Intactivism News

March 31, 2011

Charges Dismissed in Circumcision Case

The Helsinki Court of Appeal on Wednesday dismissed charges in a case involving the circumcision of a male infant that led to medical complications requiring hospitalization. A lower court had convicted the child's parents of incitement to assault and battery.

The Court of Appeal struck down the lower court ruling and the fine that has been imposed on the child's parents. Also, following the decision, they are not required to pay compensation to their son for pain and discomfort, as ordered by the District Court.

According to Wednesday's decision, it has been difficult for the parents to perceive their behaviour as assault and battery or incitement because circumcisions have been long permitted, and their legal status has been unclear.

Finland has no legislation on male circumcision. The Helsinki Court of Appeal noted that at the time of the events under review, there was not even a precedent concerning legal proceedings concerning circumcision. Circumcisions have had a sort of approval by customary law as a long established tradition.

In this case, the circumcision was performed on the premises of Helsinki's Jewish congregation in the spring of 2008 by an English rabbi who was not a licensed medical practitioner in Finland. The week-old infant was hospitalized for treatment of excessive bleeding following the procedure.

This was apparently the first time that charges of assault and battery were filed in Finland in regard to the circumcision of a Jewish boy.

The Helsinki District Court's verdict was that the hallmarks of assault and battery had been fulfilled since no pain relief was used during the procedure. The actions of the parents were classed as incitement as they did not carry out the procedure themselves.

In the autumn of 2008, the Supreme Court ruled that a medically performed circumcision carried out for religious or social reasons is not a crime. In the case that led to that ruling, the procedure had been performed by a medical doctor and an anaesthetic was administered before the operation.

Earlier story

St. Louis Attachment Parenting Examiner
March 29, 2011

Circumcision adverse event data missing from study, suppression alleged

By Andrea Sonnenberg

The Centers for Disease Control and Prevention (CDC) is currently drafting recommendations regarding routine infant circumcision in the United States due to recent studies said to have uncovered a link between circumcision and HIV reduction. St. Louis parents currently lead the nation when it comes to circumcising their sons: More than 80% of baby boys in the region are circumcised at birth. It is critical that these parents have accurate information regarding this decision. While much is known about the complications that can arise from circumcision in the neonatal period, less is known about the long-term health effects linked to routine infant circumcision.

Documents published today March 29, 2011 (see slideshow at left), may help explain this curious lack of information. Although published evidence is slim that routine infant circumcision affects an adult male in any way other than his sex life, there is evidence that in at least one study, data regarding potential adverse events linked to circumcision appears to have been deliberately suppressed. These documents tell the story in the words of such renowned doctors as Dr. Robert Star of the National Institutes of Health, Dr. Kevin Fenton of the CDC, and Dr. Howard Koh the Assistant Secretary for Health at the US Department of Health and Human Services.

In 2005, a study was published in the British Journal of Urology International. This study, “A case-control study of risk factors in men with chronic pelvic pain syndrome,” outlined a number of factors leading to chronic pelvic pain syndrome in men, as well as chronic prostatitis. According to the study, “(a) wide range of self-reported medical conditions was associated with CP/CPPS.”

While many of these conditions and lifestyle factors, including smoking, sexual habits, birth control use, and history of sexually transmitted infections, were listed in the published study, one potential risk factor was noticeably absent: circumcision.

It is unclear exactly how the data regarding circumcision was collected. While many of the other conditions were self-reported, self-reporting of circumcision status is notoriously unreliable. A survey conducted by the National Health and Nutrition Examination Surveys found that as many as 31% of circumcised men and 35% of intact men incorrectly identified their own circumcision status. Circumcision status can only be accurately assessed by a thorough physical examination, according to the CDC.

The circumcision data that was collected was allegedly never fully analyzed. These data were collected and sent to the National Institute of Diabetes and Digestive and Kidney Diseases Repository, where they were to be stored and available by application only. No public notice would be given that the data existed, and we were unable to attain these data through normal channels.

One doctor involved in this study called the omission of the circumcision data “publication bias” and likened it to the violative research bioethics conduct in Tuskegee and Guatamala, particularly in light of the upcoming circumcision recommendations regarding HIV. The CDC declined to comment on the study.

the Guardian
March 30, 2011

Female circumcision prevention post abolished by government

Charities say that efforts to eradicate the procedure will be undermined, leaving 24,000 girls at risk

By Rachel Williams

The government has abolished the only Whitehall post devoted to work preventing women and girls from the UK being subjected to female genital mutilation (FGM).

Campaigners said the loss of the FGM co-ordinator will undermine efforts to eradicate the practice. Some 24,000 girls among FGM-practising minority ethnic communities in Britain are estimated to be at risk of the procedure, in which part or all of their genitalia is cut off and stitched up without anaesthetic.

The news comes a month after the government launched guidelines to help frontline workers in health, education and social services identify and prevent FGM, and pledged its commitment to ending the practice.

But charities say that without a central government co-ordinator, crucial efforts to raise awareness among professionals on a local level, where the issue is often still not understood, could be seriously hampered. Some girls are "cut" in the UK, while others may be taken abroad in the summer holidays.

"This is a real step backwards," said Diana Nammi, director of the Iranian and Kurdish Women's Rights Organisation. "We feel it speaks about a real lack of commitment from the government and a marginalisation of this hugely important issue The new guidelines were an important step forward but efforts are now needed to ensure that they are actually read and acted on, and the government should also be working to change attitudes towards FGM within communities.

"Without a dedicated person in government to drive efforts forward, it's hard to see how this will happen. The coordinator was a link between all the organisations working in this area and now that's been lost."

She added: "We were hoping to see another post created to tackle honour killings, so we were shocked to see the one for FGM being taken away instead.

"This is only one person's salary. It's not a lot amount of money for the government but it has a huge effect within the community."

The Home Office would not comment on the funding for the role, held by Alan Webster. Responsibility for work on FGM will now be shared between officials in the Home Office, Department of Health, Foreign Office and Department for Education as part of their other duties.

Naana Otoo-Oyortey, the executive director of campaigning group Forward, said: "The government has failed to commit in terms of targets, financial resources and a strong strategic direction on FGM.

"This is made worse by their failure to ensure effective coordination of the only government action on FGM, which is the implementation of the multi-agency guidelines on FGM."

When the guidelines were launched, Lynne Featherstone, the Liberal Democrat minister for equalities, said: "I have seen first hand the effect this abhorrent crime can have on women and girls. This government is determined to put an end to it."

She wrote on her blog: "One of the challenges we face in putting an end to this practice is the lack of knowledge about how to recognise the signs and what to do when you do recognise the signs."

A Home Office spokesman said: "The work of the FGM coordinator will not end. Rather, it will continue to be carried forward by individual departments where we believe it will be better integrated.

"Female genital mutilation is a brutal act of child abuse, a clear form of violence against women and we remain absolutely committed to eradicating this practice.

"As part of our cross-government programme to prevent and tackle FGM, we have established a forum to support community engagement work to challenge FGM and published new guidelines to raise awareness of this issue with all professionals."

Swazi Observer
March 28, 2011
[The Swazi Observer has published many stories uncritically promoting circumcision. Though it includes a comments box, it never publishes comments.]

Women want to be circumcised

By Faith Vilakati

SOME women from Mankayane... want to be circumcised.

The women are also worried if their husbands’ performance in bed would be the same as it was before circumcision.

They enquired from a men team that visited the area to educate the community members about the importance and benefits of being circumcised.

...

It was while the team was explaining to the meeting about circumcision that Make Motsa asked if women could be circumcised.

“Since you started talking to us, you are busy referring to men, what about us? Can we also be circumcised to minimise the sexual transmitted infections (STI) as it is the case with men or not? I would like to know where we stand because you might find that a number of us would be interested in being circumcised,” she said.

The team explained to the gathering that it was impossible for women to be circumcised in the country since the ministry of health was against it.

It was explained that in women’s case, if circumcised, they might end up not enjoying sex because the most important part in their sexual organs had to be removed. [This is incorrect.]

The women were further told that circumcision would not affect men’s sexual activeness and performance but it would reduce the risks of one getting HIV/AIDS.

...

Man wants to take foreskin with him

A community member wanted to know if after circumcision he would be allowed to take the foreskin with him.

