Talk:Circumcision

Mentioning HIV in lede of Circumcision article

A couple of editors have been removing any mention of Circumcision's effects on HIV transmission from the lede of the Circumcision article. The initial rationale was that apparent HIV protection results from the absence of the foreskin, which is not the main topic of this article. Subsequent rationales argued that HIV was unduly emphasised, topic-peripheral. Counterarguments have been that "HIV receives a huge amount of weight in reliable sources. Nine of the first twenty PubMed results for "circumcision" (when filtering for reviews) refer to HIV in the title", "The pertinence of HIV to circumcision is backed up by the references in the text", and for "procedures we should and do discuss their health effects". Should mention of Circumcision's effects on HIV transmission be removed from the lede of this article? Jayjg ^(talk) 18:50, 6 November 2011 (UTC)

For those participating, the extensive discussion which led to this began in the middle of another, partly related discussion here. Beejaypii (talk) 19:09, 6 November 2011 (UTC)

Additionally, Jayjg has not clearly explained the crux of the debate in his posting above. He says "Should mention of Circumcision's effects on HIV transmission be removed from the lede of this article?" The real question (and anyone reading through the debate should be able to confirm this) is whether the HIV issue should enjoy the prominence in the lead it has at the time of writing, and whether it is as intrinsically related to the article's main topic as other issues which get little or no mention in the lead. Beejaypii (talk) 23:27, 6 November 2011 (UTC)

It can't possibly be about what you claim it is - if it were, you would have merely reduced its prominence in the lede. Instead, you consistently removed it altogether, as did Garycompugeek (and now PassAMethod). Please make Talk: page statements that are more congruent with your actions. Jayjg ^(talk) 11:50, 8 November 2011 (UTC)

"I've removed the HIV paragraph from the article lead. However, I do think a short sentence about the HIV issue is appropriate at the end of the paragraph in the lead dealing with conditions treated through the use of circumcision..." I posted that comment towards the end of the original debate in question, within five minutes of the last time I removed the information (though Jakew actually reverted the article edit within one minute, which I hadn't noticed at the time). Additionally, I can point you to all the places where I referred to prominence in the lead prior to that if you like. It would be helpful if you would follow the debate closely enough to be able to establish the topic of a subsequent RfC accurately. It avoids unnecessary distractions, like the dispute I'm responding to with this comment, for example. Beejaypii (talk) 09:35, 9 November 2011 (UTC)

If you felt a mention of HIV was appropriate in the lede, you would have included it, or even proposed the specific wording for such a mention, instead of simply and repeatedly excising it entirely. Your actions plainly belie your statements. It would be helpful if you would represent your actions accurately enough to be able to represent the topic of a subsequent RfC accurately. It avoids unnecessary distractions, like the dispute I'm responding to with this comment, for example. Jayjg ^(talk) 16:40, 13 November 2011 (UTC)

I've only just spotted this response of yours Jayjg. Let me clarify, I actually wrote, in full "I've removed the HIV paragraph from the article lead. However, I do think a short sentence about the HIV issue is appropriate at the end of the paragraph in the lead dealing with conditions treated through the use of circumcision, but I'll leave it to more experienced editors on that particular topic to formulate such a sentence and reference it appropriately, assuming my edit doesn't just get reverted and challenged, despite the outcome of these discussions."[1]. As can be seen from the diff, I wrote that contribution at 18:27 on the 6th November. You created the RfC at 18:50 on the same day, 23 minutes later, and I know you read my comments before doing that because of this apparently hostile contribution of yours at 18:38, also on the same day. Beejaypii (talk) 03:13, 28 November 2011 (UTC)

• Certainly the too-long lead might reasonably mention the HIV issue. However the scientific evidence is not all in support of the statements made, and the detail with controversy should be relegated to the appropriate section. A suitable sentence might read "Studies have linked circumcision to a reduced rate of HIV transmission in certain circumstances." Rich Farmbrough, 00:09, 7 November 2011 (UTC).
  

• • Mention in medical journals is, in itself, not sufficient for something to be included in the lead, because they are primary sources and because this is not a medical encyclopaedia. It doesn't matter if HIV is dicussed in the majority of medical articles about circumcision/the foreskin. That means it is a topic of interest to medical researchers, but does not demonstrate that is of especially high interest to the general reader. --FormerIP (talk) 00:20, 7 November 2011 (UTC)

• Discussion of HIV is given weight by the medical literature, so should we. HIV is mentioned by reviews, meaning that is what the medical literature in secondary sources place weight on. If the medical literature places that weight, who are we to argue with the medical literature? In a paragraph about what the medical literature talks about circumcision, we should be guided by the weight by what our sources and what the literature gives, not by what individual Wikipedia editors guess or assume a "general" reader would want to read. Yobol (talk) 00:36, 7 November 2011 (UTC)

If discussion just (or mainly) confined to medical literature, I would question whether that is good enough. Reviews are not secondary sources. If it really is noteworthy enough, it will have been discussed more widely in sources. There is a problem in having a medical claim stated as fact in the lead sourced only to two very recent primary sources. It's not that the claim may not be true, it is that it is not for Wikipedia to make the call. --FormerIP (talk) 00:53, 7 November 2011 (UTC)

Actually, reviews are secondary sources in the medical literature (see WP:MEDRS, or our article on Secondary source). That they are so widely discussed in secondary sources in the medical literature is the reason why we need to give discussion of HIV such prominence. Yobol (talk) 01:00, 7 November 2011 (UTC)

When you say "so widely discussed", how widely discussed do you mean? There are two cites in the article, both to very recent medical journals. This feels like Wikipedia trying to be too much ahead of the curve. --FormerIP (talk) 01:04, 7 November 2011 (UTC)

As noted in the RfC: "Nine of the first twenty PubMed results for "circumcision" (when filtering for reviews) refer to HIV in the title." Yobol (talk) 01:32, 7 November 2011 (UTC)

So what? Do they all support the statement in the lead? Surely if that statement is a true reflection of the state of research, the discovery will at some point have been newsworthy. Why can the information not simply be cited to the BBC website? --FormerIP (talk) 01:37, 7 November 2011 (UTC)

So what? So that's what the medical literature places emphasis on? And if that's what the medical literature places emphasis on, maybe we should too in a paragraph that disucsses the medical literature? Yobol (talk) 02:06, 7 November 2011 (UTC)

Paragraph that discusses the medical literature I'm fine with. The question raised by the RfC is more specifically about whether the conclusions of these two pieces of research should be stated as fact in the lead. --FormerIP (talk) 02:09, 7 November 2011 (UTC)

If we have a paragraph on the medical literature, shouldn't we place weight on what the medical literature places weight on, then? Yobol (talk) 14:07, 7 November 2011 (UTC)

FormerIP, the BBC covered the trials here and here, and covered the World Health Organisation recommendations here (there were several other articles as well). However, per WP:MEDRS, peer-reviewed literature should be preferred for medical information, and generally secondary sources (ie., reviews). To answer your question about how widely this topic is discussed, there are 46,500 Google Books results, 16,400 Google Scholar results, 4,870 Google News results (in archives), and 878 PubMed results for "circumcision hiv". The PubMed results including HIV represent 17% of all results for "circumcision" (which date back to 1907), in spite of the fact that HIV was first linked to circumcision in 1986. If we limit results to the last 5 years, to get a feel for the relevance in current sources, 41% (548/1329) of PubMed matches for "circumcision" refer to "HIV". The figure for Google News results for the last 5 years is similar: 39% (1360/3450). Jakew (talk) 09:25, 7 November 2011 (UTC)

