Sunday, May 20, 2012

Could Dr Robert Spitzer Inspire a New Generation of Scientists?

Many will have read about Dr Robert Spitzer's retraction of his 2001 study which claimed that 'reparative therapy' is capable of changing sexual orientation from homosexual to heterosexual. For a while, he was satisfied with data describing how people felt the reparative therapy had changed their sexual orientation, although he eventually accepted that this was a weak thesis. But those opposed to homosexuality at all costs latched on to Spitzer's findings to support their prejudices.

Later, after arguing that people's own descriptions of how their sexual orientation has changed were credible, Spitzer concluded that there was no way of determining their validity. In addition to retracting the findings of the study he also apologised to the gay community, particularly to those who underwent the therapy. All credit to Dr Spitzer for making the retraction and for apologising; this is a significant breakthrough in the way science is presented to the public.

The issue of latching on to findings that support prejudices and ignoring those that don't is important when it comes to HIV related policies in high prevalence countries. People's claims that they haven't had sex, that they haven't had unprotected sex or that they haven't had sex with anyone other than their HIV negative partner are often dismissed if the people are found to be HIV positive. But if people claim to be convinced by various HIV 'interventions' of the finger-wagging variety (ABC, Abstain, Be faithful, use a Condom, etc), they are believed. Enormous amounts of money have been spent on interventions of this sort, ostensibly supported by such claims.

Now that mass male circumcision is being aggressively (some might say pathologically) promoted for both adults and children, there is 'research' claiming that men who have been circumcised are less likely to engage in 'unsafe' sex and even that they and their partners find sex more pleasurable. Naturally this research is believed, even though there is no way of testing the validity of people's responses or of judging their responses to more credible than responses that do not support any popular prejudices.

Why is it considered so shameful for a scientist to change their mind, to admit they have made a mistake or to reanalyze something? One might expect that scientists tasked with figuring out how HIV is transmitted and finding ways of reducing transmission would be rewarded for contributing to either or both of these results. But most HIV research concentrates on sexually transmitted HIV, even though non-sexual transmission has been acknowledged since early on in the epidemic. And most interventions concentrate on sexually transmitted HIV, despite there being no clear idea of the relative contribution of sexual and non-sexual modes of infection.

Indeed, the much vaunted circumcision trials do not make it clear how many participants were infected sexually and how many were infected non-sexually, perhaps even as a result of taking part in the trial. This undermines the research itself because circumcision may be even more effective than claimed in reducing sexual transmission. But these matters are not analyzed in the published papers.

Those currently promoting male circumcision also found and published evidence that certain hygiene practices can give higher levels of protection against HIV transmission than circumcision. But there is probably less than one million dollars behind research into penile hygiene, in contrast to the tens of millions behind circumcision research or the hundreds of millions earmarked for circumcision programs. Reducing HIV transmission just doesn't seem to be driving the decisions about which data to give the most attention to.

Perhaps those behind vast circumcision programs are in quite a different position from Dr Spitzer. It's hard to imagine how their funders would react if the researchers said publicly that there is evidence that a lot of harm may result from their programs and that there are far cheaper, more effective and safer ways of reducing HIV transmission. While the notion of 'reparative' therapy is bizarre, it's easy to see why it was embraced by bigots. But what kind of attitudes could lie behind mass male circumcision programs? And how should these attitudes best be addressed before the programs do any more damage?

[For more about non-sexual HIV transmission and injectable Depo Provera, see the Don't Get Stuck With HIV site.]



Joseph said...

"Now that mass male circumcision is being aggressively... promoted for both adults and children, there is 'research' claiming that men who have been circumcised are less likely to engage in 'unsafe' sex and even that they and their partners find sex more pleasurable."

All ex-posto-facto "research" that, again, doesn't correlate with reality, and has nothing to do with HIV prevention.

More important than whether or not circumcised men engage in "unsafe sex," (actually, other studies show that circumcised men are more likely to engage in anal sex, oral sex, because they are desensitized and need other forms of stimulation) more important than whether or not their partners find sex "more pleasurable," (research actually shows that even women in circumcising cultures preferred an intact partner), the question all circumcision "researchers" seem to want to circumvent is, DOES CIRCUMCISION PREVENT HIV?

This new "research" is nothing more than an attempt to sweep people past the "evidence," or rather, lack thereof.

It must be said again and again; the famous "trials" in Africa are nothing more than carefully picked statistics which have been grossly exaggerated, and which do not correlate with the real world (IE, the US vs. Europe, Japan, HIV realities in Malaysia, the Philippines, Bangladesh etc. where circumcision is near-universal, etc...).

That circumcision "prevents HIV transmission" is an opinion based purely on causation hypothesis.

To date, circumcision "researchers" cannot demonstrably prove that the presence of the foreskin "facilitates" the transmission of HIV, and that circumcision "reduces" it.

Instead, the ineffectiveness of keratinization, and the efficiency of Langerhans cells destroying HIV can be demonstrably visualized.

The "mass circumcision campaigns" are based purely on the "opinion" of a handful of dedicated circumcision enthusiast who care more about vindicating a long-criticized cultural practice than they do about actual HIV transmission. Investigate "researchers" like Wawer, Moses, Halperin etc. and one would realize that a great deal of their life's work is based purely on connecting HIV with circumcision, which they have as of yet to successfully do.

Far from trying to discover an innovative way to prevent HIV, they've been hell-bent on setting back medical science 6,000 years.

When will these "researchers" be dismissed as the quacks they are?

They are an impertinent disservice in the fight against HIV.

Simon said...

Thank you Joseph, I think we agree that these mass male circumcision programs are premature and that their motivation appears to be based on opinion rather than scientific data.

Anonymous said...

HIV -ve dude who's lost 6 wives to AIDS

Your thoughts?

Simon said...

Thank you, yes, the article did catch my eye! It's unusual to hear a public expression of the possibility that HIV can be difficult to transmit through heterosexual sex. However, it's not definite that all his former wives died of AIDS. A friend has also pointed out that those who did die of AIDS were probably HIV positive when the man married them because they died a few years later.

But there must be a lot of confused people in Uganda; people in discordant relationships who have no idea how their partner was infected or why they don't get infected; circumcised men who become infected, even men who had the operation specifically to reduce the risk of being infected with HIV, etc.