The team that lectured residents on circumcision explained to him that even though they could allow him to walk home with his foreskin government had a law which empowered hospitals to destroy the foreskin.

“It is safer and better to allow us to keep the foreskin because we have ways of disposing them,” he said. [What exactly is the danger?]

Solomon Jele, an elderly man of the same area, told the team that he did not believe that circumcision was of any assistance, stressing that STIs had been there and were known as licondvo. He stressed that so long as the youth, mainly who were married, did not respect each other they would have STIs.

He said circumcision would not work at all if women and men did not respect one another, adding that the people who were teaching about it were wasting their time and money.

“The young people must know that it is not proper to have sex with your wife when she is on her periods and when she has just given birth. Nowadays they do exactly this and when you tell them they say you are old fashioned. Tell these people to stop what they are doing or they would lose their foreskin,” he said. [Myth piled on myth.]

Birmingham Mail
March 25, 2011

Ban extended for doc who botched circumcision on Birmingham child

By Alison Dayani

A SURGEON who botched the circumcision of a five-year-old Birmingham boy and put his life at risk has been banned from working for a further year.

Dr Shaafii Adan Dirir overdosed the youngster on local anaesthetic and left him fighting for his life.

The General Medical Council (GMC) suspended Dirir for 12 months a year ago.

But a review of his conditions last month ruled there was no evidence of improvement. Dirir did not attend the hearing.

And the GMC panel heard that he has not responded to repeated attempts by the regulatory body to contact him by letter and email.

A GMC panel extended his ban after hearing that Dirir carried out the surgery at the boy’s home in Birmingham in August 2007.

But he failed to weigh the child and instead guessed an incorrect weight. This led to the child having a fit and respiratory failure due to an excessive dose of drug Lignocaine.

The boy had to be resuscitated but survived.

“That Panel identified four areas of concern,” said a GMC spokesman.

“Dirir’s actions put the patient’s life in very serious danger, he made no record of the procedure, he showed no evidence of insight or understanding of the significance of his omissions and he had not engaged with his regulatory body, further evidencing his lack of insight.

“The doctor has not been taking any steps in the last year to engage with the GMC process or provide evidence he has remedied his deficiencies. The Panel determined his fitness to practise is still impaired.”

AllAfrica.com
23 March, 2011

Kenya: Male Circumcision - Is the Government on Right Track?

By John Chigiti

The government has recently been in the news for promoting the policy of male circumcision to combat the spread of HIV/Aids. While this move is commendable in that it seeks to reduce the spread of a disease which has taken the lives of many Kenyans and left even more infected and affected, it raises some serious legal, constitutional and ethical issues that need to be resolved. It is not clear how the government intends to ensure the success of this policy. However, if not implemented in a socially-cum-human rights based manner, it is sure to touch a raw nerve with many people.

The first thing that needs to be considered is the constitutional effect of the policy. Article 2 of the Constitution of Kenya declares it as the supreme law of the Republic and binding on all state organs at both levels of government. Article 19(1) further states that the Bill of Rights is an integral part of Kenya's democratic state and is the framework for social, economic and cultural policies. This means that the state is bound by the Bill of Rights in the policies that it makes. One might be tempted to ask, are there any constitutional rights that might be affected, taken away or violated by the government policy of promotion of male circumcision?

Article 28 of the Constitution states that every person has the right to inherent dignity and to have that dignity respected and protected. Does the state intend to compel all men to be circumcised and if so, doesn't this violate the right to inherent dignity as set out in the above article? Should circumcision be a personal decision? How will we balance between the reproductive health rights, the right to life as read along the right to health so as to get the best of this policy?

Article 29 (f) states that every person has the right not to be treated in a cruel, inhuman or degrading manner. By compelling men to be circumcised, if in fact that is what it intends to do, wont the government be violating the Bill of Rights?

Finally, Article 43 (1) (a) provides for the right to the highest attainable standard of health. Male circumcision has been scientifically proven to greatly reduce the chances of a man getting infected with HIV/Aids. By developing a policy to encourage male circumcision, is the government performing its duty of ensuring the highest standard of health by reducing the chances of HIV/ AIDS infection?

The second thing that needs to be considered is the custom and practices of the various Kenyan communities that do not practise male circumcision. If at all the policy is to yield fruit, then the implementers of the policy need to fully understand why some communities did not practise male circumcision. This can then be used in trying to build up a case for why the members of that community should adopt the practice of male circumcision. If there is no research to find out why there is no male circumcision in the community, then this initiative is likely to come up against a stone wall.

Article 44 (3) states that a person shall not be compelled by another person to perform, observe or undergo any cultural practice or rite. Is circumcision being presented as a cultural rite or as a health issue? If it is being presented as a cultural rite, then the government is not only violating the Bill of Rights but also bound to fail in its mission. The State might have a good case if the issue is attended to from a health perspective.

Another issue that needs to be considered is the opinion of the sexual partners of the uncircumcised men. We need to consider what the spouses want and what is in their best interests. We need to consider whether they prefer to have their men circumcised or uncircumcised. [Is that for "us" to consider, or is it between the couple concerned?] If it is the latter, then do they have attendant rights especially if they are a married couple? In a marriage, the parties are recognised as having conjugal rights. Does this mean that they have a related right to obtain pleasure from their conjugal union?

We need to consider the two competing rights of a sexual partner's wants versus her interests. Should she be allowed to have a say in the matter? Should she be allowed to put her health at risk for the 'right' to pleasure? [That assumes that sex with a faithful intact man puts her health at risk, but it's progress that the pleasure of intactness is a given.]

While this might seem to be a straightforward matter of the government protecting the life and health of its citizens, clearly there are more factors at play here. The government therefore needs to think soberly about this policy especially during this nascent stage of constitutional implementation when we are laying the foundation for a new order of business.

That having been said, we cannot bury our heads in the sand. A healthy nation is a wealthy nation. We have to fight HIV/Aids from all angles.

March 7, 2011

8 years on - No word on fatal circumcision

By NTANDO MAKHUBU

The unsolved deaths of their sons almost eight years ago has left parents haunted by questions about what it was that went so horribly wrong in Ward 48 in Vergenoeg, Atteridgeville, when the boys disappeared into the nearby mountains and died at an illegal initiation school.

... the police had not come forward with answers, nor had anyone been brought to book.

“What we fail to understand is what they have been doing all this time,” community member Stella Tshiezela said.

She and other residents said the police had been given leads and knew who the owners of the school were. “But they were never asked to account for the deaths,” they said.

...

Makubo did not come back from school on a Friday in June 2003, and barely a week later the family were told he had died.

...

“The following morning we got a message that he was in initiation school, a tradition my family did not subscribe to,” Makhanya said.

...

The absence of information, the silence of the police and the refusal by the state to release the boy’s post-mortem results have held the family back.

Rose Skosana, whose son Derrick, 13, suffered the same fate, said: “All we are left with are nightmares of our frightened children, dragged to the mountain and butchered by unscrupulous adults, who have been allowed to live freely among us.”

Derrick son [sic] was grabbed off the street while playing soccer on May 31. Three days later they were told he was on the mountain.

“Just as we were struggling to come to terms with that the police arrived to tell us that he had died,” the grieving mother said.

Describing the sight that met the family at the state morgue, Skosana said her son’s face was contorted in a grimace of pain, his eyes and mouth were open, and vomit covered his face and head.

“When his father inspected the circumcision wound he found that more than just his foreskin had been removed, the scar ran all the way down to his naval.”

...

The community and families said they had waited all these years for the case to reach court.

They had been told it would go to the Pretoria High Court, but in January they found that all investigations had been dropped.

“They said key information had been taken from the docket, and they could do nothing more,” community member Dan Tisane said.

...

Arkansas Online
March 7, 2011

L[ittle ]R[ock] hospital botched surgery, suit says

Filing alleges Children's surgeon mutilated infant during '09 circumcision

By John Lynch

An Arkansas Children’s Hospital surgeon mutilated their infant son in a botched circumcision, a Jonesboro couple says in a malpractice lawsuit against the hospital, doctor and nurses, claiming the error left the boy — described as a “cripple” — with a disfigured “fragment.”

Swazi Observer
March 3, 2011

24 000 men circumcised

THE ministry of health has reported that so far 24 000 males have been circumcised and they are targetting 152 000 by September this year.

