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Will Mass Adult Male Circumcision Bring an End to the HIV Pandemic?
Western organizations have big, big plans for the penises of millions of African men. They are to be clipped, and in short order. In Tanzania alone there is a plan to circumcise 2.8 million men in the next five years. What those men decide to do with their newly trimmed penises, after the mobile circumcision unit is just a painful memory, will ultimately determine whether or not these campaigns are effective at reducing HIV/AIDs rates in Africa.
In response to a scientific finding that the female-to-male HIV transmission rate is as much as 76% lower for men who are circumcised, the World Health Organization is advocating for a mass adult male circumcision in Africa. Governments and NGOs have jumped onboard, including The Bill and Melinda Gates Foundation that has promised $50 million, making 650,000 circumcisions possible in Swaziland and Zambia in the next few years.
One possible problem with this plan is that people will change their sexual behavior in response to the now lower risk of having unprotected sex with multiple sexual partners. If the scale of this behavioral effect is large enough then these programs will not only be ineffective, they could actually increase the HIV transmission rate.
This is the same argument that is used to explain why access to contraceptives increased accidental pregnancy rates over the past century.
Think of this in terms of a cost benefit analysis. A man will either wear a condom, or abstain from sex altogether, if the expected cost of unprotected sex (the risk of sexually transmitted infection) exceeds the benefit of unprotected sex (the pleasure of having sex without a condom). Following circumcision, the expected cost of unprotected sex for men is lower because the probability of being infected with HIV has fallen. Presuming the benefit to sex without a condom is unchanged (which may or may not be true) lowering the expected costs should encourage more men to be willing to engage in risky sex.
The same cost benefit approach also predicts that women will also be more willing to engage in unprotected sex if women believe that men who are circumcised are less likely to have HIV.
There is an alternative approach, however, that applies a long run approach to this same argument. If, in an area where HIV/AIDs rates are very high, men and women believe that no matter how careful they are today, infection in the future is inevitable, then they will chose to reap the benefit of unprotected sex today even when the cost is high (we have talked about this problem before). This approach takes into consideration the possibility that men who are uncircumcised have a fatalistic approach to infection, leading to risky sexual behavior, and that men who are circumcised might actually decrease risky sexual behavior today because they have reason to hope that they never will become infected.
What this boils down to is a belief in the ability of circumcision to protect them from infection.
New, yet unpublished, research finds that circumcised men who believe in this protection have fewer sexual partners than do other men (circumcised or uncircumcised) and that circumcised men who do not believe in this protection have more.
Circumcised “believers” are 10 to 20 percentage points less likely to have had multiple sexual partners (post-circumcision) than were circumcised “non-believers” and, in the long run, have a much higher likelihood of using a condom.
Circumcision is voluntary, in theory, so in the real world it is likely that the majority of men who opt for the procedure will be believers. So while this study finds that, on balance, there is no effect on risky-sexual behavior in the long-run, circumcision might lead to safer sex in general.
Good news for those who believe in the power of these programs to help bring about change in some of the world’s hardest hit regions.
I do have one more comment on the paper. The authors argue that one possible explanation for why circumcised non-believers have more sexual partners is because women find the circumcised penis more “aesthetically pleasing”. Personal preferences aside (after all, they call it a “Canadian” for a reason), I have a hard time imagining how aesthetic preferences actually translate into more sexual partners. For example, since when is the answer to the question “Why did you have sex with him” ever “Because his penis was so lovely”? Maybe for repeat performances this sort of thing matters, but for first time sexual encounter I am pretty skeptical.
Mattson, Christine, Nicholas Wilson, and Wentao Xiong. (2012) “Is Sex Like Driving? Risk Compensation Associated with Male Circumcision in Kisumu, Kenya.”
The father of all giant sea bugs was recently discovered off the coast of Java.
- A new species of isopod with a resemblance to a certain Sith lord was just discovered.
- It is the first known giant isopod from the Indian Ocean.
- The finding extends the list of giant isopods even further.
Humanity knows surprisingly little about the ocean depths. An often-repeated bit of evidence for this is the fact that humanity has done a better job mapping the surface of Mars than the bottom of the sea. The creatures we find lurking in the watery abyss often surprise even the most dedicated researchers with their unique features and bizarre behavior.
A recent expedition off the coast of Java discovered a new isopod species remarkable for its size and resemblance to Darth Vader.
The ocean depths are home to many creatures that some consider to be unnatural.
