Talk:Circumcision

Revisions to the intro

So I remember that one was my edit and looking at the intro I think it is more balanced this way and all the content is still there... + I added the reference to Southern Africa for the sake of the context of the sources as the focus is on regions with extraordinarily high HIV rates. Sf89wei (talk)

The sentence you edited is already problematic, as it is original research; none of the sources claim to be "circumcision advocates" "particularly" focussing on HIV as the main reason for it allegedly being a public health measure. The sources merely claim that circumcision reduces risk of HIV. That claim is cited repeatedly elsewhere. Your change does not address this. Any suggestions? Blackworm (talk) 23:44, 22 November 2007 (UTC)

Again, when the original research argues in favor of circumcision, none of the gatekeepers here give a damn. Blackworm (talk) 01:18, 19 December 2007 (UTC)

Should the paragraph beginning "In March 2007 the WHO and ..." really be included in the intro? There is plenty of information in the HIV section on this topic, and the preceding paragraph in the intro refers to it too. Isn't the intro currently unbalanced? Its current structure is:

• 1st para ("Circumcision is the removal..."): brief technical definition of the word circumcision and some etymological information.
• 2nd para ("The earliest pictures are ..."): earliest evidence of circumcision and its association with religion.
• 3rd para ("Circumcision is most common ..."): current prevalence of circumcision in the world (by the way: doesn't the phrase "Circumcision is most common ..." misleadingly imply that the practice is also common, but to a lesser extent, in parts of the world not mentioned in the rest of this paragraph? Why not just use the phrase "Circumcision is common ..."?
• 4th paragraph ("Opponents of circumcision condemn ..."): brief summaries of the stances of circumcision opponents and circumcision advocates, including a reference to the topic of intro paragraph 5.

The intro seems reasonably well-balanced so far, but then we have:

• 5th paragraph ("In March 2007 the WHO ..."): description of announcement by WHO and UNAIDS about circumcision and HIV prevention
• 6th paragraph ("Circumcision may also ..."): another statement about circumcision's use to treat a medical condition.

The 5th paragraph is dedicated to a more detailed description of one aspect of circumcision advocacy which is already refered to in paragraph 4; and which is treated, in detail, elsewhere in the article. There is no paragraph in the intro dedicated to any aspect of circumcision opposition. This seems unbalanced.

I would like to suggest the removal of intro paragraph 5, and perhaps intro paragraph 6 could be incorporated into paragraph 4 in some way. Also, I would like to change the phrase "Circumcision is most commmon ..." to "Circumcision is common ...". Any opinions? Beejaypii (talk) 11:30, 6 April 2008 (UTC)

Please see WP:LEAD, Beejaypii. To quote:

The lead should be able to stand alone as a concise overview of the article. It should establish context, summarize the most important points, explain why the subject is interesting or notable, and briefly describe its notable controversies, if there are any. The emphasis given to material in the lead should roughly reflect its importance to the topic according to reliable, published sources. The lead should not "tease" the reader by hinting at but not explaining important facts that will appear later in the article. It should contain up to four paragraphs, should be carefully sourced as appropriate, and should be written in a clear, accessible style so as to invite a reading of the full article.

I would think that this almost requires paragraph 5, since it "summarize[s] the most important points", "explain[s] why the subject is interesting or notable", and "reflect[s] its importance to the topic according to reliable, published sources".

I can't see any way of incorporating para 6 into para 4, since the two paragraphs have different subjects. In the language of WP:LEAD, para 4 serves to "briefly describe its notable controversies" (we briefly describe both pro- and anti-circumcision viewpoints), whereas para 6 "establish[es] context", explaining why circumcision may be performed as treatment (as opposed to arguments about whether it should be performed). Having said this, I'd be interested to read any suggestions you may have.

As for "most common", I suggest keeping the text as it is. Changing it to "common" would imply that circumcision is not common elsewhere, which may or may not be true depending on the definition, and would therefore would require us to define "common". As a relative statement, however, we avoid that difficulty. Jakew (talk) 13:03, 6 April 2008 (UTC)

Jakew, you state that paragraph 5 is "almost" (is this sufficient?) required because it "summarize[s] the most important points", "explain[s] why the subject is interesting or notable", and "reflect[s] its importance to the topic according to reliable, published sources". However, in that section of your response you didn't quote this bit of WP:LEAD: "...and briefly describe its notable controversies." Doesn't this extract from paragraph 4 of the intro "... ,while advocates of circumcision regard it as a worthwhile public health measure, particularly in the control of HIV in Sub-Saharan Africa.", together with its citations already serve the cited purposes of the lead, including the "briefly describe" bit, as far as the HIV/circumcision issue is concerned, and bearing in mind that the advice you quote from wp:lead actually applies to the lead as a whole?

The emphasis given to material in the lead should roughly reflect its importance to the topic according to reliable, published sources.

How can we establish roughly how much emphasis is given to the circumcision/HIV issue by published sources without introducing POV and weighting issues? Do we try to establish what percentage of relevant published sources emphasise this issue? If so, do we include all published sources or only those published in the last X years? And how do we estimate the importance ascribed to this issue by particular sources? Can it be proven, objectively, that the HIV/circumcision issue should receive so much weight in the lead whilst many of the other issues dealt with in the main body of the article are not mentioned there at all? If is not possible to prove this then I don't believe the inclusion of paragraph 5 can be justified.

I agree about the word common: its definition is problematic, even when relativised by using the word more. Therefore, I think we need to find a way of re-phrasing the passage in question in order to avoid these difficulties. There is more detailed information about circumcision prevalence in other sections of the article so why not just state in the intro that circumcision rates vary significantly by country and region, citing the extremes as an illustation (one estimate of the global average is provided in the intro anyway)? We could say that circumcision is almost universal in the Middle East (or cite a specific country, such as pakistan) whilst also citing the rate of 1.6% by age 15 in Denmark, for example (with appropriate citations of course). Wouldn't this be more balanced and avoid the problems associated with the imprecision of the term common.

I haven't yet come to a conclusion about paragraph 6. Beejaypii (talk) 17:03, 6 April 2008 (UTC)

Beejaypii, no, I don't think that the "advocates of circumcision" part of para 4 is sufficient, at least in its present form, because the focus of that paragraph is on (controversial) claims made by advocates on each side of the debate. To (heavily) paraphrase, it basically says "people opposed to circumcision say that it's bad (because XYZ), while people in favour of circumcision say that it's good (because XYZ)". It's a paragraph about people and their views, not the subject itself. It doesn't by itself establish notability (or perhaps even that the subject is interesting).

Para 5 does establish that the subject is notable, because it tells the reader that a significant international health organisation has deemed it to be an important issue.

I also think it would be harmful to combine these paragraphs in a modified form. At present, para 4 is quite carefully balanced, and largely contrasts the views held by some advocates with views held by advocates of another position. If we were to combine the two paragraphs, we'd be comparing anti-circumcision advocates with pro-circumcision advocates plus the WHO and UNAIDS, and would have to adjust the relative weights accordingly. This might be somewhat unkind to the anti-circumcision advocates.

You ask: "How can we establish roughly how much emphasis is given to the circumcision/HIV issue by published sources without introducing POV and weighting issues?" Well, there are two obvious ways. First, one could examine statements from medical organisations that have been issued since the RCT evidence became available (WHO and AUA). Second, one could examine recent publications. For example, if you search PubMed for "circumcision 2007[dp]", you'll find that 268 medical papers about circumcision were published in the last full year. And if you search for "circumcision hiv 2007[dp]", you'll find that 116 (more than 40%) of these discussed HIV (to put this in perspective, searching for "circumcision phimosis 2007[dp]" returns 16 papers, or approx 6%, and "circumcision balanitis 2007[dp]" returns 7 papers, or approx 3%). (According to Google News, the situation in the media is similar: 2840/5210 (~55%) of circumcision articles discuss HIV.)

Re "common", I don't think that extremes would give a representative picture, but a possible alternative might be to simply remove these sentence(s). Jakew (talk) 18:54, 6 April 2008 (UTC)

Jakew, I disagree with your assessment of paragraph 4. I think it's about people and their views on circumcision. I think it's about the fact that one group of people advocate circumcision, and another group oppose circumcision. It's about the existence of a significant debate concerning various aspects of circumcision, and some of the main aspects of both sides of that debate. It's about human rights, physical impairment, public health, HIV, and Sub-Saharan Africa. Doesn't paraphrasing (in fact, haven't you heavily abbreviated rather than heavily paraphrased?) in the way you have done divert attention away from the detail? And isn't the detail the primary focus of our discussion? Also, If I were to adopt the approach you adopt when describing paragraph 4 as being "about people and their views, not the subject itself", wouldn't I be entitled to describe paragraph 5 as being about two organisations and their statements, not the subject itself?

Is it accurate to state that paragraph 5 "tells the reader that a significant international health organisation has deemed it [the subject:circumcision] to be an important issue."? Doesn't this paragraph simply tell the reader that the WHO and UNAIDS stated in March 2007 that circumcision is effective in preventing HIV, but only partially, and not in the absence of other interventions? Does that really tell us that these organisations deem the whole subject of circumcision to be an important issue? Or does it simply tell us that these organisations deem one aspect of the effects of circumcision to be important enough, in the context of HIV prevention, to warrant the issuing of a statement?

I'd like to revisit this passage from wp:lead:

The emphasis given to material in the lead should roughly reflect its importance to the topic according to reliable, published sources.

Do your proposed methods of establishing relative emphasis meet these requirements, even roughly? Don't your methods just measure frequency of co-occurrence of key terms in reliable, published sources, rather than "importance to the topic according to reliable published sources"? Also, wouldn't the papers returned by your PubMed search, if their contents were examined, be likely to demonstrate the importance of one possible effect of circumcision to the subject of HIV, rather than the importance of that possible effect of circumcision to the whole topic of circumcision?

I'd also like to draw your attention to other passages from wp:lead:

The lead should be able to stand alone as a concise overview of the article.

Avoid lengthy paragraphs and over-specific descriptions, especially if they are not central to the article as a whole.

Does the lead, with paragraph 5 intact, "stand alone as a concise overview of the article"? I believe it doesn't because the concision of paragraphs 4's reference to the HIV aspect of the article is compromised by the "over-specific description", in paragraph 5, of one particular event related to this aspect.

Readers should not be dropped into the middle of the subject from the first word; they should be eased into it.

Doesn't paragraph 5 drop the reader into the middle of the subject?

in a well-constructed article, the relative emphasis given to information in the lead will be reflected in the rest of the text.

Is the relative emphasis given to the information in paragraph 5 reflected in the rest of the text? I've carried out some word counts which, I believe, suggest it is not: approximately 300 words out of 4600 are dedicated to the HIV/circumcision issue in the main body of the text (excluding the lead, table of contents, and everything from the see also section to the end). That's only about 7%. Paragraph 5, together with the HIV bit of paragraph 4 (from "particularly in the ...") contains approximately 60 words, which is approximately 30% of the total word count of the lead - which stands at about 210 words.

Provide an accessible overview

Does the lead, with paragraph 5 intact, provide an accessible "overview"?

Finally, I'm going to temporarily refrain from discussing the details of paragraph 3 for the moment. I intend to return to it at a later stage. I think that trying to discuss several issues at once can get overcomplicated. Beejaypii (talk) 01:12, 9 April 2008 (UTC)

Beejaypii, I deliberately omitted the detail because the content of the arguments is less important than noting that there is a controversy. In fact, we could list a completely different set of arguments for and against (as we have done in previous versions), and the paragraph would fulfill exactly the same function. But the existence of a controversy doesn't necessarily make any of the arguments involved valid, nor does it necessarily make a subject interesting.

When paragraph 5 is taken together with the material it summarises (in "HIV and other sexually transmitted diseases"), particularly "In 2007, the WHO and UNAIDS recommended that male circumcision should now be recognized as an efficacious intervention for HIV prevention,[14] but emphasised that it does not provide complete protection against HIV infection.[78]", I think it does constitute an important issue.

If you dislike my methods for determining importance, please propose an alternative. I'd be delighted to assess the subject from a different angle. Jakew (talk) 18:25, 9 April 2008 (UTC)

Jakew, can you provide an alternative version of paragraph 4 which lists a "completely different set of arguments for and against" but still fulfills "exactly the same function"? Yes, a different version would still fulfill the particular function of noting that there is a controversy, but that's not the only function which paragraph 4 is fulfilling: it also plays its part in rendering the lead "a concise overview of the article". I suspect that if a completely different set of arguments were to be provided in that paragraph, this aspect of its function would be altered to some degree. For example, would the function of the paragraph be "exactly the same" if its current reference to the HIV related argument were removed and replaced with a different argument (which I'm certainly not implying should be done by they way, it's just the example I choose to illustrate my point)? I would say that amongst paragraph 4's current functions is the one of providing a concise reference to the HIV issue in the lead, and the presence of this concise reference is one of the reasons I cite for removal of paragraph 5 and the "over-specific description" of one event related to this issue in said paragraph.

You have not responded to most of the points I made in my previous contribution. In particular, you have not countered my assertion that paragraph 5 does not reflect the relative emphasis given to its contents in the rest of the text (and you have chosen not to comment on the word counts I provide in evidence of this assertion). You have not demonstrated that paragraph 5 is not "over-specific" and you have not demonstrated that its contents are "central to the article as a whole" (with reference to the guidance provided in wp:lead). You have not shown that the presence of paragraph 5 does not compromise the concision of the reference to the HIV prevention issue in paragraph 4 in the way I suggest in my previous contribution. You have not demonstrated that your proposed methods for establishing "importance to the topic according to reliable published sources" can achieve their stated aims (and the point is not whether I dislike or like these methods, or whether I can come up with an alternative method; the point is whether or not they can be shown to be valid: can they demonstrate "importance to the topic according to reliable published sources"?). Finally, I'm aware that, with respect to the contents of paragraph 5, you "think it does constitute an important issue.": but that's a declaration of your point of view, and not sufficient justification for the continued presence of paragraph 5. Beejaypii (talk) 12:37, 11 April 2008 (UTC)

You appear to have misundersood, Beejaypii. I'm not saying that my view is that it is an important issue. I'm saying that the World Health Organisation's view is that it is an important issue, sufficiently important that they "recommended that male circumcision now be recognized as an additional important intervention to reduce the risk of heterosexually acquired HIV infection in men" (to use their language [1]).

So, I see three options: a) we leave para 4 and 5 as they are, one expressing viewpoints of pro- and anti-circumcision advocates, and the other establishing notability and global context; b) we amend para 4 so that it covers a different pro-circumcision argument; or c) we amend para 4 so that it includes viewpoints of pro- and anti-circumcision advocates in addition to the WHO and UNAIDS. Jakew (talk) 13:03, 11 April 2008 (UTC)

Jakew, I would like to take the opportunity to briefly summarise some of the arguments I've described in more detail above:

1. Paragraph 5 does not reflect the relative emphasis given to its contents in the rest of the text.
2. Paragraph 5 is "over-specific" and not "central to the article as a whole" (with reference to the guidance provided in wp:lead).
3. Paragraph 5 compromises the concision of the reference to the HIV prevention issue in paragraph 4.

In your option a) you suggest that we might leave the lead as it is. This would not address any of the three points above. Furthermore, doesn't para 3 already "establish global context" in relation to the main topic? And didn't I cast doubt, in a contribution earlier in this debate, on the validity of your assertion that para 5 establishes the notability of the article topic?

The changes you suggest in your option b) do not effectively address any of the three points above. Yes, substitution of para 4's reference to the HIV prevention issue with a reference to another pro-circumcision argument would avoid the issue of the concision of the para 4 reference being compromised by the contents of para 5, but it would also mean that the concision would be lost from the lead: we would be left only with an "over-specific" description of an event related to the HIV prevention issue - an issue which I would describe as "not central to the article as a whole" (wp:lead).

And how might the changes you suggest in option c) be made in such a way that the issues associated with an "over-specific" description which is "not central to the article as a whole" would be resolved? And how would such changes resolve the problems associated with compromising or losing the concision of the existing reference to the HIV prevention issue in para 4?

In keeping with my suggestion at the beginning of this debate, I'm going to suggest a fourth option, d): we remove paragraph 5 from the lead. I believe that we would then be left (in accordance with wp:lead) with a lead which is more consistently a "concise overview of the article", which would not, to a greater extent at least, include "over-specific descriptions, especially if they are not central to the article as a whole" and in which the "relative emphasis given to information" would be more consistently "reflected in the rest of the text".

It seems to me that complying with the suggestion, in wp:lead, that the lead should "explain why the subject is interesting or notable" is proving to be problematic due to the contentious nature of aspects of the topic of this article. Therefore, might I suggest that we keep the lead simple and try to ensure that it can at least "stand alone as a concise overview of the article" and that the article is at least "well-constructed" in the respect that, amongst other things, "the relative emphasis given to information in the lead" is "reflected in the rest of the text." Beejaypii (talk) 11:33, 13 April 2008 (UTC)

Beejaypii, thank you for summarising your arguments. With respect to your point 2, I disagree with your application of WP:LEAD, which states "Avoid lengthy paragraphs and over-specific descriptions, especially if they are not central to the article as a whole." I think that this would discourage, for example, needless detail such as specific odds ratios or the finer points of arguments, but a simple statement about what the WHO recommended is not over-specific. On the contrary, it is just specific enough to establish notability and interest, and no more.

Regarding your third point, I again disagree with your interpretation, for two reasons. Firstly, I don't see "concise" as a concrete limit on the word count (and how on earth would it be measured anyway?), but rather that we should avoid saying more than necessary. Secondly, as I've explained above, I think that paras 4 and 5 are separate issues. Sure, they both mention HIV, but from different angles.

On your first point, I agree with you to some extent. However, this needs to be balanced against what should be included. WP:LEAD lists four points that should be included: "It should establish context, summarize the most important points, explain why the subject is interesting or notable, and briefly describe its notable controversies, if there are any." Of these, para 5 covers requirements (2) and (3). As such, it is clear to me that removing para 5 would do far more harm than good, and we need to think about alternatives. Jakew (talk) 13:34, 13 April 2008 (UTC)

Recent edits

Re this edit by Blackworm which "Restored some of Mahasona's edits, removed anonIP's vandalism, rephrased some statements to better match sources": I would like "Several hypotheses have been suggested:" to be restored because it organizes the material to guide the reader; and I would like "statistically significant" and "significantly" to be restored as these have important mathematical meanings. --Coppertwig (talk) 00:29, 28 November 2007 (UTC)

It's incorrect to describe unrelated findings as hypotheses lending weight to a previous conclusion. This seems to fall under WP:SYN. The information is already organized, the paragraph describes the relation between circumcision and other inflammations or infections from the ones previously described.

As far as "significantly," the word has an entirely different meaning in statistics (the language of these papers) versus general prose, such as an encyclopedia. Basically, in statistics, "significant" means "not insignificant," i.e., not explained by random chance in all but the most extreme cases. This is definition 1 of [Merriam-Webster]. In general prose, it means, "very" or "much" -- definition 2 of same. In the sentence in question the word is used in a misleading way, once as "statistically significant" (weakening the finding, implying that there was a difference but it didn't meet some arbitrary threshold), and again only as "significant" (exaggerating the second finding). The authors of the study did not say (as to a layman), "it was significantly higher." They showed that there was no statistically significant difference in the case of HPV, and there was a statistically significant difference with urethritis. As an exercise, swap the phrases "statistically significant" and "significant" in the previous form of the sentence, and see how the POV shifts. I prefer a neutral POV, and a proper summary of the source. Blackworm (talk) 09:06, 28 November 2007 (UTC)

Jakew, you changed the sentence to reinsert "statistically significant," weakening the finding of no link between HPV and circumcision. Your edit summary said, "'no statistically significant difference' is not quite the same as 'no difference'." That's true, it isn't quite the same, but I ask you -- if the difference is not significant enough to be called significant by the researchers, from a scientific point of view, why is the difference significant enough to you? In a scientific paper, a finding of no statistically significant difference is a finding of no difference. Period. That is science. Are we to start putting "statistically significant" before every finding of no difference between circumcised and uncircumcised men in every study cited by the article, or just the ones where we want to imply there is a difference? Blackworm (talk) 17:03, 28 November 2007 (UTC)

it's not our job to assume that our readers are morons... i say leave "statistically significant" in since it is accurate. ^Law/_Disorder 10:21, 29 November 2007 (UTC)

I agree.

The source states that "There was no significant difference in the incidence of HPV infection ... between uncircumcised and circumcised men", so we are simply reporting what it says. I am concerned by protests that this results in "weakening the finding": why would we want to present a stronger claim than that presented by the source? Jakew (talk) 12:14, 29 November 2007 (UTC)

You tell me -- the previous summary indeed did, and I corrected it. It's unfortunate I don't have the time to check every source in the article, because 90% of the time that I do, the Wikipedia summary takes a more pro-circumcision stance than the source by misrepresenting its position in some way. But fine, I have no objection to this change -- I just think it's silly to insert "statistically significant" every time we report on a scientific paper finding no difference between two groups -- and it's POV to do it selectively since it injects doubt as to the finding. I will "correct" other instances of this elsewhere, I guess. Blackworm (talk) 17:53, 29 November 2007 (UTC)

we can't deal with vague accusations of selective bias.... 67.164.220.177 (talk) 06:41, 30 November 2007 (UTC)

Nothing vague about this. Quite the contrary. I'd say it was very detailed. Garycompugeek (talk) 15:07, 12 April 2008 (UTC)

Sexual pleasure

This article has a section for external links. One of the sections under external links is called "Circumcision opposition". I added a link to Sex as Nature Intended It. A couple of hours later, Avraham reverted to the previous version, calling this a "minor" edit.

As the article currently stands, there is a section for external links that represent "Circumcision opposition". One of the main arguments to be made against male circumcision is that it reduces pleasure for both circumcised males and their female partners. None of the links under "Circumcision opposition" points this out; that's why I added the link to Sex as Nature Intended It. Thus, I think that the link I added is completely legitimate (especially given that it was in an advocacy category). If anyone disagrees, I'd like to hear reasons. —Preceding unsigned comment added by Hyperion (talk • contribs) 07:44, 13 December 2007 (UTC)

"On articles with multiple points of view, the number of links dedicated to one point of view should not overwhelm the number dedicated to other equal points of view, nor give undue weight to minority views." WP:EL#Avoid undue weight on particular points of view Jakew (talk) 12:05, 13 December 2007 (UTC)

Exactly. And Hyperion, being that there is no little black m next to the reversion, from where did you get the idea that I called it minor? -- Avi (talk) 14:15, 13 December 2007 (UTC)

Avi, there is a little black m next to your reversion. What are you smoking? -- Hyperion (talk) 18:54, 13 December 2007 (UTC)

Yes, you're correct. I did not realize that rollbacks automatically coded as minor. Sorry about that. -- Avi (talk) 19:59, 13 December 2007 (UTC)

There are currently four links under "Circumcision opposition" and three links under "Circumcision promotion". Therefore, adding one more link to the former, to yield a 5:3 ratio, would hardly "overwhelm" the point of view promoting circumcision. Thus, it is clear that you are abusing this Wikipedia guideline in order to censor a point of view that makes you personally uncomfortable. And the view being represented hardly constitutes a "minority view". The only places where male circumcision is significantly practiced is America and the Muslim world. Therefore, it is the "circumcision promotion" category which is the minority view. Thus, a 5:3 ratio is entirely appropriate.

A comment on Amazon about the book that this Web site summarizes states: "After reading several books on circumcision, if I could recommend only one book on the "c" word, this would be the one." Thus, this link is essential for Wikipedia readers to be properly informed about the current stated of the male circumcision debate. If you don't like this, find another link to put in the "promotion" section.

Jakew, looking over earlier posts in the Talk page, I see you have been suppressing anti-circumcision points of view for some time time now. Give it up. -- Hyperion (talk) 18:54, 13 December 2007 (UTC)

Having nearly twice the number of anti-circumcision links is a clear case of undue weight, Hyperion, and one cannot infer being opposed to something from not practicing it. If you feel it is important to add this link, I suggest that you propose a way of doing so that does not imbalance the links. Jakew (talk) 12:32, 14 December 2007 (UTC)

I see Avi has removed the 'circumstitions.com' link, which is a satisfactory solution. I've removed the POV description of O'Hara's site. Jakew (talk) 12:39, 14 December 2007 (UTC)

What a big joke. There's an entire section of "circumcision techniques" links which are obviously from groups which support, if not encourage circumcision, that no one is counting under the "pro-" links -- meanwhile, Avi, a circumcision advocate, picks the most convincing and grisly "anti-" circumcision link to be deleted for someone else to add a mild, warm and fuzzy link that isn't convincing at all. What a farce. Blackworm (talk) 18:32, 14 December 2007 (UTC)

HIV

I've once again reverted an addition to the HIV section, which had several problems:

• Currently, four sentences cover mainstream (WHO etc) views about circumcision and HIV. The addition dedicates an additional four sentences to minority viewpoints, effectively giving them undue weight.
• The citing of Thomas (one of the ~40 or so observational studies to date) is bizarre. If we're to discuss observational studies at all, it makes more sense to cite a systematic review of observational studies rather than any individual study.
• The text also gives the impression that Thomas is an example of an author who disagrees "that male circumcision reduces female to male transmission", yet the source makes no such statement (the conclusion is limited only to one particular population).
• Similarly, the citing of Talbott is inexplicable. There are several ecological studies, why this one in particular? Jakew (talk) 14:12, 24 December 2007 (UTC)

• The four sentences from the WHO (there is no "etc.") dominate the section (as they do the lead). There is room for opposing views without undue weight issues, and invoking WP:SUMMARY when someone is claiming violation of WP:NPOV seems misguided.
• This is not a valid argument against the edit. If you have such a systematic review of relevant observational studies, present it.
• I agree that the sentence that begins "Not all authorities..." is misplaced and should be removed.
• Again, not an argument against the edit.

I support Nigelj's edit, with the exception that I believe the sentence "Not all authorities" should be deleted. Blackworm (talk) 00:36, 25 December 2007 (UTC)

I thought maybe a single sentence could be inserted instead of the four sentences, and I read through the HIV section at Medical analysis of circumcision looking for material on which to base that single sentence. I wasn't able to come up with anything. The major publications that express doubt that circumcision helps against HIV were published before the controlled trials and apparently said that we can't conclude it helps until we get the results of the controlled trials. Now that we have those results, those views are no longer relevant or are difficult to interpret or to summarize in a sentence. --Coppertwig (talk) 02:21, 25 December 2007 (UTC)

No longer relevant? I dispute that strongly. If I remember correctly, the controlled trials referenced by the WHO were halted. They were presumably scientific studies, with strict, predefined methodology, that were not carried out to their conclusion. To use "results" from incomplete trials is the prerogative of the WHO, or any group, and it certainly does not invalidate or render irrelevant studies on HIV and circumcision published previously or since. Most certainly, it does not render criticisms of the WHO's view irrelevant. What you are suggesting seem to be that we should exclude other studies from mention, because they contrast with the "mainstream" (i.e. WHO) view. That seems to me to be a violation of WP:NPOV. All of this WHO/UNAIDS stuff is recent scholarship at best; it is arguable that undue weight is given the WHO's current view given that it is a current event. That is most evident in the lead section. I suppose one could ask oneself, does the presentation of the WHO's view in the article read like a dry, factual description of their view, or does it read like an endorsement of that position? Remember that "undue weight" doesn't mean the majority view is presented as the correct view (if indeed the WHO's view represents a majority, a claim yet to be proven). Blackworm (talk) 09:16, 25 December 2007 (UTC)

All three trials included one or more interim analysis stages in their protocols, in which the monitoring board assess the data and decide, among other things, whether to stop the trial. In the case of these particular trials, they were in fact stopped.

Systematic reviews of observational studies include Weiss et al (including 27 studies) and Siegfried et al (including 37 studies). To quote from the full text of the latter's 'conclusions' (accessible at the Lancet's site via free registration):

• "The possibility exists that the observed results included in this review could be explained by confounding. Although the positive results of these observational studies suggest that circumcision is an intervention worth evaluating in randomised controlled trials, the current quality of evidence is insufficient to consider implementation of circumcision as a public-health intervention. Therefore, the results of the three randomised controlled trials underway will provide essential evidence about the effects of male circumcision as an intervention to prevent HIV infection." Jakew (talk) 12:37, 25 December 2007 (UTC)

Also, please note that the WHO did not themselves 'decide' to use these results, but 'convened an international expert consultation', and 'Based on the evidence presented, which was considered to be compelling, experts attending the consultation recommended that male circumcision now be recognized as an additional important intervention to reduce the risk of heterosexually acquired HIV infection in men'.[2]

The systematic reviews of observational studies indicate that most observational studies found a protective effect, but that exceptions exist. Bearing this in mind, how can we justify citing only two such exceptions? How can this be anything other than undue weight? If we're to refer to observational studies at all in the limited space available (which seems questionable), then wouldn't it make more sense to refer to a systematic review which gives a broad overview? Jakew (talk) 13:49, 25 December 2007 (UTC)

I had another look and this for example may still be of some relevance: "We found insufficient evidence to support an interventional effect of male circumcision on HIV acquisition in heterosexual men. " from the Cochrane thingamy. Blackworm, no, I'm not suggesting what it seemed to you that I was suggesting. I was talking about conclusions like the following, also from the same paragraph of the Cochrane whatchammy: "The results of [RCT's] will need to be carefully considered before circumcision is implemented as a public health intervention for prevention of sexually transmitted HIV." Written before the RCT results were around. Now that those results exist, it seems difficult to iterpret or summarize this statement. I'm not aware of any published criticisms of the position the WHO has taken based on the RCT results.

