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The Pediatric Forum
Comparative Effectiveness Research
February 2013

Male Circumcision Cost-effective Articles Ignore Methodological Problems and Ethical Concerns

Author Affiliations

Author Affiliation: Centre for Neuroendocrinology, University of Otago, Dunedin, New Zealand.

JAMA Pediatr. 2013;167(2):198-200. doi:10.1001/jamapediatrics.2013.832

I read the article by Kacker et al1 and the accompanying editorial2 with dismay. The authors have attempted to apply the results of randomized controlled trials of voluntary adult male circumcision (MC) and human immunodeficiency virus, herpes simplex virus,and human papillomavirus incidence in Africa to a cost-effectiveness analysis of neonatal MC in the United States. In applying the risk reduction ratios from these trials, Kacker et al have overstepped basic issues with regard to the interpretation of medical literature, including substantial assumptions regarding the external validity of these trials and their applicability to the United States. If the authors were truly interested in reducing the burden of diseases assessed, it would have been much more helpful to consider the comparative cost-effectiveness of other interventions (such as vaccination against human papillomavirus); the absence of such comparisons or even their discussion suggests the authors' interests lie not in the prevention of the diseases assessed, but in providing justification for a cultural practice in decline.

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