According to LiveScience, the Bathynomus genus is sometimes referred to as "Darth Vader of the Seas" because the crustaceans are shaped like the character's menacing helmet. Deemed Bathynomus raksasa ("raksasa" meaning "giant" in Indonesian), this cockroach-like creature can grow to over 30 cm (12 inches). It is one of several known species of giant ocean-going isopod. Like the other members of its order, it has compound eyes, seven body segments, two pairs of antennae, and four sets of jaws.
The incredible size of this species is likely a result of deep-sea gigantism. This is the tendency for creatures that inhabit deeper parts of the ocean to be much larger than closely related species that live in shallower waters. B. raksasa appears to make its home between 950 and 1,260 meters (3,117 and 4,134 ft) below sea level.
Perhaps fittingly for a creature so creepy looking, that is the lower sections of what is commonly called The Twilight Zone, named for the lack of light available at such depths.
It isn't the only giant isopod, far from it. Other species of ocean-going isopod can get up to 50 cm long (20 inches) and also look like they came out of a nightmare. These are the unusual ones, though. Most of the time, isopods stay at much more reasonable sizes.
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During an expedition, there are some animals which you find unexpectedly, while there are others that you hope to find. One of the animal that we hoped to find was a deep sea cockroach affectionately known as Darth Vader Isopod. The staff on our expedition team could not contain their excitement when they finally saw one, holding it triumphantly in the air! #SJADES2018
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What benefit does this find have for science? And is it as evil as it looks?
The discovery of a new species is always a cause for celebration in zoology. That this is the discovery of an animal that inhabits the deeps of the sea, one of the least explored areas humans can get to, is the icing on the cake.
Helen Wong of the National University of Singapore, who co-authored the species' description, explained the importance of the discovery:
"The identification of this new species is an indication of just how little we know about the oceans. There is certainly more for us to explore in terms of biodiversity in the deep sea of our region."
The animal's visual similarity to Darth Vader is a result of its compound eyes and the curious shape of its head. However, given the location of its discovery, the bottom of the remote seas, it may be associated with all manner of horrifically evil Elder Things and Great Old Ones.
It could lead to a massive uptake in those previously hesitant.
A financial shot in the arm could be just what is needed for Americans unsure about vaccination.
On May 12, 2021, the Republican governor of Ohio, Mike DeWine, announced five US$1 million lottery prizes for those who are vaccinated. Meanwhile, in West Virginia, younger citizens are being enticed to get the shot with $100 savings bonds, and a state university in North Carolina is offering students who get vaccinated a chance to win the cost of housing. Many companies are paying vaccinated employees more money through bonuses or extra paid time off.
The push to get as many people vaccinated as possible is laudable and may well work. But leading behavioral scientists are worried that paying people to vaccinate could backfire if it makes people more skeptical of the shots. And ethicists have argued that it would be wrong, citing concerns over fairness and equity.
As a behavioral scientist and ethicist, I draw on an extensive body of research to help answer these questions. It suggests that incentives might work to save lives and, if properly structured, need not trample individual rights or be a huge expense for the government.
In the United States, incentives and disincentives are already used in health care. The U.S. system of privatized health insurance exposes patients to substantial deductibles and copays, not only to cover costs but to cut down on what could be deemed as wasteful health care – the thinking being that putting a cost to an emergency room visit, for example, might deter those who aren't really in need of that level of care.
In practice, this means patients are encouraged to decline both emergency and more routine care, since both are exposed to costs.
Paying for health behaviors
In the case of COVID-19, the vaccines are already free to consumers, which has undoubtedly encouraged people to be immunized. Studies have shown that reducing out-of-pocket costs can improve adherence to life-sustaining drugs, whether to prevent heart attacks or to manage diabetes.
A payment to take a drug goes one step further than simply reducing costs. And if properly designed, such incentives can change health behaviors.
And for vaccination in particular, payments have been successful for human papillomavirus (HPV) in England; hepatitis B in the United States and the United Kingdom; and tetanus toxoid in Nigeria. The effects can be substantial: For example, for one group in the HPV study, the vaccination rate more than doubled with an incentive.
For COVID-19, there are no field studies to date, but several survey experiments, including one my group conducted with 1,000 Americans, find that incentives are likely to work. In our case, the incentive of a tax break was enough to encourage those hesitant about vaccinations to say they would take the shot.
Even if incentives will save lives by increasing vaccinations, there are still other ethical considerations. A key concern is protecting the autonomous choices of people to decide what they put into their own bodies. This may be especially important for the COVID-19 vaccines, which – although authorized as likely safe and effective – are not yet fully approved by the Food and Drug Administration.
But already people are often paid to participate in clinical trials for drugs that have not yet been approved by the FDA. Ethicists have worried that such payments may be “coercive" if the money is so attractive as to override a person's free choices or make them worse off overall.
