Intactivism News
October - December 2002

More recent news

(More recent items first)

 

Daily Nation (Kenya) - Horizon magazine
-sorry, link no longer available

Thursday December 26, 2002

Circumcision study lands into problems

By ARTHUR OKWEMBA
The Kenyatta National Hospital Ethical and Research board is uncomfortable with a study just months after it authorised a local researcher to circumcise adult males at Kisumu to establish whether there is a correlation between circumcision and HIV transmission.

Sources say the researcher ran into trouble when the board began thinking he was betraying some of the agreed aspects of the research.

It immediately last October named a committee to investigate. The team finished its work early the next month, according to board secretary Prof A. Quantai.

But Prof Quantai would not reveal the findings, saying the board must first meet to discuss them.

She said: "We are going to take a position on the matter by the second week of January. What people need to know is that corrective measures are being taken for the mistakes made."

However, informed sources claimed the board's concern was that those involved in the research had altered an approved questionnaire without its knowledge.

There is also some worry about the number of people already circumcised and about exporting volunteers' specimens abroad for further analysis.

Although local scientists have been known to do such exportation in good faith, it is said their foreign counterparts take advantage of such specimen to carry out unauthorised research.

And, in the event, they often make medical breakthroughs that benefit only their countries and, through patents, only themselves.

Asked for comment, Prof Ndinya Achola, principal investigator in the study, says he cannot comment since the matter is confidential and under consideration by the board.

Prof Achola says: "I have explained the science of the study clearly to the board and they were comfortable. For the ethics of the study is something we left to them to decide and I cannot comment on it when they are still looking into the matter."

This revelation is the latest in a study that has generated a lot of interest and debate among researchers. Many have questioned its whole safety and ethics.

What preoccupies some of them is that, if circumcision is not hygienic, it can cause complications, which have killed some men.

Prof Achola has since argued that, in their study, they use doctors and clinical officers to carry out the circumcision. Besides, their activities are being supervised by Kenyan and American Data Safety Monitoring (DSM) experts.

The study, which began six months ago, seeks to find out whether circumcised men are less likely than otherwise to be infected with the HIV

More than 300 young males have been circumcised since it began. The study requires them to be sexually active, aged between 18 and 25 and be HIV- negative. [While it is necessary that they be HIV- so that conversion to HIV+ can be detected, this introduces selection bias: those who are already resistant to HIV will be preferentially chosen, along with those who have just been lucky.] They will be monitored for two years immediately after being circumcised.

More than 600 young men out of the expected 2,000 have volunteered since the study began. Interest has been beyond the researchers' expectations.

A number of scientists, however, claim that people are being given incentives to take part and being made to believe they are HIV-proof once circumcised.

According to Prof Achola, although volunteers get free medical attention whenever ill, no incentives are given to lure them into participating.

He insists the issue of the volunteers thinking they are insulated from HIV infection has been thoroughly tackled. He is aware, says he, that, after circumcision, some young men may engage in unsafe sex thinking they are safe.

"Our approach is to educate them on HIV/Aids and we emphasise to them that no authoritative evidence has been produced to indicate circumcision reduces HIV infection," he stresses.

The study, funded by America's National Institutes of Health, is said to be the first in the world that attempts to come up with hard data on correlations between HIV infections and circumcision.

South Africa initiated its own a few weeks ago and Uganda plans to launch one soon. HIV experts think that, if the studies prove the hypothesis, then they will provide evidence for circumcision to be added to a list of public interventions in preventing HIV/Aids.

A few weeks ago, in an interview, Prof Achola insisted that all he wants is to verify earlier studies, which just compare HIV infection rates between communities circumcising men and those that do not.

He says: "We want to provide evidence based on practical results to justify or refute what other studies involving the comparison of untested phenomenon say."

HIV experts have also demanded that studies be done to produce hard data showing a relationship between circumcision and HIV infection, especially in Africa, where three quarters of the world's victims are claimed to live.

