Talk:Circumcision

Appalling sexist bias in article

There is something slightly disgusting and sexually biased about Wikipedia applying the primary description of 'genital mutilation' to females whilst avoiding its accuracy as the primary description for males. In both cases adult humans mutilate the genitals of, usually, human babies or youngsters who are not in a position to effectively resist or defend themselves. Whether or not there are religious or social beliefs or pressures underlying the practice does not justify varying the description which, by most modern thinking, amounts to a form of physical child abuse, primitive, superstitious and barbaric in origin.

If cutting the genitals of babies or youngsters is accurately termed 'mutilation' when performed on females, it is also mutilation when performed on males. — Preceding unsigned comment added by 86.167.19.166 (talk) 22:50, 23 June 2012 (UTC)

Wikipedia is not the platform for you to express your views on this subject; Wikipedia does not publish original research and does not exist to make value judgements. The thread above sums up pretty well why it is unlikely for this article to be renamed any time soon. OSborn ^arf_contribs. 23:51, 23 June 2012 (UTC)

Do you have anything to contribute about the sexist bias? — Preceding unsigned comment added by 86.167.19.166 (talk) 08:34, 24 June 2012 (UTC)

I support this discussion of this very topic. Sources support a human-rights treatment of both male MGM/circumcision and FGM. The FGM article is approached from this point-of-view. Wikipedia policies don't dictate the way editors approach a subject (but of course, any approach must be backed up by sources). In the Circumcision case, they've chosen to follow only medical literature and have largely ignored the human-rights perspective. Crimsoncorvid (talk) 02:20, 29 June 2012 (UTC)

This article already has an "ethical issues" subsection and a "legal issues" subsection. Crimsoncorvid, it would be helpful if you would provide specific suggested changes to the article. Maybe you can find more reliable sources discussing the human-rights perspective, that can be added as references here or at Circumcision controversies. Maybe you can suggest ways to re-arrange the order of the sections or shorten some sections. Note that this article, even if already too long again, is very short in comparison to the huge literature on the topic out there, so anything to be added has to be justified with an argument about due weight. ☺Coppertwig (talk) 14:53, 1 July 2012 (UTC)

"Males Preference For Circumcised Women In Northern Ghana" http://www.ajol.info/index.php/ajrh/article/viewFile/7884/1512 Improvement might be possible if the similarity between male and female genital cutting were discussed here. No rational distinction can be drawn between cutting the genitalia of either sex. Anyone with a background in human physiology understands the genital structures are basically the same. That bias merits acknowledgment in Wikipedia's voice. 201.236.221.9 (talk) 19:12, 6 July 2012 (UTC)

Wikipedia is not a place to express opinions on a topic or other editors. What counts are reliable sources, and the reason one article uses "circumcision" and another uses "mutilation" is that Wikipedia reflects what reliable sources have written. Johnuniq (talk) 03:13, 7 July 2012 (UTC)

Unfortunately, most "reliable sources" will not consider male and female genital mutilation as equal if only because of pre-established standards. Male mutilation has been accepted for thousands of years as "normal", but female mutilation has only been cast into the spotlight as a result of recent civil rights realizations. I know that Wikipedia thrives on reliable sources as its lifeblood, but consider that the fact that if more reliable sources are found supporting male mutilation than female, it is mostly because of vast patriarchical historical evidence. It's just perpetuating the male bias that most of history has. I am male, but I don't condone this sort of mutilation at all. — Preceding unsigned comment added by Fourshade (talk • contribs) 09:26, 11 July 2012 (UTC)

A German court has ruled that parents can’t have their sons circumcised on religious grounds.

This might deserve a mention in this article (or Circumcision controversies). http://www.rt.com/news/germany-religious-circumcision-ban-772/ Gråbergs Gråa Sång (talk) 12:33, 27 June 2012 (UTC)

It seems WP:UNDUE to include in this already too-large, general article about the procedure. Also, this just happened, and it looks like an appeal is planned, but the various parties involved are still studying the decision, so adding it now would fall on the wrong side of WP:RECENTISM. I was going to suggest a better spot for this would be at Circumcision_and_law#Germany, but I see someone has already added it there. Zad68 12:46, 27 June 2012 (UTC)

Fair enough. Gråbergs Gråa Sång (talk) 13:32, 27 June 2012 (UTC)

Do not think it is WP:UNDUE to include it - it is a short and simple statement. The article covers Sweden and Australia in much more detail, why not Germany? As of appeals, looking at [this http://m.aerzteblatt.de/news/50650.htm] and other headlines there won't be any. More likely those opposed to the current regulation will try to pass new laws changing the regulation. As of recentism, this has been hyped as todays headline but in reality this was the mainstream view for some time now. Richiez (talk) 22:49, 27 June 2012 (UTC)

I agree with Richie. We have 4 people in favor of including; myself, richie, graberg and bigzteve [1]. Pass a Method talk 23:12, 27 June 2012 (UTC)

Actually, when I look at the "Legal issues" section, it don´t seem like a good summary of it´s main article (Circumcision and law). How about replacing the text in that section with something like the lede from Circumcision and law? — Preceding unsigned comment added by Gråbergs Gråa Sång (talk • contribs) 15:35, 28 June 2012 (UTC)

The reliable sources reporting on this have been inconsistent in their reporting, specifically about how the court characterized the effects of circumcision, and also the effect on the legality of the procedure in Germany. The first stories seemed to downplay the decision, calling it "non-binding" and as not affecting the legal status. Later stories started giving the decision much more importance and having a big impact. If the first stories were right, and it was a non-binding opinion of one court without much lasting effect, it would be WP:UNDUE to put it here in this article. If it's as the later stories report, and would have the effect of making circumcision formally illegal in Germany, it would be appropriaFte to include a mention of it here. I am waiting for an other day or two for more clarification on this. Zad68 15:44, 28 June 2012 (UTC)

I don't know whether this has already been cleared up... If not, the truth is that the court's order is non-binding, and applies only a local scale, and other courts do not have to abide by it (no other courts have made similar ruling). The reason is becasue the court classified it as "minor bodily harm" rather than "major bodily harm." If it's not cleared up and you want me to provide references for this, I have a number of recent references that would be useful if you'd like.--Activism1234 02:07, 12 July 2012 (UTC)

Activism1234 yes please bring the sources, they could be useful for this article. Zad68 03:03, 12 July 2012 (UTC)

Sure no problem. I think on the contrary though, it won't be included in this article, if I'm reading what you wrote correctly above... But I'll bring it to back that up.