(edit conflict) I propose the following edit. Insert "Earlier, meta-analyses of observational data differed as to whether there was evidence of a protective effect of circumcision against HIV." at the end of the first paragraph of "HIV and other sexually transmitted diseases". At the same time, to avoid lengthening the article, shorten the material on balanitis and balanoposthitis as follows: change this:

“ The usual treatment for balanoposthitis is to use topical antibiotics (metronidazole cream) and antifungals (clotrimazole cream) or low-potency steroid creams.

Circumcision is sometimes used to treat balanitis, although there are less invasive treatments than circumcision that have been shown to be effective in treating most mild cases. The less invasive procedures are not as successful in treating balanitis xerotica obliterans, or BXO, which is much less common but harder to treat. Circumcision is believed to reliably reduce the threat of BXO.

”

to this:

“ Circumcision is one treatment for balanitis. The usual treatment for balanoposthitis is to use topical antibiotics (metronidazole cream) and antifungals (clotrimazole cream) or low-potency steroid creams. ”

The deleted material is already present, I believe, in the Medical analysis of circumcision article.

The material I propose to insert can be supported by the following references, which will have to be formatted appropriately and possibly the first one replaced by a reference to the study it mentions: USAID Cochrane Cochrane. --Coppertwig (talk) 14:34, 25 December 2007 (UTC)

Jakew, you make good points re the foundation of the WHO position. Looking at Medical analysis of circumcision I get the impression that there were two major meta-analyses of the observational data, which in my edit above I suggest citing. re WHO: are we (merely :-) citing WHO, or can we also (or do we already) cite the conference they base their recommendation on? --Coppertwig (talk) 14:39, 25 December 2007 (UTC)

Coppertwig, I think that the essence of your edit is fine in principle, but I have a couple of concerns about the details.

My first concern is that while one meta-analysis may provide some background information to the RCTs, I think it may be excessive to discuss two reviews of observational data. Given that the available space is limited, how much of it should we dedicate to "quality of evidence [that] is insufficient", and how much to "essential evidence"?

My second concern is that I think it is inaccurate to say that "Earlier, meta-analyses of observational data differed as to whether there was evidence of a protective effect of circumcision against HIV". Both Siegfried et al and Weiss et al reported finding that this evidence existed ("Although most studies show an association between male circumcision and prevention of HIV" - Siegfried, "Male circumcision is associated with a significantly reduced risk of HIV infection among men in sub-Saharan Africa, particularly those at high risk of HIV" - Weiss). However, Siegfried et al were concerned about whether the evidence was good enough to warrant implementing circumcision programmes: "these results may be limited by confounding, which is unlikely to be adjusted for ... the current quality of evidence is insufficient to consider implementation of circumcision as a public-health intervention."

Although the following is too long, I think it is probably the best way to summarise:

• "In March 2005, Siegfried et al. reviewed 37 observational studies. Although most studies showed an association between circumcision and prevention of HIV, they found the quality of evidence available at the time insufficient to warrant implementation of circumcision as a public health intervention. They concluded that the results of the three randomised controlled trials then underway would therefore provide essential evidence about the effects of circumcision. The first of these trials..."

Incidentally, I'm a little confused because you seem to have given the same (www.psi.org) link for both USAID and Cochrane references. Could you clarify whether this was your intent, and if not, what the links ought to be? Jakew (talk) 12:23, 26 December 2007 (UTC)

Oh, sorry about the URL's. OK, we're considering four references:

• USAID 2002 Male Circumcision: Current epidemiological and field evidence, which says "A systematic review and meta-analysis of 28 published studies by the London School of Hygiene and Tropical Medicine, published in the journal AIDS in 2000, found that circumcised men are less than half as likely to be infected by HIV as uncircumcised men. A subanalysis of 10 African studies found a 71 percent reduction among higher-risk men. A September 2002 update considered the results of these 28 studies plus an additional 10 studies and, after controlling for various potentially confoundnig religious, cultural, behavioral and other factors, had similarly robust findings. Recent laboratory studies in Chicago found HIV uptake in the inner foreskin tissue to be up to nine times more efficient than in a control sample of cervical tissue."
• Weiss et al. 2000, which says "Male circumcision is associated with a significantly reduced risk of HIV infection among men in sub-Saharan Africa, particularly those at high risk of HIV. These results suggest that consideration should be given to the acceptability and feasibility of providing safe services for male circumcision as an additional HIV prevention strategy in areas of Africa where men are not traditionally circumcised."
• Cochrane = Siegfried et al. 2003 which says "We found insufficient evidence to support an interventional effect of male circumcision on HIV acquisition in heterosexual men. The results from existing observational studies show a strong epidemiological association between male circumcision and prevention of HIV, especially among high-risk groups. However, observational studies are inherently limited by confounding which is unlikely to be fully adjusted for. In the light of forthcoming results from RCTs, the value of IPD analysis of the included studies is doubtful. The results of these trials will need to be carefully considered before circumcision is implemented as a public health intervention for prevention of sexually transmitted HIV."
• Siegfried et al. 2005 which says "Study quality was very variable and no studies measured the same set of potential confounding variables. Therefore, conducting a meta-analysis was inappropriate. Detailed quality assessment of observational studies can provide a useful visual aid to interpreting findings. Although most studies show an association between male circumcision and prevention of HIV, these results may be limited by confounding, which is unlikely to be adjusted for."

I suggest this edit (along with the balanitis changes): "Earlier, reviews of observational data differed as to whether there was sufficient evidence for an intervention effect of circumcision against HIV" and using Weiss et al 2000 and Siegfried et al 2003 as the references. I think Siegfried et al 2003 and Siegfried et al 2005 are saying essentially the same thing: that there is evidence of correlation but insufficient evidence of causation. --Coppertwig (talk) 15:14, 26 December 2007 (UTC)

Ok, thanks for clarifying. Unless I'm greatly mistaken, USAID 2002 is citing Weiss 2000. I think that Siegfried 2005 is an updated version of 2003, and as you say makes a similar conclusion: that observational studies aren't sufficient (because they are "inherently limited by confounding") and that RCTs (will) provide more definitive data. I think that, if we're to discuss the observational data, we need to distinguish between these data and those from RCTs. Jakew (talk) 15:51, 26 December 2007 (UTC)

How about this? I think it makes the distinction clearer: "Before there were any results from randomized controlled trials, reviews of observational data differed as to whether there was sufficient evidence for an intervention effect of circumcision against HIV." --Coppertwig (talk) 16:28, 26 December 2007 (UTC)

That seems perfectly reasonable to me. Jakew (talk) 22:43, 26 December 2007 (UTC)

(<<outdent) OK, I did the edit, including shortening the balanitis section. One advantage is that the two edits led to a net reduction in number of footnote superscripts of four. (I believe it's the number of footnote superscripts that causes the page to render slowly, I presume also putting a load on Wikimedia's servers.) The deleted references are still present on the Medical analysis of circumcision subpage, so that's fine. --Coppertwig (talk) 03:02, 27 December 2007 (UTC)

Sexual Effects

It seems like the sexual effects article is biased by showing more studies against circumcision then for it. Obviously, there are numerous amounts of studies on both sides. I am trying to add 2007 payne study but i am sure that it wilil get reverted by anti-circ zealots. By the way, most pro-circumcisers that try to bias it is in response to the anti circ people. 67.35.83.97 (talk) 13:38, 31 December 2007 (UTC)

I think it's amusing when people who support nonconsensual bodily amputations call others "zealots". 68.40.196.149 (talk) 06:56, 14 March 2008 (UTC)

I have to agree.

by Wild Mountain Thyme (talk) 06:45, 10 April 2008 (UTC)

Payne study

This edit inserted the sentences "A 2007 payne study recently tested circumcised and uncircumcised men for sensitivity of the glans and came to the conclusion that it was the same." and "However, recent studies have reached more balanced views that came to the conclusion it is the same." I reverted the edit. The 2007 Payne study is referenced in the Sexual effects of circumcision article, where in my opinion it's accurately quoted. In my opinion, these edits I just deleted are not an accurate representation of the study. The study said that they did not find any difference in sensitivity between the two groups. It did not say that they found that there is no difference in sensitivity: something that no statistical study could establish, since statistics can never demonstrate that two quantities are exactly equal. --Coppertwig (talk) 15:06, 1 January 2008 (UTC)

I think you're right to remove the reference to Payne's study. This article isn't the right place to discuss primary sources. Since there is only a limited amount of space available, we need to simply summarise secondary sources. Jakew (talk) 15:20, 1 January 2008 (UTC)

Adult Circumcision

There is little to no information about the circumcision procedure that adult men undergo (such as for medical or religious reasons.) Rather, the prevailing viewpoint tends to be geared towards infant circumcision. I believe this needs to be addressed. —Preceding unsigned comment added by 68.150.33.190 (talk) 22:20, 5 January 2008 (UTC)

Good point. ~ Homologeo (talk) 19:44, 1 February 2008 (UTC)

In Africa circumcision happens at adult age. Khayav made some video about it on youtube. He was circumcised as an adult. --Zslevi (talk) 18:10, 9 April 2008 (UTC)

Pictures?

Not to be inappropriate at all, but would there be any way to have a side-by-side comparison of a circumsized and uncircumsized penis? For comparison? (And those of us who are chicks, and don't really know the difference...) 63.166.22.254 (talk) 11:21, 6 January 2008 (UTC)

We used to have comparison pictures, but the uncircumcised picture was deleted according to CSD criteria I9 and G7 (copyright infringement and author request).

Here's an image of an uncircumcised penis from Commons: Image:Uncircpn.jpg. Would it be a good idea to add it to the article? I found two other pictures at Commons which at first glance seem to be labelled "uncircumcised", but apparently are actually of circumcised penises. --Coppertwig (talk) 15:11, 6 January 2008 (UTC)

There are two images at Erection#Penis erection, both of which are public domain. We could use these, or combine them into a suitable image illustrating the differences. I'd be happy to do this myself if there was consensus to do so... Jakew (talk) 16:50, 6 January 2008 (UTC)

Should we perhaps wait until we can find a suitable image of a circumcised penis that doesn't have a skin bridge, or any other sign of a botched circumcision? Blackworm (talk) 19:41, 6 January 2008 (UTC)

I can't even see the skin bridge on that picture, so I'd suggest going ahead and including both pictures, but am happy to wait if Blackworm prefers. (Congratulations for showing neutrality there, Blackworm.) (I don't dare put up a request at Commons for such a picture. Maybe someone else is braver than me about that.) --Coppertwig (talk) 23:13, 6 January 2008 (UTC)

I agree you can't see it in the thumbnail, but I definitely see it if I click on it. I'm fine with it, just thought I'd note that. Blackworm (talk) 23:17, 6 January 2008 (UTC)

I believe we're talking about Image:Flaccid-erect.jpg. OK, maybe I see the skin bridge now. In the erect picture, I think the skin bridge is something that if you follow it down towards the body, it seems to meld into a vein that sticks out. Is that right?

I'm not sure how much work it would be for Jakew to combine the images. Ideally I guess the skin bridge one would be replaced when a more suitable image is found. Actually, two images. I suggest one of a circumcised penis without skin bridge or other problems, and also (in another section of the article perhaps) a clearer, more obvious image of a skin bridge. --Coppertwig (talk) 01:14, 8 January 2008 (UTC)

Now that I've seen the difference in both pics (good Lord, what IS that thing on the end?!)(rhetorical, don't worry), I strongly think a comparison pic would be a good idea. Pictures say a thousand words, and what better way to describe the procedure than by showing the, if you will, "before" and "after" pics. No?

63.166.22.254 (talk) 08:39, 8 January 2008 (UTC)

Re survey

This material was removed from the article by Jakew: "However, in the 2007-08 global Durex sexual activity study, the United States (in which the majority of males are circumcised) ranked 25th for sexual activity, while all of the European nations surveyed (which have a majority of uncircumcised men) were in the top ten. One of the reasons for this can be attributed to the fact that circumcision was formed in religious circles as a way to prevent masturbation, as more religious societies have proven to be less sexually active than secular cultures. Also, modern polls of men show that uncircumcised males tend to masturbate more compared to their circumcised counterparts, due to the self-lubricating properties of the foreskin" with edit summary "rv original research". OK, there does seem to be some OR there -- but the last sentence looks merely unsourced, not OR. However, we might as well leave it out until somebody finds an actual source. I did some web searches and didn't find anything much. --Coppertwig (talk) 14:55, 12 January 2008 (UTC)

Off the top of my head, I can think of two studies that have assessed masturbation frequency by circumcision status. Neither support the claim. Laumann (JAMA 1997;277:1052-7) found that circumcised men masturbated more frequently, while Richters (Int J STD AIDS 2006;17:547-54) found no statistically significant difference. So even if some sources exist that support the claim, the sentence would be problematic. The "due to" claim in that sentence also looks rather OR-ish to me. Jakew (talk) 15:22, 12 January 2008 (UTC)

Jakew presents solid reasoning for removing this material - definitely looks like OR. ~ Homologeo (talk) 19:49, 1 February 2008 (UTC)

Campaigns, etc

Recently, the BBC carried a story headlined Rwanda in mass circumcision drive, in which it is explained that "Rwanda has launched a campaign to encourage all men to be circumcised, to reduce the risk of catching HIV/Aids." I'm not certain of the best article for this information. It seems likely to affect the prevalence of circumcision, but technically that's OR and a little crystal ball-ish. I suppose it could go into circumcision advocacy, though it would change the focus of that article. Previous reports indicated that several countries have similar plans, so it's probably worth giving this some careful thought. Does anyone have any ideas? Jakew (talk) 18:16, 24 January 2008 (UTC)

Perhaps Male circumcision and law or perhaps reproductive rights or human rights since it seems like a case of forcing teenage and adult males to be circumcised against their free will (the article described it as "nominally voluntary" and states that "many in the armed forces will regard it as an order"). It's also definitely circumcision advocacy since the campaign will be started, among others, "with the new born." Blackworm (talk) 20:12, 24 January 2008 (UTC)

Instead, perhaps we should start a Campaigns for semi-voluntary mass male circumcision article? I'm sure it will get filled out in the coming years, if the WHO has their way. Blackworm (talk) 22:29, 24 January 2008 (UTC)

Such silence on this momentous development...? Maybe it should just go in the main Circumcision article next to the information about the WHO's push for mass circumcision in Africa. I wonder if Wikipedia senior administrator Jayjg, a former member of ARBCOM, would now reverse his comments in the "Articles For Deletion" proposal Jakew initiated for the circumcision advocacy article:

Delete. Obvious original research, no evidence such movement or social activity actually exists. Jayjg (talk) 00:10, 5 December 2005 (UTC)

— User:Jayjg, Senior Wikipedia administrator and former ARBCOM member, in the AfD for circumcision advocacy.

Blackworm (talk) 21:15, 25 January 2008 (UTC)

And Kenya. (Filing here for convenient access at a later date.) Jakew (talk) 21:15, 9 April 2008 (UTC)

Where would this hypothetical edit go in Wikipedia?

In the context of fieldwork among the Kenuz Nubians, El Guindi has argued for "the significance of the notion of the cultural equivalence of male and female circumcision," and further argues "that this cultural equivalence extends analytically as a structural equivalence: that is, the two gendered rituals play equivalent roles in the transition of male and female children to adulthood."[3]

Since this article inexplicably bans all discussion of the circumcision of females, and the female genital cutting article bans any comparison to male circumcision (but oddly, not contrasts), it seems that there is nowhere in Wikipedia a place for scholarship concerning any comparisons of any kind between the circumcision of males and females. It seems El Guindi's published views, like all views concerning any such comparisons, are suppressed by the imposed structures. Could the reason be POV? Blackworm (talk) 07:46, 25 January 2008 (UTC)

How does an article ban anything? And what exactly are "imposed structures"? Either a piece of information is referenced and relevant to the article subject, or it's not. That said, of course there are strong POVs involved on an immediately and unavoidably personalised hot button topic like this. The only advice I can offer you is to do what I did: look for other areas of interest and don't lose yourself in the same endless dispute over and over. Wikipedia offers an increasingly comprehensive bouquet of heat and noise to dive in; endless conflicts of interest, gaming the system, intellectual dishonesty, ownership, bullying, low-level long-term disruption. There are far more places where you can't do anything to improve the encyclopedia because of dirty tactics being shamelessly employed for the sake of a questionable status quo. Why try in vein here, when you can as well try in vein elsewhere for a change? Alternatively, create a niche for yourself and write about something completely different or find other ways to participate. If however your primary goal is to educate others, then I can only hope you are willing to be educated in turn. Otherwise, you're no better than the trolls who come here with a set agenda. User:Dorftrottel 08:13, January 28, 2008

Thank you for the comment. I'm not sure if it was intended as humour but I must say I found the part about trying in vain elsewhere for a change very amusing. One major point of Wikipedia is to assume good faith, and the day I give up on that, I might as well give up on Wikipedia entirely. My primary goal is not to educate others, it's to help make a encyclopedia worthy of being called a neutral reference work. I have indeed been educated on how to do that, mostly by reading WP policies. I believe that if they are put into practice, they will work. Unfortunately, WP is still edited by humans with points of view, and sometimes even by humans wishing to promote or oppose the presentation of specific, notable, verifiable points of view.

As for how an article bans an idea, the mechanism and effect are clear -- through a strongly enforced, narrow, and incomplete definition of a topic, this article and all related articles ban the idea that circumcision also includes the circumcision of females, thus implying that the topic refers strictly to procedures on males, and that any other usage is incorrect. Any reader of George Orwell knows how control of language gives rise to control of ideas. The groups who wish to control (i.e. eliminate) the idea that male and female circumcision are in any way comparable or related have an interest in separating the terminology. This isn't done in secret; organizations like the UN's specialized agency the WHO, openly admit to be promoting the introduction of new terminology to describe female circumcision (and thus effectively redefining the term "circumcision") so as to eliminate undesired associations between the practices of male circumcision and female circumcision. They simultaneously campaign for mass male circumcision (with alarming effects, IMO) and claim that female circumcision is a human rights violation. These two tasks would be much more difficult to justify if the term used was "circumcision" in both cases. I don't believe Wikipedia, as a supposedly neutral reference, should engage in or assist this advocacy, even if 99% of editors were convinced that the advocacy is otherwise something they would support. I believe the current organization of the articles does just that, and find it difficult not to conclude that it is either purposely done to support this advocacy, or, perhaps as a matter of greater concern, done unconsciously because the WHO and similar groups have already succeeded in eliminating ideas through their recent redefinition of words and phrases in the English language. Sorry if this is soapboxish, but you asked about my goals... WP:NPOV pretty much sums them up, along with the Five Pillars. Can WP:NPOV be followed here, or are we to give up on it? Blackworm (talk) 09:03, 28 January 2008 (UTC)

FWIW, I believe the article is currently as fair & balanced as it will get. Why not go to WP:FAC? If there are still issues that could and should be improved, the article can only benefit from the attention of multiple uninvolved users. User:Dorftrottel 11:48, January 28, 2008

Female genital cutting already contains a quote which comments on a comparison of male and female circumcision: "this procedure in whatever form it is practised is not at all analogous to male circumcision." I think right next to that quote would be a good place for the above quote, per WP:NPOV. (Is it a real quote, or just hypothetical?) Since the words for female circumcision are being changed, the page on that topic seems to me a good place to discuss related nomenclature. There's no particular reason why female circumcision can't be mentioned on this page, or male circumcision on that page, if it's somehow relevant to the topic. This page may also be a possible place for such a quote; or Circumcision in cultures and religions. --Coppertwig (talk) 03:07, 29 January 2008 (UTC)

The above quote doesn't seem to be discussing terminology, and I wonder if perhaps a better approach might be to shorten the Cook quote, so that it stays closer to the topic within the 'terminology' section? In any case, Talk:Female genital cutting seems a more appropriate place to discuss changes to that article, so perhaps we should discuss it there.

I think that comparisons are sometimes useful in an encyclopaedia. For example, it might be helpful to describe a skyscraper as "about the height of the Eiffel Tower". However, where the comparison is itself controversial, the value can be diminished. For example, if we were to say that "according to author X, it is about the height of the Eiffel Tower, but according to author Y, X is a 'bloody idiot' and there is 'no comparison'", it doesn't seem to tell the reader very much about the skyscraper. Indeed, the subject no longer seems to be "the skyscraper", but instead "[the dispute over] the relationship between the height of the skyscraper and the Eiffel Tower".

I'm not saying that such material doesn't belong anywhere in Wikipedia, but I think that we need to think carefully about whether it belongs in a particular article. Since Wikipedia articles are of limited length, we can't include every piece of information that's remotely related to the subject; we must select information to summarise. "Because it's there" may be a good reason for climbing Everest, but I think we need something better for selecting material. If the dispute is itself notable, perhaps a case can be made for an article about 'the relationship between male circumcision and female genital cutting'. As an alternative, since this quote is about the cultural significance of practices "in the context of ... the Kenuz Nubians", perhaps Nubians is an appropriate place?

Similarly, there is some debate in the literature over whether circumcision may be compared to a vaccine (this often, but not always, seems to occur in the context of HIV). I'm not convinced that covering this debate would add value to the article, since it would convey little information about circumcision itself. Jakew (talk) 13:20, 29 January 2008 (UTC)

Coppertwig, I would argue that any information concerning the circumcision of females is directly related to the topic of circumcision. It seems... self-evident? As for your statement that the words for female circumcision are being changed, that seems to beg the question, Who are these benevolent masters working to change the words for female circumcision for us? And, how exactly are the words being changed? By decree? Finally, for what purpose do you believe the words are being changed? Note, I do not disagree that they are indeed being changed, in fact you seem to echo my very points above. Maybe you didn't mean it that way, but I think the particular choice of words was bang on. Blackworm (talk) 05:22, 30 January 2008 (UTC)

Female genital cutting is not "circumcision". It is amputation of the clitoris rather than the skin around it and often includes sewing up the labia. It is directly comparable to removing the entire glans of the penis and sewing the foreskin closed rather than amputating just the foreskin. Sure there are aspects of similarity, for example the social coming-of-age aspect and the fact that both procedures involve sharp implements and the genitals, but the differences are more fundamental than the similarities. Calling the amputation of a clitoris 'female circumcision' is an aspect of POV in action (I know that this is the 'traditional' term but I suspect that it originated from a misunderstanding and therefore changing the term to 'female genital cutting' or 'clitoral amputation' provides clarity rather than obscuring anything). This is not to get involved in the argument over whether the amputation of a foreskin is a good thing, but comparing the two procedures is not valid. It is like comparing electric shock treatment to using a crash cart to restart a heart... yeah, they both involve electricity but they are not really related otherwise.SimonHolzman (talk) 20:30, 30 January 2008 (UTC)

Your assertions are either debatable opinion, or patently false. Webster's gives one definition of "circumcision" as a cross-reference to "female genital mutilation." Also, your other assertions are contradicted by multiple reliable sources in the Female genital cutting article. Female genital cutting, a phrase redefined by the WHO, encompasses a range of procedures greatly varying in severity; from a piercing, a pinprick, or contact with herbs, to cutting (excision) of tiny amounts of tissue, to excision of larger amounts of tissue, to excision and infibuation (which is what you refer to). Since "female genital cutting" also encompasses procedures that do not involve any cutting, excision, or removal of any tissue, your assertion that the term provides clarity is also demonstrably false. Your other assertions are original research, unsupported by reliable sources, and are at best opinion. Luckily for you, your opinion seems to be reflected by the organization of this article. For the moment, anyhow, until a neutral party with authority reviews the multiple policy violations in this article, from the title, definition and lead on down. Blackworm (talk) 21:17, 30 January 2008 (UTC)

So the term 'Female Circumcision' is more accurate in your opinion ? The point I was making was that female circumcision is minimally comparable with male circumcision and your list of the variety of procedures encompassed by 'female genital cutting' confirms my point. Thank you for your support. BTW, since when was opinion or original research forbidden on Talk pages ?SimonHolzman (talk) 18:54, 31 January 2008 (UTC)

The above user, SimonHolzman, has likened me personally to Hitler, on my talk page, [with this edit]. I will not be responding to this user. Blackworm (talk) 23:54, 31 January 2008 (UTC)

I did not liken Blackworm to Hitler, I said that Blackworm appeared to have nothing positive to say about circumcision and then commented that most topics have some positive aspects, for example, Hitler was supposedly fond of dogs. My comparison was between circumcision and Hitler, not between Blackworm and Hitler. I apologized immediately Blackworm made me aware that he felt offended. It was not my intention to offend or insult him and while I might perhaps have expressed myself better, I still do not think that my comment can be taken as abusive by anyone who is not hypersensitive. Please look at the message I left Blackworm in his comment above and judge for yourself. I had asked Blackworm a question on his personal talk page because of a genuine interest in the answer and aware that Blackworm might legitimately choose not to answer it. However, if Blackworm refuses to respond to my questions on THIS talk page, I think it reflects more on him than on me and harms the discussion rather than furthering it. As such, since Blackworm claims to have accepted my apology, I hope that he will reply to my message above.SimonHolzman (talk) 18:12, 1 February 2008 (UTC)

I will not, because despite your apology, you continue to be incivil with comments such as "Thanks for your support" and your accusation of hypersensitivity. I too invite readers to judge for themselves whether an editor introducing themselves as Jewish, regarding a topic of high sensitivity and importance to Jews, appropriately told an editor he viewed as critical of the topic: I am curious because you seem to have no positive feelings about it, and so I wonder why this is. After all, Hitler was apparantly kind to dogs. At the very best, it was an extremely poorly chosen and ambiguous analogy. At worst, and reasonably interpreted as such, it was a gross accusation of antisemitism. Blackworm (talk) 20:30, 1 February 2008 (UTC)

Including the sentence immediately before the excerpt you chose to quote I said, Overall, I have mixed feelings about [circumcision] and see some benefits and some dangers. I am curious because you seem to have no positive feelings about it, and so I wonder why this is. After all, Hitler was apparantly kind to dogs. As I have said, I intended it as comparison between circumcision and Hitler and did not intend any slur on you. The Thank you for your support above was prior to any misunderstanding on this issue. I do not think this dialogue between us serves any further purpose. Please feel free to reply to this as I do not want to be seen to be shutting down this by having the last word, but I will not reply unless you say anything inappropriate, which I am sure you would not do.SimonHolzman (talk) 22:16, 1 February 2008 (UTC)

I have to concur with the observation that it's reasonable to compare the two practices, as long as legitimate sourcing is provided, because female genital cutting does indeed encompass a number of procedures, some of which can be considered milder and some harsher than male circumcision. Thus, I see nothing wrong with including neutrally worded comparisons in either of the articles. ~ Homologeo (talk) 20:23, 1 February 2008 (UTC)

The problem is that any reasonable comparison will be meaningless since female genital cutting encompasses many procedures while male circumcision is basically a single procedure. It's like comparing cats with Bill Gates. You would need to specify which procedure you are comparing and the differences probably outweigh the similarities. If you can draft a fair comparison, by all means do so, but I would suggest that it would be better in a standalone 'Comparison of Male and Female Circumcision' article.SimonHolzman (talk) 22:16, 1 February 2008 (UTC)

There are several authors who would agree with you, Simon, though of course there are others who would disagree. Similarly, there are several authors who believe it to be appropriate to compare circumcision to a vaccine, and others who would disagree with that. As I see it, though, this article is already quite long enough, and adding sufficient material to cover both sides of these sub-debates would make it far longer. Unfortunately, in spite of that added length, it would tell the reader relatively little about the subject of the article, but would instead discuss at great length whether certain analogies are appropriate or inappropriate. Looking at it another way, if we were to cut material from the article to make space for these analogies, I can't find anything suitable. I tend to agree that such material, if it belongs anywhere, should probably be in its own article. Jakew (talk) 23:43, 1 February 2008 (UTC)

This article's title is "Circumcision". It does not specify a gender and therefore neither should we. Garycompugeek (talk) 15:24, 12 April 2008 (UTC)

This has, of course, been discussed at some length previously (both in this section and in the archives), and I would encourage you to read through those discussions. It would be foolish to have multiple articles about "female circumcision", and as the hatnote at the start of the article notes, "This article is about male circumcision. For female circumcision, see Female genital cutting...." Jakew (talk) 15:39, 12 April 2008 (UTC)

Redirect to Male Genital Cutting?