I think this misses the point altogether, Jakew. I don't think I asked about how widely this issue was discussed in any case. It appears that there is strong, interesting but recent research pointing in a particular direction. That is not something that warrants prominent inclusion in the article as established fact. Even if the research is so strong that it eventually will be. --FormerIP (talk) 20:14, 7 November 2011 (UTC)

There is a scientific consensus regarding this point, as is clear by looking at recent reviews. To quote the World Health Organisation, "The efficacy of male circumcision in reducing female to male transmission of HIV has been proven beyond reasonable doubt."[2] Jakew (talk) 20:20, 7 November 2011 (UTC)

• We should reflect the medical literature which is fairly definitive about the decreased risk of HIV in some populations.Doc James (talk · contribs · email) 02:28, 7 November 2011 (UTC)

• The crux of the debate which led to this RfC is being ignored, and the points I raised in the debate which led to it are not being addressed. Here's a reminder:

"Male circumcision is the surgical removal of some or all of the foreskin (prepuce) from the penis." That's the article topic, defined in the first sentence of the lead. That is an act of surgery. That is not the wider issue of what might happen once that act of surgery has been performed. Conditions directly affecting the foreskin are obviously, and intrinsically, related to circumcision as defined in the lead. Methods of performing the surgery are obviously intrinsically related to it. These things deserve prominence in the lead. A condition whose chances of being contracted are statistically reduced as a consequence of not having a foreskin, is not intrinsically related to the act of performing the surgery defined as the topic of this article, and does not deserve the prominence in the lead it currently enjoys. When sources refer to circumcision, in terms of reduction in the chances of contracting HIV, they are not asserting that the surgical act (the topic of this article) itself reduces the chances (whereas the surgical act itself does directly affect conditions affecting the foreskin of course), because that would be inaccurate: the surgical act itself, for example, carried out on someone who never has sex has no impact on that person's chances of contracting HIV, therefore the act of surgery itself is not intrinsically related to HIV reduction. HIV reduction only becomes a factor when the consequences of the act of surgery are considered in combination with subsequent sexual activity. Sources employing the term circumcision, when discussing HIV reduction, are employing the term with a wider sense than that defined at the beginning of the lead. The HIV aspect does not deserve the prominence it currently enjoys in the lead of this article. It does deserve prominence in "medical aspects" however.

As you can see, it's about the nature of the relationship between HIV and the article topic as defined at the beginning of the lead, and it's about the prominence, in that lead, of the HIV related information. Beejaypii (talk) 11:06, 7 November 2011 (UTC)

So, just to be clear, have you abandoned your earlier position that the lead should not discuss HIV? Jakew (talk) 13:17, 7 November 2011 (UTC)

I think I made that clear towards the end of the HIV discussion above itself, "I've removed the HIV paragraph from the article lead. However, I do think a short sentence about the HIV issue is appropriate at the end of the paragraph in the lead dealing with conditions treated through the use of circumcision..." In fact, I think something similar to the suggestion by Rich Farmbrough earlier in this RfC would be reasonable, "Studies have linked circumcision to a reduced rate of HIV transmission in certain circumstances", though I think "the absence of the foreskin resulting from circumcision" would be more accurate instead of "circumcision" in that sentence:

Studies have linked the absence of the foreskin resulting from circumcision to a reduced rate of HIV transmission in certain circumstances.

Beejaypii (talk) 14:31, 7 November 2011 (UTC)

The distinction between circumcision and "the absence of the foreskin resulting from circumcision" does not appear to be made by sources, so there's no need (or, indeed, justification) for us to do so. In any event, I think such a sentence would fail to give due weight to such an important topic. But thank you, nevertheless, for clarifying. Jakew (talk) 17:11, 7 November 2011 (UTC)

I agree there is too much content on HIV in the lede. I propose moving the majority to the "modern procedure" section, and leaving one or two sentences. Pass a Method talk 18:16, 7 November 2011 (UTC)

"Due weight to such an important topic", in what context? I think it's been demonstrated that there is no intrinsic relationship between HIV protection and circumcision - the surgical procedure defined as the main topic of this article - in the way that there is between circumcision and various foreskin related conditions, or circumcision and the surgical methods used to carry it out (which currently gets not mention in the lead whatsoever), to cite just a few two examples. Prominence in the lead of substantial information relating to an issue which is not intrinsically related to the article topic, and which constitutes only a small portion of the main body of the article, cannot be justified. Beejaypii (talk) 20:44, 7 November 2011 (UTC)

No, Beejaypii, you've merely demonstrated that your opinion is that it isn't intrinsically related; that isn't the same thing at all. Due weight is assessed on the basis of the weight given by reliable sources, which is rather a lot in this particular case. Jakew (talk) 20:50, 7 November 2011 (UTC)

In that case, counter this "...the surgical act itself, for example, carried out on someone who never has sex has no impact on that person's chances of contracting HIV, therefore the act of surgery itself is not intrinsically related to HIV reduction."

The sources you're talking about give weight to the outcome of circumcision in combination with various types of sexual activity, between various types of sexual partner, under various conditions, amongst specific populations, over varying periods of time, in combination with an observed statistical reduction in the chances of contracting HIV, to varying degrees. It doesn't matter how they use the word circumcision, they are not giving direct weight to the procedure in its own right - the procedure which is the main topic of this article - in the way that sources dealing with conditions of the foreskin treated through the use of circumcision are; or in the way that sources discussing methods of carrying out the surgery are. Those latter two topics are intrinsically related to the article topic and primary candidates for prominence in the lead; the HIV issue is not. Beejaypii (talk) 21:25, 7 November 2011 (UTC)

By the same argument, cars require petrol in order to move, so locomotion is not intrinsically related to motor vehicles. Need I say more? Jakew (talk) 21:33, 7 November 2011 (UTC)

Locomotion is the raison d'être of a motor vehicle. Is that what you'd like HIV protection to be in relation to circumcision? That would explain a lot (your analogy, and I use that word advisedly, is not impressive by the way, in case that's not obvious by now). Beejaypii (talk) 21:44, 7 November 2011 (UTC)

The government of Malawi has introduced a circumcision programme as part of an HIV prevention scheme, in which they plan to perform 2.5 million circumcisions. Tanzania plans to circumcise 2.8 million men as part of a similar programme. What would you say is the raison d'etre of those circumcisions? Jakew (talk) 21:50, 7 November 2011 (UTC)

The raison d'être of those circumcisions is removal of the foreskin. Like locomotion to a car, the whole raison d'être of circumcision is to remove the foreskin. Beejaypii (talk) 22:01, 7 November 2011 (UTC)

Cars are produced to carry people around; that is their purpose. Circumcisions are sometimes performed to treat medical conditions affecting the foreskin. Sometimes (more often, globally speaking) they are performed for religious reasons. Sometimes they are performed for health benefits, HIV prevention being the most prominent of these. If the first is, as you argued, "obviously, and intrinsically, related to circumcision", so too are the others. Jakew (talk) 22:14, 7 November 2011 (UTC)

