Why Do Boys Get All The Circumcision?

Nawal Nour speaking with a Sudanese interpreter (c) Brigham and Women's Hospital

Though infant male circumcision is left to the discretion of parents, female circumcision performed on a minor is completely banned in the United States. This strange kind of sexism was the topic of debate at a Harvard Law School panel discussion today.

Male circumcision has long claimed to be the lesser of the two evils— safer, and with potential health benefits. Unfortunately, those potential health benefits are for people facing an AIDS epidemic, not Americans, and every medical procedure has risks.

“I don’t like seeing the poor little penises bleeding,” said panelist Dr. Nawal Nour, an obstetrician/gynecologist who founded the African Women’s Health Center in Boston. She stopped performing the procedure. Another panelist, Law Professor Sarah Waldeck, said that as a middle-age white woman from the midwest she couldn’t be objective on the issue— in her demographic, circumcision is the norm.

Waldeck’s perspective on male circumcision spoke to her early point about female circumcision— that the cultural aspects have to be taken into account when determining laws if they are going to be effective. Because the people the ban is aimed at view female circumcision as normal, she argued, the law is more likely to provoke backlash than lasting change.

“Getting people to stop circumcising their daughters is as difficult as trying to convince Jewish people to stop circumcising their sons,” Waldeck said. Dr. Nour pointed out that in a traditional Jewish bris, the circumcision is not performed in a hospital, or even by a medical professional.

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How To Mortgage Your Future.

A needle depot in Vancouver, Canada.

Just when The Washington Post reports the demise of needle exchange services in D.C., The New York Times catches up, covering the only safe injection facility in North America. Which is in Canada, of course.

The irony would be better if Vancouver had just started opened this facility, but I mean it when I say that The New York Times is catching up. InSite opened in 2003.

Still, the irony is pretty good.

As the Time’s reports, the Downtown Eastside of Vancouver was once home to the fastest-growing AIDS population in North America.

The city took action, and along with implementing needle exchange programs, they went one step further, opening InSite. People suffering with addiction bring their own drugs to the center, staffed with health care professionals, and shoot up. The facility reduces disease transmission and the risk of death from overdose.

To watch the multimedia piece, click here.

Back in the U.S., D.C. is the HIV/AIDS epidemic epicenter, and the State has responded by delaying funding to it’s needle exchange program. Both the federal and state governments are cutting funding to programs that prevent the spread of HIV, Hepatitis and STDs. I mean, why raise taxes when you can cut frivolous expenses like needle exchange programs and Planned Parenthood?

Unfortunately, cutting these programs isn’t even going to save money. The cost of running the needle exchange program in D.C. for a year is less than the cost of care for a single AIDS patient over a lifetime. Did I mention that the program serves 2,200 people?

But, I guess when even programs for starving babies are getting the axe, it’s not surprising that drug addicts aren’t garnering much sympathy.

The Great Canadian Foreskin Debate.

While Americans are debating the legality of offering all of their citizens access to health insurance, Canadians are trying to make their (universal) medical care a little more humane.

Specifically, whether or not it is okay to circumcise male infants.

Though female circumcision is usually the trending topic in genital welfare debates, a growing number of parents are choosing not to circumcise their sons, and some are even suggesting the practice be outlawed.

Referred to as “intactivists,” the people calling for a ban are asking if infants should be subjected to a medical procedure when they are too young to consent.  Which begs the question: does it provide any medical benefits?

Male circumcision is currently being promoted in Africa as a means of fighting HIV transmission, and a recent study in the Lancet found that circumcision reduces transmission of HPV, a virus links to genital warts and cervical cancer. At the same time, a 2010 study found that circumcision outside of Sub-Saharan Africa offered little benefit. In addition the both the Canadian Pediatric Society and the American Academy of Pediatrics no longer recommend the procedure because it is not medically necessary.

Whether slightly reduced HPV transmission rates are a benefit to male circumcision may not matter anyway. There are many other less invasive, irreversible ways to control HPV than lopping off part of an infant’s penis.