In the interests of NPOV, perhaps this article should be moved to 'Male genital cutting' and redirected from here, in order to correspond with the page on female circumcision which is entitled 'female genital cutting'. Bagofants (talk) 16:17, 2 February 2008 (UTC)

If and when "male genital cutting" becomes the commonly used term for circumcision, then we can move the article to reflect that. Until then, Wikipedia needs to reflect the language used in the real world. Jakew (talk) 16:32, 2 February 2008 (UTC)

Wikipedia is an Encyclopaedia, not a dictionary. It should reflect the *facts*. 'Male Genital Cutting' is a much more descriptive title for an article about the cutting of the male genitals. Perhaps upon renaming the article you could clarify with "Male Genital Cutting AKA circumcision". 'Male Genital Cutting' currently redirects to 'Genital modification and mutilation', which incidentally has a section on male circumcision. Perhaps the best solution would be to merge this article into that page, as circumcision is a form of genital modification, and some would argue a form of mutilation. Bagofants (talk) 17:08, 2 February 2008 (UTC)

This article is not about the cutting of the male genitals. It is about the removal of the foreskin of the penis, a procedure known as circumcision. Per use common names, we therefore call it 'circumcision'. "Male genital cutting", if the term were in common usage, would presumably include vasectomy, castration, penectomy, subincision, and indeed any procedure in which the male genitals were cut.

Your proposal to merge this article into the page about GM&M makes no sense. Would you propose to merge every surgical procedure article into surgery on grounds that they are forms of surgery? Jakew (talk) 17:21, 2 February 2008 (UTC)

'Every surgical procedure' is not related to genital mutulation or modification. Similarly, whilst in the Western world circumcision is usually carried out as a surgical procedure, in some parts of the world it is carried out as a ritual and for non-medical purposes. Whilst, obviously, merging all forms of surgery into one article is ludicrous, circumcision and 'genital cutting' are closely enough linked to be merged, and the total length of the article would not be excessive, so my proposal makes perfect sense. Also, you seem to have an unhealthy obsession with male circumcision. Were you circumcised yourself or it it just a sexual fetish? Bagofants (talk) 17:40, 2 February 2008 (UTC)

The fact remains that you are proposing to take an article that can be categorised in a certain way (a procedure that modifies the genitals), and to merge this into the article for that category. Logically, this is equivalent to arguing that an article that is a form of surgery should be merged into surgery. Indeed, one wonders what you propose to do with the other procedures I mentioned. Should they be merged into GM&M as well? Or perhaps they should be merged into surgery instead? Or maybe initiation rite? Actually, since most articles fall into several categories, should we get rid of separate articles and just have a single, giant article called 'Wikipedia'? Jakew (talk) 17:53, 2 February 2008 (UTC)

Following your logic, then yes, Circumcision should exist as it's own article, in which case the few paragraphs about male circumcision should be removed from the 'Genital modification and mutilation' article. In fact, the article 'Genital modification and mutilation' should be split and a new article created for each type of genital modification and mutilation featured in the article (or content merged with existing articles if they already exist), namely: body modification, voluntary gender-reassignment, involuntary gender assignment, male circumcision, and female circumcision. As articles for these subjects seem to already exist, the content within the article 'Genital modification and mutilation' is superfluous. This is, of course, following your logic of having a separate article for every single aspect of something. Bagofants (talk) 22:59, 3 February 2008 (UTC)

I guess Jakew is trying to come up with an answer, 6 days later. Funny how that works when they (him and his friends) are wrong about something. I can't wait for my comment to get reverted (as quickly as possible) or shot down by him and his pro-circ/admin/mod friends who try so hard to push their POV. I think, of all the edits ever done to the Circ page and this talk page over these years, this one suggesting the merge is the most intelligent of all. Of course Jakew and his friends would never allow their precious page to turn into a redirect and have their pro-circ agenda be smashed into a sub-category. —Preceding unsigned comment added by 206.248.159.46 (talk) 07:55, 8 February 2008 (UTC)

Circumcision is the commonly used term. It makes sense to keep it distinct. If there is future shift in word usage, then we can consider consolidation. I will add that I could not find online any dictionary that refers to circumcision as "Male genital cutting." To suggest that we ignore the conventional meaning of words is quite simply bad writing. So while Wikipedia is not a dictionary we should still use words and categories that are most broadly understood. Mattnad (talk) 12:15, 7 March 2008 (UTC)

I agree. The problem is that circumcision is the commonly used term for the act of "[cutting] off the foreskin of (a male) or the clitoris of (a female)."[4] This article is strictly about male circumcision, and thus should be titled "Male circumcision," per WP:TITLE. That there is vehemently strong resistance to this idea from a core group of editors with the minority point of view that "female circumcision" does not exist as a valid term, suggests that WP:NPOV issues continue to run wild in this article. Blackworm (talk) 21:55, 8 March 2008 (UTC)

Blackworm is unfortunately misrepresenting the position of those with whom he disagrees, and nobody has claimed that "female circumcision" is an invalid term. For previous discussions, please see the archives or Talk:Circumcision and law#Neutrality. Jakew (talk) 22:06, 8 March 2008 (UTC)

I never said you claimed that female circumcision is an invalid term, I said you believe that female circumcision is an invalid term. You avoid it, you put it in quotes when you use it, and you define "circumcision" as exclusively applicable to males and you defend that definition vigorously. You want to separate the concept of circumcision from anything related to females. I don't blame you. I could support your advocacy. But Wikipedia isn't the place for your advocacy. Blackworm (talk) 08:23, 9 March 2008 (UTC)

POV?

Am I the only one who read this article and got a Circumcision propaganda pamphlet? I think it needs some serious revising, but I won't throw up a POV tag if I'm the only one who thinks so. 202.182.83.31 (talk) 08:21, 11 February 2008 (UTC)

I agree, but there's not much point putting in a POV tag as it will get instantly removed by editors insisting to the people in the neutrality dispute that there is no neutrality dispute. And if you don't have six hours a day to engage in "discussion," I wouldn't bother trying to revise the article either. Blackworm (talk) 11:07, 11 February 2008 (UTC)

Yes throw up a POV FLAG on circumcision. This is probaly THE MOST biased page on all of wikipedia (or at least that I have ever seen.) If anything it should be about the PRACTICE. There should be a separate page with equal length given to the pro and con side. But this is a ridiculous site. It's all about how this procedure can reduce HIV even tho circumcision INCREASES herpes and clamitia, no discussion about that. It's so biased. Everyone knows that there are PROS and CONS to practically everything. But with the penis, people get touchy and wants the "truth" to spin their way. This site is a pro-circumcision propaganda page. It should be neutral. Flag it.

Yes, this article is highly biased. Let us not forget the many past studies showing medical "benefits" to circumcision which have almost all been discredited due to original authors' high disregard for the scientific method. Authors of this page seem to have their own agenda, favoring opinions of American researchers (who are themselves mostly circumcised) over non-American investigators. POV is justified. Gimmethoseshoes (talk) 00:54, 27 February 2008 (UTC)

The thing is, you can't just throw up a POV flag and then walk away. The non-neutral POV in this article, if any, has to be spelled out and challenged. I've attempted to do just that, as have others. In some cases, perhaps the challenge is unjustified; in others, perhaps it is, but we won't ever know, since all challenges seem to be intensely resisted by the same few editors, who in turn remove the POV flag without consensus. My advice would be to zero in on the content you believe violates policy, and make a case challenging it, or voice your support for others' arguments. There are plenty here and in the archives (restart archived discussions on the current page, not the archive). Do so neutrally, without attempting to simply shift the non-neutral POV to an opposing POV, and without injecting bias or losing good faith in the other editors. This is a lot of work. Is anyone up to the task? Blackworm (talk) 18:24, 27 February 2008 (UTC)

I do agree that it seems slightly biased but not, imho, worth a POV flag. I hope people continue attempting to fix it though. English wikipedia isn't North American, it's international and should reflect international standards and practices. This article seems like it's written based pretty much entirely on North America when it comes to the parts detailing pro/cons and ethical ideas. It seems to represent people against circumcision as a minority group and/or "special" in some way, while it is, worldwide, the other way around. Like I said previously most of the article is fine but if most of the people contributing weren't North American I think it'd have quite a different wording even if it would contain most of the same studies/facts. Most Scandinavians I've talked with about this, and for that matter most Europeans, seem to pretty much equate circumcision with genital mutilation. This article in no way reflects this quite prevailing point of view. I'd have a hard time pointing out the specific parts that left me with the above impression, it's pretty much just the pro/con and very value-addled way the article is presented. I might give it a shot at a later date. Araziel (talk) 05:21, 1 April 2008 (UTC)

As I understand it, your argument seems to be that the prevailing point of view is anti-circumcision, and the article ought to reflect that. Unfortunately, there are two problems with this argument. First, you haven't provided any verifiable evidence to support your claim (suitable evidence might be, for example, a reliable study in which a representative sample of people of various nationalities were polled for their views on circumcision). Second, it is difficult to understand how one could "reflect" this point of view while adhering to the neutral point of view policy. Jakew (talk) 12:54, 1 April 2008 (UTC)

Why would Araziel need evidence of that type, but you don't need evidence of that type to call those opposed to circumcision fringe or zealots or a tiny minority, running them out of this article, and throwing phrases like "undue weight" around based on your assumptions of relative prevalence of the views? Congrats, though, on your awards on your user page for keeping out anti-circumcision views. Blackworm (talk) 15:12, 1 April 2008 (UTC)

You completely misunderstand me. I didn't mean to say that the article should read like an anti-circumcision pamphlet, and bringing up studies about how people feel about circumcision is way besides the point. The offhand comment I made about my friends was just that, an offhand comment, it has nothing to do on a wikipedia article. It was done to illustrate the fact that as of right now the wording of some parts is obviously done by someone who is pro-circumcision, as opposed to, if this was written by western Europeans, it would read more like the aforementioned anti-circumcision pamphlet. As the nice and neutral people we are we naturally want neither to be prevailing, but rather it all sound rather unbiased and plain.Araziel (talk) 07:22, 6 April 2008 (UTC)

Oh, ok. I can't see the pro-circumcision wording myself (evidently being western European is not enough!). But it might help if we could discuss a concrete example. Can you give me any examples of such material? Jakew (talk) 13:08, 6 April 2008 (UTC)

The article appears to lean towards pro circumcision however it may simply be my natural aversion to genital mutilation clouding my judgment. What comes to mind after reading the entire article is the feel of it being weighted with more sources for circumcision. Sure I could add many more sources against to balence out but feel this is a hot topic and wish to throw in my 2 cents here. Garycompugeek (talk) 21:29, 8 April 2008 (UTC)

How is the attempt going so far? Blackworm (talk) 02:55, 11 April 2008 (UTC)

Pretty gritty. Deeply estabished bias. Many players. I did get a chuckle over the circumcision is evil anon ;P —Preceding unsigned comment added by Garycompugeek (talk • contribs) 03:15, 11 April 2008 (UTC)

Dubious edits

I'm reverting these edits for the following reasons:

• The edit changed *"The act of cutting off the prepuce or foreskin of males, or the internal labia of females." Webster's Revised Unabridged Dictionary (1913) [5] to *"The act of cutting off the prepuce or foreskin of males, or the labia of females." Webster's Revised Unabridged Dictionary (1913) [6] -- why would we want to misquote a source?

• Addition of: "In 1997 the New York Times printed an article on circumcision increasing one's risk of contracting herpes, clamidia, and even HIV. Since then, doctors have debated these facts with different studies, showing different results. However, the UN's World Health Organization only backs one study. [7] [8]"

• Problem 1. This report is about Laumann's study (JAMA 1997;277(13):1052-7). As I've already noted in an edit summary, we should not give undue weight to a single observational study. Since there have been some 30 or so observational studies, we clearly haven't room to discuss every primary source. Instead, if we are to discuss non-HIV STD studies, it is most logical to cite a systematic review, such as that of Weiss et al.
• Problem 2. The cited article in the NY Times mentions herpes and chlamydia, but not HIV. We should not misrepresent sources.
• Problem 3. The sentence beginning "Since then" is unsupported by sources.
• Problem 4. The WHO do not "back one study", but explicitly refer in their recommendations to three randomised controlled trials and the earlier observational studies.
• Problem 5. The second link is apparently unrelated to the preceding text.

For these reasons, I'm reverting. Jakew (talk) 23:13, 15 February 2008 (UTC)

You're right about the HIV. That was a totally different article. I'm trying to find it now but I can't remember where I found it. Anyway, yeah, just make it herpes and chlamydia or "STD's" But don't delete the entire sentence. That's mean. Please stop. The New York Times and many other well known papers have articles online about this stuff but the New York Times seems like the most well-known. They all said circumcision increases risks of many STD's other than HIV. The HIV article was a bit controversial. But thankfully, the New York Times has been around longer than the UN even. (: —Preceding unsigned comment added by 70.114.38.167 (talk • contribs)

The New York Times was simply reporting on a paper published in the Journal of the American Medical Association (arguably somewhat inaccurately: the paper reported that "We find no significant differences between circumcised and uncircumcised men in their likelihood of contracting sexually transmitted diseases."). But the problem is that Laumann's study was just one of many observational studies to assess the link between circumcision and STDs, and we need to present a representative picture. If we say "the procedure may potentially increase the risk of herpes and chlamydia", we're misleading the reader when systematic reviews indicate that the evidence overall suggests that it reduces the risk (herpes) or that there is no association (chlamydia). Jakew (talk) 12:05, 17 February 2008 (UTC)

LOL. That's the most pathetic argument I've seen in a long time. The New York Times piece should stay. LPRABCMP (talk) 21:05, 17 February 2008 (UTC)

If you want to balance the article, discuss genital warts. It's not discussed at all in this article; I'll leave the reader to decide why that is. As for undue weight, the singular opinion in a letter to the editor that it is "more humane" not to give infants anaesthesia during circumcision shines as the best example -- but good luck getting that removed, too. Blackworm (talk) 00:15, 16 February 2008 (UTC)

Great quote from a study we cite

This is from a source we use to claim that uncircumcised men are at greater risk of human papilloma virus (HPV) infection:

Circumcision was reported as being present by examination in only 14 (1.4%) participants. Self-reported and physical examination circumcision were discordant in 88 participants who classified themselves as circumcised and six who reported no circumcision but who were evaluated as circumcised by interviewers. We chose to report the findings of self-reported circumcision. The prevalence of circumcision in Mexico is very low and the interviewers who did the physical examination may not be accustomed to it and may have been unable to identify its presence.

These guys really seem like they know what they're doing, eh? The subjects could have been thinking, hmmm, I'll say I'm circumcised, and the results of my STD test will influence matter-of-fact statements about circumcision in Wikipedia, which is supposedly "more accurate than Britannica." Ha. Just goes to show how studies can show whatever they want to show. Like editors. Blackworm (talk) 19:57, 17 February 2008 (UTC)

Another great quote from a source we cite, describing another amputated penis as a result of circumcision: Immediate re-suturing of the amputated glans led to a satisfactory outcome. Haha! I love that! "Satisfactory outcome." What a world. Blackworm (talk) 20:29, 17 February 2008 (UTC)

Metzizah b’peh : isnt this where a rabbi sucks the blood off of a babies penis after he makes the incision? Should this be mentioned somewhere under the religion section? Or will the propoganda continue..... —Preceding unsigned comment added by 70.23.242.84 (talk • contribs)

Hey people. I noticed female circumcision at the top says "also known as female genital mutilation (fgm)" well we have to be fair and make sure everyone knows where to find this page. So, let's say right after the first word, "also known as male genital mutilation (mgm)" After all, some people do call it that. That's what "also known as" means. Here is some proof. http://www.mgmbill.org/ http://www.fathermag.com/health/circ/net-quot/ LPRABCMP (talk) 21:21, 19 February 2008 (UTC)

Just let me hear what you all think. (I already know what Jakew is going to think) Let me know what anybody else thinks about MGM. LPRABCMP (talk) 21:23, 19 February 2008 (UTC)

Random websites can call it whatever they wish. We are concerned with terms used in reliable sources. Jakew (talk) 21:31, 19 February 2008 (UTC)

Uh??? Also known as means... What some people may know it as...That's why you put it down. Seriously, dude. Retarded. 70.114.38.167 (talk) 21:45, 20 February 2008 (UTC)

new study

http://www.msnbc.msn.com/id/22096758/

New study (US Center for disease control, CDC) finds that circumcision does not affect HIV in American men. This is HUGE, it's definately worth going up. 70.114.38.167 (talk) 07:32, 4 March 2008 (UTC)

I doubt it will see the light of day in this article. Good luck. Blackworm (talk) 08:45, 4 March 2008 (UTC)

Same problem as with Laumann - we can't give undue weight to a single observational study. Jakew (talk) 11:24, 4 March 2008 (UTC)

Told ya. My reason was that we're not allowed to suggest that anyone believes circumcision doesn't cure AIDS. Blackworm (talk) 15:23, 4 March 2008 (UTC)

Circumcision does not cure AIDS. I am not aware of anyone reputable that claims it does. There is some evidence that circumcision reduces the chance of being infected by AIDS but I suspect that this only applies to people who are not engaged in high-risk lifestyles.SimonHolzman (talk) 23:57, 4 March 2008 (UTC)

WP:NOR. Circumcision prevents AIDS and we will not allow any studies implying otherwise to be cited in this article. Wait, uhhh... Ask Jakew why again, I'm not sure. Blackworm (talk) 01:39, 5 March 2008 (UTC)

Blackworm, I know why. (: hehehehehehe it has to do with little jake 70.114.38.167 (talk) 09:10, 5 March 2008 (UTC)

Um..why don't you actually read the article Jakew, it's not based off a single study, the CDC claims it is based off YEARS of studieS! Please stop edit warring. The CDC is reputable. Please, let's not have this again. Facts are facts jakew. 70.114.38.167 (talk) 06:00, 5 March 2008 (UTC)

I suggest that you re-read the article yourself. Jakew (talk) 09:19, 5 March 2008 (UTC)

And please do not misrepresent things by claiming that "the U.S. Center for Disease Control officially states that circumcision does not affect HIV in American men". Their factsheet on circumcision (Feb '08) may be found here. Jakew (talk) 09:25, 5 March 2008 (UTC)

A Centers for Disease Control study found that circumcision "does not appear to help American men of color" in the context of HIV prevention. Would that be an unacceptable rendering of this secondary source, Jakew? Blackworm (talk) 03:19, 6 March 2008 (UTC)

In medical analysis of circumcision#Circumcision and HIV/AIDS, we describe Millett's study as follows:

'Millett et al in a study published in The Journal of Acquired Immune Deficiency Syndromes in 2007 found no association in three major US cities between circumcision and HIV infection among Latino and black men who have sex with men (MSM). They conclude as follows: [paragraph break] "In these cross-sectional data, there was no evidence that being circumcised was protective against HIV infection among black MSM or Latino MSM."'

Although the language could doubtless be improved, that seems a fairly accurate description. Furthermore, because it is in an appropriate article in which we can and do discuss observational studies at length, we can include such a description without giving undue weight to a single study. Jakew (talk) 11:27, 6 March 2008 (UTC)

That's a rendering of the primary source. It is preferred to quote secondary sources where possible. This article dedicates a large amount of text to convincing the reader of the protective effect of male circumcision against HIV. How can one sentence presenting an opposing opinion, sourced by a major news source, be "undue weight?" I don't see anything in policy about the appropriateness of observational studies in the main circumcision article, but please correct me if I'm wrong. Your claim of undue weight seems, again, purely arbitrary; especially considering your vehement defense of the worst example of undue weight in this aticle, namely the singular opinion of two people, expressed in a letter to the editor, that it is somehow more humane not to provide anaesthesia to male infants before cutting off their foreskins. Blackworm (talk) 15:31, 6 March 2008 (UTC)

The primary source is more reliable than the secondary source (see WP:MEDRS#In science, avoid citing the popular press), and so it is preferred. However, if you insist on a secondary source, we alter that article to cite the CDC factsheet, which briefly discusses Millett's study in the section entitled "HIV Infection and Male Circumcision in the United States" (Millett is their ref 27).

As for the appropriateness of observational studies, I refer you to WP:MEDRS#Assess the quality of evidence available. Observational studies are class III in the AHRQ scheme, whereas RCTs are 1b. Where space is limited, we should therefore prefer higher quality evidence.

If we were to discuss each and every observational study, there would be no undue weight problem. However, since that is unrealistic, we need to ensure that we're painting a representative picture. Since "most [observational] studies show an association between male circumcision and prevention of HIV"[9], we need to be careful that our coverage reflects that fact. If the only observational studies we discussed were exceptions to this rule, then we would be misrepresenting the majority of the literature by giving undue weight to the exceptions. Jakew (talk) 16:01, 6 March 2008 (UTC)

Jake, your quote is disingenuous. Restoring the context of the quote: Study quality was very variable and no studies measured the same set of potential confounding variables. Therefore, conducting a meta-analysis was inappropriate. Detailed quality assessment of observational studies can provide a useful visual aid to interpreting findings. Although most studies show an association between male circumcision and prevention of HIV, these results may be limited by confounding, which is unlikely to be adjusted for. The people you quote seem to believe that the "representative picture" you wish to present as uncontested fact is actually quite blurry indeed. The problem is, of course, that what "most studies show" is presented as absolute, unopposed fact. Nowhere in this article is there any implication that it is possible that circumcision does not prevent HIV. Everywhere in this article there are implications that it does. That's JW:NPOV, not WP:NPOV. Blackworm (talk) 23:33, 6 March 2008 (UTC)

Blackworm, since I have already noted that observational studies are relatively low quality, I don't quite understand what you expect to achieve by including a long quote that basically says the same thing. Perhaps we can save time by agreeing that a) observational studies are inherently limited, and b) that most have nevertheless found similar results to the RCTs. The questions seem to be a) given the limited space, is it worth discussing observational studies, and b) if we do discuss them, how can we ensure that our discussion is representative?

As a result of a previous discussion, we added the following: "Before there were any results from randomized controlled trials, reviews of observational data differed as to whether there was sufficient evidence for an intervention effect of circumcision against HIV.[80][81]" Jakew (talk) 11:10, 7 March 2008 (UTC)

I did re-read the article, several times. It says that the US CDC claims that circumcision really does not affect the rate of HIV in American men. It did talk in detail about Hispanic and African American men, but their point is..it is not a reasonable measure, at this time, to prevent HIV in the US. Will you, kind sir, please re-read the MSNBC CDC article. Thanks. 70.114.38.167 (talk) 08:25, 9 March 2008 (UTC)

Perhaps you'd be kind enough to quote the statements, attributed to the CDC, that led you to these conclusions? Also, please quote the statement supporting your assertion that "the CDC claims it is based off YEARS of studieS". Jakew (talk) 11:27, 9 March 2008 (UTC)

Oh, okay you just edited out the whole thing instead of just putting the blacks and latinos thing (which i think is controversial in there.) Okay, we'll do it your way putting race involced, lol, always with the race with this HIV stuff. When did the Circumcision article become an HIV article? We'll quote two sources. 70.114.38.167 (talk) 12:09, 9 March 2008 (UTC)

You've now stated that: "However, the U.S. Center for Disease Control states that circumcision does not affect HIV rates among Hispanics and African Americans in the U.S."

Unfortunately, while a slight improvement, this is still problematic:

1. The claim is attributed to the CDC. However, if you look at the first slide on Millett's presentation, you'll see that "The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention". So we'd have to correct the attribution, which should be "Millett states that...". Alternatively, we could actually represent the CDC's views...
2. The claim is stronger than that made by the authors. Please examine slide 22 ("Discussion") of Millett's presentation. Their finding was that "Circumcision status was not associated with HIV infection [in Black or Latino men who have sex with men]" and there was a "Discrepanc[y] with 2 U.S.-based studies that found protective effect". On slide 28, they conclude that "Male circumcision may not provide benefit for MSM of color in the United States" (emph added), which is a weaker claim than yours.
3. The undue weight problem still exists. For example, why are we citing this study rather than the 3 others that Millett discusses in slide 5 of his presentation? Why are we not citing the 30-40 other observational studies? And what possible reason is there to cite an observational study in the lead? Jakew (talk) 12:36, 9 March 2008 (UTC)

Dubious changes

I have once again reverted a change to the lead, which added "[circumcision] is most uncommon in Canada, Europe, South America and Australasia."

Unfortunately, not only is this statement unsourced, but it contradicts the apparent source (ie., ref 8 at the end of the paragraph). In the map in ref 8, Canada and Australia are listed as '20-80%', the same as the USA which we list under "most common". The editor who inserted it may have been confused by the text of ref 8, which states "In contrast, Australia, Canada, and the United Kingdom have seen a decline in male circumcision"; this is of course a statement about trends, not absolute prevalence.

Most sources, I think, discuss where circumcision is common. If a source can be found that explicitly discusses where it is uncommon, it could be cited, but we need to take care to avoid original research (and, indeed, pointless original research - if we're going to discuss "most uncommon" then we should provide more information than all countries minus most common, which is redundant information). Jakew (talk) 15:04, 21 March 2008 (UTC)

I agree with your changes, but not your reasoning. You appear to view the statement as one about prevalence in the existing population, not the incidence of new circumcision procedures. Since circumcision is the act of circumcising, and not the state of being circumcised, "circumcision is common/uncommon..." is better interpreted as a statement on incidence, not prevalence.

The reason I agree with your changes is that the statements are unsourced and vague. Blackworm (talk) 04:31, 26 March 2008 (UTC)

To the best of my understanding, the term is used in both ways. So perhaps it should be specified which meaning is intended. DGG (talk) 15:00, 27 March 2008 (UTC)

Removed Source

Jakew you reverted my edit and listed (rv. see WP:RS and WP:SPS.) for The Circumcision Resource Center states "Circumcision removes the most sensitive parts of the penis.".

So you believe circumcision.org which has everything properly sourced is invalid? Please explain or it will go right back in. Garycompugeek (talk) 22:07, 9 April 2008 (UTC)

The source is Sorrells et al, as published in BJU International. I restored the material with proper attribution. Jakew reverted it claiming undue weight -- we'll have to see what evidence he presents of this. Blackworm (talk) 22:11, 9 April 2008 (UTC)

Certainly. To quote from WP:SPS:

"Anyone can create a website or pay to have a book published, then claim to be an expert in a certain field. For that reason, self-published books, newsletters, personal websites, open wikis, blogs, forum postings, and similar sources are largely not acceptable"

So, a self-published website (Ron Goldman's circumcision.org) is not a reliable source. Jakew (talk) 22:18, 9 April 2008 (UTC)

Thanks I've been around long enough to know what a source is. You are not the judge and jury of what is a good or bad source. First of all who supposedly own's a site is a red herring and irrellevant. Circumcision.org has all or their documentation sourced. After all it is circumcision.org not Billy Bob's blog from billybobisgreat.com. Garycompugeek (talk) 12:15, 10 April 2008 (UTC)

Whether you consider the owner of a site to be relevant or not, Wikipedia policy clearly states that "personal websites ... are largely not acceptable". WP:RS provide some guidance, too: "Articles should rely on reliable, third-party published sources with a reputation for fact-checking and accuracy." Note that it does not say "should rely on websites on the sole basis of whether they have impressive domain names." Jakew (talk) 13:38, 10 April 2008 (UTC)

Also, you seem to be under the impression that Goldman's page is reliable because he cites sources. That isn't the case. Any page can cite sources and could misrepresent them (or could even cite nonexistent sources). Unfortunately, with self-published sources (especially highly partisan sources prone to bias), that can happen quite easily, and for that reason (among others) we can't rely on them. With a source published by a third-party with a reputation for fact-checking and accuracy (such as a peer-reviewed journal), that's much less likely to happen. Jakew (talk) 14:07, 10 April 2008 (UTC)

No you simply are misunderstanding me if that's what you truly believe. My analogy is correct. If we were as stringent as you claim half of Wikipedia would qualify for speedy deletion. You seem to have some animosity towards this website because it doesn't support your POV. It is medically sourced and quite valid. The sources are not misrepresented or trying to mislead. Garycompugeek (talk) 14:56, 10 April 2008 (UTC)

Unfortunately it's true that much of Wikipedia's content fails to meet policy requirements, but that is no excuse. Wikipedia policy calls for high standards of sourcing, and with a topic such as this one that is, if anything, especially important. We can't include private, partisan websites, regardless of whether individual editors agree or disagree with the content. That means that we don't include "circumcision.org" (anti-circumcision) and we don't include "circinfo.net" (pro-circumcision), but we do include, for example, articles published in the Journal of Urology, whether pro- or anti-. Jakew (talk) 15:10, 10 April 2008 (UTC)

I hear you Jake, but you seem to be taking a literal narrow view of the policy. Perhaps you need to confirm to Wikipedia norms, not the other way around. It's clear we disagree and should step back and let consensus decide. Garycompugeek (talk) 16:37, 10 April 2008 (UTC)

I have once again reverted the addition of some material that gives undue weight to one of the five studies to test the sensitivity of the penis with respect to circumcision. If we're going to cite Sorrells, then to avoid undue weight we must as a minimum cite Masters and Johnson, Bleustein 2003, Bleustein 2005, and Payne (2007 as I recall), and probably also other studies of sensation (Masood, etc). If we were to do so, however, we would add a considerable amount of material to the article, which would basically replicate the sub-article (sexual effects of circumcision), and this would be incompatible with summary style. Jakew (talk) 22:18, 9 April 2008 (UTC)

Bah! Pure balderdash. You site undue weight when it isn't your POV. I've also noticed that Jakew and User:The way, the truth, and the light have reverted then quickly added something to article to prevent another revert. This is dirty pool in the extreme. Let's stop these silly games and work together. This article seems far from neutral. To make it neutral we need all viewpoints. I'll respect yours. Please respect mine. Garycompugeek (talk) 22:37, 9 April 2008 (UTC)

There is already a better discussion of the evidence at the detailed article Sexual effects of circumcision. That's his point. Importing only some of the studies into this article, ones that support your desired conclusion, is undue weight and clear bias. The way, the truth, and the light (talk) 22:40, 9 April 2008 (UTC)

I could say the same exact thing to you thing to you. In fact that's exactly how I feel. Garycompugeek (talk) 22:48, 9 April 2008 (UTC)

Let's please avoid labels and accusations and keep cool heads. If I understand correctly, at least some of the sources Jakew mentions make conclusions of the sensitivity of the glans of circumcised vs. uncircumcised men -- unlike Sorrells, which makes a conclusion about the sensitivity of the foreskin itself relative to other parts of the penis. Find other studies discussing the low- or non-sensitivity of the foreskin, if any exist, and we can summarize them and present a more balanced picture. Otherwise, for now, this soruce stands on its own. Including this source isn't undue weight. Undue weight is actually what we have now: citing three sources claiming no change due to circumcision, or an improvement, with no countering nor balancing views despite the existence of sources. Blackworm (talk) 22:51, 9 April 2008 (UTC)

Blackworm, if the section was about "the sensitivity of the foreskin relative to other parts of the penis", you might have a valid point. However, the section is about "sexual effects", and therefore the correct context for assessing questions of undue weight is "studies that have investigated the sexual effects of circumcision". One aspect of this is penile sensation. Some authors have chosen to address this by measuring the sensitivity of the foreskin, some by measuring the sensitivity of the glans, and others have addressed it by prospective questionnaire. There seems no reason to include only one of these categories, and to be neutral we ought to avoid doing so.