What has spurred interest in the whole issue are indications of circumcised males with low viral loads showing less likelihood of transmitting the virus to their female partners. [But viral load is widely variable, unpredictible, and usually unknown. And if circumcised men with high viral loads are no less likely to transmit HIV than intact men with high viral loads, this suggests any protective effect is actually quite weak.]

However, the same scientists have been confronted with cost and ethical issues, raising a lot of reservations about the whole approach to managing HIV/Aids.

James Ntozi, a Makerere University lecturer, has warned of money being diverted from other social needs to meet circumcision costs. [An excellent point.] Or, if the exercise is donor-dependent, then the programmes might not work.

In one its issues, The Horizons, a research organ of the Population Council, has raised fears that, in that case, "men may use their circumcision status as a reason for not using condoms, while women may be less inclined to insist on condom use if their male partners are circumcised."

"In this scenario," it adds, "women are in increased risk of contracting the virus and this may reduce the potential benefits of male circumcision on HIV transmission." [If any.]

Another fear is that the rate of female genital mutilation (FGM) in areas where the practice exists may shoot up if men's circumcision is linked to HIV prevention.

Equally emotive arguments have raised ethical questions about the age at which a person needs to be circumcised for the practice to be effective.

There are worries that older men may be left out in the strategy, since studies elsewhere in Africa show that circumcision, as a measure against HIV infection, is more effective if done before or soon after puberty begins. [If it is less effective, what would be the point of including them?]

In a 1999 research on the age of male circumcision and HIV infection risk in rural Uganda, Kelly Kiwanuka found that males circumcised before puberty between 13 and 20 had a much reduced risk compared with their uncircumcised counterparts. [As usual, this ignores culture: age of circumcision is closely connected to culture, which in turn affects such crucial factors as age of first intercourse.]

 

Business Wire - sorry, link no longer available
DEC 23,2002 12:18 PACIFIC 15:18 EASTERN

Medical Board of California Arrests Santa Clarita Resident for Unlicensed Practice of Medicine

SACRAMENTO, Calif.--(BUSINESS WIRE)--Dec. 23, 2002--The Medical Board of California's Operation Safe Medicine (OSM), in conjunction with the Federal Bureau of Investigation, served a search warrant on December 19, 2002 at the Santa Clarita residence of an unlicensed person, Todd Cameron Bertrang, for agreeing to perform female circumcisions. The procedure is an extremely painful, traumatizing mutilation of females that leaves them permanently disfigured. He also performs a similar procedure on males. He was charged with violating Business and Professions Code section 2053, a felony, by risking great bodily harm, serious injury or death by practicing medicine without a license. Bertrang was arrested and booked into Santa Clarita Los Angeles Sheriff's Department and will appear in court on January 21, 2003.

   The Medical Board of California continues to analyze evidence obtained during the execution of the search warrant. The Board's Chief of Enforcement Dave Thornton said, "The mission of the Medical Board is consumer protection. Stopping the unlicensed practice of medicine in California is a high priority with the Medical Board. We encourage anyone with information regarding additional victims of Todd Bertrang, or any other criminal activity connected to Bertrang, to contact the Medical Board's Cerritos Office at (562) 860- 2819."

   The case was referred to the Medical Board by a physician from Northern California who received information that Bertrang was performing clitoridectomies on women in Southern California. The FBI, who had received a similar complaint, also was investigating Bertrang. A joint investigation with the FBI resulted in a search warrant being obtained for the Santa Clarita residence, along with an arrest warrant for Bertrang.

   The investigation has revealed that Bertrang attracted potential patients through Web sites and may have performed various unlicensed procedures that include male and female circumcisions at his residence since 1997. These are procedures that can result in serious injury to patients who are not in a medical setting. [Or who are. Even as written, this raises a question about ritual circumcision.]