The car analogy is a dead duck, let it rest in peace; it's had a short, pointless, and hard life (a car is a machine invented and designed for a specific purpose, circumcision is a procedure with an irreversible outcome - it should stop right there really). You only partially quoted me above: "obviously, and intrinsically, related to circumcision as defined in the lead." That's what I wrote. Is that what you meant? (BTW, and just so you know I'm still in this, no more responses from me tonight I'm afraid - exam tomorrow morning). Beejaypii (talk) 23:07, 7 November 2011 (UTC)

I'd question your assertion that the parrot duck is, in fact, dead: it seems to me that it served its purpose perfectly, as evidenced by the fact that you avoided my above point entirely. Jakew (talk) 12:22, 8 November 2011 (UTC)

Actually, I asked you to clarify the question you posed because you misrepresented my argument by excluding part of the phrase of mine you quoted, whether deliberately or unintentionally (only you know which). Circumcisions are performed to remove the foreskin. If a condition is affecting the foreskin then that is obviously intrinsically related to circumcision: foreskin removed, no more condition affecting the foreskin. If a condition (i.e. HIV) might stand less chance of being contracted because a person does not have a foreskin (but it's only a perhaps), but only if that person behaves in certain ways, under certain circumstances, at some point(s) in time, perhaps remote, after the foreskin has been removed, how can you argue that the latter is as intrinsically related to circumcision, as defined in the article lead (the act of surgery which constitutes the article topic) as the former? It simply defies rational logic. I'm sorry for having to repeat this again, but if circumcision is carried out on someone who never has sex it has zero effect on that person's chances of contracting HIV. Therefore, circumcision is not intrinsically related to HIV in the way that it is intrinsically related to conditions affecting the foreskin. If circumcision is carried out on someone suffering from a condition affecting the foreskin then circumcision has an immediate and 100% effect on that condition affecting the foreskin, which it removes. Additionally, the relationship between circumcision and the various surgical methods used to achieve it is similarly intrinsic for reasons so obvious I don't think anyone would require it to be spelled out. Show me that's wrong. Show me that the relationship between the surgical act of circumcision is as intrinsically related to HIV prevention as it is to conditions affecting the foreskin or as it is to the surgical methods used to achieve it. Beejaypii (talk) 23:21, 8 November 2011 (UTC)

Actually, Beejaypii, while circumcision is generally fairly effective in treating foreskin-related conditions, it's not 100% effective. That's partly because most circumcisions leave part of the foreskin, partly because the condition may affect other parts of the penis, and partly because circumcision may reduce rather than eliminate the risk of recurrence. I think you need to explain what you mean by "intrinsically related", because you seem to be using the term in an unusual way. Is something intrinsically related to circumcision because it is sometimes performed to treat it? Is it necessary for circumcision to be completely effective? Is something intrinsically related to circumcision because circumcision is used as prophylaxis against it? Is it necessary here for circumcision to be completely effective? More importantly, once you've answered, why these particular answers? Jakew (talk) 09:28, 9 November 2011 (UTC)

You said, Jakew:

Actually, Beejaypii, while circumcision is generally fairly effective in treating foreskin-related conditions, it's not 100% effective. That's partly because most circumcisions leave part of the foreskin, partly because the condition may affect other parts of the penis, and partly because circumcision may reduce rather than eliminate the risk of recurrence.

Ok, I'll rephrase that part of my contribution above to be more precise: if circumcision is carried out on someone suffering from a condition affecting the foreskin then circumcision has an immediate and 100% effect on that condition affecting the foreskin (or that part of the foreskin) which it removes.

The definition of intrinsic intrinsically related is not at issue. Why? Because that's just an adjective a phrase I've used to denote the degree of difference in the relationship between circumcision and HIV compared to the relationship between circumcision and conditions affecting the foreskin (or part of the foreskin), or compared to the relationship between circumcision and methods of carrying it out. Avoiding the word intrinsic phrase intrinsically related: circumcision (the surgical procedure defined as the topic of the article) has a direct, immediate and undisputed effect on conditions affecting the foreskin (or the particular part of the foreskin) it removes (are you going to dispute the use of the words direct, immediate and undisputed now?) Circumcision has no effect in relation to a reduction in the chances of contracting HIV when performed on someone who does not subsequently engage in sexual activity, of various types, to varying extents, under various conditions. In the former case the effect of circumcision is entirely predictable and directly and immediately related to the procedure; in the latter it is unpredictable and entirely dependent on other factors.

Having said that, if you insist on questioning word usage: in what way, precisely, is my use of the phrase intrinsic relationship unusual? (I assume you'll be supporting your answer through semantic analysis of a large and relevant sample from suitable linguistic corpora) Beejaypii (talk) 14:24, 9 November 2011 (UTC)

I agree that it has an effect on the part removed; however I don't see why that's relevant since the text referring to therapeutic circumcision doesn't refer to the part removed but, rather, to the fact that circumcision is used as one of the treatment options for these conditions. Jakew (talk) 14:47, 9 November 2011 (UTC)

Well, it does refer to the part removed: "circumcision is also used" implies that bit, don't you think, unless you can point out a way in which reference to the use of circumcision doesn't imply the part removed, bearing in mind the definition of circumcision in this article. In fact let's substitute the term with its definition in the passage in question: "The surgical removal of some or all of the foreskin (prepuce) from the penis is also used therapeutically, as one of the treatment options for..." Beejaypii (talk) 16:44, 9 November 2011 (UTC)

Sorry, I don't see the point of this argument. Surely we can do the same with HIV: "The WHO currently recommends the surgical removal of some or all of the foreskin (prepuce) from the penis as part of a comprehensive program for prevention of HIV transmission in areas with high endemic rates of HIV" Jakew (talk) 16:50, 9 November 2011 (UTC)

Well, there's something we agree on for a change. Perhaps you'd like to express whatever it is you were trying to express in your last but one (14:47, 9 November 2011) contribution in a different way because I don't think it's clear what point you're making, if any, and what I should respond to. Beejaypii (talk) 16:59, 9 November 2011 (UTC)

I think the problem was that you stated "circumcision (the surgical procedure defined as the topic of the article) has a direct, immediate and undisputed effect on conditions affecting the foreskin (or the particular part of the foreskin) it removes". However, the text referring to treatment options does not specifically discuss the tissue that is removed. It simply says that circumcision is used as treatment. If a simple statement that it is used as treatment is intrinsically related, then surely a similar statement about it being used as prophylaxis is intrinsically related. I don't understand how you can assert one but not the other. Once again, we seem to be going around in circles. Jakew (talk) 17:08, 9 November 2011 (UTC)

"If a simple statement that it is used as treatment is intrinsically related, then surely a similar statement about it being used as prophylaxis is intrinsically related." We are not, and have not been at any point, discussing the relationship between simple statements. It's about the nature of the relationship of certain phenomena to the main article topic (as defined in the article) and what implications that has for the prominence in the lead of information about those phenomena. Beejaypii (talk) 17:32, 9 November 2011 (UTC)