Here is one from The Times of Israel, reporting on statements made by the German envoy and Israeli ministers of Knesset. -

"Michaelis pointed out that the Cologne court had ruled that circumcisions are merely considered a minor bodily injury. Had the court defined the procedure as a severe bodily injury, all local prosecution offices in Germany would have been obligated to look for offenders. In the current situation, a mohel would only be subject to penalty if someone actually took him to court in the jurisdiction of the Cologne district court.

“I know that this is not satisfying, and that a feeling of legal uncertainty persists in the Jewish communities,” Michaelis told the Israeli lawmakers. “Your colleagues in Germany are already on summer break but I am sure that this question will be picked up again if we assess that this judgment genuinely creates legal problems in Germany.”

This is from the website Inside Islam: Challenging Misconceptions, Illuminating Diversity (University of Wisconsin, Wisconsin Public Radio). "There are about 4 million Muslims and 120,000 Jews in Germany, but as of now, only those in Cologne will be affected."

And another source, CBS News - "The German ambassador, Andreas Michaelis, told the Israeli lawmakers his country was working to resolve the issue and that the ruling doesn't apply at the national level."

Is this sufficient? I hope it helps. --Activism1234 04:27, 12 July 2012 (UTC)

Pass a Method, re "We have 4 people in favor of...", may I remind you that Wikipedia policy states that this is not a democracy and that we do not vote on content decisions. Consensus is formed on the strongest policy-backed arguments. Zad68 15:48, 28 June 2012 (UTC)

The change in the reporting may be partly due to the fact that the first reports came out before it became known that both parties apparently ceded their rights to appeal. As of binding or non-binding this is relative. Any 1st or 2nd instance court is very unlikely to make a different decision although in principle they could. Higher instance courts can issue different decision in theory. In the meantime the procedure (and possible complications) must not be covered by any insurance and it is unlikely any doctor would take the legal risk to make the procedure under the conditions specified by the court. Richiez (talk) 22:48, 28 June 2012 (UTC)

Gråbergs, i dont mind that. Zad, yes, i will watch the news too. Pass a Method talk 02:01, 29 June 2012 (UTC)

Germany as most of the continental european states has not a case law. A singular verdict of a lower court brings no obligation for other courts to follow. One of the leading comments on criminal law, written by a judge from the Bundesgerichtshof, says, that religious circumcision ist not against the law according to the leading opinion in jurisprudence. (Thomas Fischer, Strafgesetzbuch und Nebengesetze, 55. Auflage, München 2008, Verlag C. H. Beck § 223 Rdnr. 6b, ISBN 978-3406565991) There exists a newer version of this comment, but usually the legal situation in Germany develops slowly... please keep this in mind. --Feliks (talk) 11:29, 29 June 2012 (UTC)

I think that we should wait until this has played out. The ruling could be struck down as it was made in a low court. I am sure it will make an interesting and relevant addition to the article no mater what the ultimate judicial outcome is. — Preceding unsigned comment added by LeetroyJnkns (talk • contribs) 10:11, 1 July 2012 (UTC)

Some things I want to add about this court decision - it should give a decent understanding of the (lack of?) importance of that decision:

Background: Circumcision has (intentionally) been a legal grey area in Germany for decades. In this case, a muslim boy was circumcised, it had some (minor) complications and the prosecution decided to press charges against the doctor. The first court aquitted the doctor, saying circumcision is legal, but the prosecution appealed. That was finally unsuccesful, but the reasoning of the court is the important part.

The reasoning and its meaning: The court said that circumcision without (acute) medical indication is illegal - even when done on religious grounds. The doctor was aquitted though, because he couldn't have known he would do something illegal. But that's an excuse that only works once - and this one time has been used up. That's the important impact, because it tells everyone in Germany (that's how it has meaning outside of the courts jurisdiction) that it's illegal. As a result, doctors are now under the threat to be convicted, while this threat didn't exist before - even if the courts decision could be ultimatively overturned in another trial.

I don't know if it is something that should be included in the article (maybe not) but I wanted to give some explanations of the situation and its meaning. --ToMaP (talk) 14:46, 2 July 2012 (UTC)

ToMaP, thanks for that analysis, it is in line with what I have been reading. However, the level of detail you are giving belongs at Circumcision_and_law#Germany and not at this already too-large general article about the procedure. This article already mentions the possible effects of this ruling under section "Legal issues", and there is a "Main article" link in that section to Circumcision and law for the reader interested in that level of detail. Zad68 15:45, 2 July 2012 (UTC)

I have to agree. --ToMaP (talk) 15:55, 2 July 2012 (UTC)

Circumcisions trend in modern countries throughout the world is to be outlawed. If this outlawing pans out, it absolutely warrants inclusion in circumcision. Rip-Saw (talk) 22:01, 3 July 2012 (UTC)

Agree with the analysis of ToMaP, in addition it should be stressed that the verdict is now final as both parties ceded their rights to appeal and accodring to German media the court sought to set a precedendce case. Richiez (talk) 12:03, 4 July 2012 (UTC)

The analysis here was correct, but in the text of the article the role of the decision as a binding precedent was presupposed. I changed this and explained a little, if too long, please cut it down to adequate size. Best--Olag (talk) 20:43, 6 July 2012 (UTC)

While I agree that there is a theoretical difference between the Anglosaxon and continental legal systems where the former did traditionally derive legality from legal precedents this difference plays an increasingly smaller role in practice today. There is plenty of laws in the US and plenty of gray areas ruled by legal precedents in Germany. As far as I know legal precedents can be overturned anytimes, in the US as well as in Germany. What is relevant here is that it was not the highest court which did the ruling. As of practical consequences, looking at the headlines of the last days it seems most major health care providers stopped the practice. Richiez (talk) 10:57, 7 July 2012 (UTC)

One point is still missing in the text. The court ruling of course applies to "children" which are bellow the age that they could decide for themselves. Religious or other circumcision of adults is not touched by this. (Accordingly, one of the suggestions how Jews could cope with the new legal situations was a symbolic ritual cut of the 8 day old boys that could be followed by a full circumcision by the age they are capable of informed consent.) As far as I know the definition of age of informed consent for this is not quite clear cut but the number "14" was often mentioned by the media.. does anyone know the exact details of that? I am somewhat suspicious of the number.. why would the age be lower than that when children can get tattoos or girls can ask for plastic surgery which is 16 in most cases? Richiez (talk) 20:06, 7 July 2012 (UTC)

You are right that precedents will have an influence on the practice of other courts. Still I would hesitate to argue that circumcision for other than medical reasons “is effectively illegal” in Germany.