For those of you brave enough to see how the procedure is done, click here.

To see the discussion, click here.

 

Will They Or Won’t They?

A second federal court judge ruled today that the healthcare law violates the constitution. The problematic provision? It requires all Americans to obtain commercial insurance, the New York Times reports.

It’s the latest development in the melodrama of universal healthcare in United States, a country that can grow organs but can’t decide if basic health insurance is really something everyone should have.

Stay tuned.

HIV Preferable to Diabetes.

Did you know that doctors are learning how to re-grow body parts? It’s true. Not even just bladders and tracheas (as seen on Grey’s Anatomy), but finger tips and nails too. But are these kind of medical advances really what we should be spending our time on? I mean, we barely know how to feed ourselves.

This was the topic of debate this past Saturday at the Harvard Business School’s 8th Annual Healthcare Conference.

The conference kicked off with a keynote address from Robert Epstein, the Chief Medical Officer at Medco, who trumpeted regenerative medicine as one of the four “amazing innovations in science that hold the promise of true healthcare reform,” along with genetics, epigenetics, and stem cell therapies

But Epstein’s assertion that these breakthroughs will help bend the cost curve down was disputed in the very next panel. Larry Fitzgerald, the chief financial officer of the University of Virginia Medical Center, thinks those types of innovations will bring the cost curve up, because they extend life rather than eliminate disease.

“Instead of having neurological problems at age 80, we’re going to have them at age 95 or 100,” he said during the Health IT panel discussion. “We’re still going to have them.”

And so emerged the topic of the day: instead of sinking our resources into ground-breaking innovation, we should be concentrating on preventative medicine and behavioural changes?

According to the U.S. State Department, chronic diseases such as obesity and diabetes account for seven out of every ten deaths in the U.S. and are projected to cause the majority of deaths worldwide by 2020, outstripping infectious diseases such as malaria and HIV/AIDS.

This topic dominated the global health panel, since treating chronic diseases will be a new challenge to the healthcare non-profits, the majority of which currently address infectious diseases.

“We have patients in Sub-Saharan Africa who say they would rather HIV than diabetes, because they can get treatment for HIV,” said Epidemiologist and panelist Todd Reid.

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The Scientific Temper.

Does better science education create more rational human beings? Bruce Alberts thinks so.

For those of you not in the know, Bruce Alberts is the editor-in-chief of Science and a former president of the National Academy of Sciences. On Thursday Alberts spoke at Harvard University, his alma mater (where he both went to college and earned his Ph.D.), explaining why and how science education in America needs to change.

People stood in the back of the room and sat in the stairwells of the lecture hall, while Alberts explained how in 1996, while he was president, the Academy released a set of science education standards that sought to put the emphasis on abstract thinking and active inquiry.

The plan outlined experiments for even children as young as five. For example, the children could put on clean white socks and walk around in the school yard, collecting dirt and seed on their socks like animals do on their fur. Back in the classroom, they could then try and separate what they thought were seeds from what they thought was dirt, using inexpensive plastic microscopes. To test their hypotheses, the kids could plant both the seeds and the dirt to see which grew.

Unfortunately, what happened next Alberts refers to as a “disaster.” The states all chose different parts of the 1996 standards to adopt, and most of what was left out was the focus on abstract thinking and active learning. Instead, students’ science education focuses on memorization and word recognition.

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Politicizing Public Health Issues.

Since the surge of gay suicides in the US, schools have been forced to confront the issue of anti-gay harassment and bullying. Unfortunately, gay rights is so contentious, politics have hijacked what is essentially a public health issue.

I previously blogged that the increased suicide risk seen in gay teens—homosexual teens are four times more likely to have attempted suicide in the last year than straight teens—begs for targeted mental health services. I also reminded everyone that homosexuality is not listed in the DSM as a mental illness. Gay teens are just people who need help. So why is this issue being debated by politically-motivated groups rather than health policy experts?

Click here to read about the debate at Salon.com