby reducing the risk of infection." So it's the glans after all, isn't it? Confusion? Don't feel to bad. The whole idea was ridiculous to begin with. HAW! HAW! HAW! > >"Perhaps you could be very specific and list your precise objections to > the statistical methods?" [quoted text clipped - 3 lines] > basing your conclusions on 69 chance hits, especially when there are so > many possible confounding factors. Can you give the probability of the results in the paper occurring by chance alone? Chris Noble >I have been specific. On several occasions in >this thread I have pointed out that it is not >correct to start with a cohort of more than 3000, >and basing your conclusions on 69 chance hits, >especially when there are so many possible >confounding factors. On the contrary, lord HAW HAW, you have not been specific - you have merely waffled on about how bad the statistics are without ever giving a coherent explanation as to why you think that is the case. It is you who talks about chance hits and likens the analysis to balls dropping into holes, and talk about confounding. FYI, if you bothered to read the stats methodology, you would appreciate that when looking at data accrued over time, one needs a method that will allow you to use time as one of the variables. You also need to control for all confounding variables that could influence the outcome, in this case the dichotomous result of HIV infection or not. Guess what? - A cox proportional hazards analysis fits the bill exactly! Results can be expressed in terms of a hazard ratio which is quite comprehensible (to everyone but you it would seem). >Don't think for a moment, Master David >that I'm impressed by the only argument [quoted text clipped - 3 lines] >racket, and I know how uninformed clinical >workers are. This is not the only argument I have presented. It is merely one of the areas that is so specific that I hoped (in vain so it seems) we would see a response that was not couched in your typically piffly, general terms. How about answering a straight question for once - what SPECIFICALLY is it that you object to in the statistical methods performed in this study? There is a good reason why my reactions are usually in general terms. They are intended for mass consumption, i.e., non-academicians must also be able to understand what we're taking about. This, however, runs counter to the intentions of you and your friends. You will always try to drag the discussion to an obscure place among the trees, from where nobody can see the forest. You hope those who are not able to follow all the technicalities will throw in the towel, assuming the con artists who keep repeating the same story will "know best". Well, I'm unwilling to play your game, least of all by your rules. Not just because I think you're wrong, but most of all because I question your motives and your intentions. Now that we have that out of the way, let's look at your beloved statistical method: the Cox proportional-hazards regression model. As you know, the hazard ratio can be expressed as a linear series of hazard functions. One of the requirement of Sir David's method is that these hazard functions must be proportional over time (i.e. constant relative hazard). Is turning serologically HIV-positive proportional over time? Do you know? Does anybody know? >"You also need to control for all confounding variables that could influence the outcome, in this case the dichotomous result of HIV infection or not." The covariate (risk factor) is certainly dichotomous in this case (you're serologically HIV+ or you're not). But to arrive at an instantaneous relative risk of an event (= turning seropositive) at any time, for an individual with the risk factor present (a foreskin)compared with an individual with the risk factor absent (mutilated), all other covariates must be the same for both individuals! Poor foreskin-choppers! No two individuals are the same. No two individuals have the same lifestyle. No two individuals have the same risk factors. I sympathise with them up to a point: Their task is difficult. I know I've done these multiple regressions myself, in the course of time-series analysis (Think of predicting the stock-, commodity- and foreign exchange markets). The problem is: There are too many factors, and not all of them are known. If these regression models worked so well, I would be a very rich man, which I'm not. But the HIV-hunters consider only one class of risk factors anyway: Sexual behavior. With this kind of tunnel vision you cannot solve any biomedical problem. Another point of criticism is that clinical investigators must not let continued follow-up depend on a participants medical condition. Violation of this condition will invalidate the results of the Cox model. Well, I read in the paper under discussion: "Home visits for late participants revealed 16 deaths among participants..." What do you think: Is death a medical condition? I should think so. And those ethics committees didn't help to make the study more credible either. You lauded the