The Circumcision Discussion

TiffyRN, BSN, PhD · Dec 21, 2006

I just didn't know where to go with it when I found out there was a secret circumcision industry sneaking around stealing foreskins to put in skin cream.

RN mom of 2 · Dec 21, 2006

i just didn't know where to go with it when i found out there was a secret circumcision industry sneaking around stealing foreskins to put in skin cream.

it's not a secret. they are not stealing them, but rather, purchasing them.

i wish i could say i compiled all this, but someone already did all the hard work!

http://www.organogenesis.com/products/testskin/physical.asp - used for testing cosmetics, very nice for animals, not so hot for little boys.

http://www.pharma.us.novartis.com/product/...df/apligraf.pdf

there are at least 3 types of cell cultures derived from foreskin. keratinocytes, melanocytes, and fibroblasts.

there are 5590 hits for "melanocyte, foreskin" on google.

http://www.google.co.uk/search?biw=919&hl=...g=google+search

http://www.cambrex.com/content/bioscience/...oid=nhem&nock=y

at this website you can buy foreskin-derived melanocytes.

http://www.cambrex.com/content/documents/t..._poster_web.pdf

that same website's melanocyte info sheet. a quote:

"nhem [melanocytes] are isolated neonatal foreskin tissue resulting from routine circumcision..."

http://cellapplications.com/hem.htm

another site's info on melanocytes. quote:

"human epidermal melanocytes (hem) are primary cells isolated from normal human neonatal foreskin."

http://www.freepatentsonline.com/5589161.html

page on melanocyte preparation.

http://www.cascadebio.com/

more melanocyte foreskins for sale here.

about fibroblasts.

a google search produces 21,300 hits for fibroblast foreskin.

http://www.ncbi.nlm.nih.gov/entrez/query.f...4&dopt=abstract

"fibroblast cultures derived from neonatal foreskin explants have been an important model for understanding the basic mechanisms of fibroblast function and activity. neonatal foreskin has been routinely usedfor establishing such fibroblast cultures in vitro."

"we found that outgrowth and propagation of viable fibroblasts in vitro occurred with foreskin samples obtained within 24 days after surgical harvesting."

harvesting???

watch for the words keratinocyte, melanocyte, fibroblast. if mentioned, ask from what the cells are derived.

to find the products on the cascade biologics site, you can do a search for "foreskin" and the products will come up. or you can follow the menus across from "products" on the menu bar. it's a bit awkward.

http://www.cascadebio.com/

6xt25 flasks of proliferating cells are $495 !!

http://www.cascadebio.com/index.cfm?fuseac...content&cid=429

(that's keratinocytes)

http://www.cascadebio.com/index.cfm?fuseac...content&cid=496

(melanocytes.)

http://www.cascadebio.com/index.cfm?fuseac...content&cid=437

(neonatal endothelial cells)

there are more types of cells for sale, but i'm sure you get the picture.

cosmetics:

according to this article: http://www.oprah.com/health/beauty/health_...reatments.jhtml

tns recovery complex is engineered from human foreskins--"dr. wexler also mentioned a new product that boosts collagen production and can rejuvenate skin called tns recovery complex. tns is comprised from six natural human growth factors found in normal healthy skin. dr. wexler told us the factors are engineered from human foreskin!"

according to this site, which is the main site of the tns complex:

http://www.skinmedica.com/smproducts/cosme...very_complex%ae

the priniciple ingredient is nouricel-md

and according to this site: http://www.hirshdermatology.com/nouricelmd.htm

" nouricel-md is a unique product that consists of a concentration of naturally occuring human growth factors derived from bio-engineered tissue cultures. these growth factors help to promote collagen production, new blood vessel growth,thickening of the epidermis, and to decrease inflammation. "

http://or-live.mediwire.com/main/default.a...articleid=24844

"the product (tns recovery complex with nouricel-md) contains a concentrated formulation of the nutrient solution

derived from manufacture of bioengineered human tissue using neonatal fibroblasts. "

"tns recovery complex with nouricel-md is a product of skinmedica, carlsbad, calif. the enriched tissue nutrient solution used in its manufacture is obtained from advanced tissue sciences. dr. fitzpatrick is founder and chairman of the board of skinmedica."

looks like skinmedica took over ats in 2003.