One can quibble about whether the term “coercion" applies to offers of payment. But even if offers were coercive, payments may still be reasonable to save lives in a pandemic if they succeed in greater levels of immunization.
During the smallpox epidemic nearly 100 years ago, the U.S. Supreme Court upheld the power of states to mandate vaccines. Compared with mandating vaccination, the incentives to encourage vaccines seem innocuous.
Exploitation and paternalism
Yet some still worry. Bioethicists Emily Largent and Franklin Miller wrote in a recent paper that a payment might “unfairly" exploit “those U.S. residents who have lost jobs … or slipped into poverty during the pandemic," which could leave them feeling as if they have “no choice but to be vaccinated for cash." Others have noted that vaccine hesitancy is higher in nonwhite communities, where incomes tend to be lower, as is trust in the medical establishment.
Ethicists and policymakers should indeed focus on the poorest members of our community and seek to minimize racial disparities in both health outcomes and wealth. But there is no evidence that offering money is actually detrimental to such populations. Receiving money is a good thing. To suggest that we have to protect adults by denying them offers of money may come across as paternalism.
Some ethicists also argue that the money is better spent elsewhere to increase participation. States could spend the money making sure vaccines are convenient to everyone, for example, by bringing them to community events and churches. Money could also support various efforts to fight misinformation and communicate the importance of getting the shot.
The cost of incentives
Financial incentives could be expensive as a policy solution. As in Ohio, lottery drawings are one way to cap the overall cost of incentives while giving millions of people an additional reason to get their shot.
The tax code could also allow for a no-cost incentive for vaccination. Tax deductions and credits are often designed to encourage behaviors, such as savings or home ownership. Some states now have big budget surpluses and are considering tax relief measures. If a state announced now that such payments would be conditional on being vaccinated, then each person declining the shot would save the government money.
Ultimately, a well-designed vaccination incentive can help save lives and need not keep the ethicists up at night.
Geologists discover a rhythm to major geologic events.
- It appears that Earth has a geologic "pulse," with clusters of major events occurring every 27.5 million years.
- Working with the most accurate dating methods available, the authors of the study constructed a new history of the last 260 million years.
- Exactly why these cycles occur remains unknown, but there are some interesting theories.
Our hearts beat at a resting rate of 60 to 100 beats per minute. Lots of other things pulse, too. The colors we see and the pitches we hear, for example, are due to the different wave frequencies ("pulses") of light and sound waves.
Now, a study in the journal Geoscience Frontiers finds that Earth itself has a pulse, with one "beat" every 27.5 million years. That's the rate at which major geological events have been occurring as far back as geologists can tell.
A planetary calendar has 10 dates in red
Credit: Jagoush / Adobe Stock
According to lead author and geologist Michael Rampino of New York University's Department of Biology, "Many geologists believe that geological events are random over time. But our study provides statistical evidence for a common cycle, suggesting that these geologic events are correlated and not random."
The new study is not the first time that there's been a suggestion of a planetary geologic cycle, but it's only with recent refinements in radioisotopic dating techniques that there's evidence supporting the theory. The authors of the study collected the latest, best dating for 89 known geologic events over the last 260 million years:
- 29 sea level fluctuations
- 12 marine extinctions
- 9 land-based extinctions
- 10 periods of low ocean oxygenation
- 13 gigantic flood basalt volcanic eruptions
- 8 changes in the rate of seafloor spread
- 8 times there were global pulsations in interplate magmatism
The dates provided the scientists a new timetable of Earth's geologic history.
Tick, tick, boom
Credit: New York University
Putting all the events together, the scientists performed a series of statistical analyses that revealed that events tend to cluster around 10 different dates, with peak activity occurring every 27.5 million years. Between the ten busy periods, the number of events dropped sharply, approaching zero.
Perhaps the most fascinating question that remains unanswered for now is exactly why this is happening. The authors of the study suggest two possibilities:
"The correlations and cyclicity seen in the geologic episodes may be entirely a function of global internal Earth dynamics affecting global tectonics and climate, but similar cycles in the Earth's orbit in the Solar System and in the Galaxy might be pacing these events. Whatever the origins of these cyclical episodes, their occurrences support the case for a largely periodic, coordinated, and intermittently catastrophic geologic record, which is quite different from the views held by most geologists."
Assuming the researchers' calculations are at least roughly correct — the authors note that different statistical formulas may result in further refinement of their conclusions — there's no need to worry that we're about to be thumped by another planetary heartbeat. The last occurred some seven million years ago, meaning the next won't happen for about another 20 million years.