• Of course I agree that the HIV material does not deserve prominence in the lead. If anything we are promoting the spread of AIDS by glorifying a minimal protective effect that circumcision has on HIV transmission...ie Reader comes to page and see circumcision reduces HIV transmissions and thinks "hey I'm cirmcusized I guess I don't have to worry about HIV" but in reality has only slightly lowered his chances of contracting HIV during unprotected sex. Let's face it when it comes to HIV, its either all or nothing for most of us, who is willing to take a chance? So to recap, I have no problem with a section on HIV in the article but the large paragraph in the lead is clearly unwarranted and provides misconception. Garycompugeek (talk) 19:39, 7 November 2011 (UTC)
• I agree with Gary. For thousands of years HIV had nothing to do with circumcision. Why all of a sudden is HIV given such prominence in the lede? If there must be a mention about HIV, one sentence in the lede is enough, and the rest should be moved to a subsection. Pass a Method talk 21:30, 7 November 2011 (UTC)
  • For thousands of years there weren't lots of scientific studies linking Circumcision to HIV; now the majority (or a plurality) of studies of circumcision are about that very topic. It would be rather absurd not to mention in the lede the current hottest topic of medical research regarding the subject. Also, please stop removing the HIV material from the lede while the RFC is on-going; you need to allow readers to view the material in context to make their decision, and you need to allow the RFC process to reach its conclusion before unilaterally trying to impose your preferred result. The RFC has been open for under two days, it's nowhere near closing. Jayjg ^(talk) 11:50, 8 November 2011 (UTC)
    • @Gary and Passamethod: we shouldn't be conducting OR on what the consequences of us placing this in the lead might do to the reader's sense of safety, that is not part of WP:WEIGHT and isn't backed by any sources. Also for thousands of years HIV has not existed, the fact that it exists now and is an incurable disease killing millions of people, and that circumcision's effects on its transmission are a major argument made by many proponents of circumcision and a relevant medical aspect make it a significant viewpoint despite being relatively recent.AerobicFox (talk) 04:11, 15 November 2011 (UTC)
• As noted, the majority (or a plurality) of studies of circumcision are about the topic of HIV, and the scientific consensus is that the effects of circumcision on HIV transmission are real and significant, to the extent that the World Health Organization actually promotes it. It would be rather absurd not to mention in the lede the current hottest topic of medical research regarding the subject. Jayjg ^(talk) 11:50, 8 November 2011 (UTC)
• I haven't seen any proposed text thus far to be able to comment on, but with respect to the current wording in the lead I think it satisfies the bare minimum of WP:LEAD in that it summarizes the correlation with HIV, and would be against anything less since I don't think anything less than what is currently written would adequately introduce the link to the HIV.AerobicFox (talk) 04:11, 15 November 2011 (UTC)
• For the record, I support the concise version of the lead I introduced earlier, and not the version which attributes significant prominence to HIV. I've explained why during the course of this RfC and elsewhere on this talk page (in discussions beginning here (above) and here (archived)). Beejaypii (talk) 21:44, 15 November 2011 (UTC)
  • Beejaypii, I'm sure you do support your personal version of the lede. But why are you attempting to edit-war it into the article[3][4] while the RFC is still on-going and there's clearly no consensus for it (see, for example, the comment immediately above yours)? Jayjg ^(talk) 05:25, 16 November 2011 (UTC)
    • I'm fairly sure the comment above mine (AerobicFox, 04:11, 15 November 2011) must refer to the version of the lead I put in place during the "edit-war" you refer to (that's one edit and one revert). I invite you to check the relevant edit times for yourself. Furthermore, why are you posing your question in the present tense ("...why are you attempting to edit-war...") 18 hours after the revert I made, and bearing in mind that I contributed the comment above 10 hours after that (making it pretty obvious I'd accepted the reversion of my revert which had occurred in the interim)? You're making it seem as if the situation you choose to qualify as an attempted "edit-war" is ongoing. It wasn't an "edit-war" and it's obviously not ongoing. I'm not going to answer a leading question of the sort you're asking, a question which could be misinterpreted as an attempt to discredit the editing behaviour of another editor in a debate about article content you feel strongly about. Beejaypii (talk) 09:48, 16 November 2011 (UTC)

Compromise proposal

Looking over the above, there seem to be a range of views. There doesn't seem to be support for outright removal of the HIV material, but there is some support (and some opposition from some, including myself) for shortening it. Having considered the issue carefully, I'm willing to propose the following compromise:

In heterosexual men, there is strong evidence that circumcision reduces the risk of HIV infection by 38-66 percent, and among high-risk populations it appears cost effective. The WHO currently recommends circumcision as part of a comprehensive program for prevention of HIV transmission in areas with high endemic rates of HIV. According to the Royal Dutch Medical Association (2010), no professional association of physicians currently recommends routine circumcision.

Please note that any deleted material should be examined to see whether it belongs elsewhere in the article. I'm just concentrating on the lead for the moment. Any comments? Jakew (talk) 09:16, 16 November 2011 (UTC)

I think my proposal is better Jakew. Firstly, your version retains the incongruous "...among high-risk populations it appears cost effective." Why does this appear in the lead at all? The question of cost hasn't been raised elsewhere in the lead. Is it really relevant for inclusion? Furthermore, as a summary of the study in question that phrase is inadequate (and that's putting it mildly). Here's an extract of the authors' explanations of their study's limitations (for anyone reading who doesn't realise, AMC = "adult male circumcision"):

There are number of limitations associated with these studies. Most of these studies did not considered complications associated with AMC in their cost-effectiveness models. It has been reported that high complication rates challenge the implementation of male circumcision for HIV prevention in Africa [49]. Another important limitation of these studies, except for Kahn et al 2006 [39], most of the authors did not considered multivariate sensitivity analysis. The uncertainty in the evidence base needs to be reflected in the model. To simultaneously assess the implications of uncertainty in all elements of evidence, probabilistic analysis should be used to establish the decision uncertainty associated with each public health intervention being compared [50], [51]. This informs decision-makers about the probability of each strategy being the most cost-effective conditional on the value that the decision maker places on a unit of health gain. Such methods can also be used to provide an opportunity to apply value of information (VOI) methods to inform priority setting in research [52], [53], [54]. Generalizability of the findings is also an important limitation. Most of the studies were based on OF trial [7]. The OF trial [7] was conducted in a single country and used prevailing or local prices to calculate costs. Economic evaluation carried out alongside a randomised controlled trial may differ significantly from usual practice or care [55]. We recommend that future economic evaluations address these limitations and be guided in part by the checklists available for assessing economic evaluations. Economic evaluation provides a useful framework to assist policy makers in allocating resources across competing needs. HIV/AIDS is a considerable burden on society resources, and prevention provides a cost-beneficial solution to address these consequences. To better inform the decision-making process, researchers must continue to produce high-quality, methodological, comparable and scientifically credible economic evaluations.(source)

So, before considering the implications of that extract, let's return to "appears cost effective". Once again, this is an editor's own analysis of a source rather than a summary of what that source actually claims. To illustrate, consider the claims made in the "Conclusions" section of the source:

"All published economic evaluations offered the same conclusion that AMC is cost-effective and potentially cost-saving for prevention of heterosexual acquisition of HIV in men. AMC may be seen as a promising new form of strategy for prevention of HIV and should be implemented in conjunction with other evidence-based prevention methods."

In other words, based on the conclusions of other studies (studies with various limitations associated with them, as illustrated in the first, larger extract, above), circumcision "may be seen as [something]", e.g. it's possible to see it in a particular way (but not everyone necessarily will). This does not equate to circumcision "appears [to be something]", which, by contrast, implies that circumcision has the characteristic of seeming to be [that something] - a stronger assertion than that made in the study's conclusion, above, and an assertion which ignores that study's limitations, as described by the authors themselves.