With this in mind, citing only Sorrells et al. is a clear example of undue weight. Jakew (talk) 23:18, 9 April 2008 (UTC)

Not clear at all. You propose unless multiple sources support your view point it is undue weight which is not what the policy is about at all. Garycompugeek (talk) 00:19, 10 April 2008 (UTC)

I suggest that you read through this discussion again, Garycompugeek, because you seem to have misunderstood. As you'll see, I haven't even mentioned my viewpoint. Jakew (talk) 11:03, 10 April 2008 (UTC)

By that logic, the current edit, which discusses glans sensitivity for about half the section, specifically citing Masters and Johnson, would also be undue weight. There's no reason not to summarize the other categories you mention. Blackworm (talk) 23:27, 9 April 2008 (UTC)

The current section does not cite Masters and Johnson, Blackworm. That's part of a quote. The present system is to cite highly reliable reviews from reputable medical organisations, and to rely on them to summarise for us. Jakew (talk) 11:03, 10 April 2008 (UTC)

Except that the system also seems to be that you, Jakew, get to choose which organization, and which precise section of that organization's review we will present. Whether we cite M&J or not, the fact is that by your logic, we present undue weight given to analyses of glans sensitivity, ignoring the seemingly more relevant question of the sensitivity of the severed foreskin. As of "the way"'s edit, the section is now horribly unbalanced. It presents sexual effects as, simply, "none, or good effects." It's JW:NPOV. Blackworm (talk) 15:33, 10 April 2008 (UTC)

Your claim is somewhat dubious, Blackworm, given that we actually quote all of the AAP's section entitled "SEXUAL PRACTICE, SENSATION, AND CIRCUMCISION STATUS" and the vast majority of the AAFP's section entitled "Sexual Functioning and Penile Problems". That's hardly evidence of selective quoting.

Personally, I would have said that prospective studies of adult circumcision patients were more relevant, but I respect the fact that you disagree. The fact that there are multiple viewpoints about what studies are most relevant is one of the things that make this issue so difficult to summarise. The question of which primary sources are "more relevant" is best left to reliable secondary sources, and we should not use a primary source to debunk the secondary (WP:MEDRS##Using_primary_sources_to_.22debunk.22_the_conclusions_of_secondary_sources). To date, as can be seen from the article, these secondary sources have focused mostly on glans sensitivity. Jakew (talk) 16:26, 10 April 2008 (UTC)

You mean a secondary source like this]? Or does the secondary source have to be an organization of people who profit financially from circumcision? Blackworm (talk) 22:57, 10 April 2008 (UTC)

No, not like that. Jakew (talk) 23:05, 10 April 2008 (UTC)

The guideline you cite is irrelevant -- a secondary source specifically commented on this study, indeed wrote an article about it, making it appear quite relevant. We don't have to cite the press; having established its notability, we can cite the original source, as I did (and which was reverted by you). Medical organizations have one point of view about male circumcision -- and their opinions on this lucrative procedure are valid, but there is no reason to decree that they are the exclusive source of information on male circumcision, especially when other researchers are indeed studying it from several other angles. That would be like insisting the "oil" article be exclusively written by Exxon/Mobil, BP, or OPEC. In any case, this is tangential -- the material is sourced, relevant, presented neutrally, and not to be suppressed because of your opinion of how much weight material critical of circumcision should receive (zero). Blackworm (talk) 16:11, 11 April 2008 (UTC)

You appear to forget, Blackworm, that Sorrells' article is cited in the full article, (sexual effects of circumcision). Nobody is suggesting that it should be excluded from Wikipedia altogether; the question is whether it should be included in a summary.

Since news articles are written about many studies (eg., [10] [11] [12] [13]), your proposed inclusion criteria (include studies which are mentioned in news articles) seems rather inadequate, since we would still end up adding an enormous amount of material, and replicating much of the content of sexual effects of circumcision. Jakew (talk) 16:30, 11 April 2008 (UTC)

As I've told you many times, I'm not really interested in the subarticles (what you call "full articles") that no one reads, as I view them as POV-forks, or apparent dumping grounds for any material critical of circumcision, or suggesting any controversy, that editors attempt to add to this article.

"My" inclusion criteria follow from WP:V and WP:NPOV. I didn't "propose" anything; I was responding to your call for secondary sources. It is not clear to me what policy or policies your inclusion criteria follow from, that would outweigh these policies. It is also not clear why your inclusion criteria causes you to vigourously insist on presenting a single letter to the editor, never referenced elsewhere, that claims that it is more humane NOT to give anaesthesia to infant boys being circumcised, when that opinion is contrary to the published statements of all medical organizations. You appear to be arguing for the exact opposite approach here. This grave inconsistency adds to the difficulty in finding a common ground as to your editorial opinions. Blackworm (talk) 21:59, 11 April 2008 (UTC)

Blackworm, the detailed articles exist in accordance with a Wikipedia editing guideline known as WP:SUMMARY, and are necessary in order to prevent this article from becoming too long. I'm afraid that I don't understand why you're telling me whether or not you're personally interested in them, and how you view them.

Perhaps my request was unclear to you, but I was asking for reliable secondary sources (policy statements, systematic reviews, etc) that were suitable for inclusion, rather than to use as guidance for selection of primary sources. As I have noted many times (eg #Payne study above), there simply isn't room in this article to discuss all the primary sources, and so it is sensible to limit ourselves to citing secondary sources that can summarise and take stock of the primaries. Jakew (talk) 22:16, 11 April 2008 (UTC)

WP:SUMMARY does not trump WP:NPOV. Further, the AAFP quote doesn't even properly reflect the source -- a part is omitted ("[...]"), making it read as if the AAFP disagrees with the belief of many that the glans of a circumcised penis is less sensitive. In fact the omitted part states (in the omitted text), Opinions differ about how this decreased sensitivity, which may result in prolonged time to orgasm, affects sexual satisfaction. But we don't seem interested in quoting that part, preferring to make it read as if the AAFP disagrees with "many" on the topic of decreased sensitivity. The AAFP saw fit to summarize sexual effects one way, and an editor here saw fit to pick and choose which parts of their summary to present, and paint a different picture. You now have editors familiar with the topic clamoring for balance and adherence to WP:NPOV, and you can seemingly only cite WP:SUMMARY to defend your reversion of their perfectly verified, neutral, and relevant edits. I don't see how you can realistically expect these editors to withdraw their objections under these circumstances. Blackworm (talk) 23:43, 11 April 2008 (UTC)

Please no more colons. These skinny paras hurt my head. —Preceding unsigned comment added by Garycompugeek (talk • contribs) 01:21, 12 April 2008 (UTC)

(Replying to Blackworm/23:43, 11 April 2008.) Blackworm, nobody is claiming that WP:SUMMARY trumps WP:NPOV. Quite the opposite, in fact: summaries must conform to WP:NPOV. So it is very important to use the limited space carefully, and to be aware that there is insufficient space to discuss every primary source. And so instead of violating WP:NPOV by giving WP:UNDUE weight to selected primary sources, we need a better strategy. The obvious strategy, strongly encouraged by WP:V, is to rely upon secondary sources instead.

I've just checked the revision history, and as I thought we originally had the full AAFP quote, but it was shortened on 16:16, September 2, 2007. I don't agree that we're misrepresenting the AAFP, but I've no objections to restoring the full quote. Jakew (talk) 11:09, 12 April 2008 (UTC)

The actual diff where the quote was shortened is here. I do not share your apparent opinion that it is "obvious" that we must suppress primary sources on sexual effects merely because their conclusions are not considered by or repeated by medical organizations profiting from circumcision. The primary source is referenced by a secondary source, which I cite above. Looking at the section as a whole, however, now that I've restored Boyle et al., it seems balanced, and I won't push any more for this source to be cited here. However, you set a precedent for reversion of cited, reliable material that I have trouble believing you would accept should it be used to remove any material casting circumcision positively. Indeed, your (and Avi's) vigourous defense of arguably fringe pro-circumcision material ("more humane not to use anaesthesia") seems incongruent with your present position. Blackworm (talk) 18:51, 15 April 2008 (UTC)

In reply to Garycompugeek's post of 12:15, 10 April 2008 (UTC): If you consider a source reliable because they cite reliable sources, I suggest instead using directly the sources cited by that source (if they're in publications considered reliable). This doesn't address other points raised above. ☺Coppertwig (talk) 23:32, 10 April 2008 (UTC)

Coppertwig, I am glad you are following the discussion, but the issue of sourcing is seemingly moot. My edit citing and attributing the material to the original source was reverted by User:Jakew. Jakew now suppresses the material on alleged undue weight grounds, supported apparently by two other editors (including an uncommon appearance by Avi), grounds disputed by two editors, including myself. Blackworm (talk) 01:14, 11 April 2008 (UTC)

It should perhaps also be noted that the article now stands with less material arguably critical of circumcision than before this new edit under dispute was made. Blackworm (talk) 01:19, 11 April 2008 (UTC)

NPOV = Balance

This article needs balance. This can be achieved in two ways. Either we start deleting some pro references (which I am against by the way), or we include more con references. Garycompugeek (talk) 16:03, 10 April 2008 (UTC)

Apparently User:The way, the truth, and the light does not agree although his voice is silent in discussion. That's 3 for you in 24. Your out of cards. I have one left but prefer to hold off and let others chime in. Your User Page suggest we have similar goals so your actions surprise me. Shine a little bit of that light in the mirror. Garycompugeek (talk) 17:41, 10 April 2008 (UTC)

I've said all I have to say. Jakew has made my case better than I could. The way, the truth, and the light (talk) 17:45, 10 April 2008 (UTC)

Penile cancer Myth

The curent vrsion is very Biased and misleading: "Studies have reported (what studies?) a rate of penile cancer from 3 to 22 times higher (where ?)in uncircumcised than circumcised men"

In "Circumcision: An American Health Fallacy," Edward Wallerstein writes: "If infant circumcision reduces penile cancer we could expect to see proportionately less penile cancer in circumcising nations as compared to noncircumcising ones. No such difference is found." Wallerstein reports that, for various years between 1966 and 1972, the annual rate of new cases of penile cancer was

0.8 for the United States (which circumcises), 0.5 for Finland, 0.9 for Denmark and 1.1 for both Norway and Sweden (all of which do not).

None of these differences is statistically significant. Further, within the same time frame, both France and the United States had the same rate, 0.3, of deaths due to penile cancer.

The American Cancer Society does not consider routine circumcision to be a valid or effective measure to prevent such [genital] cancers. Research suggesting a pattern in the circumcision status of partners of women with cervical cancer is methodologically flawed, outdated and has not been taken seriously in the medical community for decades.

Again, (a rate of penile cancer from 3 to 22 times higher ??? where?) Or, is this the American Version? Can we have some objectivity? Please! —Preceding unsigned comment added by 82.29.103.153 (talk) 19:59, 10 April 2008 (UTC)

If you read the article carefully, you'll see that after the statement ("Studies have reported a rate of penile cancer from 3 to 22 times higher in uncircumcised than circumcised men") there are footnote numbers. If you click on these, or scroll down to the references, you will find references to each study cited. For your convenience, the references are 94 and 95, which are:

1. Maden, C; et al (Jan 1993). "History of circumcision, medical conditions, and sexual activity and risk of penile cancer". J Natl Cancer Inst 85 (1): 19–24. PMID 8380060.
2. and Schoen, EJ; Oehrli, M; Colby, C; Machin, G (Mar 2000). "The highly protective effect of newborn circumcision against invasive penile cancer". Pediatrics 105 (3): e36.

As you'll note, we also cite in that section the policy statement of the American Academy of Pediatrics, as well as the American Cancer Society. With the exception of the ACS, all of the cited sources are in peer-reviewed publications. Jakew (talk) 20:12, 10 April 2008 (UTC)

That is not what the American Cancer Society states: —Preceding unsigned comment added by 82.29.103.153 (talk) 20:36, 10 April 2008 (UTC)

Misleading Information (Penile Cancer Myth)

"Statements about circumcision preventing penile cancer and cervical cancer are cropping up on the Internet" American Cancer Society. http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Misleading_Information.asp

Yes, it is an exact quote. The webpage you cite is dated 1998. The webpage cited in the article is dated 2006, and can be found here. The quote is taken from the last sentence of the third paragraph. (Incidentally, there is also another recent page here.) Jakew (talk) 20:53, 10 April 2008 (UTC)

Biased Version

"Bias is a term used to describe a tendency or preference towards a particular perspective" In our case the curent version is very biased by citing "a rate of penile cancer from 3 to 22 times higher" It is ridiculous! There are literally hundreds of contrary studies on the subject "The carcinogenicity of smegma: debunking a myth" 75 References. Yet someone chooses to disregard all the evidence to support his personal belief, based on sporadic quotes...

Whether or not prophylactic - circumcision rates are falling in the US... Paradoxically! —Preceding unsigned comment added by 82.29.103.153 (talk) 21:21, 10 April 2008 (UTC)

Agreed! Add some recent sources. Garycompugeek (talk) 21:27, 10 April 2008 (UTC)

To my knowledge, every epidemiological study has found higher risk of penile cancer in uncircumcised men. For references, see Medical analysis of circumcision#Penile cancer. Jakew (talk) 21:32, 10 April 2008 (UTC)

!!! Most info here comes from American Sources, International Sources are not present. No European studies confirm the American Circumcision Propaganda. The USA is the only Western Society promoting Genital Mutilation, a country with the highest number of Jewish doctors!!!

Be bold and add sources! Garycompugeek (talk) 19:28, 11 April 2008 (UTC)

Penil Cancer Myth Promoted by the American Academy of Pediatrics “Pediatricians have a vested interest in encouraging you to circumcise your child. They make money by selling surgery. Their organization, the American Academy of Pediatrics (AAP) provided a brochure for use by pediatricians. This brochure claimed that cancer may be prevented if you circumcise your child” http://www.fathermag.com/health/circ/acs/

American Cancer Society “As representatives of the American Cancer Society, we would like to discourage the American Academy of Pediatrics from promoting routine circumcision as a preventive measure for penile or cervical cancer” http://www.cirp.org/library/statements/letters/1996-02_ACS/

“European medical association (27 Countries) loudly to condemn the North American medical community for participating in and profiting from what is by any standard a senseless and barbaric sexual mutilation of innocent children. [Paul M. Fleiss. Circumcision. Lancet 1995;345:927.”

BRITISH MEDICAL JOURNAL - NEONATAL CIRCUMCISION DOES NOT PROTECT AGAINST CANCER
l'Association Française d'Urologie – Circumcision not encouraged for Medical reasons.
The Royal Australasian College of Physicians “After extensive review of the literature the RACP reaffirms that there is no medical indication for routine male circumcision.” http://www.health.nsw.gov.au/policies/PD/2005/pdf/PD2005_330.pdf

Western Medical organizations around the world oppose infant circumcision (amputation of the foreskin) Institutions against circumcision: European Medical Association, Canadian Medical Association, Australasian College of Physicians, and most of the world.

The “penil cancer” issue invented by the American Pediatrics was already ridiculed by the American Cancer Society.

Lets keep Wikipedia unbiased! —Preceding unsigned comment added by 82.29.103.153 (talk) 06:08, 12 April 2008 (UTC)

First of all, can I encourage you to familiarise yourself with WP:RS and WP:MEDRS? You'll find that a dubious online magazine and unpublished personal communications do not qualify.

Second, can I ask you to stay on topic? You're mixing up two different topics here: a) whether circumcision protects against penile cancer, and b) whether it is recommended. The two are, of course, separate issues.

Third, can I ask you not to misrepresent sources? You misquoted Fleiss (Lancet 1995;345:927). He did not claim that a "European medical association" actually does condemn, but instead suggested that they should. The full sentence is: "It is now time for European medical associations loudly to condemn the North American medical community for participating in and profiting from what is by any standard a senseless and barbaric sexual mutilation of innocent children."

Fourth, you cite only one reliable source (in the Wikipedia sense) that's relevant to the issue. This is another letter by Fleiss, entitled "Neonatal circumcision does not protect against penile cancer" (BMJ 1996;312:779-780). You may care to read Stanton's reply, entitled "Authors ignored main conclusion of study that they cited" (BMJ 1996;313:47) [14] Jakew (talk) 11:47, 12 April 2008 (UTC)

To date, there are no (international) replication studies confirming this hypothesis. This subject remains a controversy in the USA. No European, Canadian, or Australian studies confirm the Penile Cancer risk... —Preceding unsigned comment added by 82.29.103.153 (talk) 17:55, 17 April 2008 (UTC)

The ACS & the AAP's recommendations

Note: new subject heading inserted for clarity. Jakew (talk) 10:57, 11 April 2008 (UTC)

You cannot cherry pick items out of a source Jake. To quote your above link "Neither the American Academy of Pediatrics nor the Canadian Academy of Pediatrics recommends routine circumcision of newborns. Ultimately, decisions about circumcision are highly personal and depend more on social and religious factors than on medical evidence. " Garycompugeek (talk) 21:47, 10 April 2008 (UTC)

Garycompugeek, think for a moment. Given that the subject is the policy of the AAP, which is a more reliable source: the AAP's policy (as it appears in a peer-reviewed journal) or a webpage from the American Cancer Society? And what is actually verifiable? For the first source, one can verify that it says what it says. For the second, one can only verify that the ACS states that the AAP have this position. Jakew (talk) 21:58, 10 April 2008 (UTC)

Jake here is a direct quote from American Academy of Pediatrics. "Scientific studies show some medical benefits of circumcision. However, these benefits are not sufficient for the American Academy of Pediatrics (AAP) to recommend that all infant boys be circumcised. " on thier site [15] Garycompugeek (talk) 22:54, 10 April 2008 (UTC)

Yes. I'm afraid that I don't understand what point you're making. Jakew (talk) 23:08, 10 April 2008 (UTC)

Now your being obtuse on purpose. My point is that the American Academy of Pediatrics "does not recommend that all infant boys be circumcised". That clearly states they do not recommend circumcision. Let me clarify futher. Above you state my source from the American Cancer Society is trumped by a direct source from American Academy of Pediatrics yet I've pulled another source directly from American Academy of Pediatrics. Surely you understand my point now. Garycompugeek (talk) 00:01, 11 April 2008 (UTC)

I don't follow your logic. There's a huge difference between "circumcision of all infant boys" and "circumcision". Also, maybe I missed something, but I thought this discussion was about what the article should say about whether circumcision affects penile cancer rates. There's a big difference between on the one hand not recommending circumcision, and on the other hand stating that circumcision does not reduce cancer rates. ☺Coppertwig (talk) 00:23, 11 April 2008 (UTC)

Lot's of discussons and that is one of them this is another. If you would follow some of the threads you would note that I have not made one post about penile cancer aside that I agreed it seemed bias. Furthurmore penile cancer rates are so rare the distiction between circumcision is irrelevant. Garycompugeek (talk) 00:51, 11 April 2008 (UTC)

I've inserted a subheading above to clarify matters. Jakew (talk) 10:57, 11 April 2008 (UTC)

I agree with Coppertwig: there's a difference between what the AAP actually say and what you seem to interpret their words to mean. In their policy, they state that "these data are not sufficient to recommend routine neonatal circumcision", and in their Q&A document, which you cite, they state that "these benefits are not sufficient for the American Academy of Pediatrics (AAP) to recommend that all infant boys be circumcised". In both cases, there's a qualifier: "routine" or "[of] all infant boys", and if we omit that qualifier we change the meaning. In the article, which cites the policy, we also use the term "routine": "insufficient data to recommend routine neonatal circumcision". So what, exactly, is the problem? Jakew (talk) 10:57, 11 April 2008 (UTC)

If you're suggesting that the article be changed, Garycompugeek, please describe exactly what change you're advocating. ☺Coppertwig (talk) 12:33, 11 April 2008 (UTC)

I prefer to be bold and simply make my change however I will give this shot. "The American Academy of Pediatrics (1999) found both potential benefits and risks in infant circumcision. It felt that there was insufficient data to recommend routine neonatal circumcision, and recommended that parental decisions on circumcision should be made with as much accurate and unbiased information as possible, taking medical, cultural, ethnic, traditional, and religious factors into account." The first sentence seems misleading to me. It projects that the AAP is on the fence concerning circumcision. I propose "The American Academy of Pediatrics (1999) felt that there was insufficient data to recommend routine neonatal circumcision." plus this is unnecessary " recommended that parental decisions on circumcision should be made with as much accurate and unbiased information as possible, taking medical, cultural, ethnic, traditional, and religious factors into account." Garycompugeek (talk) 14:48, 11 April 2008 (UTC)

Garycompugeek, that's what the source says: "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision ... In the case of circumcision, in which there are potential benefits and risks". Or, in the document that you cite: "Scientific studies show some medical benefits of circumcision. ... parents should choose what is best for their child by looking at the benefits and risks." Jakew (talk) 15:04, 11 April 2008 (UTC)

So far every source I've come across on the net mentioning the AAP stance on circumcision flatly states they do not recommend it. I'b be happy to list them or you may simply do what I have done and google circumcision and start reading the links. The studies show that medical benefits do not merit circumcision. Once again you are cherry picking parts of the source to support your POV and missing the general point. This seems to be on purpose and making it increasingly difficult to assume good faith. Garycompugeek (talk) 19:44, 11 April 2008 (UTC)

This is perhaps a problem with relying on third party websites. I recommend that instead you read the AAP policy itself. Some websites have an agenda, and are likely to select the parts to quote that best serve to promote that agenda. If their agenda is anti-circumcision, they might highlight "do not recommend routine circumcision", and ignore the rest. If their agenda is pro-circumcision, they might highlight "potential benefits" and ignore the rest. (It's interesting that you should mention cherry-picking, since this is a fair description of what many of these sites do, and of the edit you propose.) Since Wikipedia has a policy of WP:NPOV, we can't promote either agenda, and must fairly represent the AAP's conclusions, not just the parts that suit a particular POV. Jakew (talk) 21:16, 11 April 2008 (UTC)

I'm willing to go along with shortening the AAP summary as Garycompugeek describes (but please retain the sentence about analgesia and stable-and-healthy, which comes after that.) Having put a lot of work into shortening this article per WP:SUMMARY, and seeing that most disputes tend to be solved by lengthening the article, I tend to be in favour of shortening edits if they're reasonable. If what we're summarizing is their recommendations about circumcision, then Garycompugeek's suggested edit seems a reasonable summary to me; benefits and risks and informed choice are relatively inessential when what's wanted is just their recommendation. ☺Coppertwig (talk) 15:39, 12 April 2008 (UTC)

I agree that what's wanted is their recommendation, Coppertwig, but there are four recommendations in the following quote, and as far as I can tell Garycompugeek intends to omit mention of all but one.

Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. It is legitimate for parents to take into account cultural, religious, and ethnic traditions, in addition to the medical factors, when making this decision.

1. That there are potential medical benefits, but that these are insufficient to recommend routine neonatal circumcision.
2. That parents should determine what is in the best interests of the child.
3. That parents should be given accurate and unbiased information, and should be given the opportunity to discuss the decision.
4. That is it legitimate for parents to take cultural, religious, and ethnic traditions, as well as medical factors, into account.

I can't see how that can be justified. Jakew (talk) 15:46, 12 April 2008 (UTC)

These are all self evident facts and not note worthy. Garycompugeek (talk) 15:58, 12 April 2008 (UTC)

If they were self-evident then I am sure the AAP would not have felt the need to state them (and many anti-circumcision advocates would doubtless disagree that point 2 is self-evident). However, they did, and they form a part of the AAP's conclusions. Jakew (talk) 16:22, 12 April 2008 (UTC)

An additional problem is that the following paragraph is: "The American Medical Association supports the general principles of the 1999 Circumcision Policy Statement of the American Academy of Pediatrics". If you turn to the AMA's policy, and scroll down to their recommendations, you'll see that they quote the above text in full (plus a sentence about pain relief). So not only did the AAP decide to state these "self-evident facts", but the AMA quoted them in full and supported them in their entirety, not just the part which you wish to quote. So your edit not only paints a misleading picture of the AAP's policy, but it also in effect paints a misleading picture of the AMA's policy as well. Jakew (talk) 16:39, 12 April 2008 (UTC)

I'd like to be able to say that medical associations whole-heartedly recommend circumcision. Unfortunately, they don't (for political and other irrational reasons). Nonetheless I'd like the statement to be presented as it was actually made. You on the other hand are attempting to introduce bias by omitting the parts of the statement that might be considered to support circumcision, and implying that there are no valid reasons to circumcise. The way, the truth, and the light (talk) 17:19, 12 April 2008 (UTC)

The reason you may not say "medical associations whole-heartedly recommend circumcision" is because scientific fact does not justify it, however your bias is clear. Garycompugeek (talk) 18:19, 12 April 2008 (UTC)

Jake you are showing disturbing signs of WP:OWNERSHIP. Perhaps you should consult others on the talk page before you revert anything not related to your POV? Garycompugeek (talk) 16:05, 12 April 2008 (UTC)

Jakew, by your argument, we would have to include the AAP recommendations in full, no matter how lengthy they are. In fact, to write a Wikipedia article, we need to condense and select. It's not enough to argue that some words supply some important information; you have to argue that it's sufficiently important to be worth lengthening the article for; or to put it another way, you have to argue that it's more important than other groups of words of similar length elsewhere in the article. So far, your only argument seems to be that those are their recommendations. If they had 75 recommendations, that argument would ask that they all be included.

I'm OK with either the original wording, or Garycompugeek"s suggestion, and I have another suggestion: keep the first sentence but delete the second bit that Garycompugeek wants to delete. It can be shortened slightly to "The American Academy of Pediatrics (1999) found both potential benefits and risks in infant circumcision, but insufficient data to recommend routine neonatal circumcision."

The AAP are not family law experts, so whether they think parents should do what's in the best interests of their children is not very relevant. It may be important enough for the AAP to include in their statement, but we have much less room here for representing the AAP's views. (It can be expanded in a sub-article -- lots more room there.) I agree that this, and the idea that it's good for parents to have information, are more or less self-evident, therefore not of high information value for this article. ☺Coppertwig (talk) 18:07, 12 April 2008 (UTC)

OK, that does seem unnecessary to me. It doesn't really make an argument for either side, and is essentially a cop out by the AAP to avoid admitting that circumcision is a good idea. The way, the truth, and the light (talk) 18:24, 12 April 2008 (UTC)

WP:NPOV, WP:OR, WP:SOAP. I thought admins were here to remind people of these? Blackworm (talk) 02:18, 15 April 2008 (UTC)

Coppertwig, I'm not saying that we have to include every recommendation, but we should include the important ones, as well as those that provide context for the first (compare "Fred does not recommend routine circumcision" with "Fred does not recommend routine circumcision, but recommends that parents should decide based upon benefits and risks" - the first could be interpreted as "recommends against parents choosing circumcision", while the second provides context to avoid that ambiguity). In particular, I think we need to include enough facts to be balanced in our treatment of the AAP's position.

I think it's reasonable enough to delete the text about information that should be given to parents, though.