fact that time is a variable in the Cox model, Master David, and I agree. It's not the Cox analysis I'm criticizing, but the way it was implemented. Did they actually the time parameter? Hell, no. They made a feeble attempt by scheduling a follow-up visit every couple of months. They lost subjects, either by death or because they were running like hell before their peepee was mutilated beyond repair. And... Let's face it: You probably know how clinicians somewhere out there in the bush do statistics. They sit in front of their laptop computer, start up a program such as SPSS or MedCalc, and input some data. Then they fix their gaze on infinity and their brain on zero, and push the button. They don't check, they don't thnk. They just accept whatever numbers the computer comes up with. Richard Hamming once wrote: "The purpose of computing is insight, not numbers" You see, if your input is 1+1, there's only one answer, namely 2. If your input is the final result, i.e., 2, then there are an infinite number of ways this result can be reached. And that's what's wrong with "HIV science". They only look at the outcome they want, then they firgure out how to arrive at it. Another pearl of wisdom, this time by Aaron Katchalsky, a biophysicist who later became president of Israel (as A. Katzir): "Give me 5 parameters, and I can fit an elephant." Well, in my curve-fitting days I tried it, and by golly! Katchalsky was right! > There is a good reason why my reactions are usually in general terms. They > are intended for mass consumption, i.e., non-academicians must also be > able to understand what we're taking about. This is one of the hallmarks of pseudoscience. Scientists attempt to convince other scientists that their ideas are correct. Pseudoscientists target lay-audiences > This, however, runs counter > to the intentions of you and your friends. You will always try to drag > the discussion to an obscure place among the trees, from where nobody can > see the forest. The only way a scientific question can be decided is by looking at the science. All attempts by rhetoric and political arguments to bypass the science is quackery. > You hope those who are not able to follow all the > technicalities will throw in the towel, assuming the con artists who keep > repeating the same story will "know best". You hope that your lay-audience that is not able to follow the technicalities and has a distrust of science will believe you because you too attack the scientists. > Well, I'm unwilling to play your game, least of all by your rules. Not > just because I think you're wrong, but most of all because I question your > motives and your intentions. You are unwilling to address the science because you have no leg to stand on. I question your motives and intentions. Chris Noble >"You are unwilling to address the science because you have no leg to stand on. I question your motives and intentions." You're taking through your hat, Mr. Noble. In my last post I approached the subject from two angles. I did not only address the lay audience, but also the scientists. I pinpointed several reasons why the requirements of the Cox model were violated in this paper, invalidating the results. It's those six authors (plus you) who have no leg to stand on. The whole discussion is ridiculous anyway: "Be safe from AIDS! Let us cut your peepee!" I guess the next discussion we we'll have will be about: "Why pigs can fly". > You are unwilling to address the science because you have no leg to > stand on. I question your motives and intentions. > Well you are right to do so. I would suggest that you approach George for an answer as for years George was in denial about the circumcision "connection". His motivation seems to have been something to do with his own sexual preferences. Icono seems to be a blend between ideological and sexually based denial. One that HIV does not cause AIDS and two that his penis is not a public health risk. >> You are unwilling to address the science because you have no leg to >> stand on. I question your motives and intentions. [quoted text clipped - 4 lines] >"connection". His motivation seems to have been something to do with his >own sexual preferences. Oh, horseshit. I don't have a foresking fetish. Nothing wrong with having one if that's what turns ya on. But that's not why I had issues about circumcision. I still do--in terms of when it's done, how it's done, equipment that's used and so forth. I am MOST interested in the data. And the data seem more compelling at this point in favor of circumcision (at least under the conditions of that study) than not. George M. Carter >>"Perhaps you need to consider your own question." > > Is this your idea of a post, Mr. Jordan? You repeat all of mine (and then > some) And you add these 8 words of your own. Is there a point you want > to make? Your shyte does not deserve any more of a response. >"Your shyte does not deserve any more of a response." I think it does. Running out of inspiration? |
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