While Germans are considered adult at the age of 18, the coming-of-age for full religious self-determination(so called "Religionsmündigkeit", see § 5 Gesetz über die religiöse Kindererziehung [RelKErzG) is considered 14 ys.

As far as I know, as yet no one ever tried to claim protection for tattoos and plastic surgery based on freedom of religion.--Olag (talk) 13:04, 9 July 2012 (UTC)

Perhaps we can find better formulation than "effectively illegal". My interpretation is that any doctor doing it in this situation has a considerable risk to face criminal prosecution and 1st and 2nd level courts are pretty likely to issue guilty verdict. Also the liablilty risk if something goes wrong is tremendous, insurance would not cover that. Not to mention, if something goes really badly wrong the criminal charges may escalate up to manslaughter. As far as I know most if not all doctors and clinics stopped the practice now? As of the age - I could certainly imagine young people wanting a variety of piercings, tatoos and other body modifications for religious reasons (Maori, Amazona Indians, some African tribes etc). Also, does Germany allow female genital mutilation for religious reasons at age 14? Richiez (talk) 11:20, 12 July 2012 (UTC)

HIV-Africa again (but not beating the dead horse this time)

I still do not believe that the HIV-Africa claims belong in the lead for reasons I've stated previously. However, the current wording is a tremendous improvement and I do not find it misleading or incorrect. Thanks to all who were involved in making this change. Crimsoncorvid (talk) 02:22, 29 June 2012 (UTC)

Fantastic, maybe we should get that dead horse taxidermied and hang it up on the wall as a trophy for our collaboration finally resulting in consensus! All of us as editors should be happy to see one of long-standing contentious points of this article get stabilized. Zad68 14:46, 29 June 2012 (UTC)

No consensus whatsoever for HIV-Africa to be in the lead, please don't overreach a conclusion from a temporary compromise. 65.6.127.171 (talk) 15:24, 29 June 2012 (UTC)

Correct. Crimsoncorvid (talk) 01:42, 30 June 2012 (UTC)

Crimsoncorvid, I disagree, there has been consensus to keep Cochrane in the lead for what looks to be at least a year by now, and consensus was most recently achieved explicitly to keep citing Cochrane in the lead in the thread you started about exactly that topic here: Talk:Circumcision/Archive_73#Lead_change_removing_Africa_HIV_information. I see in that thread you expressed that you were unsure what "consensus" means on Wikipedia (you asked "What exactly do you mean by 'consensus' on this topic?") and Johnuniq explained in part, "Consensus is agreement between experienced editors regarding the best resolution of a proposal, where 'best' is measured in terms of agreement with existing policies and practices." Here is the relevant quote from the Wikipedia policy WP:CONSENSUS: "editors try to persuade others, using reasons based in policy, sources, and common sense." Again, consensus is based on the strongest arguments based in Wikipedia policy. So in that thread, all the objections to keeping Cochrane in the lead were met with Wikipedia policy-based counterarguments, and those counterarguments were left unchallenged. The thread even ended with "Fantastic, it looks like we have consensus on this now." and that observation was left unchallenged, and the thread archived. It appears in this case that consensus came out not to your liking, but please be aware that (also from Wikipedia policy WP:CONSENSUS): "Consensus on Wikipedia does not mean unanimity." You should also be aware that continuing to edit against consensus can be viewed as disruptive editing. Zad68 03:10, 2 July 2012 (UTC)

re: zad comment "The thread even ended with "Fantastic, it looks like we have consensus on this now." and that observation was left unchallenged, and the thread archived." One might conclude that zad declared a consensus and then quoted his own declaration of a consensus. Sorry, that's not fair or aboveboard editing on the issue. 65.82.224.2 (talk) 18:45, 4 July 2012 (UTC)

Crimsoncorvid: adding: If you are unconvinced by my evaluation that consensus was achieved, I would be happy to put it out to a request for comment, so that you do not have to take my word on it. It would be ideal if we could get some uninvolved administrators, who have been entrusted by the Wikipedia community to make evaluations about consensus, to comment on it. I will be happy to do this if you will agree that if we have an evaluation from experienced, uninvolved administrators that consensus was achieved, we can indeed put this to rest. Zad68 03:16, 2 July 2012 (UTC)

Thanks for removing the word "strong" from the lead. Now I suggest removing it from the body. The Circumcision and HIV article mentions a number of studies criticizing conclusions from the randomized controlled trials (RCTs), for example pointing out that stopping trials early can introduce a statistical bias. I believe that since there are reliable sources expressing that point of view, per NPOV we can't state that there's "strong evidence" as a statement by Wikipedia. I suggest changing "There is strong evidence that circumcision reduces the risk of HIV infection in heterosexual men in populations that are at high risk." in the Sexually transmitted diseases section to "Evidence that circumcision reduces the risk of HIV infection in heterosexual men in populations that are at high risk has been called "conclusive" and "substantial"." (taking words from the two studies [2] [3] in the footnotes to this sentence; I consider that it isn't weasel words when there are footnotes to show exactly who said it.) Perhaps also adding "though there has also been criticism." and adding a footnote to Boyle or another critical study. ☺Coppertwig (talk) 21:53, 30 June 2012 (UTC)

Coppertwig, i agree with your suggestion. I have worded it as you wrote above. Pass a Method talk 15:16, 1 July 2012 (UTC)

Thanks! Perfect! Thanks for formatting the Boyle reference; maybe I'll go format a reference in some other article in return.