The report states that by 2014 the male circumcision department must have circumcised 80% of males of 15 to 49 years. [What choice will the men have?]

“Male circumcision is a new strategy under HIV prevention which has been approved by Swaziland government to be part of the comprehensive HIV prevention programme. The male circumcision package includes condom promotion HIV testing and counselling and male circumcision and risk reduction counselling,” states the report.

[In Swaziland 21.8% of circumcised men have HIV, compared to "only" 19.5% of intact men, according to the National Health and Demographic Surveys. Women with HIV account for the much higher overall figure.]

[The Swaziland Observer has printed many uncritical stories about circumcision. It includes a comment panel but never publishes comments.]

February 28, 2011

CROI: HIV Protection Lasts After Circumcision

By Michael Smith, North American Correspondent, MedPage Today

BOSTON -- The benefit of male circumcision for HIV prevention persists, even long after the procedure, a researcher reported here.

The finding comes from surveillance after the end of one of the major trials - in the Ugandan district of Rakai - that first established the benefit of the procedure, according to Xiangrong Kong, PhD, of Johns Hopkins University.

Moreover, the procedure did not induce men who were circumcised to change their sexual behavior in risky ways, Kong reported at the annual Conference on Retroviruses and Opportunistic Infections.

The post-trial period - now almost five years - "approximates" normal life and allowed researchers to see how circumcision affects both the risk of HIV and human behavior, Kong told reporters.

After the end of the trial, she said, the researchers offered men in the control arm the chance to be circumcised, and 80.4% accepted.

At the end of last year, she reported, HIV incidence was 73% lower among the original trial participants who were circumcised and those who got circumcised later, compared with those in the control arm who did not accept circumcision.

"I'm not exactly surprised," commented Kevin De Cock, MD, of the CDC, mainly because the original trials were based on observations that HIV incidence was lower among circumcised men with little or no difference in behavior. [No, they were based on cherry-picked comparisons of HIV rates between countries with different circumcision rates - not man-against-man comparisons at all.]

In a sense, he told MedPage Today, researchers knew the results of implementation of the procedure before they actually did the randomized trials. [Or rather, they knew what they wanted to find, and they found it.]

Source reference: Kong X, et al "Longer-term effects of male circumcision on HIV incidence and risk behaviors during post-trial surveillance in Rakai, Uganda" CROI 2011; Abstract 2011.

Science News
February 28, 2011

Half of adult males carry HPV

Human papillomavirus lingers for months in men, study shows

By Nathan Seppa

The virus notorious for causing cervical cancer in women also turns up frequently in men and can hang on unnoticed for months or even years, researchers report online March 1 in Lancet. The study solidifies earlier research indicating that human papillomavirus is highly prevalent in men and strengthens the case for vaccinating men and boys against it, the report’s authors say.

There are dozens of types of HPV, including more than 40 that can be transmitted sexually. Some can cause cancer.

...

Starting in 2005, epidemiologist Anna Giuliano of the H. Lee Moffitt Cancer Center & Research Institute in Tampa, Fla., and an international team of researchers recruited more than 4,000 men living in Brazil, Mexico and Florida into a study of HPV. The new study reports on the first 1,159 of these volunteers. Their average age was 32 and none had been vaccinated against HPV. Swabs of the penis and genital area of each man revealed that 50 percent were infected with at least one HPV type upon enrollment.

The researchers repeated these exams every six months, and the men completed personal-history questionnaires. Over a median of 28 months, the group acquired 1,572 new HPV infections.

The human immune system can clear HPV out of the body, and the men wiped out most of their new infections during the study period. But it took a median 7.5 months. Median clearance times didn’t vary substantially among the countries, but did vary between HPV types. Some cases lingered as long as 24 months in the men.

HPV 16 is the type responsible for the most cervical cancers in women and is covered by both vaccines. It took a median of 12 months to clear. “It’s hanging around longer, and it’s completely asymptomatic,” Giuliano says. “You don’t even know you have it.” This silent infection means a person can transmit this HPV type for longer periods and “might help explain why HPV 16 is one of the most common types in both men and women,” she says.

The data also reveal that men who reported having 10 or more sexual partners in their lifetimes had roughly twice as many HPV infections as did men who had had one partner.

...

Male circumcision and the use of condoms have shown little protection against HPV infection, Monsonego says. “HPV vaccination in men will protect not only them but will also have implications for their sexual partners,” he says.

Giuliano says she expects to have data on the full group in three years.

A.R. Giuliano et al. efficacy of quadrivalent HPV vaccination against HPV infection and disease in males. New England Journal of Medicine, Vol. 364, Feb. 3, 2011, p. 401.

http://onlinelibrary.wiley.com/doi/10.1002/ijc.24097/full

United Nations Mission in Sudan (UNMIS)
February 24, 2011

Sudan: Feature Stories: Salima - Born whole and healthy

By

Source: Date: 24 Feb 2011

In a society where the gross majority of women are forced to undergo female genital mutilation (FGM) during childhood, being uncircumcised often results in ostracism.

Aiming to counter stigmatization by creating a positive term to replace one sounding like a curse, the Salima campaign was initiated in Sudan by the National Council for Child Welfare (NCCW) with UNICEF support.

...

Salima means whole, healthy and intact, said Amira Azhari, coordinator of the national program for the abolition of female genital mutilation/cutting (FGM/C) at NCCW in Khartoum.

...

Calling someone "ya wad el ghalfa" or "you son of an uncut woman" is a harsh insult in Sudan, where according to the 2006 Sudan Household Health Survey, 69.4 per cent of the country's female population, or almost seven women out of 10, are subjected to FGM.

...

One reason why the practice continues is a traditional conviction that a circumcised woman will remain a virgin and after marriage be faithful to her husband. Basically, it is control over a woman's sexual desire, noted Ms. Azhari.

She mentioned other reasons, including unfounded beliefs that FGM results in cleanliness and good health, and that the practice is required by Islam.

Some religious leaders, however, argue that no proof can be found for this requirement in the Quran or in hadith, which are interpretations of the words and deeds of Prophet Mohammed.

"Female genital mutilation used to be practiced during pharaonic times more than 3,000 years ago," observed Ahlam Ali Hassan, professor of Islamic studies at Omdurman Islamic University, adding that FGM stemmed from long before the spread of Islam.

Awareness raising was key in abolishing genital mutilation, Ms. Hassan remarked, adding that imams and religious leaders carried a great role in informing people about its harmful health and social effects.

...

Many of them, however, uphold the custom for financial reasons, as FGM practitioners generally make at least 100 Sudanese pounds ($39) plus in-kind gifts for each circumcision. ...

The child welfare council began on an ambitious path in 2008 by drafting a national strategy to combat FGM. The strategy, building on six modules – including health, media, law and religion – aims to eradicate the practice in Sudan over the next 10 years or the course of a generation.

However, most Sudanese women still view the issue as private and tend to remain silent.

...

AFP
February 24, 2011

Swaziland looks to cut HIV with circumcision drive

By Jinty Jackson

MATSHAPA, Swaziland — "Just relax, it won't be very painful," are the last words Maqhawe Tsela hears before the nurse plunges a large needle into the base of his penis.

As the anaesthetic takes effect and the doctor readies his scalpel, 33-year-old Tsela prepares to join the ranks of a new generation of circumcised men in Swaziland, where the government has launched a mass circumcision drive to combat the world's highest HIV infection rate.

...

Time is of the essence: one in four adults is HIV positive and two percent of the country's 1.2 million people die every year of the disease.

[In Swaziland 21.8% of circumcised men have HIV, compared to "only" 19.5% of intact men, according to the National Health and Demographic Surveys. Women with HIV account for the much higher overall figure.]

...

One man boasts that he got circumcised because it is "nice to have sex without condoms" -- drawing a furious reaction from the recruiters.

"That is NOT what he was told at the clinic!" exclaims Mbogniseni Ndzimandze, the leader of the recruitment team.

[So? That is what he took away.]

...

the Seattle Times
February 19, 2011

Does Gates funding of media taint objectivity?

By Sandi Doughton and Kristi Heim

Better-known for its battles against global disease, the Gates Foundation has also become a force in journalism. The foundation's contributions to nonprofit and for-profit media have helped spur coverage of global health, development and education issues. But some people worry that its growing support of media organizations blurs the line between journalism and advocacy.