Moving on to another part of your suggested text (and as pointed out by me during this discussion with you elsewhere on this talk page) the WHO actually assert that "Male circumcision should always be considered as part of a comprehensive HIV prevention package" in the relevant source. That's not the same as what your phrase,"The WHO currently recommends circumcision...", asserts. Your phrase is inaccurate and attributes a stronger assertion to the WHO than they actually make. And, finally, the bit about professional medical associations and their recommendations is incongruous, being exclusively about routine circumcision of male minors as it is. All this further illustrates the problems caused by trying to attribute undue prominence in the lead to an issue which is dependent on so many other factors for its relationship to the surgical procedure defined as the main topic of the article. My version, by contrast, incorporates a concise summary of the HIV issue just after a concise summary of circumcision's direct use as a treatment option for conditions it has an immediate and direct effect on. I suggest that my proposal for the lead is features and an accurate and concise treatment of the HIV issue, highly congruous with the surrounding text, which is what's required for the summary of an issue in the lead, especially when that issue isn't as intrinsically related to the article topic as other issues and does not enjoy particularly high prominence in the article body. Beejaypii (talk) 15:17, 17 November 2011 (UTC)

Sorry you feel that way, Beejaypii. I'm perfectly happy with the current version, myself, but I just thought there might be room for compromise. Obviously not. Jakew (talk) 16:20, 17 November 2011 (UTC)

Your application of the principle of compromise seems to be go like this: first ignore the suggestion of another editor (me in this case) entirely, then autonomously create a prominent subsection titled "Compromise solution", then suggest a solution of your own within that section, then, finally, respond as you did above when that solution is criticised, i.e. completely fail to address a single aspect of that criticism and claim that there's obviously no room for compromise. Beejaypii (talk) 19:25, 17 November 2011 (UTC)

Several editors had already expressed concern that reducing the coverage given to HIV in the lead would fail to give due weight, there didn't seem to be much point in responding to a "suggestion" that did so to such a drastic extent. It had, in effect, been rejected before it was even proposed.

As for the above criticism, I'm frankly tiring of illogical, long-winded attempts to argue that sources don't mean what they say. "Appears cost effective" is a perfectly adequate summary of "All published economic evaluations offered the same conclusion that AMC is cost-effective"; suggesting otherwise is beyond ridiculous. Your argument about the meaning of "considered" is similarly absurd: the intent is perfectly clear (in fact, in the cited source the heading is "Male circumcision should be part of a comprehensive HIV prevention package" while the body text reads "Male circumcision should always be considered as part of a comprehensive HIV prevention package[...]"). There are times when arguments are so weak that there's no need to reply to them. Jakew (talk) 19:59, 17 November 2011 (UTC)

You are correct Jake, your argument is weak. Beejaypii I completely agree with you. You have made a number of very valid points and we should probably start going through each sentence of the article and comparing it to its source considering the bias obviously going on here. Good thing Jake doesn't WP:OWN the article. Garycompugeek (talk) 20:47, 17 November 2011 (UTC)

Jakew, there have not been any "attempts to argue that sources don't mean what they say." What there has been is arguments that what sources say has been misrepresented in this article. The way you characterise the debate implies a presumption on your part that the article already represents sources accurately.

"Appears cost effective..." is not a "perfectly adequate summary" of the source in question, and it's not even an adequate summary of the highly selective quote from that source you've presented in the summary's defence. That extract just describes the conclusions of five primary sources and does not make a universal assertion about circumcision of the type "circumcision appears...". The source authors do not claim that "circumcision appears cost-effective": they always refer to the conclusions of the five primary sources they review and then state that, on that basis, circumcision "..may be seen..." (i.e. there is the possibility of seeing it), or that the conclusions of those sources provide "compelling evidence" (i.e. the evidence from the five studies compels). That is not the same as the universal "circumcision appears cost effective", which attributes a characteristic to circumcision which is apparently independent of the person or entity considering it: a stronger claim than the source makes. Furthermore, the main source authors' conclusions are obviously tempered by their description of their study's own weaknesses. As for the argument about the heading in the WHO source: it does not contradict the bit you quote from the body text, it just doesn't go into the same detail, probably because it's a sub-heading and hardly a suitable candidate for detailed content analysis.

Unfortunately, Garycompugeek, I for one don't have time to go through the whole article, much as I'd like to. It would be a major undertaking I think, and I'm quite busy with other work. I'll do what I can when I get the time though. Beejaypii (talk) 16:23, 18 November 2011 (UTC)

So you're saying that "On these grounds, AMC may be seen as a promising new form of strategy for prevention of HIV and should be implemented in conjunction with other evidence-based prevention methods" actually means "On these grounds, there is a possibility of seeing AMC as a promising new form of strategy for prevention of HIV and should be implemented in conjunction with other evidence-based prevention methods"? That doesn't make any sense. One doesn't assert that something should be implemented because there is a possibility of seeing it as promising. One asserts that something should be implemented because it one concluded that it is promising. This is exactly what I meant by "attempts to argue that sources don't mean what they say" (not that there's any shortage of examples). Your legalistic word games are at odds with the clear intent of the authors. Jakew (talk) 17:17, 18 November 2011 (UTC)

Your legalistic word games are at odds with the clear intent of the authors. Wow Jake if that's not the pot calling the kettle black I don't know what is. That's not what Beejaypii said and I'm sure that's not what he meant. You are the biggest word twister and bad paraphraser I have yet to come across. At odds with with source author's intent...Indeed. Garycompugeek (talk) 19:42, 18 November 2011 (UTC)

So ... does this have any relevance to the current discussion, Gary? Jakew (talk) 21:40, 18 November 2011 (UTC)

You're correct to question my paraphrasing of "may be seen" with "there is a possibility of seeing" Jakew. That single paraphrase isn't comprehensive enough on its own. The phrase in question could also be paraphrased with "one is allowed to see it as" or "one might see it as" (may is polysemous after all). That doesn't make any significant difference to my argument though. Even paraphrased in those ways the phrase in the source still falls short of ascribing the characteristic of "appearing to be" to circumcision, independently of the entity considering it, as the current version of the article lead does. Furthermore, there are certainly possible motivations for not making clear, unambiguous recommendations about the implementation of circumcision. For example, one of the five studies reviewed by the source in question concludes "Male circumcision could have substantial impact on the HIV epidemic and provide a cost-effective prevention strategy if benefits are not countered by behavioral disinhibition". I'm concerned with accuracy Jakew, not with "word games", and not with making assumptions about the authors' intentions. I assume the authors of published studies chose their words carefully, that their word choice has had to pass the peer-review process, and that we should therefore be as faithful to that word choice, and the sense conveyed by that word choice, as possible. You do not seem to be particularly concerned with that, which is itself a cause for concern in view of your prominence as the editor with by far the greatest number of edits of any single editor with respect to this article. Beejaypii (talk) 21:05, 18 November 2011 (UTC)

Possible motivations for not making such recommendations are ultimately irrelevant, Beejaypii, given that they were in fact made. But the issue is completely irrelevant because we don't use that source to comment on whether circumcision is a "promising new form of strategy for prevention of HIV" or indeed whether it "should be implemented in conjunction with other evidence-based prevention methods". The actual issue is whether circumcision is cost-effective, and that's covered (in the source) in the preceding sentence, which clearly states that all included studies found that it is. Put another way, it appears to be cost-effective. Hence, the language used in the article is perfectly accurate. However, if you'd like to propose a rewording of that sentence fragment that isn't too verbose, I'm unlikely to object. Jakew (talk) 21:40, 18 November 2011 (UTC)

I presented the possible motivation to counter your broad assertion that "One doesn't assert that something should be implemented because there is a possibility of seeing it as promising. One asserts that something should be implemented because it one concluded that it is promising." I think that's unscientific and naive. We should always strive to understand a piece of research, well enough to accurately summarise it, by considering the contents of the paper which presents that research in isolation from idealised notions of human behaviour, so as not to condition our expectations and skew our perceptions, in my opinion.