   This arrest is the tenth in 2002 by investigators of Operation Safe Medicine, a special unit of the Medical Board composed of trained investigators who seek to protect a significant portion of the population by reducing access to individuals who are unlicensed and a danger to the public when they attempt medical treatment. OSM commenced in January 2001, and works closely with local and federal law enforcement agencies. The staff of investigators target the known areas where the unlicensed practice of medicine flourishes in Orange County and the greater Los Angeles area. The investigators also work other areas of the state as needed and provide training to other Medical Board enforcement staff in how to spot and respond to suspected illegal practices.

   OSM is part of the Medical Board's efforts to steer consumers away from unlicensed practitioners, whose treatment of patients has resulted in harm and even death in Southern California. The Board encourages the public to confirm they are receiving healthcare from licensed individuals by calling its Consumer Information Line at (916) 263-2382 or visiting its Web site at www.medbd.ca.gov.

   The Medical Board of California is the state agency responsible for licensing and regulating physicians in this state. --30--alx/sf*

CONTACT: Medical Board of California
Dave Thornton, 916/263-2389

 

Billings Gazette (Montana)

Medicaid budget knife cuts circumcisions

By JENNIFER McKEE
Gazette State Bureau 12/21/02

HELENA - People with Medicaid, a federal-state insurance plan for the poor and elderly, will no longer be able to get prosthetic limbs, dental care, circumcisions and some other services, state officials announced Friday.

Despite numerous cuts to programs, the state estimated its Medicaid budget would run $3.6 million into the red by June 30, according to a letter Friday to doctors, hospitals and other medical personnel who treat Medicaid patients.

To avoid busting its budget, the state's Medicaid Assistance Bureau decided to do away with some services temporarily, ax some for good, reduce payments and otherwise restrict services.

...

Other cuts include:

A permanent end to Medicaid reimbursement for circumcision, breast reduction surgery and gastric bypass surgery, a radical surgery for the critically obese that reduces the size of the stomach.

...

Ending circumcisions was expected to save $25,378.

...

Ending dental care was expected to save $291,531. Ending coverage for prosthetic limbs and other equipment was expected to save $193,750.

The department also made other cuts in the amount of money they will pay to Medicaid providers such as doctors and hospitals and made it more difficult to qualify for Medicaid. They also transferred several hundred thousand dollars from other pots of money within the state Department of Public Health and Human Services' budget.

...

Because Medicaid is funded by federal matching dollars, the state's $3.6 million in cuts actually amounts to a $13.3 million hit to the program, the letter stated.

Jeff Buska, Medicaid Bureau chief, said several doctors panels considered a variety of procedures, like circumcision and breast reduction, and concluded that they are not medically necessary.

Consequently, Buska said, the agency decided to cut coverage for those services.

"Circumcision is something we've been looking at for a long time," he said.

[See a map of US states that have abolished Medicaid circumcision funding.]

 

Fargo Forum, Fargo, ND

Hospital wants out of lawsuit over circumcision

By Steven P. Wagner
email: swagner@forumcomm.com
The Forum - 12/19/2002

Lawyers for Fargo's MeritCare Hospital want their client dropped from a circumcision trial before it heads to court.

Wednesday, attorney Jane Voglewede asked East Central District Judge Cynthia Rothe-Seeger to order the change.

The move, if ordered, would leave Dr. Sunita Kantak of MeritCare the sole defendant in the case.

Anita Flatt of Hawley, Minn., is suing the doctor and hospital, claiming she and her husband, James, weren't told complete and accurate details about removing the foreskin from their son's penis.

Anita Flatt signed a consent form for circumcision, but hospital staff didn't describe the benefits or risks of the procedure, the lawsuit says.

The procedure provides no medical benefit, argues their attorney, Zenas Baer.

Rothe-Seeger set several deadlines for lawyers to submit written requests and share information. Once lawyers submit their motions, Rothe-Seeger will oversee a final motion hearing before ruling on several legal issues.