Did you catch ABC's recent special on an incubator to boost preemie survival in Africa and a new machine to diagnose tuberculosis in the developing world?

Perhaps you saw Ray Suarez's three-part series on poverty and AIDS in Mozambique on the PBS NewsHour. Or listened to Public Radio International's piece on the rationing of kidney dialysis in South Africa.

[Or perhaps you read one of the many, many stories touting circumcision as an important new mode of HIV prevention....]

Beyond their subject matter, these reports have something else in common: They were all bankrolled by the Bill & Melinda Gates Foundation.

Better-known for its battles against global disease, the giant philanthropy has also become a force in journalism.

The foundation's grants to media organizations such as ABC and The Guardian, one of Britain's leading newspapers, raise obvious conflict-of-interest questions: How can reporting be unbiased when a major player holds the purse strings?

But direct funding of media organizations is only one way the world's most powerful foundation influences what the public reads, hears and watches.

To garner attention for the issues it cares about, the foundation has invested millions in training programs for journalists. It funds research on the most effective ways to craft media messages. Gates-backed think tanks turn out media fact sheets and newspaper opinion pieces. Magazines and scientific journals get Gates money to publish research and articles. Experts coached in Gates-funded programs write columns that appear in media outlets from The New York Times to The Huffington Post, while digital portals blur the line between journalism and spin.

The efforts are part of what the foundation calls "advocacy and policy." Over the past decade, Gates has devoted $1 billion to these programs, which now account for about a tenth of the giant philanthropy's $3 billion-a-year spending. The Gates Foundation spends more on policy and advocacy than most big foundations — including Rockefeller and MacArthur — spend in total.

Much of the money goes to analyses of policy questions, such as the best way to finance vaccines for poor countries. But the "advocacy" side of the equation is essentially public relations: an attempt to influence decision-makers and sway public opinion. The ultimate goal is to boost funding and focus from governments, businesses and other foundations for the battle against disease and poverty — particularly now, as Congress considers deep cuts in foreign aid.

...

While the aims may be laudable, the ability of one wealthy foundation to shape public discourse is troubling to some.

"Even if we were to satisfy ourselves that the Gates Foundation were utterly benign, it would still be worrisome that they wield such enormous propaganda power," said Mark Crispin Miller, professor of media, culture and communications at New York University.

Some of the foundation's approaches are controversial, such as its embrace of genetically modified crops and emphasis on technological fixes for health problems. Critics fear foundation funding of media will muffle those debates. And with only three trustees setting the overall strategy — Bill and Melinda Gates and fellow billionaire Warren Buffett — there's something "deeply anti-democratic" about such a concentration of influence, Miller said.

...

"It would be naive to believe big-money foundations don't play the same game that corporations and other special interests do," said Marc Cooper, assistant professor at the University of Southern California's Annenberg School for Communication & Journalism. "I don't find that inherently troubling."

...

A blurry line
A larger question is whether Gates funding steers media coverage in directions that serve specific foundation goals, both humanitarian and political, diverting attention from other issues.

Some grants have indeed spelled out coverage topics, including male circumcision to reduce transmission of AIDS, and clinical trials — the latter of which are crucial for Gates-supported vaccines and drugs being tested in the developing world.

...

These are just a smattering of the hundreds of policy and advocacy grants the foundation has issued. Gates isn't the sole funder for most of the groups, nor does Gates money mean grantees march to the same beat. But with virtually every major player in global health — and many in education — receiving Gates money, it's clear the foundation's voice is highly amplified in the media and beyond.

"It's an echo chamber," Cooper said.

...

British Medical Journal
February 19, 2011

Circumcision in boys and girls: why the double standard?

Personal View
by Mihail Evans

New legislation in France has led to more debate on whether wearing the veil amounts to the sexual repression of Muslim women. Islam's treatment of women is a regular topic in the Western press, yet few jump to the defence of Muslim and other little boys subjected to childhood circumcision. Indeed, the circumcision of the grandson of President Sarkozy, ironically a proponent of the veil ban, made only the gossip pages in France. As a permanent surgical genital alteration, circumcision is arguably a much more serious matter. After all, a Muslim woman has, at least in theory, the option to throw away her veil. The circumcised man's foreskin has been thrown away already.

Few countries have banned male circumcision, but even symbolic alternatives to female genital mutilation are banned in almost all Western jurisdictions. While I was a student, a female academic at my institution published a piece supportive of male circumcision. This prompted a thought experiment: suppose we found a male academic supportive of the surgical modification of female genitals. Would his views be accepted? Why can a Jewish woman speak openly to defend male circumcision and a Somali man not defend female circumcision?

Physiological research has undermined beliefs that the foreskin is "just a flap of skin" and shown it to be an integral part of the penis. With the foreskin considered an erogenous, multifunctional tissue, the established view of circumcision as a non-damaging excision is fatally undermined. It would be more appropriate to change our terminology, to speak of male genital mutilation rather than circumcision in the same way that we use female genital mutilation and not cliteradectomy.

Finland is among the few places where male circumcision is illegal, although recent judicial decisions have backtracked on this law, making exceptions for some religious circumcisions. Bulgaria banned male circumcision in the 1980s, but more as part of a cultural war on its Muslim minority than out of any overtly humanitarian concern. My partner is Bulgarian, and it amazes me that under law in the United Kingdom I could legally take my son there and subject him to the sort of horrific circumcision recorded by a Bulgarian current affairs programme (www.vbox7.com/play:72a1576e), yet my Somali neighbours would be prosecuted for attempting to appease traditional opinion by replacing female circumcision with a symbolic pinprick to the clitoral hood.

We rarely glimpse more than the very tip of the iceberg of the sexual and psychological damage caused by male circumcision. One symptom is the considerable number of men interested in foreskin restoration. That any man would be prepared to spend several hours a day for several years using taped, weighted, and tensioned devices to try to regrow a foreskin is testimony to the suffering caused in some cases. In browsing online forums such as www. restoringforeskin.org, you get a sense of the great missing continent of male conversations that are unspeakable in public: the Iranian brought up in the West who always feels something is missing when he sleeps with a woman, or the gay US man depressed that he does not have the penis he was born with, like his European lover. Male circumcision in developed countries is treated simply as a question of opinion. Most women in the UK do not circumcise their sons, but if a mother says she has had her son circumcised "to be like daddy" or for "tradition," hardly an eyelid is batted.

I was shocked by some comments from mothers, which seemed more callous than would be tolerated if gender roles were reversed. In one a mother wrote "LOL" ("laugh out loud") after telling the forum that her circumcised 4 year old "wants his old penis back." In another, a mother from South Africa says she has kept the dried foreskin "in case he wants it back later." Elsewhere on the web, it is completely acceptable to express a preference for a "cleaner" circumcised penis on women's sites. I cannot imagine that a man who advocated ways of making the vagina more "attractive" and "hygienic," let alone by surgical means, would be given a moment's hearing.

Legislation to outlaw male circumcision was put forward in Massachusetts, and although it was defeated campaigns continue in other states (see www.mgmbill.org). Dutch doctors also discussed a ban last year (BMJ 2010;340:c2987). A better way to protect the genitals of young boys might simply be to use existing laws. The Tasmanian Law Reform Institute has suggested that male circumcision may breach existing child protection laws (http://bit.ly/eLfxId). And the media have hinted at the possibility of a test case in the UK (http:// bit.ly/4GviWc). Finally, little boys in the West might be given the same rights as their sisters, but resistance is peculiarly high and comes from the most surprising quarters.

Mihail Evans is former postdoctoral researcher in ethics, University of the West of England mihail@riseup.net Cite this as: BMJ 2011;342:d978

Rapid responses

Jesus and Mo
February 18, 2011

PlusNews
February 15, 2011

RWANDA: Bloodless male circumcision to boost HIV prevention

NAIROBI, 15 February 2011 (PlusNews) - The Rwandan government plans to expand its national voluntary male circumcision programme using a new device, the PrePex system, which officials say saves both time and money.

The PrePex system works through a special elastic mechanism that fits closely around an inner ring, trapping the foreskin, which dries up and is removed after a week. [Just like an Elastrator.] A study conducted by the Rwandan Ministries of Defence and Health in 2010 found the device to be safe and effective.

