How much for a pill - or a circumcision?
The Centers for Medicare & Medicaid Services (CMS) now require US hospitals to make public their standard charges (known as chargemasters) for routine items. The hospitals are obviously not happy since they deliberately use varying names for the same procedure to hinder automatic comparison. One can see why. A group of academics at the University of Texas set out to do a manual comparison and the results defy belief. How about a difference of 18,617% between prices for one pill (5-mg tablet of amlodipine: $0.23-$43.05)? For circumcision charges ranged from $252 to $7,532.10, a 2,889% difference. Understand that this is just within Dallas County Tx! Not surprisingly, the authors conclude "Refining the minimum requirements for publishing chargemaster data could increase their utility." Obliging hospitals to use a standard list of items would seem to be the obvious step.
Read the abstract at PubMed. The full text requires payment but really it's all there in the abstract. Thanks to JH for the link.
Moroccan man presents with necrotic foreskin
A 30-year-old man suffered from phimosis. He was unable to have sex but too embarrased (and impecunious) to see a doctor. So he decided on a self-circumcision despite never having never seen the operation performed, and having no idea how it was done. A month later he fronted up to hospital. Fortunately the doctors were able to salvage the situation and the man ended up with a nice two-tone circumcision. (He is very dark-skinned, obviously originally from somewhere further south).
Bulgarian Muslims hold their pre-Ramadan feast.
Bulgarian Muslims decided that despite COVID they could hold their traditional 4-day festival before the beginning of Ramadan, since most of the festivities take place outdoors. Hundreds gathered in the picturesque mountain village of Ribnovo for feasting, singing, dancing - and circumcision. Bulgarian Muslims circumcise their sons in infancy, and 80 baby boys lost their foreskins - with much ceremony - this year.
Read the full story at Associated Press. Thanks to Tom for the link.
Three million circumcisions.
Phase 1 of the Zambian VMCC rollout circumcised three million men between 2007 and 2020. Health Minister Jonas Chanda estimated that this prevented 26,000 new HIV infections in his speech lauching the next phase of the rollout.
To put this in perspective, while we in the West are all concerned about the COVID pandemic, in Zambia AIDS is the major killer with a death rate of about 20,000 per annum. In Zambia there have been 87,872 cases of COVID and just 2,100 deaths. (Incidentally a fatality rate of 1.36% - much lower than in the UK. So much for the NHS.)
Read the report in the Zambia Daily Mail. Thanks to regular contributor DC for the link.
He reintroduced cirumcision to the Zulu people.
King Goodwill Zwelithini, the hereditary ruler of the Zulu people, died on 12th March from complications of diabetes. He was 72 and had ruled for almost 50 years. He had no formal authority in South Africa but wielded huge influence over his people, with whom he was extremely popular. He leaves behind 6 wives and 28 children (!)
The Zulu nation had traditionally practiced circumcision but King Shaka banned it in the early 19th century - see our South Africa page. Faced with the HIV crisis King Goodwill removed the ban, but only allowed medically performed circumcisions, which were strongly promoted.
A recent paper by Christina Oetzmann von Sochaczewski (there's a name to conjure with) looks at trends in circumcision and other foreskin operations in Germany. (Other operations include dorsal slit, plasties, cutting the frenulum and separating adhesions.) The overall trend for all operations was down, though infant circumcisions (a small proportion of the total) were pretty constant and, curiously, non-circumcision operations on infants under 1 year increased substantially. Another interesting point was that circumcision was the preferred option for boys under 5 and over 15, while the conservative options were more common in boys aged 5-14. Like the US study we featured on January 28th, this paper only covers hospital operations and the authors admit that many others take place in clinic and office settings.
The paper is open access at BMC Urology. Thanks to JH and JT for sending in this one - on the same day.
what would you like cut, your hair or your penis?
Panglao Island in the Phillipines is suffering. Its main income is from tourism and COVID means that this has pretty much dried up. To provide some cheer on Valentine's Day the 47th Infantry Battalion of the Philippine Army paid the island a visit giving food and gifts to children and also offering free haircuts and circumcision to the boys. The team was able to distribute food packs and gift treats to 200 children and 40 youngsters were circumcised with the help of Dr. Estrella Lim.