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other sites of interest (gleaned from john hopkins center altweb http://altweb.jhsph.edu/ it's a huge site, and i don't have time to search it all, but there is a huge amount of work going on using neonatal foreskin in in order to save animals from being used in testing):

http://www.invitroderm.com/

"alternatives to skin irritation/corrosion testing in animals"

go to "search abstracts" http://webglimpse.net/cgi-bin/webglimpse.cgi?id=36

and put in "neonatal foreskin"

5 results, all research papers using cells derived from neonatal foreskins.

http://invitroderm.com/abstracts/slivka2.html

http://invitroderm.com/abstracts/cannon.html

http://invitroderm.com/abstracts/cannon2.html

"a model of the human epidermis, epidermô , cultured from neonatal foreskin-derived normal human epidermal keratinocytes (nhek) was introduced by mattek corporation in april 1993. using highly controlled tissue culture techniques, weekly batches of epiderm are produced and shipped domestically and internationally for dermal irritancy testing, percutaneous absorption studies, and basic skin research, amongst other uses."

http://invitroderm.com/abstracts/slivka.html

http://invitroderm.com/abstracts/lake.html

"the u.s. department of transportation now requires companies to assess the skin corrosivity of raw materials and products in order to insure their safe transport. the united nations has issued guidelines and assigned packaging groups to materials based on how quickly corrosion of skin occurs in animal studies: i: less than 3 minutes, ii: 3 minutes to 1 hour, iii: 1 hour to 4 hours, and non-corrosive: greater than 4 hours. it was anticipated that epidermô , a model of the epidermis cultured from neonatal foreskin-derived normal human epidermal keratinocytes would be useful in predicting skin corrosivity since the barrier properties of epiderm have been shown to closely approximate those of normal skin."

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altbib - bibliography on alternatives to animal testing:

http://toxnet.nlm.nih.gov/altbib.html

in the search field i put in "neonatal foreskin" 5 results:

unfortunately, the search results are only held in a temp file, so they don't work when the search expires. i've given the information on how to get there, and i hope it will be possible for other people to easily pull the abstracts up.

1. "characterization of an immortalized human cell line derived from neonatal foreskin diploid fibroblasts

authors: chiang lc chiang w chang sf chen hy yu hs

source: jdermatol 1992;19(1):1-11

abstract:

a new human skin cell line, designated as ccfs-1/kmc, immortalized from human neonatal foreskin diploid fibroblast cells, has been subcultured successfully in vitro for more than 500 passages. this anchorage-dependent cell line possesses many common features of transformation such as morphological and cytoskeletal changes, hypotriploidy, infinite lifespan, increasing plating efficiency and saturation density, and decreasing serum requirement and population doubling time. human papillomavirus (hpv) type 18 dna was detected in the cell line before and after immortalization by the polymerase chain reaction (pcr) method. tumorigenicity, however, was not demonstrated in vivo. the authors report that these immortalized human fibroblasts derived from neonatal hpv-18-dna-contained diploid fibroblasts possess double minute chromosomes (dms), a karyotypic aberration usually found in cancer cells."

interesting that one, some babies appear to have already got hpv??? it's contaminated the cell line, it would be interesting to know if it manages to get into the end products.

2. "safety evaluation of human living skin equivalents.

authors: nemecek gm dayan ad

source: toxicol pathol 1999;27(1):101-3.

..the resulting product has the appearance and handling characteristics of human skin. safety evaluation of lses begins with insuring that foreskins are obtained only from healthy infants whose mothers are negative for a panel of adventitious agents."

i wonder if the mothers realise what is going on here, they're being checked out to make sure their babies are suitable before harvest....