"You don't need a sterile environment, you don't need anaesthetic, you don't need to use an operating theatre," Agnes Binagwaho, permanent secretary in Rwanda's Ministry of Health, told IRIN/PlusNews. "It does not need highly trained medical personnel, and can be conducted in a clean consultation room with a bed.

"In Africa, where we lack medical infrastructure, we feel it is the best way to go," she added.

Although cost-effectiveness studies are still under way, Binagwaho said the elimination of factors such as anaesthetic and highly trained staff as well as the gains made by the shorter healing time meant it was likely that the PrePex system would be cheaper than traditional clinical male circumcision.

"Three or four hours after circumcision, a man can be back at work," she said. "This means that the economy does not suffer because men have taken several days off work to heal."

She noted that while the UN World Health Organization (WHO) had not approved any device for adult male circumcision, the PrePex system is approved by the European Union.

"We are still waiting to see the data showing the efficacy, safety and acceptability of the device," Tim Farley, a scientist with the WHO’s Department of Reproductive Health and Research, told IRIN/PlusNews. "If the promise of the device is borne out by the data, we would be very keen to approve it."

Rwanda's HIV prevention strategy includes a plan to circumcise an estimated two million adult men within two years; only 15 percent of Rwandan men are circumcised, according to the government. [HIV prevalence in Rwanda in 2005: non-circumcised men 2.1%, circumcised men 3.8%]

...

According to WHO's Farley, the body has approved the use of three different devices - the Mogen clamp [No longer made because of $18.3 million dollars damages for glans injuries], the Gomco clamp and the Plastibell - but only for infant circumcision.

February 10, 2011

Rwanda to Sterilize 700,000 Men, PRI Pledges to 'Work Tirelessly' Against It

FRONT ROYAL, Va., Feb. 10, 2011 /Christian Newswire/ -- Steven W. Mosher, president of the Population Research Institute (PRI), expressed outrage today at a clear instance of U.S. tax dollars being used to aid a coercive campaign to sterilize 700,000 Rwandan men in 3 years. The program is being carried out under the active influence of at least two USAID-funded special interest groups: Intrahealth and Family Health International. Mosher vowed that PRI would "do everything in its power" to expose and halt the use of U.S. taxpayer funds on this campaign against the Rwandan people.

According to the BBC and Rwandan news outlets, the Rwandan government is introducing this campaign on the heels of a large-scale effort to circumcise men (a procedure which allegedly "protects against" HIV/AIDS infection). However, as the New Times reports, the real reason circumcision was included was simply because "it allows us get to the men's reproductive system and in the process we advise them on condom use and vasectomy."

Not only this, but back in 2008, health officials informed the BBC that these "circumcision campaigns" would be practiced first on "the new born and young men in universities, the army and police." This is because, while many Rwandans balk at the idea of being sterilized, "correspondents say many in the armed forces will regard it as an order" even though it will be "nominally voluntary."

"This amounts to coercion," says Steven Mosher. "First of all, saying that circumcision 'protects against AIDS' is an abuse of semantics, as circumcision doesn't provide a barrier against anything. Secondly, if it will be regarded as an order, it doesn't matter if it actually is one or not. The men will be circumcised/sterilized because they feel that they must, or risk punitive measures."

...

Radio Netherlands
February 6, 2011

Reversing female circumcision remains taboo

By Karima Idrissi and Willemien Groot

Isaad Mohammadani (28) is an active and intelligent young woman from Darfur who came to the Netherlands in the summer of 2009. She is married to the love of her life and they have a three-year old daughter. Isaad was circumcised as a girl and is considering an operation to have the process reversed.

...

Isaad lost her first baby during childbirth because she did not receive the special help she needed.

Complete
She speaks candidly about her physical mutilation and its effects on her sex life. “I’m often reluctant to have sex,” she confides. “Sometimes I manage to reach a climax, but only because my husband helps me. We try hard to create the right mood.”

But she is not content with only having occasional orgasms. “I would like to feel complete, both physically and emotionally. I want to overcome my inferiority complex.” She is considering having an operation to reverse her circumcision.

...

Tough call
Deciding whether or not to have the operation is a tough call for Isaad. Despite the problems she encounters due to her mutilation, reconstruction is still very much taboo, even among well-educated women from Darfur. She cannot even contemplate getting any support from her family in Sudan. “They would never approve. I wouldn’t even tell them.”

...

“I’m afraid to lose what it’s taken me so much trouble to achieve, especially in my sex life. A doctor in Belgium is already performing these operations, but they’re not always a success. It’s a 50-50 chance. What if the operation goes wrong, or if I end up not feeling anything anymore?”

Rudaw (The Happening, Kurdistan)
February 5, 2011

Female Circumcision is Prohibited Says Islamic Law Professor

By Soran Bahadin

ERBIL, Iraqi Kurdistan: Dr. Mustafa Zalmi, a leading Kurdish Shariah law expert, has said female circumcision, known internationally by women’s advocates as female genital mutilation (FGM), is forbidden and that he is willing to face anybody who disagrees.

...

Zalmi, who gained his doctorate in religious studies from Cairo’s prestigious Azhar University, has recently published a book on FGM and has condemned the practice.

“According to 11 verses of the Quran, female circumcision is forbidden. FGM is not practiced in Mecca or Medina, and the Kurds have taken Islam from [the culture of] these places, so why do we have FGM in Kurdistan?” said Zalmi.

...

Mullah Ahmed Shafi’i, a member of the Kurdistan Regional Government’s Fatwa Committee, supports Zalmi’s views on female circumcision.

“So far there have been a lot of different opinions on FGM from doctors, and if these views are in agreement and scientifically prove that FGM is bad for a person’s health, we will announce a fatwa against this practice,” said Shafi’i.

Furthermore, the head of the Kurdistan Doctors’ Syndicate, Dr. Hadi Naqishbandi, said the next meeting of the syndicate would discuss the practice of FGM in Kurdistan.

...

Guardian
February 6, 2011

Africa shows signs of winning war against female genital mutilation

By Tracy McVeigh

African women, including Senegalese hip-hop star Sister Fa, are leading a successful campaign against the widespread practice of female circumcision

In Africa, if you play music in an open space, any music, then people will generally come. "It is the way to reach people, to bring them together." So says Sister Fa, a Senegalese urban soul and hip-hop star who has been lending her voice to a remarkable new drive against female circumcision in 12 of the countries worst affected by the practice across the continent.

The first report into a United Nations project that began in 2008 has shown remarkable success rates with more than 6,000 villages and communities in six countries already abandoning the practice of female genital mutilation (FGM) – also known as cutting or female circumcision – with the numbers growing every month.

The change is down to a unique approach with a proper understanding of local culture, says Sister Fa, who has seen her own home town of Thionck Essyl, where she herself was "cut", abandon it altogether. ...

"We're using music because the young people are the future. They need to understand that they are not alone," Sister Fa told the Observer from Dakar, where she is on a tour called "Education Against Mutilation". Other cultural ambassadors are performing similar journeys.

"It is when you are alone, when you think: 'How can I not cut my child? She will be marginalised, pushed in a corner'," Sister Fa continued. "When the cutting ceremony is organised for the village and one girl is not there, everyone will know that she is not there, the whole village knows she is not cut. Then that girl is treated like an animal, you can't get married, you can't cook or pass water to someone for them to drink.

"So usually the NGOs come in from outside, foreigners maybe, and they try to do a demonstration and say: 'We don't want you to do this', and the people think: 'Why should we stop? This is our culture, our tradition, who are you to come here once and try to put pressure on us? This is our life, go away.' But if you reach communities and keep coming back and keep coming back, then we are finding you can change things."

...

Diop said 12 years of mistakes by well-meaning NGOs had been closely examined and the lessons learned.

"We understand that what some charities were doing before was wrong," said Diop. "They were looking at the supply side and targeting those people who were doing the cutting, but taking them out of the system doesn't stop the demand, nor does outsiders going into a village and setting up a demonstration with an anatomical model of a woman's body that shocks everyone in the village, telling them their daughters will die and then you go away never to come back. It does not suffice.

In Ethiopia, the prevalence rate has fallen from 80% to 74%, in Kenya from 32% to 27% and in Egypt from 97% to 91%. ...

"We reach the young people," said Diop. "The women, but the men too. In their head we have to make them believe they can marry a girl who is not cut. Believe me, the FGM would stop tomorrow if the men wanted it to."

