PLEASANTON, CA: Publisher won't retract Morris male-cutting article, editor resigns

Retraction Watch
November 22, 2016

Journal editor resigns over firestorm from circumcision article

Circumcision is a hot topic. So hot, questions about a reviewer’s potential conflict with the author of an article promoting circumcision prompted a journal editor to resign, and one academic to call another a “fanatic.”

It began in August, when Brian Morris, professor emeritus of molecular medicine at the University of Sydney, published a critique of a paper that itself had critiqued the practice of circumcision. But the sole reviewer of Morris’s article was a frequent co-author of his, Aaron Tobian of the Johns Hopkins School of Medicine. In his reference section, Morris listed five papers on which he and Tobian were co-authors.

A tipster forwarded us emails from Eduardo Garin, editor in chief of the journal, saying he had resigned from the journal after it refused to retract the paper, despite the fact that its sole reviewer was a frequent collaborator of the author. However, Garin is still listed as editor in chief on the journal’s site.

Garin confirmed to us that he resigned after the publisher refused to retract or correct the Morris article; however, Xiu-Xia Song, vice director of the editorial office at Baishideng, told us by email that Garin is still the journal’s editor.

Here are some specifics:
Morris’s paper is “Critical evaluation of unscientific arguments disparaging affirmative infant male circumcision policy” in the World Journal of Clinical Pediatrics, put out by the Baishideng Publishing Group. It critiqued “Risks, Benefits, Complications and Harms: Neglected Factors in the Current Debate on Non-Therapeutic Circumcision,” published in the Kennedy Institute of Ethics Journal by Robert Darby, an independent scholar who also wrote the anti-circumcision book “A Surgical Temptation: The Demonization of the Foreskin and the Rise of Circumcision in Britain.”

As usual, we sent emails to everyone else involved.

Morris defended Tobian’s impartiality, noting:
Tobian is an expert on the topic and would be highly unlikely to allow any past relation with me over an unrelated paper to influence his assessment of this recent manuscript. You are clutching at straws … and for what? Do you have a hidden agenda. If so think one would regard that as unethical…Did [Darby] put you up to this nonsense?…Tobian was not on the list of suggested reviewers. So now will you go away and stop bothering me? This is a non-issue. If you are looking for someone to annoy I suggest you go and harass Darby. When we contacted Tobian, the sole reviewer, he declined to comment, saying “I am conflicted.”
Tobian is still listed as a peer reviewer at the bottom of the journal article; Song didn’t respond to questions, about the World Journal of Clinical Pediatrics’ conflict of interest policy for peer reviewers. That policy reads:
Reviewers will decline participation in the peer review process for any manuscript if a conflict of interest exists, including interests related to the manuscript’s authors, personal interests, or academic or economic interests. If a conflict of interest becomes apparent during the peer review process, the reviewer must inform the Editorial Office immediately. There are two comments on the article, one from circumcision critic John Dalton, and the other a response from Morris. Dalton’s comment reads in part:
Morris, Krieger, Klausner and reviewer Tobian are members of an authorship cartel who seek to promote circumcision by co-authoring papers and reviewing each other’s work. [Members of the cartel include Robert Bailey, Stefan Bailis, Ronald Gray, Daniel Halperin, Godfrey Kigozi, Jeffrey Klausner, Brian Morris, Stephen Moses, Malcolm Potts, Thomas Quinn, Edgar Schoen, David Serwadda, Dirk Taljaard, Aaron Tobian, David Tomlinson, Richard Wamai, Maria Wawer, Helen Weiss andr Thomas Wiswell.] They also seek to repress papers with opposing views by writing damning reviews. Morris’s response reads, in part:
We suggest you be wary of comments posted by opponents of male circumcision. These pose a threat to good science, public health and individual well-being. The comment by Dalton provides false allegations against the authors. This appears to be a deliberate strategy undertaken in a desperate attempt to discredit high quality scientific work when no credible criticisms can be made. Darby, the author of the paper Morris et al was criticizing, acknowledged to us that the topic of circumcision raises strong feelings:
Circumcision is in itself an intensely emotional topic because it is the focus of discourses that are themselves likely to generate intense emotions: sexuality, body image, masculinity, health, religion, science etc. Most people writing on the topic have an interest one way or another and passionate feelings may arise among people on both sides of the debate: circumcision critics through resentment at having been circumcised, for example, or supporters because they have circumcised their own boys and do not wish to believe that they have done the wrong thing.

