On the Use and Interpretation of Areola/Nipple Retention as a Biomarker for Anti-androgenic Effects in Rat Toxicity Studies

Areola/nipple retention (NR) is an established biomarker for an anti-androgenic mode of action in rat toxicity studies. It is a mandatory measurement under several OECD test guidelines and is typically assessed in combination with anogenital distance (AGD). Both NR and AGD are considered retrospective biomarkers of insufficient androgen signaling during the masculinization programming window in male fetuses. However, there are still aspects concerning NR as a biomarker for endocrine disruption that remains to be clarified. For instance, can NR be regarded a permanent adverse effect? Is it a redundant measurement if AGD is assessed in the same study? Is NR equally sensitive and specific to anti-androgenic chemical substances as a shortening of male AGD? In this review we discuss these and other aspects concerning the use of NR as a biomarker in toxicity studies. We have collected available literature from rat toxicity studies that have reported on NR and synthesized the data in order to draw a clearer picture about the sensitivity and specificity of NR as an effect biomarker for an anti-androgenic mode of action, including comparisons to AGD measurements. We carefully conclude that NR and AGD in rats for the most part display similar sensitivity and specificity, but that there are clear exceptions which support the continued assessment of both endpoints in relevant reproductive toxicity studies. Available literature also support the view that NR in infant male rats signifies a high risk for permanent nipples in adulthood. Finally, the literature suggests that the mechanisms of action leading from a chemical stressor event to either NR or short AGD in male offspring are overlapping with respect to canonical androgen signaling, yet differ with respect to other mechanisms of action.

Claimed by culture: circumcision, cochlear implants and the ‘intact’ body

This review essay discusses the debates on infant male circumcision and on paediatric cochlear implants, two instances of surgical interventions done on small children without there being any pressing life-threatening indication. Reviewing these two issues together—something that has not previously been done, although there is a vast scholarly debate on both issues separately—helps frame the medical humanities and the current turn in the field towards abandoning the nature/culture and science/humanities divides. The debates on these procedures are fraught with a distinction between medicine and culture which constructs a certain kind of body as ‘natural’ and seeks to defend that body against ‘cultural’ interventions while welcoming supposedly acultural ‘medical’ interventions on other bodies. In the scholarship in medical humanities and medical ethics on these topics, this implicit nature/culture divide and view on medicine as separate from culture is also evident. My contention is that the medical humanities have important work to do here, in particular regarding a critique of the notion of the ‘whole’ or ‘intact’ body.

Uptake and outcomes of early infant male circumcision services in four counties in Western Kenya

Background: Early Infant Male Circumcision (EIMC) is part of sustainable HIV prevention strategies in Kenya. The goals of the national EIMC program are to circumcise at least 40% of all newborn male infants delivered at hospitals offering the service and keep the rate of moderate and adverse events below 2%. Objectives: To determine the proportion of early male infants (age less than 60 days) born at hospitals in four counties of western Kenya who got circumcised and document the prevalence of adverse events (AEs) among those circumcised. Methods: A retrospective descriptive study involving all records for EIMC from 1st March 2014 through 31st March 2018 in four counties of western Kenya. Data analysis was done using EXEL to document proportion of facilities offering EIMC and compare EIMC uptake and outcomes in the four counties against the national goals for the program. Results: A mean of 4.3% of total health facilities offer EIMC in the region. Siaya had the highest proportion of facilities offering EIMC while Migori had the lowest proportion. Uptake of EIMC was low at 17.4% for all male infants born, far less than the anticipated target of 40%. Average adverse event rates were 0.3%. Conclusion: EIMC uptake remains low in this region of Kenya due to small number of health facilities offering the service. The proportion of circumcised early male infants born at the target health facilities is below the national target of 40% even though the rate of adverse events among those circumcised is acceptable. Keywords: Adverse event; circumcision; early male infant; uptake; western Kenya.

Uptake and outcomes of early infant male circumcision services in four counties in Western Kenya

Background: Early Infant Male Circumcision (EIMC) is part of sustainable HIV prevention strategies in Kenya. The goals of the national EIMC program are to circumcise at least 40% of all newborn male infants delivered at hospitals offering the service and keep the rate of moderate and adverse events below 2%. Objectives: To determine the proportion of early male infants (age less than 60 days) born at hospitals in four counties of western Kenya who got circumcised and document the prevalence of adverse events (AEs) among those circumcised. Methods: A retrospective descriptive study involving all records for EIMC from 1st March 2014 through 31st March 2018 in four counties of western Kenya. Data analysis was done using EXEL to document proportion of facilities offering EIMC and compare EIMC uptake and outcomes in the four counties against the national goals for the program. Results: A mean of 4.3% of total health facilities offer EIMC in the region. Siaya had the highest proportion of facilities offering EIMC while Migori had the lowest proportion. Uptake of EIMC was low at 17.4% for all male infants born, far less than the anticipated target of 40%. Average adverse event rates were 0.3%. Conclusion: EIMC uptake remains low in this region of Kenya due to small number of health facilities offering the service. The proportion of circumcised early male infants born at the target health facilities is below the national target of 40% even though the rate of adverse events among those circumcised is acceptable. Keywords: Adverse event; circumcision; early male infant; uptake; western Kenya.

The legal status of infant male circumcision

We present an argument in support of the legal prohibition of infant male circumcision (IMC) in developed Western countries. We submit that all IMC, irrespective of whether the motivation behind it be secular or religious, violates children’s rights to self-determination (autonomy) and bodily integrity and is therefore morally illegitimate. And while IMC’s being morally wrong does not entail that it ought to be criminalised, we contend that it should be legally proscribed so as to protect children against harm and to uphold their rights. We consider and reject an argument that an exemption from the legal ban should be granted to religious parents who perceive themselves to be under a moral obligation to subject their male infants to IMC. We argue that since IMC sets back children’s basic interests and violates their rights, there is no room, and no case, for the conferring of a religious exemption.