In Europe, too, lessons of the programme need to be learned, say activists. Sister Fa now lives in Berlin. "Cutting is still here, a lot of women are in prison, but cutting is still here, nothing is changing," she said. "There are a lot of laws to punish people, but it's prevention we need."

Today is International Day Against Female Genital Mutilation

AFP
February 4, 2011

Female circumcision migrating to West: IOM

GENEVA (AFP) – Female genital mutilation has established itself in Western countries in recent years because of growing migration flows, the head of an international migration agency said on Friday.

"With the growth in migration in recent years, the phenomenon has unfortunately reached Europe (and) the United States," said William Lacy Swing, head of the International Organisation for Migration (IOM).

In an event to mark the international day of "zero tolerance" to female genital mutilation, Swing highlighted European Parliament estimates of 500,000 circumcised women living in Europe.

The IOM estimates that 100-140 million women and girls have suffered from the traditional practice.

Most of the victims are in Africa, with a few cases in Indonesia and Malaysia, according to the Inter Parliamentary Union, an association of world parliaments. [Of a sample of 262 pregnant women in Malaysia, all had been "circumcised".]

Nonetheless, it is on the wane in "many African countries" including Burkina Faso, Ghana and Ethiopia, according to African anti-circumcision campaign group CIAF.

"It's torture. Knives are used to cut the most sensitive part of the body," said CIAF head Berhane Ras-Work.

Nineteen African and 12 European countries, as well Australia, Canada, New Zealand and the United States, have adopted laws outlawing female genital mutilation.

ezine news
January 22, 2011

Male Circumcision does not reduce risks of getting HIV or STIs – new study

Abstract

Using a population-based survey we examined the behaviors, beliefs, and HIV/HSV-2 serostatus of men and women in the traditionally non-circumcising community of Kisumu, Kenya prior to establishment of voluntary medical male circumcision services. A total of 749 men and 906 women participated. Circumcision status was not associated with HIV/HSV-2 infection nor increased high risk sexual behaviors. In males, preference for being or becoming circumcised was associated with inconsistent condom use and increased lifetime number of sexual partners. Preference for circumcision was increased with understanding that circumcised men are less likely to become infected with HIV.

Citation: Westercamp M, Bailey RC, Bukusi EA, Montandon M, Kwena Z, et al. (2010) Male Circumcision in the General Population of Kisumu, Kenya: Beliefs about Protection, Risk Behaviors, HIV, and STIs. PLoS ONE 5(12): e15552. doi:10.1371/journal.pone.0015552

...

Results

...

Seven hundred and fourteen (95%) men provided self reported circumcision status and 262 (37%) consented to confirmatory visual genital exam. By self-report, 535 (75%) men were uncircumcised and 179 (25%) circumcised. By clinical exam, 180 men (69%) were medically defined as uncircumcised, 73 (28%) circumcised, and 9 (3%) were considered ‘abnormally’ or partially circumcised. Twelve men (7%) who self-reported as circumcised were clinically defined as uncircumcised. Two men self-reporting as uncircumcised were clinically defined as circumcised.

...

...

Association with HIV/HSV-2 seroprevalence, genital ulceration, and sexual risk behaviors

In this study population, circumcision status was not associated with HIV or HSV-2 seroprevalence or current genital ulceration controlling for age, lifetime number of sex partners, marital status, and ethnicity (HIV: OR = 1.0; 95% CI 0.5–2.0; HSV-2: OR = 1.0; 95% CI 0.5–1.7; Genital ulceration: OR = 0.8, 95% CI 0.3–1.8).

...

Discussion

...

This study did not detect the expected association between male circumcision and HIV seropositivity, possible due to limitations in sample size and prevalence. [Or because circumcision does not protect against HIV...] With 38% of men and nearly 65% of women HSV-2 positive, however, our ability to detect any association between genital herpes and circumcision status or preference for circumcised partners was improved – no association was found. This supports the lack of impact on HSV-2 seroconversion with MC noted in the Kisumu trial [14], but is in contrast to the protective effect noted in the Rakai and Orange Farm trials [15].

Our study had a number of limitations. As with any survey, self report bias can be a significant limitation. Additionally, there is a possibility of misclassification of circumcision status; however, in this population self report had strong agreement with confirmatory clinical exam. Ultimately, our ability to contact just over 65% of eligible participants for enrollment is a limitation and could impact the validity of our findings. Strengths of this study include a randomly selected general population sample, the availability of HIV and HSV-2 test results linked to responses to a structured interview, and a relatively large sample size.

By sampling the population from which the randomized controlled trial of MC in Kenya was conducted, this study offers insight into the early impact of that study on the surrounding community. Considering the encouraging results of that trial, the two similar trials in South Africa and Uganda, the international health community’s subsequent endorsement of MC as an HIV prevention measure, and the Kenyan government’s national plan for community based VMMC promotion and provision, this work serves as a valuable baseline for subsequent assessments of changes in characteristics, perceptions, uptake, and impact of MC in Kisumu Kenya over the coming years.

News24.com
January 23, 2011

Dewani killers 'had a party'

By Raymond Joseph

Cape Town – The two men accused of killing Swedish honeymooning tourist Anni Dewani apparently almost didn't go through with their assassination plan as they didn't have transport to the crime scene in Guguletu. Xolile Mngeni, 23, and Mziwamadoda Qwabe, 28, were allegedly recruited by Zola Tongo to kill Anni Dewani.

...

A family member of Mngeni's said his cousin had an obsession with being the only man in his peer group who had not gone through ritual circumcision, the cultural practice that separated men from boys.

"He was desperate to get money to go to the bush," said Lennox Mngeni.

"This thing always bothered him. All his friends were circumcised so he felt inferior…he felt women didn't see him as a man."

...

The Record (North Jersey)
January 21, 2011

Is case child endangerment or religous practice?

By JOHN PETRICK

A state judge is scheduled to rule Friday whether child endagerment charges should be dropped against a mother who subjected her young daughter to rituals of the Palo Mayombe faith and whose lawyer argues her First Amendment freedom of religion protect her from prosecution.

Those rituals included having the girl witness a live chicken having its heart cut out and then making the girl eat the still-beating heart, according to attorneys in court.

Attorney Joseph Manzo of Rockaway argued last week before state Superior Court Judge Joseph A. Portelli in Paterson that other religious rituals -- like the Jewish bris circumcision ceremony -- might also be consdiered unsafe, bloody or gruesome yet are not subjected to prosecution.

Passaic County Chief Assistant Prosecutor Joseph Del Russo argued that ceremonies like a bris are not comparable to taking a screaming child and subjecting her to such a physical and unsanitary ordeal. He said the girl's mother's actions were emotionally and physcially dangerous to the child, which is a crime.

...

Shortly after the ritual, the girl told a teacher she was having nightmares and felt she could not talk to her mother, Del Russo said.

...

Dolls, a shrine, religious statues, bones, machetes and bundles of sticks with numbers and names on them were among artifacts found at the home. The items, some of which had blood and animal hair on them, matched a description the girl gave about what she saw at the home.

Colichon and the Canos each were indicted on charges of fourth-degree cruelty and neglect of a child. Colichon also was indicted on a second-degree endangerment charge, and the Canos, who are married, also were charged with third-degree endangerment.

On the endangerment charges, Colichon faces a maximum of 10 years in prison, and the Canos face a maximum of five years. All three face up to 18 months in prison on the cruelty and neglect charge.

Yahoo! News
January 18, 2011

Female Genital Mutilation Banned by Islamic Leaders in Mauritania

By Wendy Rose Gould

This week, 34 well-regarded Mauritanian religious and national leaders signed a fatwa, or Islamic law, banning female genital mutilation (FGM). The fatwa is considered a huge stride toward women's rights in the Islam world.

...

The law was passed on Jan. 15, 2011, by 34 Mauritanian religious and national figures. It prohibits the practice of FGM within the country.

According to Magharebia.com, "The authors cited the work of Islamic legal expert Ibn al-Hajj as support for their assertion that [s]uch practices were not present in the Maghreb countries over the past centuries."

This new law will certainly curb the practice of female genital mutilation in Mauratania. [Will it? We shall see.]