Jury selection begins Feb. 3 in what Baer says is the nation's first trial of its kind.

Baer calls circumcision a "barbaric" practice and claims the hospital's doctors should have provided more information before the Flatts consented to the procedure.

Kantak circumcised their son, now 5, one day after he was born.

If the couple had known more about the procedure, they would have chosen not to do it, Baer said.

The hospital contends Anita Flatt was given information about circumcision and gave doctors her consent to perform the procedure.

"This information educates parents about circumcision and allows them to make an informed choice that factors in their own personal beliefs and preferences," hospital spokeswoman Carrie Johnson said earlier this week.

In court Wednesday, Voglewede said the hospital wasn't served with the lawsuit.

She denied comment after the hearing, avoiding questions about her request to drop the hospital from the suit.

However, Baer said he opposes dropping the hospital from the lawsuit.

MeritCare was served with the suit, he said.

In another twist, Rothe-Seeger said she may divide issues in the case to separate liability and damage claims.

The judge also told Baer to submit questions he'd ask potential jurors if they were questioned individually and offer alternative ways to learn about their beliefs and family history.

Readers can reach Forum reporter Steven P. Wagner at (701) 241-5542

 

Dispatch
South Africa, 19 December 2002

45 die from circumcision

BISHO (South Africa) 12/19/02
A total of 45 initiates have died as a result of circumcision-related practices so far this year. [This seems to count only deaths in Eastern Cape Province.]

The death toll is the highest since the Health Department started recording initiates' deaths in 1995.

The department recorded 41 deaths in 1995. This year's fatalities included 33 in the June season and 12 in the present season so far.

At least 68 initiates have been admitted to hospitals around the province during the December/November initiation period.

The Spethu Hospital in Ntabankulu topped the list of admittances, with 35 initiates referred there. Two of these patients are in a critical condition. Another initiate is in a critical condition in the intensive care unit at the Umtata General Hospital.

The police have arrested seven people following the deaths. They have been deemed to be in contravention of the Application to Health Standard Act, which enforces proper initiation processes.

On Sunday police in Ntabethemba arrested six people in connection with murder and contravening the Act.

Three of the six suspects will be charged with the murder and assault of a 17-year-old initiate from Saaiplaas near Tarkastad.

The three suspects -- the 65-year-old father of the boy, the boy's 24-year-old brother and a 55-year-old man -- will appear in court today.

The remaining three charged with violating the Act include a 65-year-old traditional surgeon.

In Qweqwe, not far from Qunu, a traditional surgeon was arrested for carrying out initiation rites under the influence of alcohol.

The head if the Health Department, Dr Siphiwo Stamper, urged the community to co-operate with health officials and police in reporting circumcision malpractices.

He said the community should "participate strongly" because they know when things go wrong.

"This fights needs the co-operation of the community and we will not conquer without them.

"They must be the whistle-blower as they are there ones who see these things."

Stamper emphasised that people should "tell the truth" about an incident rather than hide the real causes.

Stamper noted that co-ordination among traditional leaders, nurses and surgeons, the community and the department was "bearing fruit".

He said it was the community who had a duty to choose the "right" people to perform the rite. -- ECN

 

Dispatch online, South Africa
Monday December 16, 2002

Police probe murder after two initiates die

By Denver Donian, Crime Reporter

EAST LONDON -- Police are investigating two cases of murder following the deaths of circumcision initiates at the weeekend.

Sergeant Namhla Mdleleni said an initiate died in the Tarkastad hospital on Sunday after allegedly being tied up and beaten with sticks by a traditional doctor, an "ingcibi", and his assistant, police said.

Mdleleni said Mbulelo Kotsiwe, 21, of Ntabetemba was circumcised about two weeks ago.

"Two days after the circumcision he developed complications but refused to be attended to by the traditional doctor," Mdleleni said.

She said it appeared that the "doctor" and his assistant became angry with the initiate and tied him up with rope.