Additionally, the underlying reason why they recommend that parents should decide is outlined in an Authors' Reply in Pediatrics by Dr Lannon on behalf of the Task Force. She indicates that this recommendation is based upon the AAP's assessment of the potential medical benefits, not of legal issues. To quote: "The critical distinction between female genital mutilation and male circumcision is the potential medical benefits of male circumcision. These potential benefits warrant a parental role in decision making about this procedure."[16] (emph. added) Jakew (talk) 18:36, 12 April 2008 (UTC)

Still not note worthy. Very self evident that a parental role should always be assumed ie parents should be parents. Garycompugeek (talk) 18:44, 12 April 2008 (UTC)

Please re-read the quote again. Lannon specifically contrasts circumcision with a situation in which a parental role in decision making is not warranted (in the AAP's view). She's saying, in effect, that because' of these potential benefits, a parental role in decision making is justified. So this recommendation (that parents should determine what is in the best interests of the child) is made on the basis of the AAP's determination of the potential medical benefits. Jakew (talk) 18:51, 12 April 2008 (UTC)

I see your point, Jakew. If we just say they "do not recommend" routine circumcision, then that could be misinterpreted as meaning that they recommend against it; but if we also include some of the self-evident phrases, then their meaning becomes clear. So the self-evident stuff may be necessary to establish the meaning of the other stuff, even if it's not of much value on its own; unless there's a slight chance we could come up with shorter wording that carries the same meaning as understood by people from a variety of POV's. E.g. they "do not recommend for or against routine neonatal circumcision" or something. ☺Coppertwig (talk) 18:54, 12 April 2008 (UTC)

(ec) You sure they're not family lawyers? Do they really assert that there are situations where a parental role is not warranted? I don't think they go that far. ☺Coppertwig (talk) 18:54, 12 April 2008 (UTC)

Hmm, I'd go along with your suggestion, Coppertwig, but I think that it might be best to use language similar to that used by the AAP itself. How about something like "The American Academy of Pediatrics do not recommend that all infant boys be circumcised, and state that parents should choose what is best for their child by looking at the benefits and risks" (this is adapted from the AAP's Circumcision Information for Parents)? Jakew (talk) 19:10, 12 April 2008 (UTC)

The CDC seems to think this "In 1999, the American Academy of Pediatrics (AAP) changed from a neutral stance on circumcision to a position that the data then available were insufficient to recommend routine neonatal male circumcision." [17] Garycompugeek (talk) 19:00, 12 April 2008 (UTC)

I don't know why that should be interpreted as an anti-circumcision statement. Perhaps there is more context? The way, the truth, and the light (talk) 19:05, 12 April 2008 (UTC)

Perhaps you see this as a circumcision endorsement? If you beleive I've taken out of context follow the link I've provided and read the entire paragraph. Your vague accusations ill become you. Garycompugeek (talk) 19:15, 12 April 2008 (UTC)

No, I don't, as I already stated. However, I don't think we have any evidence to suggest that it is anti-circumcision; and I did read the link you provided. The way, the truth, and the light (talk) 19:18, 12 April 2008 (UTC)

Arbitrary section break

That sounds fine to me, Jakew.☺Coppertwig (talk) 19:22, 12 April 2008 (UTC)

I don't understand the CDC's statement at all. What do they mean by implying that that's non-neutral? In which direction do they think it's non-neutral? I can see arguing either way. ☺Coppertwig (talk) 19:22, 12 April 2008 (UTC)

First, good break. Come now, the CDC clearly states that they believe the APA is not neutral, therefore they must be for or against. Do you truly wish us to believe CDC wishes us believe the APA is pro circumcision? Garycompugeek (talk) 21:21, 12 April 2008 (UTC)

WHO ARE YOU

There are many sources stating WHO is incorrect or the data is inconclusive. I feel it should be removed on this basis. Thoughts? Garycompugeek (talk) 19:59, 11 April 2008 (UTC)

Please review the usage of the {{disputed}} template. It is only meant to be used to identify "…a Wikipedia article as having content whose truth or factual nature is in dispute." That the WHO made the statement is completely factually accurate. That others dispute it should be brought in the text. Thank you. -- Avi (talk) 20:02, 11 April 2008 (UTC)

In response to your initial statement, the proper WP:NPOV response would be to bring the WHO statement and representative notable disagreements. not to remove the WHO. There are many statements in the article that are disputed; perhaps every statement in this article is disputed, is it your intention to have it deleted? -- Avi (talk) 20:03, 11 April 2008 (UTC)

Negative. The intention would be to remove if false (not sure why we wish to publish) or add the sourced disagreements (which wouldn't be necessary if we remove) confusing to the reader but I'll play along... Perhaps you can help me in my endeavors? Garycompugeek (talk) 20:18, 11 April 2008 (UTC)

It might be helpful, Garycompugeek, if you were to cite some reliable sources that have criticised the WHO's statement. Jakew (talk) 21:19, 11 April 2008 (UTC)

Are the peer-reviewed studies being contested? If so, which of them are suspect and who is questioning their validity? Or is it the WHO's interpretation of the findings that are in question? It's a little unclear exactly what the objection is without more details. Kindest regards, AlphaEta 21:35, 11 April 2008 (UTC)

The CDC quotes "There are as yet no convincing data to help determine whether male circumcision will have any effect on HIV risk for men who engage in anal sex with either a female or male partner, as either the insertive or receptive partner." [18] sourcing Koblin BA, Chesney MA, Husnik MJ. Garycompugeek (talk) 22:20, 12 April 2008 (UTC)

Presumably this isn't an example of a source stating that the WHO is incorrect, since it is very similar to the WHO recommendation 3.5: "Clear messages should be developed to inform communities about what is known and what is not known about male circumcision, including lack of data on direct protection for women, or for either partner during anal sex with men or women."[19] Jakew (talk) 22:29, 12 April 2008 (UTC)

An Inconsistency between the summary and the body of the article

The article summary reads:"Male circumcision is a religious commandment in Judaism as well as in Islam." However, the article says:"Some Fiqh scholars state that circumcision is recommended (Sunnah); others that it is obligatory.[24] Some have quoted the hadith to argue that the requirement of circumcision is based on the covenant with Abraham.[25] While endorsing circumcision for males, scholars note that it is not a requirement for converting to Islam."

In view of this, it would be preferable for the summary to state: Male circumcision is a religious commandment in Judaism and is customary in Islam. Michael Glass (talk) 23:04, 11 April 2008 (UTC)

How about "is a religious commandment in Judaism as well as sometimes in Islam." ☺Coppertwig (talk) 02:09, 12 April 2008 (UTC)

How about is a religious commandment in Judaism and recommended or obligatory in Islam. It is also and customary in some Christian churches in Africa including some Oriental Orthodox Churches. This wording mirrors the wording later in the article and makes it clear that it is only some Christian churches in which circumcision is customary. Michael Glass (talk) 08:39, 12 April 2008 (UTC)

Yes, very good. ☺Coppertwig (talk) 15:30, 12 April 2008 (UTC)

Neutrality tag removed?

If you do not believe the neutrality of this article is in question then you are ignoring large swaths of this discussion. I suggest you put it back or explain yourself better than "silly tag". Garycompugeek (talk) 18:25, 12 April 2008 (UTC)

Since you have refused discussion User:The way, the truth, and the light I have replaced the tag. Garycompugeek (talk) 21:37, 12 April 2008 (UTC)

Intro

I oppose this edit which removes pro- and anti-circumcision info from the intro. While I think perhaps the intro could be balanced more between pro- and anti- by adding a tiny bit of info on risks and/or pain and/or by shortening the WHO/HIV bit, nevertheless taking almost all the really interesting information out of the intro is not the answer IMO. NPOV means presenting both sides, not sweeping both sides under the carpet. Garycompugeek, could I convince you to revert back to the original intro? What are your reasons for shortening it? ☺Coppertwig (talk) 18:45, 12 April 2008 (UTC)

I am not opposed to putting both back into the article but feel the intro should be without controversy. Garycompugeek (talk) 18:50, 12 April 2008 (UTC)

Why do you feel the intro should be without controversy? There is controversy in the real world about this subject; the article should reflect that controversy, per NPOV; and the intro should be a summary of the article, per WP:LEAD, and therefore should also summarize the controversy IMO. —Preceding unsigned comment added by Coppertwig (talk • contribs) Jakew (talk) 19:39, 12 April 2008 (UTC)

I tend to agree - WP:LEAD is fairly clear that we should "briefly describe its notable controversies, if there are any". This deletion has also messed up the references. Could you restore the material, Gary? Jakew (talk) 19:39, 12 April 2008 (UTC)

Sure we can state the controversy but lets break down sources in thier respective sections. Garycompugeek (talk) 21:39, 12 April 2008 (UTC)

Can you explain what you mean? It isn't at all clear. Jakew (talk) 22:33, 12 April 2008 (UTC)

I see you believe there is no controversy concerning the benefit of circumcision. Please explain? Garycompugeek (talk) 22:56, 12 April 2008 (UTC)

To whom is that comment addressed? That doesn't represent my belief and I don't think it represents Jakew's. I don't see anything in what you've written, Garycompugeek, that looks to me as if it's intended to be an argument in support of your position that there should be no controversy in the lead. If I missed something, please mark it clearly as being such an argument. ☺Coppertwig (talk) 23:13, 12 April 2008 (UTC)

I was referring to Jakes comment edit. Perhaps I misundertood it? Garycompugeek (talk) 23:17, 12 April 2008 (UTC)

Jakew's comment of 22:23, 12 April seems to be not expressing Jakew's beliefs, but asking for clarification, which you haven't provided, of your message of 21:39, 12 April. ☺Coppertwig (talk) 23:22, 12 April 2008 (UTC)

I'm refering to "restore properly sourced and NPOV material in lead, instead of one-sided claim of controversy. this should also fix broken refs" this comment of Jakes. I showed him my clarification when he asked with my edit. This was my clarification. Garycompugeek (talk) 23:32, 12 April 2008 (UTC)

Gary, why are you removing properly sourced, relevant material from the lead, expressed in quite neutral ways, and replacing it with an unsourced opinion? Jayjg ^(talk) 02:20, 13 April 2008 (UTC)

Read the discussion Jayjg. They are back now and I shall abide by consensus. Please assume good faith. Garycompugeek (talk) 03:04, 13 April 2008 (UTC)

Garycompugeek, I'm not sure whether I understand what you're saying. I think you mean that this edit is your clarification of what you mean by this comment. I still don't see any arguments for removing controversy from the lead, but I gather you're now willing to keep the original material in the lead so perhaps that doesn't matter. ☺Coppertwig (talk) 03:25, 13 April 2008 (UTC)

I think JakewJayjg was assuming good faith. He was just asking for you to give a reason for your edit. Asking for a reason for an edit is a normal Wikipedian interaction. ☺Coppertwig (talk) 03:35, 13 April 2008 (UTC)Apologies to all concerned: I confused two familiar 5-letter usernames beginning with Ja. Of course, I think Jakew is also AGF. 13:48, 13 April 2008 (UTC)

As you note, Coppertwig, this may be a moot point, but it seems that some explanation would be helpful, as there seems to be some confusion. I think that this confusion may be due in part to my edit summary when I restored the material in the article; evidently this was not sufficiently clear. I also think that it is partly due to Garycompugeek's comment above, which did not make it clear that it was in response to an article edit, and instead gave the impression that it was in reply to an earlier comment.

In my message above (of 22:33, 12 April 2008), I asked for clarification of Garycompugeek's earlier message. I understood Gary's edit to the article (of 23:44, April 12, 2008) to be a response; judging by Gary's message above (dated 23:32, 12 April 2008, but timestamped 00:32, April 13, 2008), this was his intent.

Gary, somehow my edit summary gave you the impression that I believe that there is "no controversy concerning the benefit of circumcision". I don't understand why this is, as I thought I had made it clear that the problems were sourcing and one-sidedness, and I didn't suggest that the statement was incorrect. The problem was that your summary ("There is great controversy concerning the benefit of circumcision") was entirely one-sided: it considered only the "pros" and presented them as controversial, in effect advancing an anti-circumcision point of view. A slight improvement would have been to say "There is controversy concerning the benefits and harms of circumcision", but of course this is still a fairly narrow view of the controversy that omits, for example, claims of violations of rights. And, of course, it is completely unsourced and hence unverifiable. Jakew (talk) 11:58, 13 April 2008 (UTC)

Oh, I see. Garycompugeek may have thought that by deleting the sentence "There is great controversy concerning the benefit of circumcision" you were expressing an opinion that the sentence was false, when actually you were stating that it was unsourced and that presenting only that sentence without others to balance it gives a misleading impression. Analogously but more extremely, a misleading impression could be given by stating only "Some people have died from circumcision", which is true (I believe) but ignores benefits and a low death rate. NPOV is more than just keeping only true statements.

Although it was clear to you that Garycompugeek's edit was a reply, nevertheless someone like me who may not be checking the page as frequently might not happen to notice the relative timing of edits and messages and might expect the discussion here to be readable on its own. When an edit or edit summary becomes part of a discussion, I think it's helpful for one of the participants to quote or link to it, to assist others who might be trying to follow the discussion either at that time or later on. ☺Coppertwig (talk) 12:29, 13 April 2008 (UTC)

You do understand correctly now Coppertwig. I do apologize for the lack of clarity. I was being bold and showing Jake what I meant and and should have expounded better here. I have no problem with the revert and would not object to Jake's suggestion "There is controversy concerning the benefits and harms of circumcision". Surely we can source something to this degree if we wanted to. The point I am/was trying to make was more of an encapsulation of the intro stating the controversy in simpler terms. Garycompugeek (talk) 12:54, 13 April 2008 (UTC)

Can you help me to understand what problem you're trying to solve here, Garycompugeek? Why do you think the lead needs to be simpler? Jakew (talk) 13:42, 13 April 2008 (UTC)

Thats a great question Jake. Thank you for asking. You may have noticed I feel the article is out of balence. The Pro source of WHO endorsing circumcision to prevent AIDS is itself very controversal. Nothing wrong with controversy but a source like that should have other sources illustrating the controversy and that makes the intro too busy taking the focus away from simply what is circumcision. The fourth paragraph sums up both pro and con with sources. That I feel is perfect, more is WP:UNDUE. Summerizing I would like to move the WHO pro source to another location than the intro or a con source illustrating circumcision no HIV benefit. Garycompugeek (talk) 20:31, 13 April 2008 (UTC)

Garycompugeek, in the above section you've been asked for some sources criticising the WHO's recommendations. Since you say that their endorsement is "very controversal", it seems to me that we really need to be able to examine some of these sources, in order to be able to determine the scope and extent of this controversy, and to evaluate questions of undue weight. For example, if it turns out that there is a relatively large amount of criticism in reliable sources (perhaps more so than agreement), then we would need to reflect that in terms of the weight given to each viewpoint. On the other hand, if there is relatively little (or no) criticism of the WHO's decision in reliable sources, then again we need to reflect that state of affairs. Jakew (talk) 20:56, 13 April 2008 (UTC)

Title dispute

Is the title of this article still in dispute? If so, could someone please clearly state the problem, or point me to the discussion, so that it may be addressed? Otherwise, the tag should be removed. Thanks, AlphaEta 01:10, 14 April 2008 (UTC)

The title was never in dispute. The tag states "The neutrality of this article's title and/or subject matter is disputed." This would be an or subject matter case in point. Garycompugeek (talk) 01:23, 14 April 2008 (UTC)

Okay, I see. Is the subject matter dispute separate from the concern regarding the article's balance, or lack thereof? Thanks, AlphaEta 01:28, 14 April 2008 (UTC)

The neutrality of the article is in dispute and it is considered unbalanced. Garycompugeek (talk) 01:46, 14 April 2008 (UTC)

The title is actually disputed. As this article is about male circumcision, and not circumcision, it should be titled Male circumcision per WP:TITLE. This one required pages and pages of "discussion" to keep the status quo safe. Blackworm (talk) 03:50, 14 April 2008 (UTC)

I have removed both tags, since they were added inappropriately. If anyone wishes to restore them, please create a section on the talk page including a clear and detailed statement of the specific problems to be addressed. There is some useful guidance in Wikipedia:Dispute templates (both in the intro and in the section entitled "Banner templates"). Jakew (talk) 11:57, 14 April 2008 (UTC)

Jake you have inappropriately removed these tags and there is nothing wrong with the way they were added. Your refusal to work with editors who do not share your viewpoints is telling. You must learn to compromise and incorporate other viewpoints. Garycompugeek (talk) 15:06, 14 April 2008 (UTC)

"They should normally not be used without a clear description from the applying editor of the rationale, preferably presented in a numbered list form in a separate section which includes the template name. ... If one must be used, please make a thorough note listing deficiencies or items being disputed in bulleted or numbered paragraph format under a clear notice section heading." Wikipedia:Dispute templates Jakew (talk) 15:40, 14 April 2008 (UTC)

These tags were added at 21:06, April 11, 2008 and 21:36, April 11, 2008. They were removed at 12:48, April 14, 2008, and were then re-added at 15:41, April 14, 2008. Nearly four days have therefore elapsed since they were first added, and almost a day has elapsed since they were restored. Due to the above messages (including a quote from the appropriate page), in addition to the edit summary used when they were removed, it should be crystal clear that, for each tag, a "clear description from the applying editor of the rationale"/"thorough note listing deficiencies or items being disputed in bulleted or numbered paragraph format under a clear notice section heading" should be made on this talk page. This has not been done.

These descriptions are essential if we are to understand and deal with these issues. If the article is unbalanced, for example, we need a clear and detailed description of how it is unbalanced, in what sections it is unbalanced, and what the correct balance ought to be. Put simply, you need to explain the problem in sufficient detail that someone else can understand it, fix it, and know that it has been fixed. Comments made so far (eg., "the article appears to lean towards pro circumcision however it may simply be my natural aversion to genital mutilation clouding my judgment.") are simply inadequate, as they are far too vague and subjective.

Since the tags were added inappropriately, without these descriptions, they currently serve no function (indeed, they are actively misleading, since they point towards a talk page section that doesn't exist) and should really be removed. However, to give Garycompugeek time to prepare the rationales, I will wait for another day. Jakew (talk) 11:51, 15 April 2008 (UTC)

Come now Jake. You have lifted my very first comment on this page. I wished to state my position and not labor under false pretenses. You on the other hand claim neutrality yet show tremendous friction towards any con stance. I did not post these banners and walk away. I have been very active and will remain so. I shall try and summarize my doubts of unbalance. Note however I am far from the only editor who shares concern. I will start a new title for the banners listing my concerns and urge other editors to do the same. Garycompugeek (talk) 13:14, 15 April 2008 (UTC)

Ok, Gary, I will look forward to your explanations.

To be fair, I could have used a more recent example. For example, when AlphaEta asked you in this section whether the tags were independent of each other, or whether they covered the same issue, you replied "The neutrality of the article is in dispute and it is considered unbalanced", which is simply a restatement of the tag itself, rather than providing information that allows anyone to evaluate the underlying issues.

As for "show tremendous friction towards any con stance", I believe that your efforts have thus far attempted to move the article away from WP:NPOV, for reasons that I've explained in detail elsewhere on this talk page, and for that reason I've largely opposed them. I'm not suggesting that you're acting in bad faith; far from it, in fact. I'm sure you're trying to fix some problem or other which you consider to be "unbalanced", but until I can understand what you're trying to do, all I can do is to evaluate the effect of your fixes as edits in their own right and, where necessary, fix those. Jakew (talk) 13:39, 15 April 2008 (UTC)

I appreciate that response Jake. Pardon the analogy but you simply cannot see the forest for the trees. I do not mean that in a belittling way but if you saw the problems you would have already have tried to solve them. Whether by design or not your edits generally represent the pro side or slanted in that direction. You may have noticed other pro editors who have been backing you up for this reason. There is nothing wrong with any of that as long as both sides are fairly represented. I am working on the banner summation and will post it when complete. Garycompugeek (talk) 17:20, 15 April 2008 (UTC)

Balance Tag

Note to editors: These are my reasons please feel free to add your on own concerns.

1. I would to flesh out the medical and sexual effect/aspects respectively. I have many peer reviewed sources that seem to be missing.
2. The US policies should include a summary from the CDC
3. Only the United Kingdom is represented for Europe a few more notable med associations from other European countries should be included ie France, Spain, Germany…am not particular about inclusion just better representation of European stance
4. China being the most populous country in the world should probably be represented. Garycompugeek (talk) 20:05, 16 April 2008 (UTC)

Thanks for posting this explanation, Gary. Some questions in response:

1. What peer-reviewed sources do you have in mind?
2. Half agree, half disagree. I have considered adding the CDC, along with the WHO, to the 'policies' section but decided against doing so for two reasons. Firstly, they are already represented elsewhere in the article, and secondly we have to be conscious of the article length (it is supposed to be written in summary style, after all).
3. To my knowledge, no English-language versions of circumcision policies are available for medical association policies representing these countries. If you've been able to find them, I'd be grateful if you can let me know where. After all, if we can't find them, we can't cite them!
4. Again, if you're aware of where Chinese medical association policies may be found, I'd be grateful if you'd share that information.

These seem to be general comments about additions that you'd like to make or see made. They don't seem to warrant the "unbalanced" tag. Do you agree that it can be removed? Jakew (talk) 20:20, 16 April 2008 (UTC)

No. I am content with the intro and allowed the neutrality tag to be removed. The medical and sexual sections are unbalenced. I will post them soon time permitting. Garycompugeek (talk) 21:32, 16 April 2008 (UTC)

Ok. Can you please post your explanation as soon as possible (say, within the next 24 hours)? The tag has been present for five days now, and you still haven't justified its presence. Jakew (talk) 21:38, 16 April 2008 (UTC)

Circumcision reduces penis length - Some of the penis length and circumference because its double-layered wrapping of loose and usually overhanging foreskin is now missing, making the circumcised penis truncated and thinner than it would have been if left intact. An Australian survey in 1995 showed circumcised men to have erect penises an average of 8mm shorter than intact men. [1. R. D. Talarico and J. E. Jasaitis, "Concealed Penis: A Complication of Neonatal Circumcision," Journal of Urology 110 (1973): 732-733. 2. Richters J, Gerofi J, Donovan B. Why do condoms break or slip off in use? An exploratory study. Int J STD AIDS. 1995; 6(1):11-8. ]

"circumcision is an iatrogenic cause in the etiology of a concealed penis" - Concealed Penis:Rare Complication of Circumcision A. Adil Esen, Güven Aslan, Hatem Kazmolu, Deniz Arslan, lhan Çelebi - Department of Urology, Dokuz Eylül University School of Medicine, Izmir, Turkey Garycompugeek (talk) 22:17, 17 April 2008 (UTC)

I have looked up "Why do condoms break or slip off in use? An exploratory study" in the Department of Public Health, University of Sydney, Australia. While circumcision is one reason given I was looking for data on penis length. I have reviewed both sources directly and see no justification of that point in those sources however we should probably include the concealed penis complication. Jake I see what you mean about left and right side websites posting their own conclusions. I shall continue researching the other sources. Garycompugeek (talk) 22:41, 17 April 2008 (UTC)

Gary, thanks for checking out the Richters et al. article. As you probably know, the International Journal of STD & AIDS' website hasn't posted articles pre-dating January 1996, so you saved me a trip to the library! Kindest regards, AlphaEta 01:26, 18 April 2008 (UTC)

The Frenar Ridged Band, the primary erogenous zone of the male body. Loss of this delicate belt of densely innervated, sexually responsive tissue reduces the fullness and intensity of sexual response. [Taylor, J. R. et al., "The Prepuce: Specialized Mucosa of the Penis and Its Loss to Circumcision," British Journal of Urology 77 (1996): 291-295.]

The Frenulum The highly erogenous V-shaped web-like tethering structure on the underside of the glans; frequently amputated along with the foreskin, or severed, either of which destroys its function and potential for pleasure. [1. Cold, C, Taylor, J, "The Prepuce," BJU International 83, Suppl. 1, (1999): 34-44. 2. Kaplan, G.W., "Complications of Circumcision," Urologic Clinics of North America 10, 1983.]

The Foreskin's 'Gliding Action' - the hallmark mechanical feature of the normal natural, intact penis. This non-abrasive gliding of the penis in and out of itself within the vagina facilitates smooth , comfortable, pleasurable intercourse for both partners. Without this gliding action, the corona of the circumcised penis can function as a oneway valve, scraping vaginal lubricants out into the drying air and making artificial lubricants essential for pleasurable intercourse. [P. M. Fleiss, MD, MPH, "The Case Against Circumcision," Mothering: The Magazine of Natural Family Living (Winter 1997): 36-45.]

Emotional Bonding Circumcision performed during infancy disrupts the bonding process between child and mother. There are indications that the innate sense of trust in intimate human contact is inhibited or lost. It can also have significant adverse effects on neurological development. Additionally, an infant's self-confidence and hardiness is diminished by forcing the newborn victim into a defensive psychological state of "learned helplessness" or "acquired passivity" to cope with the excruciating pain which he can neither fight nor flee. The trauma of this early pain lowers a circumcised boy's pain threshold below that of intact boys and girls. [1. R. Goldman, Circumcision: The Hidden Trauma (Boston: Vanguard Publications, 1997), 139-175. 2. A. Taddio et al., "Effect of Neonatal Circumcision on Pain Responses during Vaccination in Boys," Lancet 345 (1995): 291-292.]

Circumcision Removes the Most Sensitive Parts of the Penis - Sorrells, M. et al., “Fine-Touch Pressure Thresholds in the Adult Penis,” BJU International 99 (2007): 864-869.

This peer reviewed and published information needs to be incorporated into the article. Garycompugeek (talk) 22:51, 16 April 2008 (UTC)

For goodness sake, Gary, this is a blatant copyright infringement of this anti-circumcision website. Not only does it utterly fail WP:NPOV, but it is plagiarism. Jakew (talk) 22:59, 16 April 2008 (UTC)

As if I had copied them onto the article Jake. The examples were copied from the above website, in the UK, I'm sure you are familure with it. This does not invalidate the science or the sources. It also does not matter if an "anti circucision" website host the sources. I'm not proposing we quote the website just the studies. I repeat these studies need mention in the article. Garycompugeek (talk) 00:33, 17 April 2008 (UTC)

A little advice for all of us: I would suggest that all information added to this article be derived from a direct reading of the peer-reviewed studies. It would be a mistake to base new information on the editorial synopeses of pro- or anti-circumcision sites. This is the only way we can guarantee that information isn't misrepresented. Kindest regards, AlphaEta 01:21, 17 April 2008 (UTC)

Why can we not quote the sources directly? Garycompugeek (talk) 01:48, 17 April 2008 (UTC)

I don't have a problem with direct quotes from peer-reviewed sources. Is that what you meant? Maybe I misunderstood the question. AlphaEta 02:17, 17 April 2008 (UTC)

We can (and do) cite peer-reviewed sources directly. For example, we already cite Taddio (1997) in this article (ref 54). And we cite Sorrells (2007) and Taylor (1996) in sexual effects of circumcision. And we cite Kaplan in medical analysis of circumcision. All of which is perfectly appropriate. (Others are less appropriate, for example neither Fleiss' magazine article nor Goldman's book are peer-reviewed articles.)

But in each and every case we cite the article directly, and the claim we attribute to the article is based upon a careful reading of the source itself. And because we have policies such as WP:NPOV and WP:V, we must treat the material neutrally, we can't extrapolate beyond the sources, and we can't, to be blunt, invent claims out of thin air which we then attribute to sources. Jakew (talk) 10:58, 17 April 2008 (UTC)

So this Dr. Ronald Goldman who has wrote the book "The Hidden Trauma" and runs the Circumcision Resource Centert in Boston, a non profit organizaion, is not quoteable? Garycompugeek (talk) 19:07, 17 April 2008 (UTC)

See ref 49. Jakew (talk) 19:14, 17 April 2008 (UTC)

Thank you Jake. I thought I remember seeing him somewhere in the article. Ok so we do quote him but you object to quoting him from the Circumcision Resource Center because it is not peer reviewed magazine or university publication. Note that it is permissible to quote from there however if all of our sources are peer reviewed I can understand wanting to keep it that way. I am content with Goldman's ref although I may attempt to change some order or phrasing. I will attempt to locate the other above sources in likewise peer reviewed articles. I'm sure they were published somewhere. Garycompugeek (talk) 20:21, 17 April 2008 (UTC)

Tags are not weapons. No compelling rationale for the tag has been advanced, beyond an ideological opposition to circumcision itself. Please do not deface articles with spurious tags; instead work with editors to improve articles. Jayjg ^(talk) 02:08, 18 April 2008 (UTC)

I disagree. This article has multiple open disputes, especially regarding neutrality. Please do not accuse editors of bad faith without evidence beyond your personal conclusion of their ideological opposition to circumcision. Some editors here are working together in an atmosphere of civility and respect. Blackworm (talk) 03:33, 18 April 2008 (UTC)

The Tags have the same purpose they have always had. I have used them to illustrate unbalance and neutrality disputes while working with other editors here in discussion. Regardless of my personal stance I have only interest in truth and facts and have readily admitted any misconceptions I have encountered. Progress has been made in my opinion and I shall continue my endeavors. Garycompugeek (talk) 14:34, 18 April 2008 (UTC)

Choice of source in lead

As noted in the above section, the CDC and WHO make very similar statements about lack of data regarding whether circumcision is protective against HIV for either partner during anal sex with men or women. Because of this, it seems best to cite WHO for this and the preceding statement: there seems little reason to cite both, and in fact doing so adds several hundred bytes to the article length while containing the same information.