But even admitting that, it has to be said that the intensity Prof. Morris brings to the debate is in a class of its own, and I don’t think it is unreasonable to describe him as a fanatic…I don’t think Morris has any particular aversion to me – he tends to hate all circumcision critics equally, and generally responds to them with great personal venom.

BELGIUM: Circumcised men get less pleasure

Reuters
February 14, 2013

Male circumcision tied to less sexual pleasure

by Andrew M. Seaman
(Reuters Health) - Men circumcised either as children or adults report less intense sexual pleasure and orgasm than their uncircumcised counterparts, according to a new study from Belgium.

"We're not saying less sexual activity or satisfaction, but sensitivity," said the study's senior researcher Dr. Piet Hoebeke, from Ghent University Hospital.

The new study surveyed 1,369 men over the age of 18, who responded to leaflets handed out in train stations across Belgium.

The men were asked whether they were circumcised, and were then asked to rate how sensitive their penis was, how intense their orgasms were and whether they experience any pain or numbness when they are aroused.

Overall, 310 men who took the survey were circumcised, and 1,059 were not. Each rated how sensitive their penis was on a scale from 0 to 5, with higher numbers being the most sensitive.

Overall, uncircumcised men reported between 0.2 points and 0.4 points higher sensitivity and sexual pleasure when their penis's head - known as the glans - was stroked during arousal, compared to circumcised men.

For example, uncircumcised men reported an average sensitivity score of 3.72 when they or their partner stroked the top part of their penis's glans, compared to 3.31 amongst circumcised men.
Uncircumcised men also reported more intense orgasms.

"It's not a very big difference in sensitivity, but it's a significant difference," Hoebeke said.

Currently, about half of U.S. baby boys have their foreskin surgically removed at birth, and about 30 percent of men around the world are circumcised.

Some religions, such as Judaism and Islam, consider circumcision part of religious practice, while other people choose circumcision for possible health benefits - including a reduced risk of urinary tract infections (see Reuters Health article of December 7, 2012 here:).

Hoebeke and his colleagues write in BJU International that there are few studies researching whether foreskin plays a role in sexual pleasure. But Dr. Aaron Tobian, who studies circumcision but was not part of the new study, said that previous randomized controlled trials - considered the gold standard of medical research - looked at sexual performance and satisfaction. [They were studies of adult volunteers for circumcision - not the gold standard at all.] Those studies, he said, did not find a difference. [Becauses the questions were too vague to do so.]

One possible explanation for any potential difference in sensitivity is that a man's foreskin may protect his penis's head from rubbing against underwear and clothing. It's possible, the researchers write, that friction makes the head of the penis thicker, drier and ultimately less sensitive. [Another is simply that the foreskin itself is sensitive, as Taylor found.]

The researchers also found circumcised men were more likely to report more pain and numbness during arousal than uncircumcised men, which Hoebeke said is likely due to scar tissue.
"I'm amazed that people report pain during sexual pleasure… That's very amazing and that was unexpected," he said.

‘ABUNDANTLY CLEAR' EVIDENCE
Tobian, from Johns Hopkins University in Baltimore, said the findings are missing important context.
"The medical evidence and the benefits of male circumcision are abundantly clear," Tobian told Reuters Health. [This is not "context", but another issue altogether.]

"If there was a vaccine out there that reduces the risk of HIV by 60 percent, herpes by 30 percent and the penile cancer causing HPV by 35 percent, the medical community would rally behind it," said Tobian. [There is little or no evidence that circumcision does any of those things.]

The American Academy of Pediatrics says the benefits of male circumcision outweigh the risks, but stops short of recommending universal circumcision (see Reuters story of August 27, 2012 here:).

SOURCE: bit.ly/X7j39D BJU International, online February 4, 2013.

BALTIMORE: "Oh noes, leaving babies intact will cost billions!"

Los Angeles Times
August 21, 2012

As circumcision declines, health costs will go up, study projects

By Eryn Brown
A team of researchers estimates that every procedure not performed could lead to significant increases in lifetime medical expenses because of STDs.

Declining rates of circumcision among infants will translate into billions of dollars of unnecessary medical costs in the U.S. as these boys grow up and become sexually active men, researchers at Johns Hopkins University warned.

In a study published Monday in the Archives of Pediatric and Adolescent Medicine, a team of economists and epidemiologists estimated that every circumcision not performed would lead to significant increases in lifetime medical expenses to treat sexually transmitted diseases and related cancers — increases that far surpass the costs associated with the procedure.