3. "use of fluorescent redox indicators to evaluate cell proliferation and viability. authors: Rasmussen e

source: in vitro mol toxicol 1999;12(1):47-58.

...cultures of human neonatal foreskin fibroblasts were exposed to equal concentrations of the two dye solutions in the cell culture media..."

4. "use of an in vitro skin model for determining epidermal and dermal contributions to irritant responses

authors: slivka sr zeigler f

source: j toxicol, cutaneous ocul toxicol1993;12(1):49-57

.... an in vitro skin model was used to study the responses of epidermal and dermal cells to irritants. this model consists of neonatal foreskin fibroblasts grown into a three-dimensional dermal structure on a nylon mesh....."

5. "in virto toxicity of various classes of test agents using the neutral red assay on a human trhee-dimensional physiologic skin model

authors: triglia d braa ss yonan c naughton gk

source: in vitro cell develop biol 1991;27a(3):239-244. (28 refs)

toxicity data were presented for the following classes of test agents: 15 detergents, five alcohols, ten metal chlorides, five perfumes and colognes, four shampoos, three conditioners, three moisturizers, three pesticides, and four antimicrobial preservatives. dose dependent cytotoxic responses were observed for all test agents in each category. a new three dimensional human skin model consisting of several layers of actively dividing and metabolically active human neonatal foreskin derived fibroblasts and epidermal keratinocytes grown on nylon mesh were used to assess the toxicity of these agents. a slight modification of the published neutral red viability assay was used for endpoint determination. the potential utility of the human dermal fibroblast epidermal keratinocyte, three dimensional substrate as an in-vitro toxicology assay system was described. "

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mattek corporation manufactures all kinds of human tissue substitutes, all the ones ending in -derm, and epiocular being derived from neonatal foreskin. it's interesting to see the other human tissues they use too, breast tissue, oral tissue from people undergoing tooth extraction.

http://www.mattek.com/pages/products

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http://www.msnbc.com/modules/cosmetic_surg...ntent.asp?p=all

"human collagen

what

injectable collagen derived from newborn foreskin left over after circumcision. to create the product, fibroblasts-the cells that produce collagen-are isolated from the foreskin, and replicated in a culture where they are primed to pump out collagen. mcghan medical corp. has petitioned the fda for approval of two formulations of the foreskin-derived collagen: cosmoderm, which is thinner, and cosmoplast, a thicker version.

use

to fill fine lines, deep wrinkles and scars, and plump lips.

duration

three to six months.

cost

it hasn't been priced yet but doctors expect it to cost about the same as bovine collagen: $300 and up.

pros

* no allergy test or waiting period required.

* can be used on patients with a bovine allergy.

* mixed with anesthetic so less painful than hylan gel or products derived from cadaver tissue.

cons

* potential side effects include: redness, swelling, bruising, infection and small risk of allergic reaction. "

*mcghan medical corp is now known as inamed aesthetics, http://www.inamed.com/corporate/

http://www.inamed.com/products/facial/us/p...nformation.html

more info:

http://or-live.mediwire.com/main/default.a...&articleid=3757

choices to consideron the list of soon-to-be-marketed products are a series of bioengineered human collagen products from mcghan - cosmoderm-i nst, cosmoderm-ii nst, and cosmoplast nst. this material is derived from cultured neonatal foreskin using a single line cell source, and each of these products is said to have the same performance characteristics as their respective bovine collagen counterparts - zyderm-i, zyderm-ii, and zyplast. however, with the bioengineered human material, the need for skin testing is obviated.

a number of recently available filler agents, including cymetra (life-cell), fascian (medical aesthetics international), and dermalogen (collagenesis) are developed from allogeneic material obtained from tissue banks - an industry not currently under the regulation of the fda.

cymetra is a micronized form of alloderm, which is acellular freeze-dried human cadaver dermis. the material for production of these agents is obtained only from american association of tissue banks (aatb) guideline compliant facilities.