Arguments expressed in favour of using the WHO source for both include (taken from edit summaries):

• "WHO source makes the same claim as the CDC." -- AlphaEta [20]
• "no point citing two sources here when one supports both statements. happily, this also reduces the article length slightly" -- Jakew [21]

The argument expressed in favour of using separate sources was (again, taken from edit summaries):

• "I prefer a different source than WHO" -- Garycompugeek [22]
• "Reverted to AlphaEta intro edit" (technically not an argument, but included here for the sake of completeness) -- Garycompugeek [23]

Besides the personal preferences of one editor, are there any actual arguments in favour of using separate sources? Jakew (talk) 17:29, 14 April 2008 (UTC)

AlphaEta has specificly stated no side per "minor cleanup of duplicated material -NOT making an editorial decision on which reference should stand". Are you going to straw poll for every edit that doesn't support your POV? Garycompugeek (talk) 18:22, 14 April 2008 (UTC)

In general, discussion is preferable to polling, Garycompugeek. Consequently the above is an attempt to review and summarise arguments that have been made in favour of one or the other source, and to request elaboration and/or further input. Since I understood AlphaEta's edit summary (please correct me if I'm wrong, AlphaEta) to mean that (s)he did not intend the edit to be taken as an editorial decision, I did not include it. Jakew (talk) 18:50, 14 April 2008 (UTC)

As per Jake and AlphaEta, I do not see any reason to remove the WHO other than Gary's preference. While it would be wonderful to be able to accommodate each and every one of us and our preference in wikipedia, that is an impossibility, and without a valid and compelling reason to change the current consensus, it should remain as it is. -- Avi (talk) 19:18, 14 April 2008 (UTC)

Wonderful but not practical. Which is why we do things through consensus. Be Bold and make changes then come to discussion to talk about edit conflicts and differece of opinion. You and Jake have expressed yours and I have shown mine. We can be patient and see if anyone else ways in or you may revert. 3R should prevent an edit war and I will abide by consensus. Once again AlphaEta has stated no decision see please stop putting words in his/hers mouth. Garycompugeek (talk) 19:41, 14 April 2008 (UTC)

Both of the references (CDC and WHO) support the new material, so I'm not compelled to argue one way or the other. I do like the fact that including the CDC reference (in addition to the WHO ref) grants readers access to a broad spectrum of information, but it certainly isn't necessary to support the new sentence. Perhaps Gary could explain exactly why the CDC link is preferred. More importantly, does the newly added information ease concerns regarding article neutrality and balance? Previous comments seemed to indicate that the WHO findings were the primary area of contention, is this correct? Kindest regards, AlphaEta 19:47, 14 April 2008 (UTC)

I feel WHO's statement "but also stated that male circumcision only provides partial protection and should not replace other interventions to prevent the heterosexual transmission of HIV." is not equal to the CDC quote that "male circumcision may not prevent HIV transmission". The CDC quote is part of my effort to balance the article out in this section. Your help is appreciated regardless of personal feelings about this contentious issue. Garycompugeek (talk) 20:27, 14 April 2008 (UTC)

Gary, as far as I can tell, you're comparing the wrong statements. The CDC's statement is this:

• "There are as yet no convincing data to help determine whether male circumcision will have any effect on HIV risk for men who engage in anal sex with either a female or male partner, as either the insertive or receptive partner"

Which we presented as:

• Furthermore, the Centers for Disease Control and Prevention (CDC) indicates that male circumcision may not prevent HIV transmission from men to women, and data is lacking for the transmission rate of "men who engage in anal sex with either a female or male partner, as either the insertive or receptive partner."[15]

And the WHO's statement is this:

• "Clear messages should be developed to inform communities about what is known and what is not known about male circumcision, including lack of data on direct protection for women, or for either partner during anal sex with men or women."

Which we presented as:

• The WHO also indicates that male circumcision may not prevent HIV transmission from men to women, and data is lacking for the transmission rate "for either partner during anal sex with men or women."[14]

Jakew (talk) 20:39, 14 April 2008 (UTC)

Negative Jake. I meant exactly what I said with quotes directly from the article. While both sources cover the same topic the CDC's has more weight and clarity. If you feel they are the same why not compromise with me and drop the WHO source? I have no problem keeping them both as one currently one backs up the other and gives the reader another valuable source. Garycompugeek (talk) 20:54, 14 April 2008 (UTC)

Gary, you're comparing part of the second sentence in one version with part of the first sentence in both versions. Yet the two versions only differ in the second sentence. To show you what I mean, here are longer extracts from the two versions:

• (CDC version) In March 2007 the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) stated that male circumcision is an effective intervention for HIV prevention, but also stated that male circumcision only provides partial protection and should not replace other interventions to prevent the heterosexual transmission of HIV.[14] Furthermore, the Centers for Disease Control and Prevention (CDC) indicates that male circumcision may not prevent HIV transmission from men to women, and data is lacking for the transmission rate of "men who engage in anal sex with either a female or male partner, as either the insertive or receptive partner."[15]
• (WHO version) In March 2007 the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) stated that male circumcision is an effective intervention for HIV prevention, but also stated that male circumcision only provides partial protection and should not replace other interventions to prevent the heterosexual transmission of HIV.[14] The WHO also indicates that male circumcision may not prevent HIV transmission from men to women, and data is lacking for the transmission rate "for either partner during anal sex with men or women."[14]

I've put "also stated" in bold to clearly show that it is present in both versions. The following sentence is what differs between the two versions.

As for dropping the WHO source, I think that would be a mistake, because the present version is potentially confusing. To illustrate why, consider the following scenario:

• Bob thinks that circumcision is a terrible thing, but he thinks that there may be a reduction in urinary tract infection rates.
• Alice thinks that circumcision is a terrible thing, but he thinks that there may be a reduction in urinary tract infection rates.

Now, suppose we said "Bob thinks that circumcision is a terrible thing. Alice thinks that there may be a reduction in urinary tract infection rates." It's technically true, but does it represent the sources fairly? I think not: it creates the impression that Bob is opposed to circumcision, while Alice is in favour of it. In fact, both have very similar positions.

There's a similar situation in this case. The CDC introduce their document by stating that "Several types of research have documented that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex", and the WHO "recommended that male circumcision now be recognized as an additional important intervention to reduce the risk of heterosexually acquired HIV infection in men". But both express caveats, and indicate that there are certain types of transmission in which it may not be protective.

But the problem is, if we quote the WHO's recommendation and the CDC's caveat, we create the illusion that the two are in disagreement. To avoid creating that misconception, we should either a) quote the WHO for both the recommendation and caveat (thus representing the caveat as what it is: a part of a larger whole), or b) quote the WHO's recommendation and caveat, in addition to the CDC's overview and caveat. Since that would involve a large amount of repetition, though, it seems best to just quote the WHO. Jakew (talk) 21:14, 14 April 2008 (UTC)

Oh, one addition: I think we can cite the CDC elsewhere in the article. The reader can benefit from this additional source wherever it is cited; it doesn't have to be in the lead. Jakew (talk) 21:26, 14 April 2008 (UTC)

Corroboration from another source does not imply ambiguities. Garycompugeek (talk) 22:35, 14 April 2008 (UTC)

I'm sure that's true, but I don't understand what relevance it has to the present discussion. Jakew (talk) 22:44, 14 April 2008 (UTC)

I made a few additions to the intro, resulting in the following paragraph:

In March 2007, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) stated that male circumcision is an effective intervention for HIV prevention, but also noted that male circumcision only provides partial protection and should not replace other interventions to prevent the heterosexual transmission of HIV.[14] Furthermore, while the WHO and the Centers for Disease Control and Prevention (CDC) acknowledge that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, both indicate that it may not prevent HIV transmission from men to women, and that data is lacking for the transmission rate of "men who engage in anal sex with either a female or male partner, as either the insertive or receptive partner."[14][15]

Rationale: Gary's primary concern was an overreliance on the WHO meta-analysis and a possible overstatement of the benefits of circumcision on HIV transmission. He also felt we should include a citation to the CDC's interpretation of these findings. A sentence was formulated to address the lack of data for penile to vaginal and penile to anal/anal to penile transmission of HIV in circumcised men. Jake felt that the new sentence did not accurately reflect the level of agreement between these two health organizations. More specifically, the paragraph may be misconstrued to indicate that the CDC and WHO positions are actually at odds with one another. After reading his argument, I agree, and to alleviate this concern I've added extra information to hint at the robust agreement between these two organizations while also accurately and honestly demonstrating the weak points of the meta-analysis. AlphaEta 01:44, 15 April 2008 (UTC)

Well done. Garycompugeek (talk) 02:03, 15 April 2008 (UTC)

So previous to this, we had only about 30% of the lead being about how great the WHO and other advocates think circumcision is for HIV prevention. Now, it's about 50%. The lead is now even more unbalanced than it already was. Male circumcision is not all about being awesome and great and how the WHO loves it, even if that's mostly what it is to the editors here. That part of male circumcision was already overrepresented in the lead, and now it's just ludicrous. Blackworm (talk) 02:11, 15 April 2008 (UTC)

The material was greatly expanded to address previous concerns about balance. If you think it should move from the lead to the body, I won't object. In fact, I'll be bold and give it a shot. Or we can just complain about it, but I doubt that will be too fruitful. Regards, AlphaEta 03:49, 15 April 2008 (UTC)

My being bold hasn't historically been appreciated. When I suddenly see six editors, including admins, some with previous connections, come in here, throw up a neutrality banner, then proceed to edit such that the material is more unbalanced, I tend to be a bit too intimidated to be bold. Or perhaps I'm frozen in confusion. I support your edit, even if overall it gives even more weight to the idea the circumcision "prevents" HIV (by repeating the claim). Here, I'll be bold, too. Blackworm (talk) 06:57, 15 April 2008 (UTC)

The word "acknowledged" seemed like we were stating a truth (i.e., who were they acknowledging it to?). I edited it. Blackworm (talk) 07:31, 15 April 2008 (UTC)

I goofed on the edit summary, it should read that it HAS become highly detailed.... Sorry for the confusion. AlphaEta 03:55, 15 April 2008 (UTC)

While it is not how I would have done it, I also must compromise. AlphaEta has demonstrated just balancing of given data. The addition of the CDC article illustrates more doubt. It's true it corroborates lower HIV infection with circumcision, it also negates those findings lacking data to speculate. It also brings up an important point of geography linking the majority of Americans already circumcised. Continue to provide sources. Your help is appreciated. Garycompugeek (talk) 02:35, 15 April 2008 (UTC)

I would assume any attempt to bring more sources would result in more objections of undue weight or questionable editorial judgments citing WP:SUMMARY. Modus operandi around here. Stick around, your help is appreciated. Have you stopped arguing for the inclusion of the sourced material you brought to this article and which has been reverted? Blackworm (talk) 02:44, 15 April 2008 (UTC)

No I have not. I ran out of reverts at the time and have been researching the matter. Third parties may be quoted as long as they use valid peer reviewed sources and you broke down the source well. Garycompugeek (talk) 03:40, 15 April 2008 (UTC)

(unindenting) I think that if the paragraph is considered in isolation, these are excellent edits. However, we seem to have forgotten what the paragraph is for. I'm now very concerned, because the lead no longer contains any reference to the WHO recommendations. Yet these should be included in the lead, because they "summarize the most important points, [and] explain why the subject is interesting or notable". So either a) we need to write a new paragraph for the lead, or b) we need to move the paragraph back to where it was. I understand and agree with concerns about the length of the paragraph, and for this reason I would suggest that we use something similar to the "WHO version" quoted above, which a) addresses Gary's concern about balance, and yet b) doesn't imply disagreement between the WHO and CDC. Jakew (talk) 11:23, 15 April 2008 (UTC) (edited 12:33, 15 April 2008 (UTC))

Arbitrary section break

Thinking about this some more, I may have a possible alternative for use in the lead (I'm quite happy with the full paragraph in the body of the article):

• The World Health Organisation (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the Centers for Disease Control and Prevention (CDC) state that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, but indicate that it may not prevent HIV transmission from men to women, and that data is lacking for the transmission rate of men who engage in anal sex with either a female or male partner, as either the insertive or receptive partner.[ref][ref]

My rationale is as follows. I have identified the following constraints on the wording:

1. Blackworm has expressed concern about the amount of content dedicated to the HIV issue, and indicated that fewer words would be preferable.
2. Gary has expressed a desire to cite both the CDC and WHO, and has also expressed the view that the second sentence is a stronger caveat than the "but also stated" part of the first.
3. I have expressed the view that we need to accurately reflect the level of agreement between the respective health organisations.

Meeting these requirements simultaneously is a challenge, to say the least. Adding the CDC as a source requires at least seven additional words for attribution alone, which of course conflicts with the first constraint. At first I thought of deleting the second part of the first sentence ("but also noted...). Then, it occurred to me that with a little restructuring we can actually delete the entire first sentence. As a result, we a) reduce the word count, b) cite both the CDC and WHO in the intro, and c) avoid creating the impression that the CDC and WHO are at odds with each other.

So, any thoughts? Jakew (talk) 15:31, 15 April 2008 (UTC)

My concern is that instead of providing a general overview of the article, we may be trying to add too much detail to the lead. The question then becomes, if the material is detailed in the body, should we simply re-work the existing sentence to become an accurate and inclusive summary? I agree that the WHO finding is one of the more important aspects of this article. Can it be integrated into the existing sentence as follows?

• Opponents of non-medical circumcision condemn infant circumcision as being medically unjustified, an infringement upon individual bodily rights, and a cause of sexual impairment,[9] while advocates of circumcision regard it as a worthwhile public health measure,[10] particularly in light of the WHO's meta-anlysis and recommendation that it should be recognized as an effective intervention for heterosexually acquired HIV infection in men.[WHO ref]

Specific implications for sub-Saharan Africa (... be used to control HIV transmission in Sub-Saharan Africa.[11][12][13]) can be moved to the relevant paragraph in the body, as the WHO recommendation does not limit itself to this geographic area. Regards, AlphaEta 16:38, 15 April 2008 (UTC)

I have a few reservations, but I think I'm happy to go along with that suggestion with one change: change "...WHO's meta-anlysis and recommendation..." to simply "...WHO's recommendation...". The reason is simple: WHO did not perform a meta-analysis (in the conventional sense), but simply reviewed the available evidence (the first - and, to date, only - published meta-analysis of the HIV RCTs was published somewhat later, in PMID 18316997). Jakew (talk) 16:51, 15 April 2008 (UTC)

What part of the opponents' position are we going to focus on, with a phrase like "particularly in light of ..." ? Blackworm (talk) 17:02, 15 April 2008 (UTC)

Are we trying to turn the lead into something it isn't? The current sentence reveals that there is opposition to and support for non-therapeutic and infant circumcision. As far as I'm concerned, pointing out that a debate exists should suffice. However, the sentence also includes some of the arguments used by each side to support their positions. It is not meant to serve as an in-depth analysis of the strenths and weakenesses of each and every argument. The main text is a more appropriate place to conduct such comprehensive analyses. Thanks, AlphaEta 18:56, 15 April 2008 (UTC)

There is no argument presented in support of the anti-circumcision position in the lead. By using a phrase like "particularly in light of," we are making an argument for circumcision in the lead. I suggest we add, particularly in light of state-sponsored mass circumcision programs described as "nominally voluntary" by the BBC.[24] Blackworm (talk) 19:02, 15 April 2008 (UTC)

We're not making an argument for circumcision, just documenting an argument that has been made (eg., "The preventive effect of circumcision against HIV has now officially been accepted by the World Health Organization, the United Nations, and the National Institutes of Health, and some African countries have begun adult circumcision as a public health measure." Schoen EJ. Should newborns be circumcised? Yes. Can Fam Physician. 2008 Jan;54(1):22.). But more importantly this change is an attempt to incorporate the WHO's recommendation into the introduction while, at the same time, addressing your earlier concern about the word count. The result is that we discuss three claims made by anti-circumcision advocates ("medically unjustified, an infringement upon individual bodily rights, and a cause of sexual impairment") and one (albeit more detailed) argument made by pro-circumcision advocates ("worthwhile public health measure, particularly in light of..."). Jakew (talk) 19:31, 15 April 2008 (UTC)

The HIV transmission issue is an integral part of the pro-circumcision position, as evidenced by the link you provided. The circumcision campaign in Rwanda isn't a response to random "public health" concerns, it is specifically a response to the WHO's position. That's why I felt it deserved mention. Of course, there's a good chance I'm wrong, so any serious suggestions are greatly appreciated. AlphaEta 19:34, 15 April 2008 (UTC)

If there is significant objection to the current entry, here's a possible alternative:

• Opponents of non-medical circumcision condemn infant circumcision as being medically unjustified, an infringement upon individual bodily rights, and a cause of sexual impairment,[9] while advocates of circumcision regard it as a worthwhile public health measure,[10] particularly in the control of HIV transmission.[WHO ref]

Thoughts? AlphaEta 19:51, 15 April 2008 (UTC)

The current article state "Opponents of non-medical circumcision condemn infant circumcision as being medically unjustified, an infringement upon individual bodily rights, and a cause of sexual impairment,[9] while advocates of circumcision regard it as a worthwhile public health measure,[10] particularly in light of the WHO's recommendation that it should be recognized as an effective intervention for heterosexually acquired HIV infection in men.[11]" kind of brings us back to where we were originally. While things are a bit more condensed I dislike the WHO reference without a rebuttal. I have studied much of the testing and admit the findings show circumcision reduces risk because the skin is not as soft and susceptible as an uncircumcised penis however it does not prevent, it simply lowers the risk of acquiring. If I was circumcised I would not feel safe having sex with an HIV person without a condom (not sure I would even do that). We must not mislead the reader that circumcision prevents HIV transmission or that condoms or other contraceptives are not a better alternative. Garycompugeek (talk) 20:00, 15 April 2008 (UTC)

(edit conflict; this is in reply to AlphaEta) Problematic, I think, for several reasons. Firstly, I think we need to name the WHO, so that the reader can decide how much credibility to give to their position. Secondly, I'm not comfortable with describing the WHO as an "advocate of circumcision", and I think it's inappropriate and disrespectful to describe them as such. Thirdly, I think it presents a distorted picture of the debate to compare, on one hand, individual authors with anti-circumcision views, and on the other hand, the World Health Organisation. Jakew (talk) 20:04, 15 April 2008 (UTC)

(Outdent.) Jakew writes, We're not making an argument for circumcision, just documenting an argument that has been made... I think that's debatable, but it's moot; the point I was trying to make is that in the opposing case, we are not even documenting any arguments made. We only document the opposition, and present vague grounds (i.e. conclusions) of the opposition without presenting any of their arguments. In the supporting case, we also present conclusions ("public health measure"), but we additionally present facts to support the position (i.e. the WHO's position). Thus we actually present the argument. I much prefer (and support) AlphaEta's above version, which avoids presenting the argument.

I don't believe describing the WHO as an advocate of circumcision is inappropriate nor disrespectful. They clearly advocate not only male circumcision, but mass male circumcision to the extent that state-sponsored programs citing the WHO are now circumcising their males on a "nominally voluntary" basis. I'm not alone in thinking so: WHO and UNAIDS Advocate Circumcision to Fight HIV Infection By Jon Cohen ScienceNOW Daily News 28 March 2007.[25][26] Blackworm (talk) 20:29, 15 April 2008 (UTC)

After reading Blackworm's prior analysis, I understand the point that the current construct supports the pro- position (i.e. public health) with an argument (the WHO's recommendation). The con- position simply notes their views, but does not qualify them with supporting arguments/recommendations. In other words, we bolster the pro- position with the WHO recommendation, but we simply list the con- arguments. If necessary, we can re-word the sentence so as not to mis-represent the WHO's position (by asociation with the citation). AlphaEta 20:39, 15 April 2008 (UTC)

(edit conflict) I don't dispute that since March 2007 they advocate circumcision, Blackworm. After all, their role is to evaluate evidence and recommend accordingly. The problem is that the WHO are no more "advocates of circumcision" than they are "Mycobacterium tuberculosis opponents" or "advocates of clean water", and describing them as any of these presents them solely in terms of their position on a single issue. Compare "WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends." and "WHO is an advocate of circumcision." Don't you see a slight problem?

Since there seems to be some opposition to the present version, which seem to stem from using a single paragraph to express both the controversy and the WHO's views, can I request comments on my alternative suggestion above (dated 15:31, 15 April 2008)? Jakew (talk) 20:46, 15 April 2008 (UTC)

No, Jake, I don't see a problem. Obviously the WHO's position on circumcision is what's relevant here, not the fact that they describe themselves as "responsible for providing leadership..." or the other things you mention. We're not defining the WHO here, we're stating the views of circumcision advocates; and the WHO is among the most prevalent, influential, powerful and outspoken advocates, along with certain organized religions.

To be honest I don't fully understand your suggestion -- you state we can remove the first sentence, but as far as I can tell the paragraph is composed of only one sentence. What sentence are you referring to? Blackworm (talk) 21:04, 15 April 2008 (UTC)

And by the way, Jake, I question your writing, I don't dispute that since March 2007 they advocate circumcision, Blackworm. After all, their role is to evaluate evidence and recommend accordingly. What is the purpose of writing that if not to state your personal view that circumcision advocacy is grounded in a sound evaluation of all evidence? Blackworm (talk) 21:29, 15 April 2008 (UTC)

(edit conflict) Blackworm, there is a difference between "WHO advocates circumcision" and "WHO is an advocate of circumcision" (or, similarly, citing WHO as an example of "advocates of circumcision"). The former describes an act or stance, whereas the other characterises the source itself as an advocate (with connotations of possible bias).

As for my suggestion, I proposed to remove the reference to the WHO from the paragraph we're currently discussing, and instead treat the controversy and the WHO recommendations separately, as before, with a following paragraph reading: "The World Health Organisation (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the Centers for Disease Control and Prevention (CDC) state that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, but indicate that it may not prevent HIV transmission from men to women, and that data is lacking for the transmission rate of men who engage in anal sex with either a female or male partner, as either the insertive or receptive partner.[ref][ref]" Jakew (talk) 21:43, 15 April 2008 (UTC)

Sorry, Jake, I don't see a difference. One who advocates/opposes X is an advocate/opponent of X. If calling someone who advocates circumcision "an advocate" has an improper connotation of possible bias, then so does calling one who opposes circumcision "an opponent" (as we have in the lead, currently, with apparently no objection from anyone).

Your proposed edit appears to misrepresent the CDC's position. Nowhere do they state that circumcision reduces the risk; they state that several types of research document that circumcision reduces the risk. The former is a statement of belief in the view, the latter is a statement that research espousing the view exists. Clearly the UN agencies (WHO/UNAIDS) you mention have that view, but it's not clear that the CDC does. Blackworm (talk) 22:01, 15 April 2008 (UTC)

I oppose this edit, which again makes the focus of the lead section the UN agencies' reasoning for their advocacy of circumcision, and subtly interprets the CDC's position as concurring with the UN ("evidence indicates"). All this, while neglecting mention of the CDC's caveats in extrapolating the data obtained in Sub-Saharan Africa to other parts of the world, neglect of mention of any criticism of the view, as well neglect of mention of the "nominally voluntary" mass male circumcision programs underway in Africa that the's WHO's promotion of this view has apparently caused. Blackworm (talk) 23:37, 15 April 2008 (UTC)

Re this sentence proposed by Jakew: "The World Health Organisation (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the Centers for Disease Control and Prevention (CDC) state that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, but indicate that it may not prevent HIV transmission from men to women, and that data is lacking for the transmission rate of men who engage in anal sex with either a female or male partner, as either the insertive or receptive partner." I think this is a little too detailed for the lead: I see the reader's eyes starting to glaze over. Also, the last part seems unnecessary to me. How about just "The World Health Organisation (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the Centers for Disease Control and Prevention (CDC) state that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex". It really means the same thing as the whole sentence, IMO. The word "specifically" could be inserted before "by men" to try to emphasize the limitations, thus performing a similar role as the deleted last part of the sentence. I agree with Blackworm that there shouldn't be too large an amount of space taken up in the lead with the HIV stuff. By the way, Jakew, I like your Bob and Alice point. ☺Coppertwig (talk) 00:54, 16 April 2008 (UTC)

I agree with Coppertwig. Perhaps we are trying to pack the lead with too many details, modifiers and qualifiers. A brief sentence in the introduction noting the effect of circumcision on HIV transmission, as drafted by coppertwig, should suffice. Furthermore, it will direct readers to the relevant, highly-detailed section in the body of the article. AlphaEta 01:29, 16 April 2008 (UTC)

(Edit conflict.) I support a shorter summary in the lead along the lines of what Coppertwig suggests. However, Jakew's "Bob and Alice" analogy fails to note the difference between what the two sources say. Bob and Alice say identical things. The CDC and WHO do not. I've seen no evidence to show that the CDC state that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex -- the CDC source brought indicates that they believe several types of research have documented such a conclusion. These two ideas cannot be considered equivalent. It is apparent from the CDC's subsequent detailed recounting of the studies undertaken and the conclusions drawn, and their caveats regarding universal extrapolation of these conclusions, that they are silent in that source on the WHO's position (which apparently embraces this extrapolation). To present these two sources as one, unified statement implies a unity between the sources that is the product of careless editorial judgement, and not a demonstrated real-world agreement or joint statement. In short, in my opinion, it fails WP:OR. Can I suggest, The World Health Organisation (WHO), other UN agencies, and the Centers for Disease Control and Prevention (CDC) (U.S.) note research concluding that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex. (I'm not rigid about removing UNAIDS although frankly if we were to list every agency of the UN every time they say the same thing (which seems to be all the time), that seems like a case of undue weight through repetition.) Blackworm (talk) 01:37, 16 April 2008 (UTC)

I also agree with Coppertwig. Unless anyone can think of a better suggestion, I think we should stick with this. Jakew (talk) 10:54, 16 April 2008 (UTC)

I'm not sure about your point, Blackworm. The CDC statement says "Several types of research have documented that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex." and "After adjustment for confounding factors in the population-based studies, the relative risk for HIV infection was 44% lower in circumcised men. " These sound to me to be stating that there is such a risk reduction, although I acknowledge some ambiguity in that regard. Your wording also seems accurate and I would accept it. I would avoid having two parentheses in a row either by using a semicolon "(CDC; U.S.)" or by putting "(U.S.)" before "Centers for Disease Control". ☺Coppertwig (talk) 12:18, 16 April 2008 (UTC)

"Note research concluding that" is a little too weak to be a fair representation of any of these organisations: none are merely noting - all three are taking action as a result, whether "consult[ing] with external experts in April 2007 to receive input on the potential value, risks, and feasibility of circumcision as an HIV prevention intervention in the United States and to discuss considerations for the possible development of guidelines" (CDC) or actively recommending in the case of WHO and UNAIDS). I think that the present wording is fine, but I've no objection to changing it to "state that evidence indicates that". Jakew (talk) 13:34, 16 April 2008 (UTC)

I'm afraid I stand by my objection. Not to be difficult, but none of the other quotes brought verify that the CDC state that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex. The two CDC quotes Coppertwig brings could be copied verbatim right into Wikipedia without attribution to the CDC, they are so neutral and verified (the first references research, the second refers to one study). The quotes Jakew brings show that there is interest in further study; that is clearly far from stating that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, on the contrary it could be taken as evidence of the CDC exercising caution in reaching that seemingly bold conclusion. Far from a call to action (I don't see the CDC calling for mass male circumcision, for example), it's a call for consultation. To lump the CDC in with the WHO (who do call for mass male circumcision) in that view is not verified, and thus seems unacceptable. Blackworm (talk) 06:31, 17 April 2008 (UTC)

Upon reflection, I think Jakew's suggestion ("state that evidence indicates that") is close enough to the source that I can abide by it. It's certainly an improvement. I still think it goes further than the source by implying that the CDC hold the view, and cannot understand both your objections to this criticism. Blackworm (talk) 18:26, 24 April 2008 (UTC)

I feel this is important and should be worked into the end of the paragraph... "3) confers only partial protection and should be considered only in conjunction with other proven prevention measures (abstinence, mutual monogamy, reduced number of sex partners, and correct and consistent condom use)." number three of the CDC's closing summary. Garycompugeek (talk) 16:49, 16 April 2008 (UTC)

You mean something like "but also stated that male circumcision only provides partial protection and should not replace other interventions to prevent the heterosexual transmission of HIV"? Jakew (talk) 16:52, 16 April 2008 (UTC)

Yes... See last edit to article. Garycompugeek (talk) 18:10, 16 April 2008 (UTC)

Prevalence info in lead

Jakew, you recently edited the paragraph, in the lead, about the global prevalence of circumcision. I believe your edit has now removed the information I included in order to try to avoid the problems associated with the imprecision of the term common. We are now left with the unqualified relative phrases "most common" and "less common" to contrast different prevalences of circumcision in selected countries. Unfortunately, "less common" is very ambiguous. For example, let us consider a hypothetical world made up of just six countries: a, b, c and x, y, z. If the prevalence of circumcision is 90% in countries a, b and c, and the prevalence is 89% in countries x, y and z, it is logically correct to state that circumcision is most common in a, b and c and less common in x, y and z (if we can agree that 90% equates to common that is). However, if the prevalence in a, b and c is >80% and the prevalence in x, y and z is <20%, then I believe that simply stating that circumcision is most common in a, b and c and less common in x, y and z, whilst logically correct, is extremely imprecise, perhaps even to a misleading and unencyclopaedic extent: it effectively conceals that fact that a large majority prevalence is being contrasted with a small minority prevalence. And where imprecision leads to such a high degree of interpretability, and the cost of greater precision is just a couple of sets of parantheses, four digits, six words, and two percentage symbols, perhaps greater precision should win the day. I suggest that this:

Circumcision is most common (greater than 80% prevalence) in the Middle East, the USA and parts of Africa and Asia. It is uncommon (less than 20% prevalence) in Central and South America, India, China, some southern African states, New Zealand, and most of Europe.

is more encyclopaedic (and therefore preferable) to this:

Circumcision is most common in the Middle East, the USA and parts of Africa and Asia, and less common in Central and South America, China, and much of Europe

What do you think? Beejaypii (talk) 20:31, 16 April 2008 (UTC)

Hi Beejaypii,

I tried to retain your addition of "uncommon", while addressing a serious problem. By saying "circumcision is most common (greater than 80% prevalence) in..." or "is uncommon (less than 20% prevalence) in...", we are implying that what follows is an exhaustive list. Not only is an exhaustive list inappropriate for the lead, containing too much detail, but the above may well omit countries that should be in either category but aren't.