"It removes the religious mask such practices were hiding behind," says Dr. Sheikh Ould Zein Ould Imam, professor of jurisprudence at the University of Nouakchott in a Magharebia.com article. "We do need, however, a media campaign to highlight the fatwa, explain it and expound upon its religious and social significance."

Many men and women - both Islamic and not - declared this a victory for female rights, saying the fatwa was long overdue.

"Where were those imams for the past decades, when [FGM] killed dozens of girls each year? Were the imams and circumcision victims on two different planets? Personally speaking, I find no answer to those questions. All I am trying to say is that we needed that circumcision-prohibiting fatwa a long time ago. I was victimized by that brutal custom when I was seven, and it left an indelible psychological scar," said Miriam, a 30-year-old housewife circumcised as a young girl.

WHAS11.com
January 13, 2011

Doctor faces lawsuit for allegedly wrongfully amputating man’s penis

By Adam Walser

(WHAS11) – A local doctor faces a lawsuit and he is accused of wrongfully amputating a man's penis.

The case has been in the works for more than two years.

A man's penis was amputated during what was supposed to be a routine procedure here at Jewish Hospital in Oct. 2007.

Jewish Hospital and the anesthesiologist named in the lawsuit reached a confidential settlement last week.

The case against the doctor was supposed to go to trial Monday, but that's been delayed because of questions about whether both parties could have received a fair trial given all of the publicity about the case.

Hundreds of documents have already been filled with information about what a Shelby County man is calling a medical mistake.

Photos too graphic to show are also included in the files.

Phillip Seaton says he went to Jewish Hospital for what he thought was a routine circumcision operation on Oct. 19, 2007.

But when he awoke from the surgery, he discovered that the doctor had removed his entire penis.

The doctor who performed the surgery, Frankfort Urologist Dr. John Patterson says he removed Seaton’s penis because he discovered a cancerous growth on it.

He says he performed the procedure to keep it from spreading.

But the lawsuit alleges that the doctor was not given authorization to remove his penis.

And it indicates that performing the procedure deprived Seaton the opportunity to get a second opinion.

The cancer turned out to be a stage one cancer, considered by many medical experts to be treatable.

...

A new hearing to schedule a court date is scheduled for next Wednesday.

Earlier story

Australian Doctor (Registered medical practitioners and students only)
January 17, 2011

Circumcision row erupts

By Sarah Colyer

CALLS for more widespread circumcision of infant boys to prevent HIV transmission have prompted a barrage of angry letters in the latest issue of the Medical Journal of Australia.

The long-standing debate over circumcision was reignited by an article in the MJA last September, which claimed infant circumcision should be considered a 'surgical vaccine' against HIV.

The authors - Professor David Cooper, director of the National Centre in HIV Epidemiology and Clinical Research; Dr Alex Wodak from Sydney's St Vincent¹s Hospital; and Professor Brian Morris, a molecular biologist at the University of NSW - argued male circumcision was one of the most powerful interventions available in the fight against HIV.

But their views have been strongly criticised by letter-writers in the latest issue of the journal, which dedicates five pages to readers' responses.

Among the eight letters published, one warned that around nine newborn boys would die every year from complications if two-thirds were circumcised at birth.

Co-authored by Dr George Williams, former director of the newborn intensive care unit at Sydney Children's Hospital, the letter stated that circumcision constituted 'legal battery', as children were unable to give their consent.

Another letter argued that while the case for circumcision to prevent HIV was high in hyperendemic countries such as South Africa, it was not the same in Australia, where most HIV occurred among gay men.

Research among gay men had failed to show circumcision would protect against HIV, according to the letter's authors, from the Australian Research Centre in Sex, Health and Society at La Trobe University.

One letter-writer also claimed circumcision could impair both male and female sexual satisfaction.

In response to the outcry, Professor Cooper and his colleagues stood by their initial article, warning an HIV epidemic was likely in Australia unless male circumcision rates increased.

"Parents have a duty to help prevent renal damage, physical, inflammatory and hygiene problems, STIs and cancers in their sons and their sons' future sexual partners. They can do this by arranging for their sons to be circumcised," they wrote.

The Royal Australasian College of Physicians' current policy states there is no medical indication for routine neonatal circumcision.

Medical Journal of Australia 2011; 194:97-101

The letters themselves

Earlier story

The Standard (Kenya)
January 11, 2011

Circumcision driving boys out of class in Igembe

By HAROLD AYODO

Nairobi, Kenya
A study released recently shows that boys are dropping out primary school in droves after undergoing circumcision in Igembe district.

In the study titled Drop Out Among Male Pupils in Primary Schools of Igembe District, Kenya, scholars from Chuka University College reveal that the male child in the district is in danger of missing out on the gains of F[ree ]P[rimary ]E[ducation].

The researchers say the annual traditional circumcision/initiation ceremony is now fast overturning gender equivalence in favour of girls.

Normally, the population of boys is higher than their female counterparts in most counties countrywide over several factors. According to the study carried out on 6,455 Standard Eight pupils, boys were dropping out after turning rebellious after undergoing the cut.

Approximately 76.7 per cent of 153 [117] head teachers and 83.3 per cent of 153 [127] guidance and counseling masters said the cut was driving boys out of class.

Most of them either demanded a share of their parent’s property or turned into the lucrative miraa (Cartha endulis) [Catha edulis, khat/quat, a plant containing a euphroic and stimulant drug] business arguing they were adults. Majority of the male pupils dropped out in class five and six (37.2 per cent), Standard Three and Four (14.8 per cent) and class Seven and Eight (30.1 per cent).

Most of the pupils who drop out end up in employment either as house boys, herdsmen or adopt stealing for survival.

Scholars from Chuka University College who undertook the study now say with this reality, the male child faces a grim future.

... the ratio of boys to girls stood at 1:1 from pre-school to Standard Four.

Chuka University College (CUC) department of education chairman Dr George Muthaa and lecturers Dr David Bururia performed the study....

"Majority of the boys who dropped out after the cut claimed they were grown up and had the freedom to engage in their activities of choice," Muthaa says.

Traditionally, boys who undergo initiation are presumed to have crossed over to adulthood and could marry or inherit property of their parents.

The study entailed 6,762 respondents — 6,455 Standard Eight pupils, head teachers (153), guidance and counseling teachers (153) and a district education officer.

... the high drop-out of boys who embrace the miraa trade is fast affecting the enrolment of girls in school.

"Boys dropped out and making it in the miraa trade are using the proceeds to lure girls out of school leading to sex and early pregnancy," Mwenda says.

MGMBill.org
January 11, 2011

Intactivists Push for State, Federal Bans on Infant Circumcision

Proposed legislation from MGMbill.org would protect boys from genital cutting the same way that girls are protected.

SAN DIEGO, California – Intactivists from across the country are once again calling on state and federal lawmakers to prohibit circumcision of boys. Regional directors from the children’s rights group MGMbill.org submitted proposed bills to more than 2,800 legislators yesterday, urging them to extend the existing ban on forced female genital cutting to include males.

Matthew Hess, the group’s president, said circumcision is medically unnecessary and robs men of their right to an intact body. “Boys are born with a foreskin for a reason,” said Hess. “The foreskin functions like an eyelid, providing protection and keeping the penis moist and sensitive. It also contains thousands of nerve endings and acts as a natural lubricant during sexual activity. Boys deserve to be legally protected from forced circumcision the same way that girls are protected.”

Ron Low, director of MGMbill.org’s Illinois state office, ... said "... the specialized nerve endings removed from circumcision do not grow back, and it’s a crime that so many men must go their entire lives without ever experiencing sex the way nature intended.”

MGMbill.org’s Washington state office director believes that circumcision is a choice for each man to make on his own.

“I left my two sons intact because I felt it was the right thing to do,” said Jennifer Coulter, who lives near the westernmost part of the Puget Sound. “But deciding whether to circumcise a boy is a choice that no parent should ever have to make, because male and female children deserve the same right to genital integrity. We need to amend current laws that protect girls from genital cutting so that boys are protected, too. It’s only fair.”

Male circumcision has been under intense legal scrutiny over the past year. In March, the Massachusetts Joint Committee on the Judiciary debated MGMbill.org’s genital integrity bill for that state. The bill was defeated, but it marked the first time in U.S. history that a legislative body held a public hearing on a bill that would specifically outlaw forced circumcision of males. ... And in November, a group of intactivists garnered national attention when they began collecting signatures to put the San Francisco MGM Bill on the November 2011 ballot. The measure would prohibit circumcision of boys throughout the City and County of San Francisco.

