Advocating the benefits of male circumcision: are doctors well informed?

Madhivanan and Krupp rightly point out the health benefits of male circumcision, and this continues to get substantiated through newer reported studies (1, 2, 3). The authors conclude that given the reluctance of the government and health authorities to take up male circumcision as a public health prevention strategy, the onus should be on physicians to explain to their patients the usefulness and risks/benefits of the procedure according to current medical knowledge so that patients can make informed choices.

While I agree with this formulation, there are a couple of relevant concerns. One is the fact that this would probably be useful for middle class and upper class patients who have the resources to undergo the procedure in the absence of provision in the public sector (which most poor patients approach for surgical procedures). Though it is true that male circumcision does not cost a lot to perform, it could still be a significant cost for those who are economically disadvantaged.

The second issue is a question about the knowledge of recent evidence about benefits of male circumcision among physicians in India. It is doubtful if most Indian physicians know about it. Medical textbooks are often many years out of date on current medical progress. There is no established system in India for sharing medical updates. Continuing medical education courses and conferences do not reach a large number of physicians and in any case these are often dominated and supported by pharmaceutical promotions and the pharmaceutical industry (other than perhaps medical device companies) has nothing to gain by promoting the procedure. Medical associations are a possibility, but these have limited memberships.

Information of significance to patients keeps emerging on a regular basis. For example, recent published research has shown that advanced paternal age is associated with neuro-developmental disorders, dyslexia and reduced intelligence in offspring; that extra vitamin E ingestion has no benefit, and could even be harmful; that consistent use of statins is associated with a lower risk for all-cause mortality among patients with and without coronary heart disease (4, 5, 6). Most physicians remain unaware of these kinds of recent advances.

We need to devise better systems of regularly updating the medical knowledge of physicians in India to ensure that they can provide patients with information of importance to them, like the utility of male circumcision, thus acting in their patients’ best interests.