Do I trust The World Health Organisation?

At present we have the exciting H1N1 Swine Flu "am I going to get it or not?" times. And the WHO has helpfully altered some conditions to allow it to be dreadfully sweet and proclaim it to be a pandemic.

According to Richard Seah, the WHO spells out three conditions that must be met before a disease will be declared a pandemic:

• There must be a disease new to a population - or at least a disease that had not surfaced for a long time.
• This disease must be caused by disease-causing agents that infect humans, causing serious illness.
• The agents must spread easily and sustainably among humans.

But, prior to 11 June 2009, there were two other conditions that had to be met:

• There must be a high morbidity
• There must be a high mortality rate.

Patently neither of those is true, certainly not today. Which makes me wonder why the WHO changed its definition. Naturally they will present compelling reasons which stand up to mild scrutiny, but I find I mistrust them. Something else is going on. And that something else might be political or commercial.

After all, governments could be using a mild flu strain to test pandemic response processes, and commercial organisations will make a huge profit out of the public panic associated with any word ending in the letters 'd e m i c'.

The WHO is not immune to marketing things that suit it, either. And that is a further reason why I find it hard to trust. If you want an example, just look at male circumcision.

Male circumcision has a long history and religious tradition, in the Jews going back to Abraham, in other cultures going bak similar aeons. I've never been sure why religion and tradition wishes to mutilate a perfectly functional anatomical part, and why the penis is chosen for a tribal marking, but there it is.

And there it was until the Victorians decided that masturbation had to be discouraged at all costs, and that circumcision without anaesthetic was a suitable punishment for a boy caught masturbating. Masturbation, you see, was thought to weaken the body. And it's fun. And fun may not be had, not if the Victorian prurient puritan idiots had anything to do with it.

There is a load of stuff on the history of male circumcision, and you can find it very easily. That's not where this article is headed. Nor is it headed towards the two rampant circumcisers in the USA, Kellog, of the cereals and Graham of the cookies, despite the fact that they caused the almost universal circumcision of infant boys in the USA, a nasty practice that is, thankfully, dying out.



The video does not make happy viewing. It makes such unhappy viewing that you may need a youtube account in order to view it. It's horrible.

The operation is profitable, free from trauma for the surgeon, and also provides a ready supply of tissue for the cosmetics industry for facial rejuvenation creams for the ladies. Excusers and proponents also cite its use in growing skin tissue for burn victims.

Permit me to feel somewhat sick here. But look all of this stuff up for yourself.

So, when I see that the WHO recommends circumcision as a universal prophylactic against HIV infection, I start to wonder who has paid for this research and who benefits. Let us be clear here.

The only effective method for prevention of HIV transmission is to wear a condom.

There is a discussion, a technical discussion, of the part played by circumcision in reducing (if it does) HIV transmission which is worth reading.

de Vincenzi I, Mertens T. Male circumcision: a role in HIV prevention? AIDS 1994;8(2):153-60 is the paper, and it states in its conclusion:

The potential public-health benefits of male circumcision have been greatly discussed in the past 50 years, often in a passionate and emotional manner. However, relatively few studies have been carried out and those that have, present conflicting results. The major criticism of most of the studies preformed to date is the lack of attention given to potential confounding factors, which could be related to both circumcision status and risk of sexually transmitted infections, such as sexual behaviour or differences in hygienic practices, or differential use of specific health facilities. As Poland [48] noted, "We must remember that circumcision is not performed randomly."

Therefore, further efforts are still required to quantify the relative risk associated with the lack of male circumcision. Some of this can be achieved by using observational designs which better address the limitations discussed above. Laboratory and primate research might also continue to provide useful information.

As the safety, expected benefits, feasibility and acceptability of mass circumcision are all questionable, neither public-health interventions nor intervention studies appear to be defensible options before there is stronger evidence from observational studies in different settings that show lack of male circumcision may be a genuinely independent risk factor for the transmission of HIV.

Studies released even after this paper show very little difference from those criticised within it, which brings me back to my distrust of the WHO.  The apparent bias that they show seems to be widespread. It's widespread enough to have become fodder for conspiracy theorists. Good luck with that.

But it seems entirely susceptible to putting the needs of pressure groups first. And I wonder why that is.

I don't subscribe to conspiracy theory. I'm an Occam's Razor man. I see the answer in the dollar. If there is a buck to be made then folk will seek to ensure that they are the ones making the buck.

But, as a tailpiece here, mothers, fathers, please stop routine infant circumcision. It has no medical benefits. It's a practice that should be allowed to die out.  Now don't give me a load of religious stuff about it. I haven't attacked your religion. If it's a religious matter then this article was not for you. Take that and discuss it somewhere else. I respect but dislike your tradition. But this article as not about that at all. This article is about marketing of things to the gullible and the vulnerable.