In addition to every member of Congress, state legislators in Arkansas, California, Florida, Georgia, Illinois, Iowa, Maryland, Minnesota, New York, Oregon, Pennsylvania, South Carolina, Texas, and Washington all received the MGM Bill proposal yesterday.

Vancouver Sun
January 8, 2011

Nigerian family struggles to protect daughters from painful African tradition

Mother and girls are trying to become refugees in Canada to avoid genital mutilation

By Lori Culbert

A Metro Vancouver mother is waging a legal battle to keep her three daughters in Canada to protect them from the controversial tradition of female genital circumcision in their native Nigeria.

The family has lost one legal skirmish but won a second, and is now preparing for a hearing before the Immigration and Refugee Board (IRB) to find out if the mother and daughters -- now aged eight, 14 and 16 -- can remain in Canada.

Their incredible journey is spelled out in documents, at the Federal Court of Canada, that tell a tale as inspirational as it is heartbreaking.

Both Naomi Koin and her husband come from tribes in Nigeria that continue to circumcise young girls -- a practice that includes the partial or complete removal of external genitalia.

Koin became a Christian in 1986 and in 1993 married Rotimi, also a Christian.

( The Sun agreed not to publish Rotimi's last name to protect the privacy of his and Koin's daughters. The couple declined to be interviewed for this story, saying they did not want to speak publicly until the IRB has made its final ruling in this case.)

The couple are united in their opposition to female circumcision, which the United Nations has criticized "as a form of persecution."

But Rotimi's relatives remain committed to the practice, and, according to Koin, continued to "harass the family and threaten them" to try to get the three girls to undergo the procedure.

"As my daughters grew older, the efforts and desires of my late father-in-law to force them to be circumcised intensified. The in-laws would appear at my home, yell from the outside, calling me names and insulting me," she said in court documents.

Koin could not, she argued, just move from Lagos to another area in Nigeria to escape her in-laws because she had a public career: She hosted a weekly Christian talk show and children's program on TV, recorded religious music CDs, and was an actress in a soap opera.

Rotimi, now 50, had moved to the United States in 1999 -- where he is a pastor in Houston -- to try to establish a life that would allow him to get his wife and children out of Nigeria.

Koin tried three times to obtain visitor visas to join her husband in the U.S., but was turned down.

She received visitor visas for London, England, where she has relatives, and flew there in 2005 and 2006, but was told by a British lawyer the immigration process would take years and she would not be able to work during that time.

In July 2007, she was granted a visitor visa for Canada, and made plans to move here in September of that year.

That August, the family had its last confrontation with Rotimi's relatives, which occurred while Koin was at work and her three daughters were at home, momentarily left alone by their maternal uncle.

The eldest daughter relayed to the IRB what happened: "My Dad's relatives told me that my Mummy had given permission for me and my two sisters to go on holidays to their village; they wanted us to pack our bags and go spend some time with them. Because my Mum had given an instruction earlier never to leave the house without speaking to her, I went into the bedroom, called my Mum, told her everything, and she told me not to go anywhere."

When Koin arrived home, the daughter said she could hear her mother and her father's relatives "yelling at each other really loudly. I felt really scared."

Some of Koin's fierce opposition to this practice must surely come from her own horrific experience of being circumcised at 12, as part of a public ritual that included no anesthesia to dull the excruciating pain.

"I screamed and cried inconsolably until I had no more strength. I bled profusely and almost fainted. I was in shock and could not believe that my mother had allowed this to happen to me," Koin recalled.

...

Perhaps the most straightforward argument in this long legal drama, though, comes from Koin's 14-year-old daughter, who simply told the IRB:

"I understand that circumcision means that I would have to be cut in my private parts. I am really afraid of being circumcised in Nigeria and I do not want to do it."

Reuters
January 7, 2011

Circumcision helps stop wart virus, study finds

By Maggie Fox

WASHINGTON (Reuters) - Researchers have documented yet another health benefit for circumcision, which can protect men against the AIDS virus, saying it can protect their wives and girlfriends from a virus that causes cervical cancer.

["Yet another benefit" from the same small team that brought us all the other "benefits".]

Wives and girlfriends of circumcised men had a 28 percent lower rate of infection over two years with the human papilloma virus or HPV, which causes warts and cervical cancer, they reported in the Lancet medical journal on Thursday.

"Our findings indicate that male circumcision should now be accepted as an efficacious intervention for reducing the prevalence and incidence of HPV infections in female partners. However, protection is only partial; the promotion of safe sex practices is also important," Dr. Maria Wawer and colleagues at Johns Hopkins University in Baltimore wrote.

Wawer's team piggybacked the HPV study onto a larger study that has shown circumcised men are less likely to be infected with the human immunodeficiency virus that causes AIDS.

"We enrolled HIV-negative men and their female partners between 2003 and 2006, in Rakai, Uganda," they wrote in their report in the Lancet medical journal.

They were able to get details on HPV infections for nearly 1,000 of the women, all identified by men as long-term sex partners such as wives. After two years, 27.8 percent of the steady partners of circumcised men had HPV infections, compared to 38.7 percent of the partners of uncircumcised men.

[A difference of 6.2 infections per hundred person-years.]

HPV infection is best known as the primary cause of cervical cancer, but it causes genital warts and can also lead to cancers of the anus, penis, head and neck.

[A near-necessary, but far from sufficient cause.]

There are dozens of strains of HPV, which are highly contagious and which infect the majority of the population within a few years of beginning sexual activity. Most people clear the virus but in some, it can cause changes that lead to cancer.

Cervical cancer is the second most common cancer in women worldwide and is expected to kill 328,000 this year, mostly in developing countries.

[This frightening statistic is all but irrelevant without specificing the degree of linkage between HPV and cervical cancer, cervical cancer and death.]

GlaxoSmithKline and Merck make vaccines against HPV but they are not available to most women in developing countries.

[While circumcision is?]

Circumcision removes the foreskin of the penis, which is rich in immune system cells targeted by HIV and perhaps other viruses. Taking off the foreskin likely makes the penis less likely to carry a range of microbes, Wawer's team said.

"Male circumcision has now been shown to decrease HIV, herpes simplex virus-2, and HPV infections and genital ulcer disease in men, and also HPV infection, trichomoniasis, and bacterial vaginosis and genital ulcer disease in their female partners," Wawer's team wrote.

"Thus, male circumcision reduces the risk of several sexually transmitted infections in both sexes, and these benefits should guide public health policies for neonatal, adolescent, and adult male circumcision programs."

[Their real agenda, spelt out at last.]

SOURCE: bit.ly/ftkvlB The Lancet, January 8, 2011.

The Swaziland Observer
January 4, 2011

Circumsice [sic] Challenge a non starter

By Ashmond Nzima

POOL- THE much anticipated ‘Circumcise’ Pool Challenge tournament, which was scheduled for this coming weekend has now been postponed to January 22.

The E30 000 Population Services International (PSI) Swaziland sponsored tournament will be open to circumcised players only.

It was initially slated for November 27 last but had to be postponed to January 8 this year after it was felt that some of the would-be- players were not able to circumcise for them to be eligible to enter the competition, as they were held up at school.

Billiards Association of Swaziland (BAS) president, Mbongwa Dube confirmed that the Manzini Pool Club as well as The George Hotel would now play host to the preliminary round of the tournament towards the end of the month, as there were logistics that were still being finalised.

“We have just entered the New Year, so we are still trying to sort out finer details of the tournament. As an organising committee, we’re still working out a few issues like the number of people who got circumcised in order to participate in the competition, how they will play as well as other related matters. I can assure the players that they event will definitely begin on the weekend of January 22-23 this year,” Dube said.

The tournament, meant to encourage pool players to embrace a healthy lifestyle was launched at the Swaziland National Sports Council offices about three months ago.

["A healthy lifestyle"? Will it be confined to non-smokers? Pool is proverbially played in smoke-filled rooms, and making such a restriction would really do some good.]

Several players reportedly went for circumcision in order to partake in the tournament.

Apparently, scientific trials have shown that male circumcision can reduce, by up to 60 percent, a man’s risk of becoming infected with . [sic]

Earlier story