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(2) MALE
INFERTILITY LINKED TO TESTICULAR
CANCER
(3) INTERNATIONAL
RESEARCH OFTEN UNETHICAL
AND IRRELEVANT
(4) THE
DIGITAL DIVIDE: CAN THE INTERNET
IMPROVE THE
HEALTH OF DEVELOPING
(Towards evidence based circumcision
of English boys:
survey of trends in practice)
http://bmj.com/cgi/content/full/321/7264/792
Too many English boys, especially those
under the age of 5,
are being needlessly circumcised reveals
a study in this
week's BMJ.
Rickwood and colleagues analysed only medically
indicated
circumcision rates for the Mersey region
and its health
districts for 1975 to 1997, and for England
between 1984
and 1986, and between 1990 and 1998. Circumcisions
are
usually done for phimosis ± a condition
in which the foreskin
cannot be pulled back over the glans of
the penis, leading to
scarring and potential blockage of the
urethra. At birth, the
foreskin is almost always non-retractable,
but in most boys it
becomes movable as they get older.
The results of the analysis showed that
similar rates of
circumcision were being carried out in
the Mersey region and
England as a whole. Since the mid 1980s
the trend has been
for fewer circumcisions among boys up
to the age of 4,
smaller decreases among 5 to 9 year olds,
and static rates
among 10 to 14 year olds.
Around 12,200 circumcisions are carried
out for medical
reasons every year, and if these rates
remain the same, almost
4 per cent of English boys would be circumcised
by the time
they are 15, say the authors; the equivalent
proportion in
Liverpool would be 1.5 per cent. But,
say the authors, true
phimosis affects only just over half a
per cent of all boys, is
rarely found before the age of 5, and
peaks at around the age
of 11. While the decreases in the rates
are encouraging, they
say, too many unnecessary procedures are
still being done.
The cost of needless surgery also takes
its toll on the NHS,
point out the authors. Halving the circumcision
rate, which is
perfectly feasible given the evidence,
would save £3 million,
they say.
Contact:
Mr Anthony Rickwood, Department of Urology,
Alder Hey
Children's Hospital, Liverpool.
(2) MALE INFERTILITY
LINKED TO TESTICULAR
CANCER
(Risk of testicular cancer in men
with abnormal semen
characteristics: cohort study)
http://bmj.com/cgi/content/full/321/7264/789
(Editorial: Testicular cancer and
infertility)
http://bmj.com/cgi/content/full/321/7264/781
Men who have infertility problems have
an increased risk of
developing testicular cancer, finds a
study in this week's
BMJ. Sperm quality has possibly been falling
over the past
few decades while the rates of testicular
cancer have been
rising, and it is thought that the two
could be linked.
Jacobsen and colleagues analysed the sperm
quality of semen
samples taken from over 32,000 men in
Copenhagen
between 1963 and 1995. Sperm count, motility,
and shape
were assessed. Cancer rates were studied
and compared
with those expected for the whole population
of Denmark to
determine levels of risk.
There was a strong association between
men with infertility
problems and the subsequent risk of testicular
cancer. Men in
couples with fertility problems were over
1.5 times as likely
to develop testicular cancer as other
men. The risk remained
constant over time, suggesting that sperm
abnormalities had
been present many years before the diagnosis
of cancer, say
the authors.
Although no one feature was specifically
linked to increased
risk of testicular cancer, men with poor
semen quality overall
were between twice and three times as
likely to develop
testicular cancer. Men with low sperm
counts who had
fathered children in the past had a lower
risk of developing
testicular cancer than men who had been
unable to father
children at all. Poor sperm quality was
also associated with
an increased risk of cancers of the abdominal
cavity
(peritoneum) and digestive organs.
The authors conclude that there may be
common risk factors
for poor sperm quality and testicular
cancer, and suggest that
these factors may be present in the developing
male fetus.
Contact:
Rune Jacobsen, Department of Epidemiology,
Institute of
Public Health, University of Copenhagen,
Denmark.
Email: R.jacobsen@pubhealth.ku.dk
(3) INTERNATIONAL
RESEARCH OFTEN UNETHICAL
AND IRRELEVANT
(A new look at international research
ethics)
http://bmj.com/cgi/content/full/321/7264/824
International research is often unethical
and irrelevant to the
needs of developing countries, argues
Professor Solomon
Benatar of the University of Cape Town's
Bioethics Centre,
in this week's BMJ. And it fails to address
the huge inequities
in global health.
Too much reliance is placed on international
declarations to
define what is ethical, all of which are
open to interpretation
contends professor Benatar. For example,
it may not be right
to use placebos in trials. The "standard
of care" for
international research has not been adequately
defined and no
description is offered that goes beyond
mere drug therapy.
The standard of medical practice and research
in the United
States, where half of all global health
expenditure is spent on
just 5 per cent of the world's population
every year, cannot
be the standard for most other countries.
And concerns about abuses of research ethics
have failed to
be extended to deprivation as a result
of poverty and other
threats to freedom, he writes. And the
fact remains that 90
per cent of all medical research is undertaken
on diseases that
account for just 10 per cent of global
ill health.
"Research ethics must be more deeply rooted
in the context
of global health," writes professor Benatar.
"It must
forthrightly address the social, political,
and economic forces
that widen global inequities in health,
and it must ultimately be
concerned with reducing [these]."
Contact:
Professor Solomon Benatar, Department of
Medicine and
Bioethics Centre, University of Cape Town,
South Africa.
Email: solly.benatar@utoronto.ca
(4) THE DIGITAL
DIVIDE: CAN THE INTERNET
IMPROVE THE HEALTH OF DEVELOPING
NATIONS?
(Disseminating health information
in developing countries: the
role of the internet)
http://bmj.com/cgi/content/full/321/7264/797
Despite the internet being hailed as one
of the potential
solutions to improving the health of populations
in developing
countries, the current digital divide
is far more dramatic than
any other inequity in health or income,
according to a paper in
this week's BMJ.
There are currently more internet hosts
in New York than in
the entire African continent; more hosts
in Finland than in
Latin America and the Caribbean; and in
India, many villages
still lack a working telephone, reports
Tessa Tan-Torres
Edejer of the World Health Organisation.
She argues that,
although there have been some pioneering
efforts to increase
access to health information in developing
countries, the ratio
of people who have access to the internet
to those who do
not is currently 1:5000 in Africa, compared
to 1:6 in the
United States or Europe.
Efforts are being made to bring technologies
to developing
countries, says the author. Centres that
provide access to
on-line health information in remote areas
are being
established, and credible organisations
are developing
valuable databases. Issues such as inconsistency
of health
information and limited access to research
from developing
countries are also being addressed.
The greatest challenge is getting people
to use and interact
with the technology, says the author.
Once this is achieved,
she concludes: " the internet can provide
a mechanism for
users to become active partners in the
dissemination of
information and in policymaking."
Contact:
Tessa Tan-Torres Edejer, Global Programme
on Evidence
for Health Policy, World Health Organisation,
Geneva,
Switzerland
Email: tantorrest@who.ch
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