(healingwell.com content: interest in restoring volume stimulus for new fillers same article.

Jelli_Belli · Dec 21, 2006

Wow, what amazing posts from onehusbandsevenkids and RNmomof2. It's amazing the information you can find with a little research.

I wish I had those websites when my sister in law was trying to decide whether or not to circ my nephew. As it is my husband and I always watch Penn&Teller's show "Bullshit" on Showtime and they did an episode on the myths surrounding circumcision and it did a wonderful job of debunking all the lies that mainstream culture feeds new mothers. Anyhoo, she watched it and needless to say she was smart enough to make the right decision. Thanks for the info though, I'm always trying to convert the masses.

nursejohio, ASN, RN · Dec 21, 2006

This might explain why heterosexual transmission is much less rampant in the United States specifically, and West generally. There is a much higher incidence of circumcision here.
~faith,
Timothy.

Before I jump on the "let's mutilate baby boys for the sake of infections they may or may not ever be exposed to" bandwagon, I'd have to see more research. I understand that circumcision influenced the infection rate in Africa, but what kind of patient population did they use? Did they have access to condoms, information on their proper use, access to adequate hygiene practices (running water, soap, and education on how to care for an intact member)? If they aren't able to have the cleanliness we take for granted, and have no access to condoms.... maybe circs are an option.

Has anyone considered the impact of societal norms? Most American girls can feel secure insisting on condom use, even if they choose not to. On a continent that still largely practices female mutilation, what are the odds that a girl can say "Not until you have some protection?" That needs to be considered as well as the hygeine, condoms and education as well.

I'd give more weight to the findings if there was some information about the socio-economic and education status of the study groups. As a rule, even the 'more prosperous' African nations are pitifully poor by US standards and as such, don't have access to the same resources we have. Proponents of circ'ing will jump on this as "proof" that they're right, most without questioning what the results would be applied to men in the US. A more appropriate study would be studying 2 groups of American men, hetero and homosexual to see if there was a significant difference in infection rates between circ'd and intact.

Check out post # 6 with numbers. Our circ rate (60%) is surpassed only by Israel (90+%) but our HIV rate (250k) is double that of our closest follower (Japan with a 0.2 circ rate, HIV rate of 125k). Countries with a circ rate 1/10 of ours have infection rates that put ours to shame.

Just a few points to ponder before jumping into the 'boys should all be cut' or 'boys should all be left as god made them' debate

nursejohio, ASN, RN · Dec 21, 2006

Are you guys not aware that they use local anesthesia when they do a circumcision?

Most younger docs will attempt to place a local block. A lot of older ones still don't because "it's quick and he won't remember it anyway" I've heard docs tell parents they always use anesthetics to get the consent signed and watched them go right into the circ room and start chopping away without so much as EMLA, much less the lidocaine nerve block they said would be used. I wrote up incident reports each time, but I doubt anything's changed.

allnurses Guide · Dec 21, 2006

Most younger docs will attempt to place a local block. A lot of older ones still don't because "it's quick and he won't remember it anyway" I've heard docs tell parents they always use anesthetics to get the consent signed and watched them go right into the circ room and start chopping away without so much as EMLA, much less the lidocaine nerve block they said would be used. I wrote up incident reports each time, but I doubt anything's changed.

One of our docs refuses to use lidocaine . . . I refuse to assist him.

steph

nursejohio, ASN, RN · Dec 21, 2006

Good for you! I was brand new to L&D, only doing a couple weeks in the nursery to get used to normal babies and had the misfortune to be working while a few were done. The ones with anesthesia weren't as horrendous, but still... didn't create a happy baby

mvanz9999, RN · Dec 21, 2006

lol! read below what i have already stated in various ways. invalid study!!!!!!