Back to specifics. Those studies "offered the conclusion" that circumcision is cost effective. That's how the reviewing study expresses it. That does not mean that "circumcision appears to be cost effective" without qualification. It would be much more accurate and honest to state, in the appropriate part of the lead, "and five published economic evaluations selected for review offered the conclusion that it is cost-effective in these populations." Again, the problems associated with attributing undue prominence to the HIV issue in the lead arise: too much needs to be expressed (with so much ground having to be covered) to accurately represent HIV's non-intrinsic relationship with the act of surgery which constitutes the main article topic, circumcision. A concise summary in the appropriate part of the lead, congruous with the rest of that lead, seems more preferable. Beejaypii (talk) 00:29, 19 November 2011 (UTC)

Or, more concisely, "studies find that it is cost-effective". Jakew (talk) 09:26, 19 November 2011 (UTC)

Is that a serious suggestion on your part? Beejaypii (talk) 15:25, 20 November 2011 (UTC)

That question could be taken as meaning that you consider that wording ridiculous and are rejecting it, or it could be taken as meaning that you like the wording and are just checking whether Jakew is actually willing to use it. It's hard to get along online without tone of voice to help clarify things and establish rapport, so we all have to make allowances and make extra effort to AGF and get along. ☺Coppertwig (talk) 21:30, 26 November 2011 (UTC)

Why are you delivering that mini-lecture to me Coppertwig? Where did I not AGF? Beejaypii (talk) 01:43, 29 November 2011 (UTC)

I haven't had time to read the whole discussion, but Beejaypii makes some good points in message dated 15:17, 17 November 2011 (UTC). I agree that "appears to be" seems too strong in light of Beejaypii's arguments in that comment, and suggest "studies have found it to be cost-effective" instead. Also maybe something like "WHO recommends considering" rather than "WHO recommends". Jakew, please seriously consider such modifications to your proposed compromise. ☺Coppertwig (talk) 14:38, 26 November 2011 (UTC)

I've no objection to either of your changes, Coppertwig. I don't agree that they're remotely necessary (as I've pointed out, the cited source summarises itself with the words "Male circumcision should be part of a comprehensive HIV prevention package", so unless one wishes to assert that the source is misrepresenting itself, one must admit that the word "considered" is not needed for a fair summary), but I can't see that they do any real harm. Jakew (talk) 10:05, 29 November 2011 (UTC)

The source doesn't "summarise itself" with the words "Male circumcision should be part of a comprehensive HIV prevention package". That's a sub-heading, and in the manner of sub-headings it elides a great deal of information, and the limited information it does present is devoid of its immediate context. A sub-heading of this type simply gives the reader a rudimentary idea of what to expect in the associated section and why it might be of interest to read it (consider "Maximising the public health benefit" as a sub-heading later in that source as more evidence of this). It's also a structural feature of the text in question, helping to introduce a new section and visually separating it from the previous section. Why are you trying to argue that a sub-heading of that kind takes precedence over the relevant body text as the basis for an accurate summary? It just doesn't make sense. Beejaypii (talk) 12:45, 29 November 2011 (UTC)

The heading is acting as a summary of the recommendations in the subsection that follows, obviously. It doesn't "take precedence", it just condenses what follows into a few words. Jakew (talk) 13:32, 29 November 2011 (UTC)

Which part of those recommendations do you think the sub-heading in question is accurately summarising exactly? You seem confident it's an accurate summary, so I assume you can explain why in detail, rather than simply asserting that it's obviously acting as a summary, or that it "condenses what follows into a few words." Beejaypii (talk) 00:49, 1 December 2011 (UTC)

The part which we've been discussing. Jakew (talk) 09:47, 1 December 2011 (UTC)

Can I assume then that you're arguing that this sub-heading:

Male circumcision should be part of a comprehensive HIV prevention package

is an accurate summary of this from the body text:

Male circumcision should always be considered as part of a comprehensive HIV prevention package...

Is that what you're arguing? Beejaypii (talk) 13:00, 1 December 2011 (UTC)

How about this version of that paragraph?

In heterosexual men, there is strong evidence that circumcision reduces the risk of HIV infection by 38-66 percent, and among high-risk populations studies find it cost-effective.The WHO recommends that circumcision, along with other strategies such as counseling to reduce the number of sexual partners, be included in comprehensive community programs for reduction of risk of HIV in heterosexual men in areas with high endemic rates of HIV. Ethical concerns remain regarding the implementation of campaigns to promote circumcision. According to the Royal Dutch Medical Association (2010), no professional association of physicians currently recommends routine circumcision. Some bodies have discussed under what circumstances neonatal circumcision is ethical.

I think we need to be careful with the wording; I think it's misleading to say, as the article says now, "The WHO currently recommends circumcision ..." because it could in my opinion be too easily read as meaning that the WHO is recommending to individual men to get circumcised, which I think they are not; I think they are recommending to countries to provide circumcision services along with informed consent etc. "Studies have concluded that" seems to me to be a fact; "appears to be" seems to be a viewpoint. Wikipedia asserts facts, not viewpoints. WP:ASF. Everybody please remember to WP:AGF etc. ☺Coppertwig (talk) 16:34, 26 November 2011 (UTC)

How about this version, though you'll have to familiarise yourself with the whole debate to in order to understand why I suggest that of course. Beejaypii (talk) 02:12, 29 November 2011 (UTC)

Can I assume you're not prepared to comment here? Beejaypii (talk) 14:04, 11 December 2011 (UTC)

Proposal 2

I like what we have right now

Circumcision reduces the risk of HIV infection in heterosexual populations that are at high risk. Evidence amongheterosexual men in sub-Saharan Africa shows a decreased risk of between 38 percent and 66 percent over two years and in this population it appears cost effective. Evidence of benefit for women is controversial and evidence of benefit in developed countries and among men who have sex with men is yet to be determined. The WHO currently recommends circumcision as part of a comprehensive program for prevention of HIV transmission in areas with high endemic rates of HIV. Ethical concerns remain regarding the implementation of campaigns to promote circumcision.According to the Royal Dutch Medical Association (2010), no professional association of physicians currently recommends routine circumcision. Some bodies have discussed under what circumstances neonatal circumcision is ethical.

