A group of Chinese authors studying the Shang Ring, “a device that allows professionals to perform hundreds rather than tens of” circumcisions in a day, as had to retract the paper after editors apparently figured out they had changed some dates in the paper so it wouldn’t look as though they were trying to publish it twice. Or maybe they just changed the dates for some other reason, while publishing it twice anyway — it’s not clear.
Here’s the Journal of Urology notice for “A Randomized Clinical Study of Circumcision with a Ring Device Versus Conventional Circumcision,” by Cheng Yuea and colleagues from the Medical College of Ningbo University, the Traditional Chinese Medicine Hospital, and Taizhou First People’s Hospital:
It has come to the attention of the editors that the data in this article were 1) published previously in the Chinese Journal of Urology (32: 333–335, 2011), which the authors failed to acknowledge, and 2) that the data had been manipulated relative to changing the dates of the current study. When the authors were asked to address the fact that the material submitted to The Journal of Urology had been previously published, despite their signatures on the form indicating that this material was original and not previously published elsewhere, and the discrepancy with regard to the dates of the study, their response did not reconcile the omission and inconsistencies that were raised, therefore questioning the validity of the current study. Therefore, the editors of The Journal of Urology wish to retract this article.
All of that suggests that this sentence from the original study is, well, a bit of a cock and bull story:
To our knowledge no such study has been done previously.
So what exactly is “circumcision with a ring device?” We’ll let bioethicist Stuart Rennie, of the University of North Carolina-Chapel Hill, handle this sensitive and delicate matter for us. From his blog:
The New York Times has an article about new methods to speed the process of circumcision, complete with pictures of what to the untrained eye look (predictably?) like cock rings of a fairly utilitarian sort. The most promising of these devices seems to be the PrePex, which basically involves putting a ring around your Johnson, and cutting off blood circulation to the foreskin, until the latter comes off ‘like a fingernail’ as one proponent so sensitively put it. Apparently the clinical trials on male circumcision and HIV gave birth to a growing industry in foreskin removing clamps, from China’s somewhat sinister sounding Shang Ring to the exoticism of the Turkish Ali’s Klamp, to the device that terrorized many a South African penis a few short years ago, the infamous Malaysian Tara KLamp. That is the new story: which plastic gadget most cost-effectively whips off the African foreskin?
Leaving aside the notion of cock rings of a fairly non-utilitarian sort, we think you have the picture now.
We’ve asked the corresponding author for more details about how this happened, and will update with anything we learn.
Notwithstanding this journal’s requirements that trial registration info be provided, I wonder the authors did so and if the editors verified this before accepting the paper. According to clinicaltrials.gov, the only registered Shang ring study were in Zambia http://clinicaltrials.gov/ct2/results?term=circumcision+AND+ring&recr=&rslt=&type=&cond=&intr=&outc=&spons=&lead=&id=&state1=&cntry1=&state2=&cntry2=&state3=&cntry3=&locn=&gndr=&rcv_s=&rcv_e=&lup_s=&lup_e= and the only Chinese circumcision study is in Nanjing http://clinicaltrials.gov/ct2/show/NCT01477593?term=circumcision+AND+China&rank=2
“new methods to SPEED the process of circumcision” – mine sweeping and circumcision are two tasks that should not be rushed.
I can honestly say from personal experience that the performance of a circumcision should NOT be “rushed” or hurried, nor done while distracted or intoxicated, and the tools should be carefully fitted to the member. In addition, an injection of perhaps 1/2 to 1cc of 1% lidocaine WITHOUT epinephrine at the base of the member will allow the patient complete relief of discomfort for the duration of the procedure (usually they fall asleep)… or you could just pop one of those plastic jobs on and don’t forget to wash your hands before and after.
Just a tip after doing about a thousand of those procedures.
It’s not supposed to be funny. I have always been in favor of newborn circumcision despite the naysayers. The difference in incidence of penile cancer (and cervical cancer) (usually due to HPV subtype) alone justifies the procedure; resistance to HIV is a bonus factor.
On another point closer to your blog’s purpose: it seems the Chinese have been doing a lot of deceptive things in journals and elsewhere for many years, starting with the surgical procedure demonstrated to Western scientists, supposedly done with only acupuncture anesthesia (the patient was also getting fentanyl IV.) I think, from what I’ve seen, that the Chinese are highly susceptible to fraud due to the way their universities are organized. Caveat emptor.
I suspect this may be the tip of the iceberg (no pun intended).
Over the last 10-15 years the medical literature has been flooded with papers favourable to circumcision which, for 150 years or more has been a treatment looking for an indication. here is evidence of a small group of procircumcision authors in contact with each other to flood the literature with material favourable to circumcision. See for example: http://circleaks.org/index.php?title=File:MCIRC_-_Msg_16.pdf
There is a low level misconduct in much of the recent literature on circumcision in so far as that the reference citations fail basic fact checking. This is so common it is difficult to know where to start. Much of this material should be retracted because of misrepresentation of the references or undisclosed interests by the authors.
It is also of interest that the big 3 circumcision female to male HIV trials were terminated early for benefit (which always overestimates treatment effects) and have no transparency as to the data or the constitution of the data monitoring committeed. One contact who requested the study data told me privately “they are playing their data very close to their chest”.
Likewise the Wawer study into the effect of circumcision on male to female transmission was “terminated early for futility” before increased male to female transmission by circumcision became significant.
Editors would be advised to require full access to the data for any procircumcision papers they receive and to scrutinise critically any they have published. T
In response to “puzzled monkey”, at least 99.9% of men will never get penis cancer whether circumcised or not. It denies a child’s tright to autonomy if they are circumcised without the need to treat disease before they are old enought and mature enough to give or withhold consent in their own right denies them the right to autonomy.
Also in response to “puzzled monkey” – wouldn’t it be less invasive to give boys the HPV vaccine? And even if some of them do go on to develop penile cancer, at least they’ve had the use of their foreskin in the meantime.