Sorry, I reverted the change because there hasn't been consensus to water down the citation of Cochrane in this manner in all the many times it has come up for discussion in the archives. This was most recently discussed here: Talk:Circumcision/Archive_73#Citing_Cochrane (also mentioned in Talk:Circumcision/Archive_73#Criticism_of_Cochrane) without consensus to change this article, and that was only 18 days ago. Has something new happened in the past 18 days, or are there new policy-based arguments being raised? I would like to avoid rehashing the same old arguments again, but please review WP:MEDRS, specifically "Ideal sources for such content includes general or systematic reviews published in reputable medical journals" and Cochrane is a systematic review published by one of the most reputable and highly respected medical review organizations around. It would be against Wikipedia policy regarding undue weight to give Boyle-Hill what looks like equal footing. Zad68 03:34, 2 July 2012 (UTC)

Now I notice another sentence in that section: "Whether it protects against male-to-female transmission is disputed". It gives two references, one saying there is weak evidence and the other saying there is no evidence. I've only read the abstracts (not sure if I have access to the whole articles). However, that doesn't look to me like a "dispute". I suggest changing this to "There is little or no evidence that it protects against male-to-female transmission". ☺Coppertwig (talk) 22:19, 1 July 2012 (UTC)

Coppertwig, good catch! I made this change. I had to specify that the (lack of) evidence is talking about HIV in particular, because it is that particular STD that the abstracts were talking about in regards to the paucity of evidence, and the section head the sentence is under is "Sexually transmitted diseases" in general and not HIV in particular. I also cleaned up the end of that sentence for logical flow. I guess if someone finds equally reliable sources that say that there is evidence that circumcision reduces M to F HIV infection, we will put back the "dispute" wording. Zad68 03:54, 2 July 2012 (UTC)

Thanks, Zad. Sorry, maybe I'm beating a dead horse, but the lead currently says "A Cochrane meta-analysis of studies done on sexually active men in Africa found that circumcision reduces the infection rate of HIV among heterosexual men by 38%-66% over a period of 24 months" and this sounds to me as if it could be interpreted to mean something different from what it should mean. What's that 24 months doing in there? Is the rate of HIV 38% to 66% lower at the end of the 24 months than at the beginning -- that is, that circumcision cures HIV? That's what it sounds like and I don't think that's what the studies said. How about deleting the "24 months" and changing "infection rate" to "infection risk" or "transmission rate"?

Re in the body of the article: I have nothing against citing Cochrane. I've argued that saying that there's strong evidence, in Wikipedia's voice, goes against NPOV. Please don't revert to this statement again without clearly stating on the talk page that you believe that it's consistent with NPOV to state that there is strong evidence in Wikipedia's voice in spite of the existence of more than one reliable source expressing a contrary point of view, and also providing an argument supporting your position. Zad, as I understand it, your main argument is against the "although" clause citing Boyle. I don't agree with your argument: I don't see an "although" clause without even a word of detail as being equal footing. However, I haven't had time to look into relative weighting of sources, so I'm not sure at this point whether the "although" clause should be included or not. However, for the rest of the sentence, I believe a change is appropriate as I've argued. I don't see this as watering down: only as providing appropriate attribution. (Why would readers believe Wikipedia more than they would believe the sources?) I'm changing it to "Evidence has been found to be strong that circumcision reduces the risk of HIV infection in heterosexual men in populations that are at high risk", without the "although" clause. ☺Coppertwig (talk) 22:16, 2 July 2012 (UTC)

Good grief. After all that we've gone from "There is strong evidence" to "Evidence has been found to be strong". There really is no point in trying to improve this article, is there? --Nigelj (talk) 22:43, 2 July 2012 (UTC)

Now it's not only superflorous but also poor grammer. I still say "Strong" is a qualifier conclusion we should not be adding. Garycompugeek (talk) 14:41, 3 July 2012 (UTC)

As an outsider, I can tell you that the plug for HIV Africa in the lead is quite bizarre. — Preceding unsigned comment added by 184.38.59.124 (talk) 16:14, 3 July 2012 (UTC)

Coppertwig, re:

The lead currently says "A Cochrane meta-analysis of studies done on sexually active men in Africa found that circumcision reduces the infection rate of HIV among heterosexual men by 38%-66% over a period of 24 months" and this sounds to me as if it could be interpreted to mean something different from what it should mean. What's that 24 months doing in there? Is the rate of HIV 38% to 66% lower at the end of the 24 months than at the beginning -- that is, that circumcision cures HIV? That's what it sounds like and I don't think that's what the studies said. How about deleting the "24 months" and changing "infection rate" to "infection risk" or "transmission rate"?
— User:Coppertwig

I encourage you to read the abstract of the Cochrane report (link to it here), which says exactly this. For your convenience, here is the Authors' conclusions" section, directly quoted in full:

There is strong evidence that medical male circumcision reduces the acquisition of HIV by heterosexual men by between 38% and 66% over 24 months. Incidence of adverse events is very low, indicating that male circumcision, when conducted under these conditions, is a safe procedure. Inclusion of male circumcision into current HIV prevention measures guidelines is warranted, with further research required to assess the feasibility, desirability, and cost-effectiveness of implementing the procedure within local contexts.

And here is the "Plain language summary -- Male circumcision for prevention of heterosexual acquisition of HIV in men" section, directly quoted in full:

Results from three large randomised controlled trials conducted in Africa have shown strong evidence that male circumcision prevents men in the general population from acquiring HIV from heterosexual sex. At a local level, further research will be needed to assess whether implementing the intervention is feasible, appropriate, and cost-effective in different settings.

