HIV, Circumcision, and Ethical Experimentation

In a fascinating story, the BBC reports that a randomized trial of circumcision halves the rate of HIV infection among heterosexual men in Kenya and Uganda consistent with previous evidence from South Africa. The story laudably notes that circumcision should not be thought to justify sex without protection and this point should not be overlooked. What I find fascinating is the consequence of a pilot study for experimentation. In short, the US NIH had to stop the trials early because it deemed a continuation of withholding circumcision from the control group unethical. While in this case, I cannot disagree; it would be morally reprehensible to continue. That said, I fear that this creates a dangerous experimental precedent for treatments with consequences that are less well known. Were it not that circumcision is a practice that dates back centuries, but instead was a pharmaceutical, say Vioxx or some relation, might we be inclined to engage similar moral concerns and ultimately support the wide employment of a treatment that leads to forms of longer term harm that might have been known were the study to have continued. In short, in this case it makes sense. What I hope is that researchers remain skeptical because a part of the justification for rigorous trials is the hope that unintended consequences may be discovered.