While we state that it is beneficial in high risk mean we need to indicate that their is no evidence for benefit in women and low risk or MSM populations.Doc James (talk · contribs · email) 05:34, 27 November 2011 (UTC)

I just made some changes in the article. Please don't put statements like this in the article: "Circumcision reduces the risk of HIV infection in heterosexual populations that are at high risk." I don't think any of the reliable secondary sources say anything like that. If they do, I haven't seen it; please quote here on the talk page what the source says to support such a statement. As far as I've seen, the reliable secondary sources do not say that circumcision reduces the risk. They only say that there's strong/conclusive evidence, or that studies have concluded, and stuff like that. Even if one source says that, we don't necessarily have to say it too: it could be the opinion of that source's author. (WP:ASF.) We could debate it in that case. However, if none of the (high-quality secondary) sources say it then we certainly shouldn't say it. Also, the word "men" has to be in there! Otherwise the reader may jump to conclusions about women. I think the high-quality evidence is just that it reduces the risk in heterosexual men. I may not have access to the first source so please quote here on the talk page what it says to support the statement. Also, it's been discussed above why "appears to be" cost-effective violates WP:ASF. — Preceding unsigned comment added by Coppertwig (talk • contribs)

Perhaps you'd be willing to counter the arguments I've made, in the course of the discussions above, against the predominance of the coverage of the HIV issue in the lead of this article? If those arguments are not forthcoming the implication will be that you, Jakew (and other like-minded editors with respect to this issue) feel it's acceptable to ignore arguments you've failed, or not even tried, to counter in the course of debating article content. Beejaypii (talk) 14:02, 11 December 2011 (UTC)

Weight of HIV in lead

Let's use a table to get a general idea of how much weight the topic of HIV gets in sources about circumcision, and use that to influence how much space if any to give to HIV in the lead. I'm starting the table; I invite others to edit it and add to it. ☺Coppertwig (talk) 16:49, 11 December 2011 (UTC)

I've added an extra column to the table. I invite others to edit the new column along with the rest of the table. Beejaypii (talk) 01:04, 14 December 2011 (UTC)

source type	percentage	method	method weakness(es)
books	20%	First ten "Google Books" results for "circumcision", percentage of books for which specific "Google Books" searches showed that the book mentions HIV or AIDS.
literature reviews (any time)	29%	PubMed search for "circumcision hiv" as fraction of search for "circumcision". Using "limits" restrict to reviews.
literature reviews (since RCTs)	57%	PubMed search for "circumcision hiv" as fraction of search for "circumcision". Using "limits" restrict to reviews published after 1 Dec 2005.
"reliable source" books
recent books (since RCT's)
scholarly articles (since RCT's)	50%	Since 2005. Google Scholar search for "circumcision hiv" as fraction of search for "circumcision"	"circumcision restoration" gives 40%. "circumcision fruit" gives 52%. "circumcision chocolate" gives 9%. Also, "circumcision hiv" since 2008 gives 36% (why choose 2005 in particular?)
news articles (since RCTs)	41%	Google News search for "circumcision hiv" as fraction of search for "circumcision". Search from 1 Dec 2005 to present.
web pages

You don't appear to have read the debate. It is not about whether the word circumcision is mentioned in given sources, it's about the nature of the relationship between HIV prevention and the surgical procedure, and topic of this article, circumcision, as compared to the relationship between that surgical procedure and other topics mentioned in the lead and in the article. You're just trying to test the prevalence of co-occurrence of one term with one or both members of another pair of terms. Beejaypii (talk) 18:07, 11 December 2011 (UTC)

The appropriate weight for a sub-topic (within the context of a given article) in WP is essentially the weight given to that sub-topic within the wider subject in reliable sources. As such, while it's a fairly crude methodology, it's among the best available. Jakew (talk) 18:18, 11 December 2011 (UTC)

Beejaypii, the relevant guideline here is Wikipedia:Manual of Style/Lead section#Relative emphasis. It states:

In general, the emphasis given to material in the lead should reflect its relative importance to the subject, according to reliable sources. Do not hint at startling facts without describing them... This should not be taken to exclude information from the lead, but to include it in both the lead and body.

Coppertwig's analysis gives a very clear indication that, in order to comply with WP:LEDE, this article's lede must make significant mention of HIV. On the other hand, your argument(s) so far have either ignored or outright contradicted Wikipedia's guideline regarding ledes. Going forward, please make sure your arguments argue for compliance with Wikipedia's policies and guidelines, rather than the opposite. Thanks! Jayjg ^(talk) 19:41, 11 December 2011 (UTC)

Instead of making broad accusations ("...your argument(s) so far have either ignored or outright contradicted Wikipedia's guideline regarding ledes.") could you provide some concrete examples of that Jayjg, so I know what you're referring to exactly? Beejaypii (talk) 20:23, 11 December 2011 (UTC)

Beejaypii, your argument earlier about an intrinsic relationship between things seemed to be based on your own analysis, not on Wikipedia policy or reliable sources. Sorry I didn't have time to reply to your earlier comment. My recent edit to the article was not intended to express a position about how long the comments about HIV should be in the lead. I was only correcting misleading information while trying to change the length as little as possible. Note that in the table, the 20% for books doesn't mean 20% of the lead should be about HIV. That's the percent of books which mention it at all, not the percentage of sections of a book that discuss it. Looking at just the book search (which may not have been reliable sources) it would suggest reducing the amount, but looking at the scholarly articles search it would suggest increasing it. Overall maybe it's about right. Maybe it's not necessary to say "38 percent and 66 percent": maybe too specific for the lead, as these are numbers subject to experimental error. The version I proposed above was intended to be a compromise between a version by Beejaypii and the current article, and took into account comments from the discussion including comments by Beejaypii; what do you think of it, Beejaypii? ☺Coppertwig (talk) 23:13, 11 December 2011 (UTC)

"...your argument earlier about an intrinsic relationship between things seemed to be based on your own analysis, not on Wikipedia policy or reliable sources." It's very difficult to know what to respond to when accusations are so imprecise. Could you provide examples of where and how I contravened Wikipedia policy, and of the parts of my analysis which require reliable sourcing?

And with respect to your word searches, would you mind including precise details of all your search formulations in each case, to aid discussion (perhaps direct links to the results)? Beejaypii (talk) 23:54, 11 December 2011 (UTC)

An additional study published in the March 2010 Journal of Preventative Medicine is here for your perusal, guys: http://physics.georgetown.edu/~rmca/Elephant_in_the_Hospital/Circumcision_and_HIV_Prevention_2010_Green_AJPM.pdf. Would this study require or call for an additional citation in the lede where contradictions to the WHO's findings are mentioned (and/or in the Sexually Transmitted Diseases subheading?)TGTommyrocket (talk) 16:44, 12 December 2011 (UTC)TGTommyrocket

It's an extreme minority opinion piece; including it in the lead would constitute undue weight. Jakew (talk) 16:58, 12 December 2011 (UTC)

I guess I'm confused about what constitutes a minority piece and what is acceptable as a legitimate study since study I referenced was published in the Journal of Preventative Medicine, "the official journal of the American College of Preventative Medicine." Is there something I am missing about when and how to reference citations from reputable sources? Although, again, it seems the lede is def leaning more toward neutrality whereas before it inaccurately represented the experiment findings as fact instead of the results of the minor studies. By including the fact that the HIV studies have been disputed and by adjusting the wording in the lede, it now seems more objective. — Preceding unsigned comment added by TGTommyrocket (talk • contribs) 20:22, 12 December 2011 (UTC)

If you think about it, every study is published in one journal or another, so the fact that it's published in a journal isn't by itself terribly impressive. It's certainly an adequate source, in the sense that it meets the requirements of WP:RS, but that isn't by itself sufficient. After all, more than 5,000 studies have been published on the subject of circumcision, and we can't possibly cite all of them in the lead. We have to select a handful of sources — those most deserving of inclusion. And to do that we need to consider how important, and how representative, each source is. As I pointed out, since Green et al express an extreme minority viewpoint (one expressed by very few reliable sources), including it in the lead would over-represent that point of view. Jakew (talk) 22:06, 12 December 2011 (UTC)