So, to answer What's that 24 months doing in there?, it's in there to report the findings accurately. Previously we had "Strong evidence from Africa indicates that circumcision reduces the risk of HIV infection in heterosexual men by 38-66%", which I thought was more clear to read than what we have now, but that was changed to the current wording most recently after discussions and reaching consensus here, and I actually like your suggestion to remove "over 24 months" (and I'd rather use the word "acquisition rate" over "infection rate" but then we'd run into WP:PARAPHRASE problems) but I do not want to edit against the current consensus. I can't tell if your question circumcision cures HIV? is rhetorical in nature and intended to point out your concern about how a reader might misinterpret the wording, or if that is actually what you are taking away from how it is worded. I do not think the current wording would cause a typical reader in our target audience to misinterpret our paraphrase of the finding so substantially as to think "circumcision cures HIV".

re:

I've argued that saying that there's strong evidence, in Wikipedia's voice, goes against NPOV. Please don't revert to this statement again without clearly stating on the talk page that you believe that it's consistent with NPOV to state that there is strong evidence in Wikipedia's voice in spite of the existence of more than one reliable source expressing a contrary point of view, and also providing an argument supporting your position. Zad, as I understand it, your main argument is against the "although" clause citing Boyle. I don't agree with your argument: I don't see an "although" clause without even a word of detail as being equal footing. However, I haven't had time to look into relative weighting of sources, so I'm not sure at this point whether the "although" clause should be included or not.
— User:Coppertwig

I'll say outright that stating in Wikipedia's voice that there is "strong evidence" not only is in accordance with WP:NPOV, it is perfectly in line with Wikipedia policies and guidelines, and many examples of using Wikipedia's voice to make a statement like this can be found in WP:GA- and WP:FA-quality articles. To understand why this is the case, please read the medical manual of style, specifically the section Wikipedia:Medmos#Writing_style, where it says,

Do not provide a detailed analysis of an individual study unless the analysis itself is taken from a published reliable source. Wikipedia should concisely state facts about a subject. It should not discuss the underlying literature at any length. Generally speaking, the facts will be found in the conclusions or results section of a study, not in the detailed methodology. Articles that rely on secondary sources are less likely to fall into the trap of discussing the size of a single study, its methodology, its biases, and so forth. Thus, "washing hands after defecating reduces the incidence of diarrhea in the wilderness", not "An uncontrolled survey involving 132 experienced long-distance backpackers on the Applachian trail in 1997 concluded that washing hands after defecating reduces the incidence of diarrhea in the wilderness."

(emphasis mine) The Cochrane review is the most preferred kind of source for medical information (WP:MEDRS, "Ideal sources for such content includes general or systematic reviews...) I gave a specific example of how these standards have been applied to the article Aspirin in this thread: Talk:Circumcision/Archive_73#Citing_Cochrane, and also in that thread, Jmh649 (talk · contribs) (Doc James, a practicing E.R. physician and a driving force behind Wikipedia:WikiProject Medicine), confirmed, "Typically when a source is a good as Cochrane we simply state the facts 'In Africa circumcision reduces the risk of HIV infection in heterosexual men by 38-66%.'" Here are a few more examples of the application of this guideline in WP:MEDICINE WP:FA-quality articles:

• Antioxidant says, "By itself, UA-related risk of gout at high levels (415–530 μmol/L) is only 0.5% per year with an increase to 4.5% per year at UA supersaturation levels (535+ μmol/L)." and not "A 1987 study by Campion, Glynn, and Delabry found that, by itself, UA-related risk of gout...".
• Bupropion says, "The addition of bupropion to an SSRI (primarily fluoxetine or sertraline) resulted in a significant improvement in 70–80% of patients who had an incomplete response to the first-line antidepressant." and not "A 1997 study by Bodkin et al. and a 1998 study by Spier found that the addition of bupropion to an SSRI..." etc.

and the studies used to support these statements made in Wikipedia's voice aren't as highly-valued by WP:MEDRS as our Cochrane study. The argument against "although..." has already been discussed, for a most recent discussion please see Talk:Circumcision/Archive_72#Statistic_removal, which goes into exhaustive detail of the relative strengths of Cochrane and the many other studies supporting its findings vs. Boyle/Hill and others, how WP:FRINGE applies, and how WP:UNDUE guides us in deciding on their use.

Also I am finding that change in wording to "Evidence has been found to be strong..." isn't an improvement and is actually more tortured wording to say effectively the same thing. If you don't mind, let's find a better way to say it, or perhaps return to the previous wording.

Zad68 16:54, 3 July 2012 (UTC)

The new wording IS a tremendous improvement, especially from since when I first entered the debate on the wording. Back then, I'm pretty sure the lead as it is written currently would have been reverted immediately, so it is nice to see that healthy debate enlightened everyone. I know I sure learned a lot about wikipedia policy, and I'm sure everyone learned something about how medical journals and studies work. if only the US government worked so smoothly (or any government...). Then again, it did take several months to re-word just the lead! :P Rip-Saw (talk) 22:13, 3 July 2012 (UTC)

I made an NPOV copy-edit of the sentence "A Cochrane meta-analysis of studies done on sexually active men in Africa indicates that circumcision reduces the infection rate of HIV among heterosexual men..." (emph. mine), by editing "indicates" to "suggests". The word was edited by Yobol to "found", which is the strongest possible word one could use here. This is now in Wikipedia's voice to mean circumcision has been found to decrease HIV transmission in all heterosexual men; let's remember that this conclusion was inferred by one organization (albeit a strong one), but is still an argument with a good deal of evidence pointing to the contrary, especially with respect to the sources that have argued circumcision reduces HIV transmission particularly in high-risk areas (like the conclusions stated by two of the authors of the three RCTs). Even "indicates", the word I changed in the first place, is more NPOV than "found"... FactoidDroid (talk) 03:11, 5 July 2012 (UTC)

Please review my 16:54, 3 July 2012 reply to Coppertwig earlier in this thread (and the previous Talk threads it references) which addresses exactly this. As I already mentioned, according to Wikipedia WP:MEDMOS guidelines, the article should say, "Circumcision reduces the female-to-male HIV transmission rate by 38%-66%..." without referencing the underlying study or putting any qualifiers on the strength of the evidence. The current wording that references the study is an exception to the guideline, made as a compromise with those who objected to such wording. Zad68 14:35, 5 July 2012 (UTC)

Zad86: I have no intention of challenging your claim of consensus. To do so would be to beat the dead horse further. I've made my opinion on this subject quite clear, but I also have no intention of "editing against consensus" or "disruptive editing" on this topic. I agree that there was consensus on the wording improvements and I do appreciate that. Crimsoncorvid (talk) 02:00, 6 July 2012 (UTC)

Reference to a serious, reliable source about the estimated number of deaths caused by circumcision

On July 7 I included a reference to an article in "Thymos: Journal of Boyhood Studies" that concluded that around 117 male infants die from circumcision each year, including complications from anastehesia reaction, stroke, hemorrhage and infection.

