Compelled to mate, yet firmly attached to the rock, barnacles have evolved the longest penis of any animal for their size - up to 8 times their body length - so they can find and fertilize distant neighbours.

Graduate student Christopher Neufeld and Dr. Richard Palmer from the Department of Biological Sciences at the University of Alberta have shown that barnacles appear to have acquired the capacity to change the size and shape of their penises to closely match local wave conditions. When wave action is light, a longer (thinner) penis can reach more mates, but at times of higher wave action, a shorter (stouter) penis is more manoeuvrable in flow and therefore can reach more mates.

The research, published in Proceedings of the Royal Society B, suggests that sexual selection - competition with other males, female choice, sexual conflict between males and females - is not required to explain variation in genital form. In barnacles, this variation appears to be driven largely by the hydrodynamic conditions experienced under breaking waves.

A new study presented to the 15th Conference on Retroviruses and Opportunistic Infections (CROI) in Boston, USA, yesterday, Monday 4th February, showed that circumcising men after they had acquired HIV did not stop them infecting their partners, and may even have increased the risk.

The study was carried out in the Rakai district of Uganda by Dr Maria Wawer, Professor of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health, and colleagues.

The researchers found that if couples started having intercourse before the circumcision wound in the HIV infected male partner had healed, there was a greater risk of the woman becoming infected.

Wawer and colleagues analysed the results of an intent to treat trial of 165 heterosexual couples. In 94 of the couples the men were circumcised and the rest were controls.

They found that:
The rate of HIV infection of women in the group where the man had been circumcised was slightly higher but not significantly different to that of the control group (13.8 versus 9.6 per 100 person-years, 24 month cumulative rate).

In both groups the infection rate in women was highest in the first six months after the trial start date.

In the group where the men had been circumcised, during the first six months of follow up, 18 couples started having intercourse again at least five days before the wound was officially healed. This led to 5 HIV transmissions to the woman, a rate of 27.8 per cent.

This compared to 63 couples in the circumcision group who waited until at least 5 days after the wound had officially healed before having intercourse again. This resulted in 6 HIV transmissions to the woman, a rate of 9.5 per cent.

The rate of transmission in the first six months of follow up in the control (non circumcision) group was 6 out of 68, or 8.8 per cent, which is on a par with the rate of transmission for the circumcision group subset that waited until the wound had healed before resuming intercourse.
On the positive side, the study showed that circumcision improved the general genitourinary health of the men, even if it did not stop them passing the virus on.

This is an interesting result that stands in sharp contrast to earlier studies in Africa in which it was shown that circumcising men who are not infected with HIV reduces their risk of infection.

Persuading men to become circumcised as a way to protect themselves from HIV is an important strategy that is beginning to take hold in Africa, with public health programs reaching out to villages.

Dr Wawer said circumcision was a clear way of men showing they had taken the step to protect themselves and reduce the spread of AIDS. When the men are bathing together in the river it is clear who has and who has not been circumcised and it is natural that men who are already infected will then want to carry the same mark so as not to stand out from the others.

There appears to be an interesting point here about the timing of circumcision that suggests the earlier the better as far as reducing HIV transmission. Studies have shown that men circumcised before being infected with HIV and then later become infected with HIV still have a lower risk of passing the virus on to their partners. But this study shows that men who are circumcised later, after becoming infected with HIV can’t stop the virus from being passed on, and may even have a higher risk of passing it on.

Dr John Mellors, who is co-chairman of the conference’s scientific program pointed this out to MedPage Today, saying that it could be something to do with later circumcision “the surgery, something related to that at a later stage of life, tips the balance in favor of the virus being transmitted”.

Summaries of recent coverage related to CMS appear below.
Competitive bidding: Internist Laboratory, Sharp HealthCare and Scripps Health on Tuesday filed a lawsuit to block a Medicare pilot program that is testing competitive bidding for laboratory services, CQ HealthBeat reports. The providers allege that CMS should have filed a public notice for the program and received public comment before the pilot was launched, according to attorney Patric Hooper of Hooper, Lundy & Bookman. CMS spokesperson Peter Ashkenaz said that the pilot program “was mandated by Congress to determine whether competitive bidding can be used to provide laboratory services while maintaining value, quality and access to care” (CQ HealthBeat, 1/30).

Erythropoiesis-stimulating agents: Nearly 91% of oncologists and hematologists surveyed said that their patients have experienced adverse consequences as a result of a CMS rule limiting Medicare coverage for ESAs used to treat anemia in chemotherapy patients, according to a study released on Wednesday by US Oncology, CongressDaily reports. The study found that more than 75% of 282 oncologists and 25 hematologists surveyed said a blood transfusion was required for about 17% of their patients because of the rule and that 30% had to reduce chemotherapy treatments for 19% of patients (Edney, CongressDaily, 1/31).

Medicare Health Support: CMS on its Web site on Tuesday posted an announcement that MHS — a pilot program intended to coordinate care for Medicare beneficiaries with diabetes and congestive heart failure in five states and Washington, D.C. — is “not meeting the statutory requirements of improved clinical quality outcomes, improved beneficiary satisfaction and the achievement of financial savings targets,” The Hill reports. Starting in July, about 68,000 beneficiaries will be dropped from care-coordination programs, according to The Hill. CMS said it will wait until it receives a report from outside auditors before deciding whether to launch the second phase of the program, but the “negative assessment this week does not bode well for the program’s future prospects,” The Hill reports (Young, The Hill, 1/30).
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