Read the story at Page One. Thanks to DC for the link.
seems to be missing its target.
A February 2021 article in UNAIDS bemoans the fact that the 2020 target of 25 million circumcisions in the 15 priority African countries is not going to be met. The program started off well but is now faltering. They point out that male circumcision provides 60% protection against female-male transmission of HIV. That's as good as some of the COVID vaccines - ed.
Thanks to DC for the link.
would you like your penis enlarged at the same time?
A group of Italian urologists and plastic surgeons have developed a method of adult circumcision which takes only a few minutes longer than the standard operation and - they claim - gives a modest, but significant, increase in penis size. The idea is that after cutting off the foreskin they completely retract the shaft skin, exposing Buck's fascia (the inner penis shaft) and severing all the loose connections between the shaft and the skin. The skin is then pulled forward again and sutured in the normal way. Of the 36 patients, one apparently gained 2 cm in length but the mean was just 7 mm. 5 gained only in girth. A complication rate of 13 patients out of 36 seems a bit worrying, though all resolved spontaneously.
Slight decline - but that's not the whole story
A recent paper in the Journal of Urology looks at circumcision rates before and after 2012, when the American Academy of Pediatrics changed its position and recommended the procedure. Overall 55% of boys were circumcised, with a decrease over time though there was no significant difference before and after the AAP policy change. "The rate of neonatal circumcision varied widely by region, race and socioeconomic status" being highest among whites with private health insurance. The authors comment "Among some populations access to neonatal circumcision has become increasingly limited despite evidence of its benefits."
To put this into perspective Medicaid, the public insurance system in the US, is administered by state governments and some have decided to remove benefits for neonatal circumcision. This doesn't mean that infants in those states don't get circumcised, just that those without private insurance tend to get it done as an outpatient procedure after discharge. See our news item for 18th October 2020 (scroll down to find it).
The paper is Nationwide Circumcision Trends 2003-2016 and you can read the abstract at the Journal of Urology - access to the full text requires payment. Thanks to our regular correspondent JT for the link.
VR headsets as distraction during circumcision - for the mother!
In Turkey boys are circumcised some time after age 5. Apparently this is more stressful for the mother than the child - really? An article in the International Journal of Nursing Practice "The effect of virtual reality on mothers' anxiety during children's circumcision: ..." describes an experiment where 30 mothers were shown video on VR headsets during their sons' circumcision while 30 others were not. One one measure the 'VR mothers' showed less signs of stress, on another there was no difference. One might think that if the mothers were not going to see the procedure a sweet cup of Turkish coffee and a cake would have been better stress relievers than a video. Also, a video might have been an effective distractor for the boy.
You can read the abstract at PubMed. The full paper is behind a paywall. Thanks again to both JH and Brian Morris for sending in this item.
Comprehensive African study debunks the myth
One line peddled by opponents of the African VMCC programme is that the sense of immunity that circumcision confers will lead young men to take more risks in their sex lives. This is really extraordinarily demeaning to Africans, implying they are little better than animals. Previous studies have suggested that this was untrue, and now a substantial, prospective, study in the South African Journal of HIV Medicine: "Sexual risk compensation following voluntary medical male circumcision: Results from a prospective cohort study amongst human immunodeficiency virus-negative adult men in Botswana" by Lisa Spees and colleagues confirms that the myth is just that.
Now there is a split in the neo-Fascist DF party
A Danish task force was set up to report on guidelines for infant and child circumcisions, but the Danish Pediatric Association withdrew from it for strange reasons. Surely they should be promoting circumcision? Do they like seeing baby boys suffering from urinary tract infections? More cynically, perhaps they see more money in treating UTIs than in performing circumcisions. Now the citizen petition to ban circumcision of under-18s, first launched some years ago, has finally reached parliament. But the far-right populist DF party has split, since some members want to permit Jews to follow their religion, but not Muslims! The mainstream Social Democrat party opposed the ban, so it will not pass.
Read the whole sorry story in the Fair Observer. Thanks to DC for sending in this item.
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