The user Zad68 reverted to the previous version, claiming that my contribution was "vandalism".

How can it be vandalism to include an accurate representation of a credible and important research finding in a high-quality peer-reviewed scientific journal?

Why shouldn't people be informed that serious researchers find that on average 117 children are dying per year from circumcision in USA alone?

Zad68 claims that my contribution is an "inaccurate paraphrase of unreliable source's interpration of an unreliable source that fails WP:MEDRS". This is a very strange point of view.

My reference to the source was very accurate, taking a sentence from the source and only adapting grammar slightly to make it fit into the Wikipedia article. My source is very reliable, and it fits very well with the abstract made by the authors of the original source. The original source is research material presented in a peer-reviewed scientific journal. How Zad68 can claim this to be "unreliable" is unknown, especially when comparing this scientific article with some of the other sources that look more like opinions than facts.

http://www.icgi.org/2010/04/infant-circumcision-causes-100-deaths-each-year-in-us/ — Preceding unsigned comment added by Joreberg (talk • contribs) 14:48, 8 July 2012 (UTC)

Hi Joreberg, thank you for taking your concerns to the Talk page, I'm happy to address them:

• First, my revert of the edit as "vandalism" was indeed a mistake on my part as I simply hit the wrong link, and I apologize. As soon as I realized my mistake, I made a null edit with the edit summary ((null edit) previous edit summary incorrect, meant to type "rv inaccurate paraphrase of unreliable source's interpretation of an unreliable source that fails WP:MEDRS (not sure why that ended up as rvv) to indicate just that. You did see this edit summary as you quoted it in your post above, so hopefully this no longer an issue.
• I am glad that you take Wikipedia's sourcing standards for medical claims seriously. You correctly identify that sources cited need to be credible, reliable sources, and that peer-reviewed content published in scientific journals can be good sources for such information. So, let's look at the sources:
• The article currently uses a statement from the American Academy of Family Physicians, one of the largest medical organizations in the United States, putting the death rate from circumcision complications at 1 in 500,000 procedures. Using the AAFP estimate of 1,000,000 neonatal circumcisions performed each year, AAFP's numbers would project out to 2 deaths per year.
• The author of the Thymos article, Dan Bollinger, is the owner and editor-in-chief of the International Coalition for Genital Integrity (ICGI). (Articles at icgi.org posted by "ICGI" are shown to be by Bollinger, if you click on the ICGI link, and this lists Bollinger as the main contact.) Web citations of Bollinger show he is an anti-circumcision activist, so this is concerning regarding his impartiality. Further, I cannot find any relevant academic credentials for Dan Bollinger. From the results of my Web searches, he appears to have pursued a degree in Industrial Design and has a business selling refrigerator magnets, but I cannot find any evidence that he is affiliated with any university or hospital, holds a Ph.D. or M.D., or in fact has any formal medical or scientific training whatsoever, all of which would be basic requirements for Wikipedia to value his work in supporting a medical claim. Joreberg, if you could find any credentials for Bollinger beyond what I found, please bring them forward, it would really help the case to use Bollinger's work.
• As Carl Sagan said, "Extraordinary claims require extraordinary evidence." Bollinger's article puts the rate at 117 deaths per year, fully 58.5 times than the AAFP number. This is orders of magnitude out of line with the AAFP statement, making this an extraordinary claim.
• Thymos, the journal is which the article appears, is a social science journal and not a medical journal--it describes itself as publishing "current research and reflections on boys’ lives." It is described as "peer-reviewed," but the only editor listed is Diederik F. Janssen. Janssen's C.V. says he has an M.D. but is not affiliated with any university, hospital or medical organization, and lists his research interests as "anthropology of life phases, anthropology of the body, young masculinities, ethnosexology, poststructural theory in anthropology and education"--again, these are sociology areas of research, not medical. I could not find any other editors listed doing the peer review; it appears to be just Janssen himself, and this would be rather weak for a peer review board.
• The ICGI editorial you quote to support the 117 number is not a direct quote lifted from the Bollinger article, but rather a blog post from Dan Bollinger, quoting himself. (I also find it disingenuous that Bollinger doesn't identify himself as the author of both the blog post and the Thymos article, but that's not really relevant for this discussion.) Even if we were to accept Thymos as a reliable source for medical claims, ICGI.org is a self-declared anti-circumcision organization, and so the editorializing it hosts is most certainly unsuitable to support any kind of medical claim, much less such an extraordinary one.

So to summarize, your instincts are good regarding what we should be looking for to support a medical claim, but the sources for this medical claim fail at every turn, and, in my judgment, can in no way be used to overturn the number from the highly-respected AAFP by a factor of nearly 60. However, if you are still unconvinced, I would be happy to post the claim and the source (along with the analysis of it I have provided here) to the Wikipedia Reliable Sources Noticeboard to get further opinions on it.Zad68 18:03, 8 July 2012 (UTC)

---

Zad68,

Thank you very much for your extensive comments! They were very useful!

I have looked more deeply into the matter now. I hadn't read the actual Thymos article myself (Many scientific journals still take paid for their content, which creates a terrible barrier between science and the tax payers who pay for the science). I found a blog entry from a person who has had access to the Thymos article and provided many quotes from it. He also provided comments to the quotes, and from going through these I now realize that there are several logical flaws in the Thymos article. The blog entry is available here: http://circumcisionnews.blogspot.no/2010/05/fatally-flawed-bollingers-circumcision.html

It does indeed seem that the Dan Bollinger who has written the Thymos article is indeed the same as the Dan Bollinger who is selling fridge magnets, e.g. from a LinkedIn profile: http://www.linkedin.com/in/danbollinger If a person is selling refrigerator magnets, this doesn't prove that what the person is wrong, but it doesn't do anything to build up credibility in the field of medical science. Likewise, having a PhD is not a requirement for saying something interesting, but those who have one would get some credibility from that. Like you, I haven't found any academic credentials for Dan Bollinger.