"They then beat his entire body with sticks and blunt objects and it appears as though they left him for dead," she said.

Mdleleni said when Kotsiwe was found tied up by a passerby he was taken to the Tarkastad hospital where he died on Sunday morning.

According to doctors Kotsiwe had suffered head and internal injuries which were believed to have resulted in his death. A postmortem will be held today.

There have been no arrests and police are investigating a case of murder.

Phumlani Nonqalela, 14, died at an initiation school at Mpoza, near Lusikisiki, on Saturday, Superintendent Nondumiso Jafta said.

Nonqalela was one of six youths unlawfully circumcised by an unregistered "ingcibi" at the school.

"The suspect is believed to have called the boys to a gathering where he assaulted them and then circumcised them without their parents' authority," Jafta said. Nonqalela later developed complications and died.

Police are investigating cases of murder, assault and unlawful circumcision. An arrest is expected shortly.

 

Intactivist Honoured

The Sun (London)
December 1, 2002

 

Meet the unsung heroes

By MICHAEL LEA

EIGHT unsung heroes were last night honoured for their true grit with new national awards backed by The Sun.

They were recognised at a gala dinner for campaigns which have helped improve others’ lives.

Each won an Oyster Award — named because when grit gets inside an oyster’s shell it creates a pearl.

The winners, chosen from more than 150 entries from around the country, also received a trophy and £1,000 of holiday vouchers for a well-deserved break. ...

The awards are the brainchild of National Lottery operator Camelot and Common Purpose, a group helping businesses and communities work together. ...

Julia Middleton, chief executive of Common Purpose, said: “The judges were extremely impressed by the standard of entry, which obviously made the judging process incredibly difficult. ...

Health

John Warren

JOHN WARREN

DOCTOR Warren founded Norm UK, a national charity to tackle the practice of male circumcision. It educates men and offers alternative treatments.

Since 1994 the consultant physician, 60, of Harlow, Essex, has helped more than 3,000 men. Norm UK also offers advice to parents of boys told they need the operation.

Men left traumatised by circumcision, either for medical or ritual reasons, can also get information and help.

John says “The prize will enable people within the group to travel abroad and meet up with colleagues working in the same area.”

 

from the New York Times, Nov 3 2002 (registration required)

Foreskin-harvesting firms file for bankrupcy protection


Companies That Seek Cures Now Fight For Life

By ANDREW POLLACK

WHEN the terror attacks halted air traffic last year, an exception was made for a private jet flying from Southern California to Washington. It carried sheets of human skin cells to treat people burned at the Pentagon.

Now the manufacturer of that biotechnology product, Advanced Tissue Sciences, is itself in need of emergency aid. The company, based in San Diego, filed for bankruptcy protection last month and is still operating, although it has been unable to raise money.

"What we ran into was the change in the investment climate," said Abe Wischnia, the senior director for investor relations at Advanced Tissue Sciences. "A year or two ago, we would have had no trouble raising additional money."

...Since the beginning of July, at least 45 biotechnology companies in the United States and Europe have announced layoffs or other cutbacks, according to BioCentury, a newsletter.

Among the companies in the most precarious positions are those whose research breakthroughs have attracted much attention in the past. Such technology often tends to be not only far-reaching, but also far out in terms of the time when it will start making money. These are exactly the types of businesses that risk-averse investors are now shunning.

...[G]rabbing headlines does not always translate into business success. Sales have been slow for Advanced Tissue Sciences' artificial skin, which costs up to $600 a sheet and competes with ordinary bandages.

[When these tissues were announced, much was made of the claim that a single foreskin could be grown to the size of six football fields. Either the process is extraordinarily expensive or the babies were being, very literally, ripped off.]

Organogenesis, of Canton, Mass., a competitor of Advanced Tissue Sciences in the artificial-skin business, filed for bankruptcy protection a few weeks ago. ...

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