Circumcision is a hotly debated and emotional issue in the U.S., where rates have been falling for decades. In the 1970s and 1980s, about 80% of baby boys were routinely circumcised in hospitals or during religious ceremonies; by 2010, that figure had dropped below 55%, according to the Centers for Disease Control and Prevention.

Some of that decline is due to shifting attitudes among parents, but at least part of it can be traced to the decision by many states to eliminate Medicaid coverage for the procedure in order to save costs. Today 18 states, including California, do not provide Medicaid coverage for the procedure, which is considered cosmetic by many physicians.

But in the last decade, studies have increasingly shown that removing the foreskin of the penis has significant health benefits, said Dr. Aaron Tobian, senior author of the new study.

Three randomized trials in Africa have demonstrated that circumcision was associated with a reduced risk of contracting HIV, human papillomavirus and herpes simplex in men. One of those studies documented a reduced risk of HPV, bacterial vaginosis and trichomoniasis in the female partners of men who were circumcised.

Circumcision is believed to prevent STDs by depriving pathogens of a moist environment where they can thrive. The inner foreskin has been shown to be highly susceptible to HIV in particular because it contains large numbers of Langerhans cells, a target for the virus.

Tobian and his colleagues developed a computer-based simulation to estimate whether declining circumcision rates would lead to more STDs and thus higher medical costs.

If circumcision rates remained about 50% instead of the higher rates of years past, the lifetime healthcare costs for all of the babies born in a single year would probably rise by $211 million, the team calculated.

[This has not been the experience of the rest of the developed world, such as the English-speaking world, where the experiment of mass circumcision was tried and abandoned.]
 
If circumcision rates were to fall to 10% — which is typical in countries where insurance does not cover the procedure — lifetime health costs for all the babies born in a year would go up by $505 million. That works out to $313 in added costs for every circumcision that doesn't happen, the report said.

In this scenario, nearly 80% of the additional projected costs were because of medical care associated with HIV infection in men, the team wrote.

The model includes only direct medical costs such as treatment for penile and cervical cancer, which are associated with HPV infection. It doesn't consider nonmedical or indirect costs, such as transportation to doctors' appointments or lost income.
[Nor does it include costs for revision surgery or other sequelae of botched circumcisions.]
 
To Tobian, the message is clear: Government efforts to save money by denying coverage for circumcision are penny-wise but pound-foolish.

"The federal Medicaid program should reclassify circumcision from an optional service to one all states should cover," he said.
[So much for states' rights.]
 
That sentiment was echoed in an editorial accompanying the study. UCLA health economist Arleen Leibowitz wrote that by failing to require states to cover circumcision in Medicaid plans, the U.S. reinforces healthcare disparities.

"If we don't give poor parents the opportunity to make this choice, we're discriminating against their health in the future," she said in an interview. "If something is better for health and saves money, why shouldn't we do it? Or at least, why shouldn't we allow parents the option to choose it?"

Ellen Meara, a researcher at the Dartmouth Institute for Health Policy and Clinical Practice who was not involved with the study, praised the researchers for conducting a careful analysis. But she questioned whether data from HIV studies in Africa were generalizable to the U.S. Medicaid population.

Still, it's "the best information we have," she said. "There's nothing better to plug in."
[It's rigged, but it's the only game in town. No US study has found sufficient evidence of a connection between circumcision and HIV to justify doing it to babies.]
 
The analysis comes a week before the American Academy of Pediatrics is scheduled to release a new policy on circumcision. Since 1999, the doctors group has taken a neutral stance on the procedure, saying that "the scientific evidence demonstrates potential medical benefits" but that it's not strong enough to say that circumcision should be routine.

Some reports have indicated that the new policy will state that the health benefits of circumcision outweigh the procedure's risks, but will stop short of recommending it for all baby boys. A spokeswoman for the academy declined to comment before the policy is formally released Monday.
A shift in position could boost support for circumcision, since both pediatricians and parents look to the academy for guidance, Leibowitz said.

USC health economist Joel Hay said the new study was inherently flawed because ethical concerns about the procedure trumped any economic analysis of its potential benefits.

"You're taking an asymptomatic individual and forcing a procedure on him," he said.

Hay also argued that Americans didn't need circumcision to prevent HIV infection because they had other options, such as using condoms. He said that just last month the U.S. Food and Drug Administrationapproved the use of a once-a-day pill called Truvada to reduce the risk of HIV transmission in high-risk groups.

"There's no reason why people have to engage in this irreversible procedure," he said.