And your observation that the Thymos journal is more directed towards social sciences than medicine also seems to be correct, relevant and important.

So I now realize that you did a very correct decision in taking away the reference I made to the Thymos article. Thank you!

(We agree that my contribution was definitely not "vandalism". I don't agree that my paraphrase was incorrect either, but when the source is so flawed as in this case, it doesn't help if the paraphrasing is done correctly...)

Your skeptic comments to the works of Dan Bollinger should be published in some more prominent place than this discussion field. The general public should be warned against pseudo-science.

Thanks for taking the time to provide such an extensive and convincing answer! — Preceding unsigned comment added by Joreberg (talk • contribs) 21:18, 8 July 2012 (UTC)

Glad to help, you're welcome! Zad68 01:48, 9 July 2012 (UTC)

Proposed new photo File:Rituelle Beschneidung.jpg does not improve this article along Wikipedia guidelines

Wikipedia articles are meant for the general reader, and are not targeted toward surgeons or other specialists. Wikipedia guidelines and practice reflect that. The new photo File:Rituelle Beschneidung.jpg proposed to be added to the article is not in line with WP:MEDMOS, specifically:

"Shock value: Some images of medical conditions or procedures disturb some readers, e.g., because of visible deformities or the presence of blood. Potentially disturbing images should be not be used for their shock value, for decoration, or merely to add an image."

It is also not in line with Wikipedia:Offensive material:

"'Not censored' does give not special favor to offensive content -- Especially with respect to images, editors frequently need to choose between alternatives with varying degrees of potential offensiveness. When multiple options are equally effective at portraying a concept, Wikipedia does not prefer the most offensive options merely to 'show off' its ability to include possibly offensive materials. Images containing offensive material that is extraneous, unnecessary, irrelevant, or gratuitous are not preferred over non-offensive ones in the name of opposing censorship. Rather, they should be judged based solely on other policies for content inclusion."

The photo's shock value and gratuitous nature are not in line with these guidelines. To see these guidelines in practice, I took a look at other WP:MEDICINE articles and compared the nature and number of human medical/anatomical photos chosen with those in this article. Compare the the photos in this article to WP:MEDICINE Good articles:

• Abortion–breast cancer hypothesis -- No graphic human medical/anatomical photos; one illustration
• Bates method -- No graphic human medical/anatomical photos; 6 black-and-white photos
• Brachytherapy -- No graphic human medical/anatomical photos; two hospital-setting photos but no surgery
• Coffin birth (defined as "the expulsion of a nonviable fetus through the vaginal opening of the decomposing body of a pregnant woman") -- No graphic human medical/anatomical photos; in fact, no images at all
• Condom -- One low-contrast photo of a condom on a glans penis, the text of the use of the condom is supported by a black-and-white pencil illustration and no photos
• Mental status examination -- No graphic human medical/anatomical photos
• Tracheal intubation -- Three human medical/anatomical photos of much less shock value than the proposed photo

Please take special note of the photos in this article as compared to Brachytherapy (another surgical procedure) and Condom (involving the same body part). If our goal truly is to improve this article according to Wikipedia standards, we need to bring the image selection in line with with the WP:GOOD medical articles, and File:Rituelle Beschneidung.jpg does not move this article in that direction. Zad68 19:26, 12 July 2012 (UTC)

• 
  Plastibell circumcision day 6 post operation
• 
  Circumcision with a clamp
• 
  Injection of lignocaine at 10 o'clock and 2 o'clock

How, according to you, is the photo of the circumcision using a plastibell not offensive but the circumcision using a clamp offensive? Both methods of circumcision are widely used and must be equally illustrated, otherwise it is an obvious bias. And there is also a photo of an injection in the article, which is much less useful but as offensive/inoffensive as the other two photos, and no one asked for its removal.--89.226.117.72 (talk) 19:44, 12 July 2012 (UTC)

Hi 89.226.117.72, sorry your response does not at all address any of the Wikipedia guideline-based reasons (backed up with examples of implementation) I gave why the file is not an improvement for the article. I did not say anything about the Plastibell picture or the injection picture, and I did not discuss bias. Could you please read what I wrote and address my points based in Wikipedia policy and guidelines? Thank you. Zad68 20:40, 12 July 2012 (UTC)

File:Rituelle Beschneidung.jpg is not more or less offensive of the two other photos of the plastibell and of the injection. It does not show more blood or more genitalia than the photo of the plastibell. This photo illustrates this type of circumcision and therefore is necessary, relevant, not gratuitous and not extraneous (see Wikipedia:Offensive material). The medical articles you listed above do not include any graphic human photos but it has never been a rule and has never been applied on this article; As everyone can check, the photo of the plastibell and of the injection have been in this article for months. Your interpretation of the Wikipedia guideline is wrong. Do not misinterpret them, thank you.--89.226.117.72 (talk) 06:57, 13 July 2012 (UTC)

Thank you for finally engaging my arguments (although, again, in this discussion I am not talking about the relevance or nature of the OTHER images in this article). You are saying that this image improves the article in the following way: It is relevant and informative as an image of the procedure. I agree with you. It is good to see also that you agree with me that the WP:MEDICINE WP:GOOD articles do not include any graphic human photos. Based on these two things, if a different image could be found that also improves the article in the same way--by providing a relevant illustration of the procedure--and that image were to be more in line with the nature of the images in the WP:MEDICINE WP:GOOD articles, that would be an improvement over File:Rituelle Beschneidung.jpg, correct? Zad68 10:58, 13 July 2012 (UTC)

If you think this article shouldn't contain graphic images (this is not my opinion), then all of them should be removed or replaced, not just this one. You can't decide to apply strictly the rules just for one image and not for the others, it would be a double standard. Maybe we should ask for the opinion of other contributors on that matter.--89.226.117.72 (talk) 11:49, 13 July 2012 (UTC)

To be clear, I actually agree with you, as I think the article would be improved along Wikipedia guidelines by removing the Plastibell recovery and anesthesia injection images because they are really less relevant to the subject of the article than an appropriate image of the procedure itself. So we agree on a number of points here:

• We agree that the article could be improved by selecting an appropriate image of the procedure itself
• We agree that the relevant guideline is WP:MEDMOS
• We agree that the existing WP:MEDICAL WP:GOOD articles do not include any graphic human photos

However, I feel that there are several rather serious problems with File:Rituelle Beschneidung.jpg as an image proposed to increase the encyclopedic educational value of this article:

• It is very hard for the lay-person to tell what is going on in the image. There are other images that are more understandable to the layperson.
• It is described as "circumcision with a clamp" but that is vague at best. Nearly all circumcisions are done with clamp. There are lots of different clamps. Take a look at this list: Circumcision clamp Which one is being used? It is very clearly not the Gomco clamp and it is very clearly not the Mogen clamp. By the description, it doesn't seem like it's a Plastibell procedure, as that's not usually described as a "clamp." So this image actually reduces the encyclopedic educational value of the article by adding confusion.
• The description in German attached to the image is: "Rituelle Beschneidung eines Kindes durch einen muslimischen Arzt in einem deutschen Universitätsklinikum. Es bestand keine Vorhautverengung." which appears to translate as: "Ritual circumcision of a child by a Muslim doctor in a German university hospital. There was no foreskin." What does "There was no foreskin" mean? Does it mean that this was an unusual circumcision case? Again, confusion.
• Also as I have previously mentioned, the nature of the image does not appear to be in line with the images selected for the existing WP:MEDICAL WP:GOOD articles.

So, let's open the discussion, which of the images of the procedure available to us would best improve the encyclopedic value of the article along WP:MEDICINE WP:MEDMOS guidelines? Here is a selection to choose from:

• 
  A 22-year-old Canadian man being circumcised with a Gomco clamp.
• 
  A baby midway through a Plastibell circumcision.
• 
  "Circumcision with a clamp"
• 
  "Circumcision with a clamp" in black and white

I also agree with you that we should get a wider range of opinions on this, so I will invite a few members of WP:MEDICINE to comment, including a regular Wikipedia contributor who is also an emergency room M.D. and a steward of the WP:MEDICINE WP:MEDMOS guideline itself. Zad68 13:48, 13 July 2012 (UTC)

IMO it looks like we should have a sub article describing the procedure of circumcision if we are using images that are this specific. This image can than go on that subpage. With the amount of text here one image is sufficient in that section. For example see Ingrown toenail and Surgical treatment of ingrown toe nails

Doc James (talk · contribs · email) (please reply on my talk page) 14:01, 13 July 2012 (UTC)

Thanks for the input Doc James. It sounds like you are saying that this image File:Rituelle Beschneidung.jpg is not a good choice for this general encyclopedia article about circumcision because it is too specific, do I have that right? Also, can you give us some detail about what is going on in that image. Is it a normal-looking circumcision procedure "with a clamp"? The only clamps I see in that image look like hemostats, which I'd imagine are used in nearly every circumcision procedure. The hemostat in the foreground looks like it's pointing at something, can you tell what it's pointing at? What is this picture being used to illustrate? Zad68 14:32, 13 July 2012 (UTC)

RFC: Which image?

Which image of the circumcision procedure (if any) should be added so that the article is improved in accordance with WP:MEDICINE WP:MEDMOS guidelines? (NSFW) Zad68 16:07, 13 July 2012 (UTC)

Available to the article are:

• 
  File:My_gomco_circ_may96.jpg -- A 22-year-old Canadian man being circumcised with a Gomco clamp.
• 
  File:Plastibell1.jpg -- A baby midway through a Plastibell circumcision.
• 
  File:Rituelle Beschneidung.jpg -- "Circumcision with a clamp"
• 
  File:Rituelle Beschneidung black and white.jpg -- "Circumcision with a clamp" in black and white

RFC !votes and comments

• File:My_gomco_circ_may96.jpg

(!Voting as RFC initiator) -- Before 11 July, the article did not have any medical image of the procedure itself. On 11 July, an image was proposed to be added. There is agreement that the article could be improved by selecting an appropriate image of the procedure, there is agreement the appropriate guideline to follow for the image selection is WP:MEDICINE WP:MEDMOS, and there is agreement that the current WP:MEDICAL WP:GOOD articles do not include any graphic human photos. But, we do not have agreement as to which image to select. I do not feel either of the "Rituelle Beschneidung" images (color or black and white) improve the article as they are confusing (you can't tell what's going on in the photo). Also, the color version is too graphic to be in line with WP:MEDMOS, and is out of line with the existing pictures selected for the WP:MEDICINE WP:GOOD articles. (See my comments in this section above regarding the pictures in WP:MEDICINE WP:GOOD articles.) The relevant section of WP:MEDMOS is:

"Shock value: Some images of medical conditions or procedures disturb some readers, e.g., because of visible deformities or the presence of blood. Potentially disturbing images should be not be used for their shock value, for decoration, or merely to add an image."

Also this section of Wikipedia:Offensive material applies:

"'Not censored' does give not special favor to offensive content -- Especially with respect to images, editors frequently need to choose between alternatives with varying degrees of potential offensiveness. When multiple options are equally effective at portraying a concept, Wikipedia does not prefer the most offensive options merely to 'show off' its ability to include possibly offensive materials. Images containing offensive material that is extraneous, unnecessary, irrelevant, or gratuitous are not preferred over non-offensive ones in the name of opposing censorship. Rather, they should be judged based solely on other policies for content inclusion."

Improving this article to the point where it can be submitted for WP:GOOD status should be our goal. Of the choices, I see File:My_gomco_circ_may96.jpg as the image available to us that is the most clear and illustrative of the procedure, meets content guidelines, and stays within nature of the images selected for our WP:GOOD medical articles. Zad68 16:07, 13 July 2012 (UTC)

I find this picture "Rituelle Beschneidung.jpg" unacceptable. I admit I am so timid I cannot look at the picture and therfore place the shock way up there. If we drive people away from the article because of the images we have selected, we are not improving the main article. Perhaps as Doc James has supplied, a circumcision surgery sub article could be created with many grisly illustrations. I am not a doctor and lets be honest, most of us are not used to this degree of carnage. Garycompugeek (talk) 17:05, 13 July 2012 (UTC)