"extreme minority viewpoint" you say? huh? where's your proof? — Preceding unsigned comment added by Mock The Knife (talk • contribs) 04:16, 13 December 2011 (UTC)

@ Jakew - several questions regarding your perspective: The point of view expressed by the WHO is based solely on the Sub-Saharan RCCTs. Therefore, is it the WHO's recommendation which tips that viewpoint toward being a majority one despite the fact that no further studies were conducted? Or is it the recognition the Sub-Saharan studies have gotten which indicates that they are more important and more deserving of the weight they are given in the WIKI lede? Finally - given the prominence of the journal which published the "minority" study, doesn't that lend credence to its argument? Seems that the number of opposing studies would warrant a more balanced lede. TGTommyrocket (talk) 04:46, 13 December 2011 (UTC)TGTommyrocket

Let me begin with a couple of corrections. Firstly, the WHO's policy change was prompted by the RCTs, but it wasn't based solely on them. They did not consider that evidence in a vacuum, but also referred to the substantial body of observational studies (of which there are now perhaps 40-50, most of which found a protective effect of circumcision). Secondly, please note that we don't actually cite the RCTs themselves; instead we cite secondary sources that refer to and summarise them.

With that said, let me address your questions. First, the WHO/UNAIDS endorsement certainly helps establish it as a majority viewpoint, but it's the prevalence of the viewpoint across sources that really matters. And if you look at reviews published in the last 4-5 years that have addressed the issue of circumcision and female-to-male HIV transmission, the vast majority regard it as effective and a promising intervention. There are a handful of exceptions, of course. Finally, the "prominence" of the journal is a very weak argument for inclusion. If we include this paper because of that, then we'd have to include every other paper published in journals of the same or greater prominence, and that would probably imply thousands of papers. Also, bear in mind that the critique of Green et al was published in the same journal. Jakew (talk) 09:36, 13 December 2011 (UTC)

It was opined that "Green et al express an extreme minority viewpoint", the Opinionators might reference their evidence for such a dismissive, pejorative opinion. — Preceding unsigned comment added by Mock The Knife (talk • contribs) 17:10, 14 December 2011 (UTC)

Very well. I've just conducted a PubMed search for "circumcision HIV", limiting the results to reviews. I examined the first 50 results and, for each publication, examined whether it was positive or negative towards circumcision as female-to-male HIV prevention. Two were negative[5] [6]. Twenty four were positive[7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] [22] [23] [24] [25] [26] [27] [28] [29] [30]. The remainder either addressed male-to-male and male-to-female transmission (which are dealt with separately), or it was not possible to easily categorise their point of view from the title and/or abstract. Jakew (talk) 18:37, 14 December 2011 (UTC)

Another crackpot theory bites the dust? Somebody's got some splainin' to do ...

Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns Gregory J Boyle and George Hill December 2011 Journal of Law and Medicine http://www.salem-news.com/fms/pdf/2011-12_JLM-Boyle-Hill.pdf — Preceding unsigned comment added by Mock The Knife (talk • contribs) 04:10, 15 December 2011 (UTC)

If there is a point to the above, I'm afraid it's unclear... Jakew (talk) 09:35, 15 December 2011 (UTC)

made it new section to prevent such confusion

Norway

A suggested law proposal has been issued by Norway's government, so that free circumcisions can be provided at public hospitals. Link, [31]--85.196.118.210 (talk) 13:47, 12 December 2011 (UTC)

The WHO estimates prevalence in the United States and Canada at 75% and 30%, respectively.[9], although in the U.S. the Centers for Disease Control reports that 65% of newborns were circumcised in 1999, and overall proportion of newborns circumcised was stable from 1979 through 1999. www.cdc.gov/hiv/resources/factsheets/circumcision.htm — Preceding unsigned comment added by Mock The Knife (talk • contribs) 17:44, 13 December 2011 (UTC)

Edit request on 13 December 2011

I'd like to link the word "anecdotal", which can be found twice in the article, in subheads 2.2 and 3.2, to the "Anecdotal evidence" article (http://en.wikipedia.org/wiki/Anecdotal_evidence). Personally, I figured out it couldn't have anything to do with an anecdote, as a joke, but couldn't either be sure of its meaning.

P.S: I'm new to this; am I warned if someone tends to my request?

Tiago Moita (talk) 00:03, 14 December 2011 (UTC)

Edit request on 14 December 2011

This article should be titled "male genital mutilation" to coincide with the equivelant article on female genital mutilation.

74.198.150.155 (talk) 13:44, 14 December 2011 (UTC)

 Not done: This proposal comes up from time to time, but consistently fails to gain consensus. See Talk:Circumcision/Archive 68#Proposed merger with Genital Mutilation for the last discussion. Jakew (talk) 13:51, 14 December 2011 (UTC)

Journal of Law and Medicine update: December 2011

Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns – Gregory J Boyle and George Hill

In 2007, WHO/UNAIDS recommended male circumcision as an HIV-preventive measure based on three sub-Saharan African randomised clinical trials (RCTs) into female-to-male sexual transmission. A related RCT investigated male-to-female transmission. However, the trials were compromised by inadequate equipoise; selection bias; inadequate blinding; problematic randomisation; trials stopped early with exaggerated treatment effects; and not investigating non-sexual transmission. Several questions remain unanswered. Why were the trials carried out in countries where more intact men were HIV-positive than in those where more circumcised men were HIV-positive? Why were men sampled from specific ethnic subgroups? Why were so many participants lost to follow-up? Why did men in the male circumcision groups receive additional counselling on safe sex practices? While the absolute reduction in HIV transmission associated with male circumcision across the three female-to-male trials was only about 1.3%, relative reduction was reported as 60%, but, after correction for lead-time bias, averaged 49%. In the Kenyan trial, male circumcision appears to have been associated with four new incident infections. In the Ugandan male-to-female trial, there appears to have been a 61% relative increase in HIV infection among female partners of HIV-positive circumcised men. Since male circumcision diverts resources from known preventive measures and increases risk-taking behaviours, any long-term benefit in reducing HIV transmission remains uncertain. http://sites.thomsonreuters.com.au/journals/2011/11/28/journal-of-law-and-medicine-update-december-2011/ — Preceding unsigned comment added by Mock The Knife (talk • contribs) 17:59, 15 December 2011 (UTC)

FYI (revert FGM to traditional term), "I would like to stress that female circumcision is not genital mutilation, which is indeed dangerous. They are two things that are very different." Indonesia's health ministry, the Departemen Kesehatan http://www.guardian.co.uk/science/the-lay-scientist/2011/dec/06\1 — Preceding unsigned comment added by Mock The Knife (talk • contribs) 19:16, 19 December 2011 (UTC)

Proposed edit for opening paragraph, Muslim view

The opening paragraph's second to last sentence is grammatically inaccurate and I've found a better source for the information, but the page is locked. If someone with edit privileges would be so kind as to change part of the sentence from "male circumcision is widely practised and most often considered to be a sunnah.[7] " to read "male circumcision is widely practised, and is considered part of the Sunnah (recorded words and actions of the prophet Muhammed)." and change the source for citation number 7 to http://www.bbc.co.uk/religion/religions/islam/islamethics/malecircumcision.shtml, I feel it would make the opening paragraph better. As it is now it reads clumsily and does not allow one unfamiliar with the word sunnah to understand. 68.115.35.110 (talk) 10:28, 20 December 2011 (UTC)