*********

intactivism

the uganda and kenya studies claim to find that circumcised men are less likely to contract hiv than intact men. now the head of unaids, dr peter piot, is reported to have said, given the grim hiv situation in southern africa, it was important to promote the idea of widespread circumcision. he said baby boys should be targeted first but then attention should switch to adolescent boys and adult men.

this is utter folly, a waste of resources and a dangerous distraction from the real issues of hiv/aids (as well as a human rights violation). at the moment we can only hope dr piot has been misquoted.

babies do not have sex. any benefit of infant circumcision in preventing the spread of hiv/aids will not take effect until they reach puberty.
the studies were of volunteers. infant circumcision raises ethical issues. it can certainly be argued that it breaches
- the united nations universal declaration of human rights,
- the international covenant on civil and political rights, and
- the united nations convention on the rights of the child.
[*]the studies were cut short. over a longer period of time, the supposed benefit of circumcision will be reduced. in particular
- the circumcised group was told to abstain from sex for six weeks, or use condoms. the control group was not.
[*]circumcision is not cost-free or risk-free. even if the studies are correct, is 56 circumcisions to prevent one man getting infected with hiv the most effective way of spending the money, time and expertise?
[*]circumcising men disempowers women important co-factors of hiv/aids are of course condomless sex and "dry sex". circumcising men makes it harder for women to refuse these, and no less risky to accept them.

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[color=#dd0000]you would have to circumcise 56 men to prevent one of them contracting hiv in one year.

and the number needed to prevent hiv longer term is higher.

doctors could spend their time better spent treating people with ulcerative disease and malaria, which make hiv transmission easier

and using the money saved to promote safer sexual practices.

few accepted medicines have such a high nnt.

on this basis, the nnt in developed countries such as the usa, where the hiv rate is relatively low (0.6% compared to 4.1% in uganda), would be much higher - it would take 380 circumcisions in the us to prevent one case of hiv.

circumcision and hiv

TrudyRN · Dec 21, 2006

I have absolutely no faith that circumcision has anything whatsoeve to do with HIV prevalence but thank you for an interesting topic.

TrudyRN · Dec 21, 2006

Most younger docs will attempt to place a local block. A lot of older ones still don't because "it's quick and he won't remember it anyway" I've heard docs tell parents they always use anesthetics to get the consent signed and watched them go right into the circ room and start chopping away without so much as EMLA, much less the lidocaine nerve block they said would be used. I wrote up incident reports each time, but I doubt anything's changed.

I seriously hope that you will report this physician to the appropriate hospital committees and to the licensing body, as he is guilty of malpractice, I believe and certainly of ethical violation. Lying to a patient's parent????? How often has this happened? Does he put his promise in writing? How do you know he does this? This is a complete outrage and I wonder if you have any liability if you know he does this but don't step in and report him.

TrudyRN · Dec 21, 2006

one more and then I'll leave it alone because the entire issue raises by BP.
"I think this child has an infected member after neonatal circumcision;" Fournier's gangrene.
6 day old baby with infection from circ and the horrifying consequences
very graphic.

This is horrible! I hope the parents got an excellent lawyer. And I hope they became very verbal proponents of not circumcising. I regret so much having our kids circ'd. We did it for religious reasons but I think it is barbaric, religion or not.

God put the foreskin there and it should be left. Why, I wonder, did He tell Abraham to remove part of it? Or did he say to remove it or just cut it? Or what???

onehusbandsevenkids · Dec 21, 2006

Most younger docs will attempt to place a local block. A lot of older ones still don't because "it's quick and he won't remember it anyway" I've heard docs tell parents they always use anesthetics to get the consent signed and watched them go right into the circ room and start chopping away without so much as EMLA, much less the lidocaine nerve block they said would be used. I wrote up incident reports each time, but I doubt anything's changed.

Exactly. My best friend said this happens with several of the docs in her facility. She's intervened several times and stood there insisting that something be used appropriately. The parents are assured by the doc that lidocaine will be used and it is not used.

Another doesnt say anything about pain relief, my friend says the parents assume that something will be used and that they have to specifically request pain relief or the doc will not use it.

Crazy.