If you're concerned about "less common", then please suggest some other alternatives. Jakew (talk) 20:43, 16 April 2008 (UTC)

Ok Jakew, I see your point. How about this:

The prevalence of circumcision varies across the globe. For example, it is greater than 80% in the Middle East, the USA and parts of Africa and Asia, whilst it is less than 20% in Central and South America, China, parts of southern Africa, and most of Europe (these lists are not exhaustive). According to the World Health Organization (WHO), global estimates suggest that 30% of males have been circumcised.[8]

What do you think? Beejaypii (talk) 22:35, 16 April 2008 (UTC)

If you say "for example", then I think it's unnecessary to also say "these lists are not exhaustive", and I would mildly prefer leaving it out for brevity. ☺Coppertwig (talk) 22:43, 16 April 2008 (UTC)

(edit conflict) Much better. I suggest three small changes (deletions struck out):

• The prevalence of circumcision varies across the globe. For example, it is greater than 80% in the Middle East, the USA and parts of Africa and Asia, whilst it is less than 20% in Central and South America, China, parts of southern Africa, and mostmuch of Europe (these lists are not exhaustive). According to the World Health Organization (WHO), global estimates suggest that 30% of males have been circumcised.[8]

My rationale: Firstly, "much" is somewhat better, and "most" may even be inaccurate, depending on whether we're talking about number of countries, land area, total population, and indeed what definition of Europe one uses (for example, if one includes Turkey and the Muslim states in Eastern Europe). Hence "most", to my mind, raises more questions than it answers, and is a little WP:ORish, too. Secondly, I think that the parenthetical comment is redundant, since the sentence begins with "for example" which, to my mind, makes it clear that these are just examples. Finally, since these are examples, it makes sense to give the same number of examples (4) of each. Jakew (talk) 22:47, 16 April 2008 (UTC)

I believe that it is most accurate to state that circumcision is not usual in most of Europe. This is true of Northern and Western Europe and also Russia, where circumcision is largely confined to the Muslim and Jewish minorities. In the Balkans, circumcision is again largely confined to Muslim and Jews and not to the other religious groups. My understanding is that Muslims are in a majority in Albania, Bosnia and around Kosova. Turkey is overwhelmingly in Asia Minor but even including European Turkey, most of Europe is not predominantly Muslim or Jewish. Michael Glass (talk) 23:05, 16 April 2008 (UTC)

Jakew and Coppertwig, I too had my doubts about the parenthetical comment. The second and third opinions you've offered have convinced me it should be removed. However, with a nod to the comments of Michael, and looking at the map in the WHO information package referenced by the paragraph, I don't think the phrase "much of Europe" is adequate. I suggest the following version:

The prevalence of circumcision varies across the globe. For example, it is greater than 80% in the Middle East, the USA and parts of Africa and Asia, whilst it is less than 20% in Central and South America, China, and most of the countries of Europe. According to the World Health Organization (WHO), global estimates suggest that 30% of males have been circumcised.[8]

How's that? Beejaypii (talk) 23:19, 16 April 2008 (UTC)

Good, Beejaypii. How about "most European countries"?

Isn't it misleading to say that the prevalence of circumcision is greater than 80% in the U.S.? Perhaps over 80% of males are currently circumcised, but I think the rate of circumcisions of newborns is lower than 80%. (Not sure.) "prevalence of circumcision" could be understood as meaning "prevalence of the custom of circumcision", in other words, that over 80% of newborns are regularly circumcised. I'm not keen on the word "prevalence", anyway -- makes it sound as if circumcision is superior or something. How about "The percentage of males who have been circumcised varies across the globe. ..."

Quoted from manual of style: "In American English, U.S. is the standard abbreviation for United States; US is becoming more common and is standard in other national forms of English. ... When the United States is mentioned along with one or more other countries in the same sentence, U.S. or US can be too informal, and many editors avoid it especially at first mention of the country (France and the United States, not France and the U.S.). ... U.S.A. and USA are not used unless quoted or as part of a proper name (Team USA)." Therefore it should be probably "United States" and otherwise "U.S." or perhaps "US", not "USA". (What spelling convention is used in this article?) ☺Coppertwig (talk) 01:43, 17 April 2008 (UTC)

Looking at the cited source, it does actually say "prevalence" in the title, so I don't think that's a problem. However, the US is categorised as "20-80%", not >80%. (Another problem caused by introducing such specific language - when I expressed concern about omitting countries that should be in either category but aren't, I completely forgot about the risk of including countries in either category but shouldn't be!)

I think that "most European countries" suffers from the same problems as "most of Europe". There would be a similar problem in saying ">80% in most of Africa" - it may well be true, but it might not be, depending on definitions, and in any event we'd need to cite a reliable source to avoid original research. Jakew (talk) 15:10, 17 April 2008 (UTC)

Jakew, you are are correct: the US is incorrectly categorised in the way you describe. I'm afraid this was simple human error on my part.

Would you mind providing an example of a definition of the phrase "most European countries" which would cause the statement "The prevalence of circumcision ... is less than 20% ... in most European countries" to be untrue in relation to the map provided in the cited source? And is it really original research to observe said map, see that most of the European countries are coloured yellow (which is the colour used to indicate "< 20% prevalence" according to the map legend) and deduce that the prevalence of circumcision is less than 20% in most European countries? Isn't that an "obvious deduction" (wp:notor)? Beejaypii (talk) 07:59, 18 April 2008 (UTC)

Beejaypii, I recognise that this was a simple human error on your part, and I don't blame you for it, but wouldn't you agree that it illustrates rather nicely why we need to rely upon the analyses of reliable sources, especially for more complex claims such as "most" (ie., >50%) of a geographical area with more than one definition? Jakew (talk) 11:18, 18 April 2008 (UTC)

Global prevalence should be stated before individual regions. This paragraph is disputed owing to the fact that the WHO estimate of 30% is among the highest quoted in reliable sources, which present a range of one-sixth (16%) to one third (33%). These truths are in the prevalence of circumcision article, but Jakew has incomprehensibly refused to allow the one-sixth figure to appear in any form in the circumcision article lead section. Now, it seems we are stating more WHO estimates as fact without attribution to the WHO, with odd, potentially misleading prose apparently extrapolated from a WHO prevalence map, where the lowest prevalence category is "less than 20 percent." If I said "less than 20 percent of planet Mars is composed of water," that may be technically true, but it is misleading in that it implies that the percentage is somewhere close to 20%, not 0.0% as the case may be. Similarly, stating that the prevalence of circumcision is "less than 20%" in China or other areas has the same problems. Rather than base our detailed prose on such vague estimates, we should present the ranges of global prevalence estimates, and keep estimates about regional prevalence attributed and with a similar level of vagueness ("common," "less common," "more common") as the sources. Blackworm (talk) 19:09, 17 April 2008 (UTC)

Consent and the Levinson article

At present, the part of the Consent section reads as follows:

In a cultural or religious context, Levenson argues that circumcision is of significant enough importance that parental consent is sufficient and that any possible misgivings surrounding the issue of consent are not significant enough to limit the exercise of infant/childhood circumcision. [27].

The Levinson article is a significant discussion of circumcision from a Jewish perspective which ridicules the idea that the only one to consent to circumcision is an adult. It says:

The only persons who may consent to medically unnecessary procedures upon themselves are the individuals who have reached the age of consent," goes the Declaration of the First International Symposium on Circumcision--is like saying that he will at the same point decide what his mother tongue will be."[28].

I have no objection to Levinson's article being linked to the Circumcision article but this does not amount to the detailed argument in favour of parental consent that is attributed to him. Therefore the argument wrongly attributed to Levinson should be removed from the article forthwith. Michael Glass (talk) 12:46, 22 April 2008 (UTC)

I agree that the attribution is incorrect, Michael, but I suspect that it ought to be attributed to Adrian M Viens (Value judgment, harm, and religious liberty. J Med Ethics 2004;30:241-247)

To quote:

• What anticircumcision proponents maintain is that parents are unjustified in believing their child would also maintain their religious values. It is argued that because we do not know if a child will decide to become a follower of their parents’ religion, it would be better if circumcision decisions were delayed until adulthood, so that if an individual wants to remain a member of the religious community and his uncircumcised status was a barrier to religious marriage or burial, he could consent to the procedure as an adult. The problem is that such decisions are not seen to be able to be delayed until this time—the religious significance of the procedure is to be done in childhood. ... Anticircumcision proponents argue that in as much as it is important for parents to be accorded religious liberty (that is, the freedom to appeal to religious principles to guide their moral choices), concomitantly, it is just as important for the child to be accorded religious liberty (the freedom to choose whether he wants to join his parent’s religion, another religion, or no religion at all). It is maintained that people are not born with a particular set of religious beliefs and it is not a child’s choice to be brought up under certain religious traditions or customs. A valid point; however it would be untenable in practice not to make decisions for children because they may have chosen differently. Infants and children cannot make decisions for themselves, and parents have a duty to make decisions on behalf of their child concerning their wellbeing, such as religious upbringing, choice of schooling, immunisation, living environment, dietary requirements, insurance and investments for the child, and so on. Parents need to have the freedom to make decisions for their children based on what they view as best, on the balance of benefits and risks. ... As it presently stands, there is an absence of sufficient evidence or persuasive argumentation to warrant changing the current policy—that parents should have the freedom to make an informed and well deliberated choice concerning whether the procedure is in their son’s interest.

Jakew (talk) 13:27, 22 April 2008 (UTC)

WP:SOAP. Odd, however, that the "Declaration of the First International Symposium on Circumcision" isn't mentioned in the article. Perhaps if it took a more positive spin, it would be. Blackworm (talk) 14:26, 22 April 2008 (UTC)

Banning Jakew from editing this page any longer

Folks, while I think Jake must be a fine and upstanding gentlemen, it seems to me that if his contributions to this article were to be considered as a whole, it would become pretty clear that, no matter how much he may protest, he is pushing an agenda. He tirelessly monitors this specific article, so much so that he has a barnstar awarded for it and now has taken to posting missives in support of one viewpoint.

While his enthusiasm is certainly there, I would argue that it has taken on an oppressive quality over the years: smacking down and/or ruthlessly engaging anyone who dares to contribute in a way he does not consider within the guidlelines. And while he may argue that he is within the letter of the guidelines, I think he's missing the overall rationale and has fallen pretty clearly outside anything reasonable.

Again, this is only my opinion, but I think it's now past the point of common sense and wonder if anyone here agrees with me? Jake, would you consider holding off on touching this page for some period like 30 or 60 days - just to see what might flourish? Lexlex (talk) 04:30, 24 April 2008 (UTC)

Not going to happen, especially since this bizarre edit of yours will be pounced upon as clear evidence of your lack of good judgment. If anything your post above distracts from the real issues, and by association diminishes the arguments of those who may indeed believe this article is unbalanced toward one viewpoint, or that Jakew and his longtime supporters here have in fact displayed a disregard for neutrality and a disregard for any editor who would bring to light any sourced material critical of circumcision. Blackworm (talk) 04:53, 24 April 2008 (UTC)

Really? That's a rather agressive response. Wow. A one time attempt at semantic consistency is considered a lack of good judgement? My goodness, how weird. Truly, would you not agree that this article is being monopolized and it's really becoming rather silly? What might you propose? Lexlex (talk) 06:42, 24 April 2008 (UTC)

I apologize if my response startles you, but it is peanuts compared to the accusations of POV-pushing and bad faith that routinely fly here, on the basis of things very similar to your edit I link above. I've proposed plenty in the last three or four archives of this Talk. I would propose that more editors who don't have much of an opinion on the topic read past discussions and join in current discussions, but that is beyond my control. I am not affiliated with an e-mail network or a Wikiproject. The only RfC in recent memory attracted one outside editor. I'm not that surprised, as this topic seems to instill fear of being labeled an "anti-circumcision zealot" or worse, as has been done by the administrators here. Blackworm (talk) 07:05, 24 April 2008 (UTC)

Oppose. Jakew's contributions to this page are very valuable. He helps the page maintain stability, precision of factual accuracy, and NPOV. Every editor has a personal bias. From each person's POV, their own POV is exactly neutral and all the others are biassed one way or another. The interaction among editors of different POV's tends to help produce a NPOV article. Jakew has an excellent understanding of Wikipedian NPOV and is very skilful and diligent at finding ways to word the article so that it does not claim even slightly more than what the sources say. I've learned from Jakew while working together on this page about details of how to implement the NPOV and NOR policies. This page gets frequent contributions from drive-by editors ranging from vandalism to well-meaning but in most cases off-base edits, and Jakew's tireless monitoring helps maintain a quality article, keeping only those few edits which improve on an already carefully honed article.☺ Coppertwig (talk) 11:13, 29 April 2008 (UTC)

Wait a second! This whole discussion is out of order. I shouldn't have participated in it. This page is for discussion of the content of the article Circumcision. Comments about individual editors are not appropriate here. Maybe you want dispute resolution. This discussion should be closed. ☺ Coppertwig (talk) 23:46, 29 April 2008 (UTC)

Circumcision since 1950

This section starts off with an incomplete discussion about changes in incidence, and then veers into the completely irrelevant. The third par - "In some South African ethnic groups, circumcision has roots in several belief systems, and is performed most of the time on teenage boys" - has presumably been true since white colonization. It should be deleted. The next paragraph, though it cites sources that discuss incidence, addresses itself to motivations for choosing infant circumcision in the US. There is no reason to believe that parental motivation (primarily social conformity plus "perceived medical benefit" in unknown proportions) have changed since 1950. Worse the first sentence - "A study in 1987 found that the prominent reasons for parents choosing circumcision were 'concerns about the attitudes of peers and their sons' self concept in the future,' rather than medical concerns" - misrepresents its source, which says: "The strongest factor associated with the circumcision decision was whether or not the father was circumcised." The second sentence seems to have no purpose except to introduce a speculation that has no evidentiary basis in the study itself. It would seem best to delete the entire paragraph. The two obvious trends since 1950 are the steep declines in incidence for all English-speaking countries beside the US, and the rise in incidence in S Korea. It would seem logical to therefore exand the first paragraph to include Australia, New Zealand and (white) South Africa, where rates have declined from > 80% to < 20%. Johncoz (talk) 20:03, 24 April 2008 (UTC)

Prevalence of circumcision

This section seems to have two major problems.

1. It confuses prevalence[29] and incidence[30]. These are only the same in countries that have had stable incidence rates for several generations, and the mix-up is very confusing for the reader.

2. More seriously, it fails to give the expected overview of global prevalence by region and religion, and instead seems to randomly pick a handful of countries. For a general article on circumcision it should provide a short snapshot of the findings in the main prevalence article (which also needs some work). I suggest something like the following:

Estimates of the proportion of males that are circumcised worldwide vary from one sixth to a third. WHO has estimated that 664,500,000 males aged 15 and over are circumcised (30% global prevalance), with almost 70% of these being Muslim. Excluding majority Muslim countries and Israel, prevalence in Latin America and Eurasia is less than 20% (often much less), with the exceptions of the Philippines, which has a prevalence greater than 80%, and South Korea, which is approaching that level. Estimates for individual countries include United Kingdom 16%, Spain and Denmark < 2%, Finland and Brazil 7% and Thailand 13%.

WHO estimates prevalence in the United States and Canada at 75% and 30%, respectively, though there is wide variation in published estimates for the US with figures as low as 56%. Prevalence in Africa varies from less than 20% in some southern African countries to near univeral in North and West Africa. Both Australia and New Zealand, like Canada, are experiencing long-term drops in prevalence as a result of declining incidence rates since the 1970s. The change is strongly age-graded, with a 2000-01 Australian survey finding 32% of those aged 16-19 years circumcised, 50% for 20-29 years and 64% for those aged 30-39 years.

The citations for all these figures already exist. Note that I have rounded the percentages, since giving such guesstimates to one or two decimal places conveys an altogether unreal impression of accuracy. Johncoz (talk) 20:03, 24 April 2008 (UTC)

This looks very good. Your use of percentages is much more consistent than the current section. Also, it maintains a neutral point of view and is well written. My advice is to be bold and add it to the article (with references). We can hash out the details here. Kindest regards, AlphaEta 23:19, 24 April 2008 (UTC)

I have a couple of concerns about this proposal. First, while the figures may well be sourceable, there seems to be rather a lot of interpretation and synthesis. It's possible that sources can be found for this, of course, but I'm concerned that it may be original research. Second, "Excluding majority Muslim countries" seems to be a rather odd (and not entirely neutral) way of expressing things - one could just as easily say "excluding non-Muslim countries, the rate is high in...". But perhaps this is how the source in question puts it?

I certainly agree with the desire to give an "overview of global prevalence by region and religion", as Johncoz puts it. Jakew (talk) 23:35, 24 April 2008 (UTC)

It looks good to me. I don't see anything odd about saying "excluding majority Muslim countries"; a statement has just been made about Muslims (70% of world circumcisions) so it's natural to then also comment on relatively non-Muslim areas. Mathematically it's the most concise way to describe the situation. Maybe "other than" would sound better than "excluding". I think Johncoz has done a good job of describing the whole world as opposed to the current version which I suppose is basically the summary I arrived at mostly by deleting material from the previous longer version. NOR doesn't mean we always have to use precisely the same words as the sources. Thanks for clarifying the definitions of prevalence and incidence. ☺ Coppertwig (talk) 23:54, 24 April 2008 (UTC)

Jake, it is worrying to me that you feel there may be OR-violations, since that is something I have scrupulously tried to avoid. It would be helpful if you could specify which passages are concerning you so we can either discuss or I can alter, if required. [[User:Johncoz|Johncoz](talk) 00:40, 25 April 2008 (UTC)

Johncoz, it's difficult to make any definite statement until I can see a version with sources. At the moment I can only guess, based on asking myself how I'd go about sourcing the material. However, the sentences I'm concerned about include "Excluding majority...", "Prevalence in Africa...", and especially "Both Australia". We'd need sources for these, per WP:NOR: "All interpretive claims, analyses, or synthetic claims about primary sources must be referenced to a secondary source, rather than original analysis of the primary-source material by Wikipedia editors." Jakew (talk) 10:39, 25 April 2008 (UTC)

Jake, I have placed my proposed version with all citations on my user page. Check it out and let me know what you think Johncoz (talk) 20:15, 25 April 2008 (UTC)

Thank you, Johncoz. I was mistaken about the sentence beginning "Prevalence in Africa". It looks very good indeed, but I would like to propose some improvements.

• The sentence beginning "Excluding majority Muslim" seems to contain some synthesis and interpretation. I propose to replace it with something much closer to the sources, such as: "The prevalence in low in Latin America.[cite Drain or WHO] Circumcision is nearly universal in the Middle East and in Central Asia, but is generally low elsewhere in Asia.[WHO] In Europe, circumcision is generally associated with religion or immigration.[WHO]"
• The sentence beginning "Both Australia and New Zealand, like Canada" is a synthesis of three sources. What's needed is a single source. I don't know of such a source, but the WHO document (p17) covers both Australia and Canada. I would therefore suggest editing the sentence to read "Both Australia and Canada...", and attributing the sentence to the WHO. I'd also suggest deleting the following sentence, which gives a disproportionate amount of detail to Australia.

Jakew (talk) 21:48, 25 April 2008 (UTC)

Jake, thankyou for your feedback. However, I find myself disagreeing with your assessment.

• I don't believe there is any "synthesis" or "interpretation" happening. Though there may be several different facts in each sentence, each fact is independently supported by reference to a verifiable source. The empirical reality that the UK, Australia, NZ and Canada have all experienced large falls in circ rates over the past few decades is surely well supported by the sources and uncontroversial, and combining these facts in one sentence is hardly synthesis. Interpretation would be to suggest a common reason for these trends without having a secondary source to reference.
• More seriously, your suggested redraft deletes verifiable content with vague generalisations. Eg "the prevalence is low in Latin America" when the WHO doc actually says "A recent multi-country survey found no countries in Central or South America with circumcision prevalence greater than 20%"; that survey was Drain, which I reference. Even worse, "In Europe, circumcision is generally associated with religion or immigration" changes gear from hard data to a discussion of the reasons for prevalence, a distinctly backward step, IMHO. I would suggest my formulation (with footnotes) precisely represents the situation displayed in the WHO map.
• The last sentence is intended as an illustration of the trends in all non-US English-speaking countries. We could use UK or Canadian data to a similar effect, but Richters is the most recently published and based on a very substantial survey. Since these falls are in fact the most substantial change in circumcision prevalence globally for 50 years (apart from South Korea), it would seem to be worth the extra few words in what is already a pretty tight section.Johncoz (talk) 23:00, 25 April 2008 (UTC)

Johncoz, allow me to respond:

• If each fact is independently supported by reference to a verifiable source, yet no verifiable source makes the overall claim (in this case, that that "the UK, Australia, NZ and Canada have all experienced large falls in circ rates over the past few decades"), then it is synthesis. Please see WP:SYN.
• Re "the prevalence is low in Latin America", I have no objection to being a little :more specific. How about "the prevalence is reported to be <20% in Latin America"?
• Re Europe, the problem is that a colour-coded map is a primary source. Per WP:NOR, "Any interpretation of primary source material requires a reliable secondary source for that interpretation." Unfortunately, the WHO document contains relatively little discussion of Europe; the only relevant material I could find was "...currently, as in the rest of Europe, neonatal circumcision predominantly related to Muslim or Jewish religion, medical indications or immigration from circumcising countries.", which I attempted to paraphrase.
• I would suggest that we need to find a source that makes generalisations about trends in non-US English-speaking countries, and use any illustration from that. Jakew (talk) 23:16, 25 April 2008 (UTC)

Jake, it seems we agree on Latin America ;-)

• On Europe, my proposed text is doing no more than summarising in a few words what is in the main prevalence of circumcision article:

Less than 20%

The following countries have a circumcision rate of less than 20%: Iceland,[5] United Kingdom,[5][28] Ireland,[5] Sweden,[5] Norway,[5] Finland,[5] Denmark,[5] Estonia,[5] Latvia,[5] Lithuania,[5] Portugal,[5] Spain,[5] France,[5] Switzerland,[5] Italy,[5] Netherlands,[5] Belgium,[5] Slovakia,[5] Germany,[5] Poland,[5] Czech Republic,[5] Hungary,[5] Greece,[5] Bulgaria,[5] Romania,[5] Moldova,[5] Ukraine,[5] Austria,[5] Belarus,[5] Russia.[5]

Where footnote 5 is in fact referencing the WHO map as its primary and only source. Whats's the difference?

• On the issue of non-US English-speaking countries, I am not keen to be making any generalisations, implicitly or explicity, but simply in presenting the facts and letting the reader draw their own conclusions. So perhaps this might work for everybody. 1) Delete ", like Canada," and attach the Wirth citation to the first mention of Canada (so at least we cover the fact that there has been a change. 2) Add a final sentence: "Prevalence in the UK is also age-graded, with 12% of those aged 16-19 years circumcised, and 20% of those aged 40-44 years", referencing Davis et al. That way we enrich the content while avoiding any appearance (however tenuous) of "synthesis" (we also lose the Montreal Gazette citation, which is a pretty low quality source). Does this work for you? (I've made the changes on my user page so you can more easily evaluate them. Johncoz (talk) 00:56, 26 April 2008 (UTC)

I have also removed the parenthetical "(often much less)" from the draft, as it was redundant given that specific examples of the range of values follow. Johncoz (talk) 01:49, 26 April 2008 (UTC)

Included Colombia and Taiwan estimates (from peer-reviewed sources) in the examples list, providing a much better balance. Also appended some word counts. Any further comments or suggestions for improvement on the draft most welcome.Johncoz (talk) 05:12, 26 April 2008 (UTC)

Johncoz, the WHO map contains no more and no less information than a table of countries and percentages, so for the sake of argument, imagine that it is. The list you quote, then, is nothing more than a simple re-expression of the "table" itself. However, if we state "Excluding majority Muslim countries and Israel, prevalence in Latin America[5] and Eurasia[1] is generally less than 20%[6] with the notable exceptions of...", this contains more information than is present in the "table", since it is an analysis of the table. The "table" itself does not contain the division into Muslim/non-Muslim countries, nor a subdivision of non-Muslim countries into exceptions, etc. If the source in question was a table of schoolchildren and their heights, we couldn't stratify by gender and calculate the mean height & 95% CI ourselves; we'd need a source for that. This is no different.

Re non-US English-speaking countries, I've had a look at the (current) version of the 2nd paragraph on your user page, and I think it's a definite improvement. However, we need to delete Wirth from the sentence "WHO estimates prevalence in the United States and Canada[14] at 75% and 30%, respectively[1]", as this is actively misleading (Wirth is not the WHO). Also, we need to delete "Prevalence in the UK is also age-graded...", as we're already covering UK prevalence in the preceding paragraph, and this serves no purpose here except to perform implied synthesis by juxtaposition.

The sentence "Both Australia and New Zealand are experiencing long-term falls" needs to be made closer to the cited source (suggest "In both Australia and New Zealand, the circumcision rate has recently declined.")

Finally, I wonder if we could reduce the number of references cited, perhaps by extracting examples from, eg., the WHO document. The current version on your user page is 6,874 bytes, which is probably due to the large number of refs. Jakew (talk) 11:03, 26 April 2008 (UTC)

Jake, some useful suggestions - let me deal with them in reverse order.

• I agree there is an issue with many citations, but I cannot see a way around it without compromising verifiability. I have tried to recycle as many references as possible. The WHO document, which in many respects is a tertiary source, has some severe limitations and egregious factual errors (look at the adult male population figures for the UK and Australia in table 1, for instance). I'd welcome any specific suggestions.
• I am happy with the existing wording of the OZ/NZ sentence (note that Richters is also a source), since the stated fact is not disputed by anyone commenting on this trend, but I will nonetheless have a second look at the wording in search of an acceptable compromise.
• The final two sentences are not about overall prevalence, but about age-grading - which is a crucial point about past and future prevalence trends. Having made the addition in the response to your earlier criticisms, I am now strongly in favour of retaining it.
• I am happy to delete the Wirth citation. On reflection, you are quite right - it does not sit comfortably there.
• The Latin America and Eurasia phrasing looks like becoming a real sticking point. Having carefully considered your response, I maintain my position that this sentence (with its footnote) does no more than precisely state what is both in the WHO map and the main prevalence article. If this is disallowable "analysis", then we may as well delete the other 2.5 million articles on Wikipedia, IMHO. It is also an extremely economical way of presenting a large swathe of data in what is of necessity a very short overview (as Coppertwig noted). Perhaps other editors may have some views on this question.
• I will advise here when I have updated the draft. Regards, Johncoz (talk) 12:34, 26 April 2008 (UTC)

Thank you for your response, Johncoz. I'll look forward to reading the updated draft. In the meantime, a few comments, in no particular order:

• I don't think that it's essential to reduce the number of citations, but it would be desirable to reduce their number by citing secondary sources with data for several countries instead of primary sources. Another option may be to simply cite fewer specific examples. I would regard any unpublished criticism of the WHO document as original research by definition.
• I think you're overreacting in saying that 'If this is disallowable "analysis", then we may as well delete the other 2.5 million articles on Wikipedia'. This is a problem with a single sentence in a mostly excellent proposed addition to an article. The basic principle of WP:NOR is that if an analysis has not been published in reliable sources then we shouldn't publish it either. The alternatives aren't that terrible: we either remove the claim or we find a reliable source that makes it (or an approximation, as in my earlier suggestion). This also applies to the "crucial point about past and future prevalence trends" - if it's that crucial, it will already have been made in a reliable source, and if it proves impossible to find such a source, it may not be all that crucial.
• Whether or not the stated claim is disputed is largely irrelevant. If we're attributing a claim to a source, we can't extrapolate beyond that source, otherwise the claim is not only unverifiable but the source is misrepresented. In this respect, citing sources in Wikipedia carries a "promise" that the reader can verify that claim attributed to the source is actually made by the source. Jakew (talk) 13:24, 26 April 2008 (UTC)

I have updated the draft. On the points you raise, Jake …

• "I would regard any unpublished criticism of the WHO document as original research by definition." So would I. One can only hope a peer-revoewed critique will appear in the future.
• On the examples, reliable prevalence data for non-English-speaking countries is as rare as hen's teeth and I am not aware of any source that has pulled together these studies (apart from pro and anti circ propagandists). That's why we have encyclopedias.
• On age-grading, both sources (Davis for the UK and Richters for Oz) explicitly mention age-grading, and link it to a historic decline in incidence. So we don't have a problem.
• In relation to the "Excluding Muslims ..." sentence, consider this. The WHO map is in fact not a table but a totally unlabelled map. Whoever compiled the main prevalence article must have painstakingly compared the splotches of colour with an atlas in order to generate the lists. Was this creating information that was not in the source? Yes. Was it "original research" in the sense of WP:NOR? Of course not. Utilising basic geographic (including demographic) data to clarify source data is not OR. Johncoz (talk) 18:36, 26 April 2008 (UTC)

(unindenting) Johncoz, am I correct in thinking that this diff represents the sum of your changes? Assuming that it does, a few comments:

• Agree with the removal of Wirth (also, I'm pleased to note that this reduces the number of references by one).
• The sentence "The circumcision rate has declined sharply in Australia and New Zealand since the 1970s, leading to an age-graded fall in prevalence, with a 2000-01 survey finding 32% of those aged 16-19 years circumcised, 50% for 20-29 years and 64% for those aged 30-39 years." is now problematic for two reasons. First, it is misleading, as the second of the two sources is a survey of Australian data, yet it is presented as data for both Australia and New Zealand. Second, it is synthesis of two sources to advance a claim made by neither. One source (Richters) states that circumcision rates in Australia have fallen since the 1970s. The other source states that rates in both countries have "fallen considerably in recent years". The correct thing to do is to report on what one or the other says, not to try to synthesise the two.
• And I've discussed the problems with "Excluding majority Muslim..." above.

Regarding the above points:

• I'm glad we both agree that such unpublished criticism is original research.
• There is some prevalence data in Drain and WHO that may be usable.
• Re age-grading, there isn't an WP:NOR problem with citing either Dave or Richters. The trouble comes when we use them both together, to advance a position stated by neither. In this case, both the juxtaposition and the choice of wording ("Prevalence in the UK is also age-graded") appear to advance your stated belief that there have been "steep declines in incidence for all English-speaking countries beside the US", and what you need to do instead is to find a source that makes this specific claim.
• Finally, regarding "excluding muslims", we could certainly consider removing the information in that article, but I have to say that I don't find your argument persuasive. The WHO labels their map "Global Map of Male Circumcision Prevalence at Country Level", so there can be little doubt that the "splotches of colour" are, indeed, countries. Reading the map requires no more special skill than reading English, and indeed this task could easily be automated. This contrasts sharply with a) taking the map, b) taking additional data from elsewhere, c) stratifying the resulting data by both circumcision prevalence and dominant religion, and d) making generalisations about the results. For such analysis, as WP:NOR clearly states, we must cite a reliable source. Jakew (talk) 21:37, 26 April 2008 (UTC)

Johncoz has my support for this redraft. It summerizes in a clear concise manner. Garycompugeek (talk) 02:05, 25 April 2008 (UTC)

Jakew, re "excluding muslims": I suppose you may be right. For example, (in the spirit of WP:SYN), if a different source is used for the religion data, we wouldn't know whether they're using a definition of religion that's relevant to circumcision rates, e.g. with respect to practicing versus non-practicing members of a religion, or whatever. However, in the spirit of WP:IAR: are you just applying the SYN rule for the sake of it, or do you really think there's an important concern here? After all, this is an overview using rounded-off numbers. Look at it this way: suppose we said "Except for African countries..." and then somebody objected because the list of which countries are or are not in Africa wasn't from the same source as the data. Wouldn't that be taking NOR too far? ☺ Coppertwig (talk) 22:12, 26 April 2008 (UTC)

Coppertwig, I think this sentence violates WP:NOR in several ways, including but not limited to WP:SYN. Regarding primary sources such as maps, we're supposed to "make no analytic, synthetic, interpretive, explanatory, or evaluative claims about the information" therein. In my view, this sentence does most if not all of these.

Am I just applying this rule for the sake of it? Categorically not, for several reasons.

One of these is that, generally speaking, this kind of analysis can be susceptible to errors, and we owe it to our readers to ensure that they receive information that has gone through publication processes (peer-review, etc) that have been set up to check for such errors. This policy, as with others, is beautifully designed, and properly applied helps to minimise the chances of that happening. Also, given consistent application of WP:V and WP:NOR, readers should be able to expect that the cited sources will likely give further information (as is true with most other sources). For example, suppose we could find a source that stated that "Excluding majority Muslim countries and Israel, prevalence in Latin America and Eurasia is generally less than 20%". If I were reading that, I might want to read the source in more detail, with the expectation that I'll be able to find out about the sources used in this analysis, how "majority Muslim" was determined, etc. Why violate that expectation?

Another reason is that WP:NPOV requires us to represent, with appropriate weight, significant views that have been expressed in reliable sources. When an analysis proves to be so difficult to source then I think that's a clue that we're trying to represent a view that hasn't been expressed in reliable sources, and that's an WP:NPOV minefield (for example, if Wikipedia is first to publish this interpretation, we could find scholars citing us, and perhaps criticising the analysis, so what then? "Wikipedia says X but author Y disagrees" is absurdly self-referential...). That problem doesn't occur when we stick with statements that have been made elsewhere (even if they aren't ideal), for example in my suggestion of 21:48, 25 April 2008.

Finally, as I commented above, "Excluding majority Muslim countries..." is somewhat non-neutral. Even phrased differently, the underlying message of the sentence structure is that majority Muslim countries are unimportant (consider "excluding families of immigrants, the population of England is 100% white" - how would a black person feel about that? And what about "the population of England is 10% black, 6% other, and 84% white"?). Again, if we stick to published analyses, this problem doesn't occur (or if it does we can at least attribute the claim).

I think that there's rarely a case for applying WP:IAR to the core policies, and I don't think this is such an occasion. Jakew (talk) 23:09, 26 April 2008 (UTC)

OK, how about this approach: the question is whether we're talking about an unambiguous list of countries or not. If we say "excluding countries listed in Table 3 in publication X, ..." then that's unambiguous. (I think.) In that case, it's simple application of logic and is OK and does not violate WP:SYN (I think). Just saying "countries with majority Muslim population" is probably not unambiguous and may change with time, but it might be possible to say "countries listed by publication X as being majority Muslim countries", even if publication X has nothing to do with circumcision.

This doesn't solve the possible connotations of the use of the word "excluding", but I figure if we're going to use "prevalence" because it's technically correct and we ignore its connotations, we can do the same with "excluding". As someone who tends to think like a mathematician, I would tend to exclude the application of any argument that excludes the use of the word "exclude". ☺ Coppertwig (talk) 00:02, 27 April 2008 (UTC)

Coppertwig, thinking over your suggestion it occurs to me we could just link to Majority Muslim countries article, which has a spiffy table that presumably is updated as new data comes to hand. Johncoz (talk) 03:05, 27 April 2008 (UTC)

The problem then is how do we ensure that it is correct? To set aside, for the moment, the issue of WP:SYN, here is what I would want to do (or see) before I could be confident that there were no errors. First, I would want to convert the WHO map into a table (fairly straightforward). Then, I would want to add a column for % Muslim, taken from that article (as an aside, do we know if that article is complete?). Finally, I'd need to add a boolean-valued column to indicate whether the country is in Eurasia. Only when all this is done could I even check the assertion.

What I don't understand is this: what is so terrible about the alternative (citing verifiable analyses such as, eg., my suggestion of 21:48, 25 April 2008)? Jakew (talk) 11:27, 27 April 2008 (UTC)

I will put together a table along the lines you suggested, Jake. I was going to check the accuracy of that data anyway, and tabulating it systematically is probably a good idea. Johncoz (talk) 13:43, 27 April 2008 (UTC)

Jake, I fear we are in danger of losing sight of our goal here, which is to provide a snapshot in about 200 words of global circumcision prevalence that is accurate (ie true), properly sourced and consistent with Wikipedia guidelines and the main article on the subject. A tall order, but I would suggest the draft text does a substantially better job than the existing section. And the consensus in this discussion seems to favour that judgement, particularly since no one has raised any issues in relation to the facts as stated.

On Eurasia, the question surely is: does the sentence accurately convey what the reader will see on the WHO map (which by the way is not a primary source), should they consult it, or what they will read if they go to the prevalence article? The answer is surely yes. There is in fact no dispute about which countries are “majority Muslim” with the exception of Kazakhstan (est. 47-53%), which I have now added to the footnote of 20-80% exceptions. The importance of Islam to circumcision prevalence is surely clearly stated in the very first sentence (“with almost 70% of these being Muslim”).

On age-grading, it is simply a fact clearly stated by the sources that prevalence is age-graded in the UK and Australia as a result of earlier declines in child incidence. There is no controversy I am aware of about this fact (it is just the way the demography works), and the text does not seek to draw any further conclusion. There is no synthesis. The same falling incidence is of course true for New Zealand and Canada, as clearly stated in the History of Circumcision article and many sources, but having already deleted the Canada reference in response to your objection I would be happy to delete NZ as well rather than pile on yet another citation if you believe mentioning it in the text is “misleading”.Johncoz (talk) 01:48, 27 April 2008 (UTC)

Johncoz, although there are a few remaining issues, I would certainly agree with your statement (that "the draft text does a substantially better job than the existing section"). As far as I'm concerned, the Australia sentence is now okay. I refer to my comments above about the Eurasia sentence. Jakew (talk) 11:27, 27 April 2008 (UTC)

I'm not sure if I'm following the whole discussion (is there a draft somewhere that's being edited?) but I have another suggestion: how about saying "In n₁ countries the rate is over 80%; in n₂ it's between 20% and 80%, and in n₃ it's below 20%." (replacing the n's with numbers), or else "In some countries the rate is over 80%, and in some of the others it's less than 20%". (I haven't consulted the source. Blackworm, these are draft sentences that may need some work and indicate nothing about my beliefs.) The reader could refer to the main article on the topic to get the details i.e. which countries.

Re synthesising two sources about falling rates: I think it is possible to synthesise them: I think you can say that the rate has fallen in both countries. That takes a subset of the information of each source. ☺ Coppertwig (talk) 17:24, 27 April 2008 (UTC)

Jake I have concocted a table as requested after reconciling the WHO map with the mainprevalence of circumcision article, the Majority Muslim countries table and external sources (eg atlas) where required. It's quick and dirty but has the info. The good news is that it fully verifies the accuracy of the Eurasia sentence. On the downside(s)the Majority Muslim countries table is inexplicably missing Albania and Kyrgyzstan, however there is an even better table at Islam by country, and I propose to link to that; and the prevalence article it turns out has many major omissions (eg China Taiwan), which I have noted in the table.

The draft is on my user page. Johncoz (talk) 17:48, 27 April 2008 (UTC)

[←outdent] Could we bring the draft to this talk page? It may help alleviate confusion. Thanks, AlphaEta 20:05, 27 April 2008 (UTC)

Sure. Here's a copy of the current draft text. I'll leave the master with references on my user page as a convenient location for edits and change control.

Estimates of the proportion of males that are circumcised worldwide vary from one-sixth[3] to a third.[4] WHO has estimated that 664,500,000 males aged 15 and over are circumcised (30% global prevalance), with almost 70% of these being Muslim.[1] Excluding majority Muslim countries and Israel, prevalence in Latin America[5] and Eurasia[1] is generally less than 20%[6] with the notable exceptions of the Philippines, which has a prevalence greater than 80%,[7] and South Korea, which is approaching that level.[8] Estimates for individual countries include Spain[7], Columbia[9] and Denmark[10] less than 2%, Finland[11] and Brazil[7] 7%, Taiwan[12] 9% and Thailand[7] 13%.

WHO estimates prevalence in the United States and Canada at 75% and 30%, respectively.[1] Prevalence in Africa varies from less than 20% in some southern African countries to near universal in North and West Africa.[5] The circumcision rate has declined sharply in Australia since the 1970s, leading to an age-graded fall in prevalence, with a 2000-01 survey finding 32% of those aged 16-19 years circumcised, 50% for 20-29 years and 64% for those aged 30-39 years.[13][14] Prevalence in the UK is also age-graded, with 12% of those aged 16-19 years circumcised, and 20% of those aged 40-44 years.[15]

Johncoz (talk) 22:17, 27 April 2008 (UTC)

There appears to be broad agreement that the current draft text is superior to the existing section. That being the case, I will now make the change.

There is a continuing discussion about the Eurasia sentence. The current status of that discussion is summarised (by jakew and myself) at the NOR noticeboard. Johncoz (talk) 18:24, 28 April 2008 (UTC)

More deceptive figures.

The World Health Organization (WHO) stated that studies of three trials provide compelling evidence that male circumcision provides a 50–60% reduction in HIV transmission from female to male.

This is a relative risk reduction. In absolute terms it reduces the risk from 0.3% per sexual contact to 0.12-0.15%. So an absolute risk reduction of less than 1/5th of 1%. Big fucking whoop. HIV is not nearly as easy to spread as American propaganda over the last 20 years has implied to children, and it is despicable to claim this as a valid medical pretext for circumcision. --76.222.55.11 (talk) 19:28, 25 April 2008 (UTC)

Please see WP:TALK. I can only suggest that you write to the WHO and explain your concerns. Jakew (talk) 21:57, 25 April 2008 (UTC)

There's a valid point in there. We find it normal to repeat that "male circumcision provides a 50% reduction in HIV..." without discussing absolute risk, but then we say "more circumcised men reported having been diagnosed with genital warts compared with uncircumcised men (4.5% and 2.4%)" instead of something absolutely frightful and unacceptable derived from the exact same information, like "being circumcised increased reporting of genital warts by 87.5%." It's spin; it's right there in the sources' presentation of the data (especially circumcision advocates like the WHO), and it's sometimes right here in our rewording of sources. How does one cut through it? By consistently taking the same spin as the sources? Blackworm (talk) 22:46, 25 April 2008 (UTC)

What you call "spin", Blackworm, is the interpretation of data as it appears in reliable sources. Obviously our coverage needs to be close to that interpretation, because our role is to express "significant views that have been published by reliable sources", not to express the view of Wikipedia editors who have their own personal interpretation of data that have been published in reliable sources. Jakew (talk) 23:50, 25 April 2008 (UTC)

When reporting the WHO's recommendation, I agree with Jake that we should keep the relative percentage as reported in the citation. However, I think Blackworm has salvaged a valid point from the original post. Reporting the relative risk as indicated by the WHO does not preclude us from adding absolute risks for each individual, randomized, controlled trial:

• In Kisumu, Kenya, "the 2-year HIV incidence was 2.1% (95% CI 1.2-3.0) in the circumcision group and 4.2% (3.0-5.4) in the control group (p=0.0065)...."
• In South Africa, "There were 20 HIV infections (incidence rate = 0.85 per 100 person-years) [0.85%] in the intervention group and 49 (2.1 per 100 person-years) [2.1%] in the control group...."
• In Rakai district, Uganda, "the modified intention-to-treat analysis, HIV incidence over 24 months was 0.66 cases per 100 person-years [0.66%] in the intervention group and 1.33 cases per 100 person-years [1.33%] in the control group...."

Does this serve as a possible solution? AlphaEta 00:53, 26 April 2008 (UTC)

I think it's an excellent solution to the problem of the presentation either RR or absolute risk. Since Jake seems to concede above that the text is the interpretation of the WHO (and not editors here), it would follow that we must make must that clear throughout. We could do something silly like preface the entire section with "Everything below is the view of the WHO." I would rather, though, use the data referenced by the WHO, see the data consistently separated from the WHO's statements, and presented as neutrally as possible, exactly as AlphaEta does above. Then, we can state the WHO's conclusions and recommendations (e.g., mass male circumcision).

I will begin to look at the sources and see how to properly integrate them into the above suggested edit, making minor revisions as necessary. Jake, would you like to help? Is there anything in the above you find to be accurately sourced, with a source you know? Blackworm (talk) 01:26, 26 April 2008 (UTC)

I agree it is worth preparing a draft. An extraordinary number of people (who are not statistically savvy) come away with the impression that for instance there is a 50% chance of contracting HIV if one is uncircumcised. The same thing happened with HRT some years ago. Providing absolute risks as an adjunct is a good way of helping to clarify this without distorting the data.Johncoz (talk) 02:07, 26 April 2008 (UTC)

Blackworm, you've misunderstood. I'm not saying that the text is the interpretation of the WHO specifically; I'm saying that it is the interpretation in the sources (this is also true of the trials themselves. To quote examples from the abstracts linked above: "a reduction in the risk of acquiring an HIV infection of 53%", "a protection of 60%", "estimated efficacy of intervention 51%").

I'm not convinced that quoting absolute figures is useful to the reader, since they depend upon the prevalence of the disease, which varies dramatically by population. Relative risk is somewhat more useful in general statements, and since secondary sources generally focus on these figures, it makes sense for us to do the same. I would suggest adding detailed information about the individual trials to medical analysis of circumcision. Jakew (talk) 11:24, 26 April 2008 (UTC)

[edit conflict.] Sorry, in case it's not clear, I'm referring to ideas for the edits presented in the previous discussion section as well. Blackworm (talk) 02:10, 26 April 2008 (UTC)

Possibly the meaning of relative risk could be made clearer to the reader by using a phrase like "approximately half as many circumcised men contract HIV ... as compared to circumcised men". (This sentence would probably need some work to make sure it's accurate etc.)☺ Coppertwig (talk) 14:13, 26 April 2008 (UTC)

Jake, I haven't misunderstood anything. The statement above says "the WHO [...] compelling evidence [...] provides ..." Yes, WHO, we know; circumcision is compelling and a provider of great things. Let's present the data, including absolute risk in the trials, then the WHO can tell us how this data is "compelling evidence" and how males in Africa should be lined up and circumcised on a "nominally voluntary" basis. Presenting an interleaved mix of WHO circumcision advocacy and data is why people are coming here saying this article reads like a circumcision brochure.

Our job here is to have the reader understand the topic. The relative risk is important, since it's the goal of these studies to find it, but the absolute risk is too, to put the relative risk in context. We do this already for penile cancer, for example, where even the 200%-2100% relative risk increase we state ("3 to 22 times") isn't enough for medical organizations to recommend circumcision as a preventative option, due to the very tiny absolute risk. Let the reader decide.

Coppertwig, your suggested edit extrapolates the results of these trials to all men. It seems you believe that it is a fact that circumcision reduces all males' chances of contracting HIV by 50%, and we should present it as such without attribution of the view. I disagree. Blackworm (talk) 18:40, 26 April 2008 (UTC)

Reading the HIV article I have noticed they use a similair quote "A meta-analysis of twenty-seven observational studies conducted prior to 1999 in sub-Saharan Africa indicated that male circumcision reduces the risk of HIV infection" sourced to Weiss, H.A.; M.A. Quigley, R.J. Hayes then balance it with "However, a subsequent review indicated that the correlation between circumcision and HIV in these observational studies may have been due to confounding factors." sourced to Siegfried, N., Muller, M., Deeks, J., Volmink, J., Egger, M., Low, N., Walker, S. and Williamson, P.. Concerning the importance we seem to be placing on this I find this new source illuminating. Garycompugeek (talk) 20:09, 26 April 2008 (UTC)

I think the newer randomized controlled trials make those results obsolete. Basically, they're just saying we don't know; but after the RCT's we're much more certain. ☺ Coppertwig (talk) 21:04, 26 April 2008 (UTC)

You're correct, Coppertwig. Siegfried et al. said this about the RCTs then underway: "Although the positive results of these observational studies suggest that circumcision is an intervention worth evaluating in randomised controlled trials, the current quality of evidence is insufficient to consider implementation of circumcision as a public-health intervention. Therefore, the results of the three randomised controlled trials underway will provide essential evidence about the effects of male circumcision as an intervention to prevent HIV infection." Jakew (talk) 21:42, 26 April 2008 (UTC)

Because the OP was allowed a soapbox moment to highlight the relatively low risk of contracting HIV per sexual encounter, I request that the same luxury be afforded to me so that I may point out how this risk actually translates into new cases in the field. According to UNAIDS, 2007 saw 1.7 million new cases of HIV in sub-Saharan Africa (this staggering number is actually much improved from 2001). Multiple studies conducted in the 1980's and 1990's indicated that approximately 80% of new HIV infections in Africa are the result of heterosexual contact.[31], [32], [33] If this holds true, then 1.36 million people acquired this disease last year as a result of a "low risk" encounter! More recently, researchers have suggested that perhaps the estimate of heterosexual acquisition was overstated.[34] For the sake of argument, let's say only 40% of new cases in Africa are the result of heterosexual encounters. This still means that 680,000 people contracted a virus that leads to an incurable illness. Furthermore, the areas most greatly affected by HIV lack sufficient stocks of anti-retrovirals and other treatments to keep AIDS at bay. Yes, HIV is nowhere near as easy to contract as herpes and other viral STDs, but it is far from a propaganda effort to suggest that heterosexual spread is a real threat. I shall now step down from the soapbox and promise not to make a habit of it. Please check my math and let me know if there are errors in my extrapolations. Kindest regards, AlphaEta 03:25, 27 April 2008 (UTC)

Based on the above responses from my previous post I do not believe the general thrust of my meaning was understood. Based on the data I believe that circumcision can decrease chance of HIV transmission in any orifice, not propaganda. The point was if the one source was cancelling out the other sources perhaps we should only use the follow up sources of the controlled trials? Another point, to keep things in a balanced perspective, is Only WHO and UNAIDS seem to be advocating it as a way to fight HIV. The major medical schools of thought seem to believe this alone is not justification for circumcision leading us to believe there are better methods to avoiding HIV. I know we source this at the end of the original WHO statement but it seems to get diluted in the article. Garycompugeek (talk) 19:15, 28 April 2008 (UTC)

Gary, only two policy statements have been issued/revised since the publication of the three RCTs. One of these was the joint WHO/UNAIDS statement, and the other was the AUA statement. For obvious reasons, we can't know how any other medical organisations view the issue until they issue their new policies. Jakew (talk) 19:37, 28 April 2008 (UTC)

Be Bold

There are many well thought out suggestions above, and some I feel might be too complicated for the reader. Overall I urge Johncoz to make the changes that he feels are correct and let the wiki process do the rest. Remember the article belongs to the encyclopedia not Jakew and final decisions lay with the community. Garycompugeek (talk) 12:44, 26 April 2008 (UTC)

As you may have gathered, I am new to the Wikipedia community. But my understanding of the protocol for a substantial change to a "controversial" topic is that it should be discussed on this page first and if there is disagreement, reasonable steps should be taken to reach a consensus. (And yes, I am trusting in the fact that the article does not belong to any individual or group). I have no doubt that the wiki process will further improve whatever emerges out of this discussion, but in the meantime I am in no special hurry. Johncoz (talk) 18:55, 26 April 2008 (UTC)

Speed is not of the essence and I have surmised your caution. By all means please take your time. Please view this as encouragement for you seem to have consensus forming. Garycompugeek (talk) 20:01, 26 April 2008 (UTC)

Plastibell

The passage on Plastibell technique does not describe the technique, unlike the Gomco and Mogen passages. This is both unbalanced and creates the exceedingly odd impression of non-surgical surgery (the foreskin just "comes away" after some days). The Plastibell article does have an accurate description but had no citation, which I have now fixed with a reference to a British Medical Journal article. I propose that we replace the existing text with the following:

With the Plastibell, the adhesions between glans and foreskin are first divided with a probe. Then the foreskin is cut longitudinally and the Plastibell placed over the glans and covered over by the foreskin. A ligature is tied firmly around the foreskin, crushing the skin against the groove in the Plastibell, and the excess skin protruding beyond the ring is trimmed off. The remnant foreskin and clamp come away in three to seven days.

And use the same BMJ reference. The proposed text is 74 words; by comparison the Gomco passage is 102 words. Plastibells are now used in the majority of infant circumcisions in the developed world. The change would make the external link redundant —- so it could be deleted. If anyone wants to quickly compare the three pieces of text, I have placed them here. Johncoz (talk) 23:52, 28 April 2008 (UTC)

I think this is a good description, and your rationale for the addition makes sense. I can only say be bold. Jakew (talk) 11:23, 29 April 2008 (UTC)

I concur. This is a nice addition to the article. Well done! AlphaEta 14:04, 29 April 2008 (UTC)

Well done. ☺ Coppertwig (talk) 23:50, 29 April 2008 (UTC)

Neutrality

I'll add this for Jakew, who deleted my tag, even though I fully explained my editing it in in the extra information (so apparently he didn't check the History). Anyone visiting this talk page can clearly see that there are neutrality disputes. Comments about the page being too "anti-circumcision" or too "pro-circumcision" are everywhere. From what I can see, the debate still stands. I, as a person new to the Circumcision page, cannot see the logic in trying to pass this off as written from a "neutral" point of view when the neutrality is being discussed on the talk page. The tag advises readers that the article is thought by some to be biased; until the whole issue is sorted out, that tag is to stay. Cervantes de Leon (talk) 01:43, 30 April 2008 (UTC)

Every controversial topic will have people that complain about neutrality, so, if that were the standard, they would all be tagged. What we can't have are people coming and putting tags on stuff just because they don't like what's presented in the article. This article is already better sourced than almost all Wikipedia articles, precisely because it is controversial and many people from both sides of the argument have gone over it; therefore it's reasonable to believe that it should be considered neutral. If you can't come up with specific POV problems in the article, then your tag simply becomes an objection to the article in general and that is POV. The way, the truth, and the light (talk) 01:52, 30 April 2008 (UTC)

I agree with The way, the truth, and the light. If you're going to have a tag, the tag should have a link to the specific section of the talk page, and the specific section should state precisely what needs to be fixed in the article to make it NPOV. This section doesn't do that, so the tag is not appropriate. Besides, I think the article is fine. Debate about POV on the talk page is normal and healthy and is part of what keeps the article neutral IMO. Besides, opinions will always vary as to what is neutral. ☺ Coppertwig (talk) 02:04, 30 April 2008 (UTC)

• I'd like to be able to say that medical associations whole-heartedly recommend circumcision. Unfortunately, they don't (for political and other irrational reasons). - The way, the truth, and the light 17:19, 12 April 2008
• It doesn't really make an argument for either side, and is essentially a cop out by the AAP to avoid admitting that circumcision is a good idea. The way, the truth, and the light 18:24, 12 April 2008

Needless to say, I don't believe this user is in a position to comment neutrally on this article, despite the fact that that user's side can betray whatever POV they wish and be met with deafening silence from the administrators listening, rather than the blast of WP:RULES and administrative threats anyone apparently opposing that POV receives. Blackworm (talk) 02:29, 30 April 2008 (UTC)

I don't think editors' POVs has anything to with this issue, and the whiff of conspiracy theory you introduce does not help clear the air. The issue here is about drive-by tagging. The aim, after all, is to produce the best possible article, and the application of tags must apply to the content of the article, not the content of its talk page. I look forward to reading any suggestions Cervantes de Leon may have about strengthening this article's NPOV. Johncoz (talk) 03:29, 30 April 2008 (UTC)

What you call conspiracy theory, is documented in the last few archives of this Talk. Again, the fact that the POV tag is always added by editors who perceive a pro-circumcision slant, and immediately removed by editors who express a pro-circumcision slant, should say something about the true level of neutrality of the article. Blackworm (talk) 04:39, 30 April 2008 (UTC)

The relevant policy, to which Jakew referred, is WP:DRIVEBY and states: "Drive-by tagging is strongly discouraged. The editor who adds the tag must address the issues on the talk page, pointing to specific issues that are actionable within the content policies, namely Wikipedia:Neutral point of view, Wikipedia:Verifiability, Wikipedia:No original research and Wikipedia:Biographies of living persons. Simply being of the opinion that a page is not neutral is not sufficient to justify the addition of the tag. Tags should be added as a last resort." (emphases added) Johncoz (talk) 02:18, 30 April 2008 (UTC)

WP:DRIVEBY is not policy. That page also states, In general, you should not remove the NPOV dispute tag merely because you personally feel the article complies with NPOV. Rather, the tag should be removed only when there is a consensus among the editors that the NPOV disputes have indeed been resolved. Blackworm (talk) 02:29, 30 April 2008 (UTC)

The guideline about removal of tags presumably applies to those tags that have been correctly added in the first place (ie in accordance with the guidelines I quoted). In other words, drive-by deletion is no more valid than drive-by addition. In both cases, the action should be discussed on the Talk page first in relation to the specific issues in dispute, and an attempt made to reach consensus for either action. This is particularly so with articles as controversial and exhaustively worked over as this one. Johncoz (talk) 02:47, 30 April 2008 (UTC)

"...until the whole issue is sorted out...." I admire your optimism! Unfortunately, this is a highly polarized issue, and as such, it is unlikely that any one of us will ever be completely satisfied with the neutrality of this article. To simply say that the article is not neutral provides insufficient substance for debate (for either side). We must base our discussion on specific recommendations and reliable sources. If you have any particular concerns, they can be addressed on this talk page. Since I've joined this discussion (about three weeks ago), consensus building been notably civil. Kindest regards, AlphaEta 03:38, 30 April 2008 (UTC)

Tag removed, point taken. In retrospect I am beginning to think that I should have simply kept my mouth shut...