Talk:Circumcision/Archive 68

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Circumcision Controversy

I can't believe we still argue about this. Believe it or not circumcision is a controversial practice. Check out this nifty paragraph we used to describe it from the old intro Doc wants to change.

There is controversy regarding circumcision. Arguments that have been raised in favour of circumcision include that it provides important health advantages which outweigh the risks, has no substantial effects on sexual function, has a low complication rate when carried out by an experienced physician, and is best performed during the neonatal period.[11] Those raised in opposition to circumcision include that it adversely affects penile function and sexual pleasure, is justified only by medical myths, is extremely painful, and is a violation of human rights.

Furthermore for some odd reason Wikipedia list "Circumcision" as a contoversial topic right here List of controversial issues. I would also like to point out this essay Controversial articles that we should be using as a guideline to edit this article. The new intro violates WP:NPOV and needs to be rectified immediantely. Garycompugeek (talk) 14:57, 23 June 2011 (UTC)

I agree. The current lead seems to imply that circumcision is a recomended health benefit. We should give both opinons. The previous lead was better. Pass a Method talk 18:44, 23 June 2011 (UTC)
We updated the lead and current consensus across the project supports this. Now if stuff is missing from the update we can look at including it. I am not adverse to improving what is currently there based on recent research. Doc James (talk · contribs · email) 22:07, 23 June 2011 (UTC)
The current lede couldn't possibly "imply that circumcision is a recomended health benefit", since the closing two sentences are

Ethical concerns remain regarding the implementation of campaigns to promote circumcision.[18] Medical associations of some developed countries have issued policy statements in which they do not recommend routine circumcision.[19]

These broad claims of edits that supposedly made the lede "pro-circumcision" have no specifics and bear no relation to the actual text of the lede, and therefore carry no weight. Jayjg (talk) 02:09, 24 June 2011 (UTC)
Compare those sentences to this alternative:

While circumcision used to be routinely performed on newborn boys, today no medical body recommends the procedure. Many people believe that neonatal circumcision is a violation of the rights of the child.

That would make it a pretty unbiased lede. The fact that the current lede only glancingly mentions neonatal circumcision is embarrassing. LWizard @ 06:45, 24 June 2011 (UTC)
While humour can occasionally be of benefit, LizardWizard, I really don't think this sarcasm is constructive. Jakew (talk) 08:30, 24 June 2011 (UTC)
See, this is our problem. You literally don't know an unbiased lede when you see one. I was not being sarcastic. LWizard @ 16:18, 24 June 2011 (UTC)
I didn't expect that anybody would seriously try to claim that a paragraph that was entirely negative (and of dubious accuracy) about neonatal circumcision could be presented as "unbiased", and therefore presumed you must be joking in order to make some point or other. I apologise for misunderstanding. Jakew (talk) 16:26, 24 June 2011 (UTC)
What is needed are the references for said paragraph. We are not to be basing this on our own opinions but on the published literature. Please provide the recent review articles that states "today no medical body recommends the procedure". Doc James (talk · contribs · email) 16:42, 24 June 2011 (UTC)
I didn't mean to propose that bit as a whole paragraph. I was proposing it to replace the two sentences Jay blockquoted above, which are tacked onto the end of twice as much content about how circumcision cures AIDS. It's only unbiased in that context. And yeah, I know I don't have a reference and that that eliminates the possibility of making such a strong statement. LWizard @ 07:40, 25 June 2011 (UTC)

How do you define "recent research" Doc James? Is it just the Africa HIV studies? The current lead also touches upon the historical and religious aspects of this surgical procedure - which certainly isn't recent research. --Sunfox1 (talk) 00:03, 24 June 2011 (UTC)

Per WP:MEDRS "Look for reviews published in the last five years or so, preferably in the last two or three years." [1]. I am more flexible for issues that are not directly medical and would accept 10 years. Doc James (talk · contribs · email) 00:09, 24 June 2011 (UTC)

I disagree with your removing of policy statements based on WP:MEDRS Doc. Unless an organization has issued a statement or a new policy that policy stands indefinitely regardless of the MEDRS doctrine. MEDRS is trying to keep science updated where and when possible and really has nothing to do with the AMA’s 1999 quote that virtually all specialized societies and medical organizations do not recommend circumcision. Typically only third world non English speaking countries who do not practice safe sex are recommending circumcision to reduce HIV transmission. The majority of our readers come from the US and other English speaking countries this being the English version of Wikipedia. That being said the Cochrane and Krieger statements carry little weight and certainly should not be in the lead intro. Garycompugeek (talk) 21:05, 24 June 2011 (UTC)

The AMA review is over 10 years old and therefore is certainly not the up-to-date high quality evidence we strive to base our articles on (as you should know if you had read the guideline). That you would say a Cochrane review, which is one of the highest quality and highest reputation sources for medical information, "carries little weight" shows an alarming disregard for the medical literature and our guidelines (as MEDRS singles out Cochrane as an especially high quality source). This is very concerning for special pleading to push certain sources for their points of view rather than a neutral evaluation of the available literature. Yobol (talk) 21:19, 24 June 2011 (UTC)
Yobol I said nothing about the quality of the sources (which you should know if you read my previous post). I said their topic carries little weight to the english speaking world and do not belong in the lead intro. I also stated that a policy does not become invalidated in time. What is alarming is the unbalanced less informative intro that you appear to support. Garycompugeek (talk) 22:59, 24 June 2011 (UTC)
It's not unbalanced, per WP:UNDUE. Appropriate weight is given to the most recent and highest quality sources, of which Cochrane reviews are one. (As an aside, you seem to be claiming that the trial results are not generalizable to populations in more English speaking populations, one that I cannot see a good rationale for.) Actually, medical consensus changes over time as new data is evaluated. This is the precise reason why we have very specific time guidelines in WP:MEDRS. As policy statements get older, especially in eras where there are significantly new data introduced (as appears to be the case here), they become more and more irrelevant as the data is out of date. Yobol (talk) 02:12, 25 June 2011 (UTC)

Simple solution is to find better refs to support the content you feel is missing.Doc James (talk · contribs · email) 23:13, 24 June 2011 (UTC)

I've been working on a new paragraph for the lead, but I only have so much time to spend on it. I need to compile a worldwide list of resources for victims of sexual assault on another site (WAY bigger job than I thought it was going to be...), which I consider more important, and that's taking up all my free time at the moment. All I have so far on the lead is:
Circumcision is one of the most controversial surgical procedures.[2][3][4] There are differing views on the ethical and human rights issues associated with neonatal circumcision[5][6], potential medical benefits[7], and possible effects on sexual function[8].
Two more sentences are needed, one from the pro-perspective, and one on the con. Could take me a while. If anyone wants to add anything, feel free. kyledueck (talk) 01:16, 25 June 2011 (UTC)
So you've managed to find three sources that say circumcision is controversial? Two of them are fairly old, and a hyperbolic claim such as "most controversial" would never be appropriate, unless that was the consensus of reliable sources, rather than just something you were able to find in a tiny minority of sources. Also, why the reliance on Australian sources? We've been through this before; Australia relatively small population, so WP:UNDUE is a problem. And finally, the lede should summarize the article's body. If you trying to use sources in the lede that aren't used in the body, then you've gone about this the wrong way, and will never achieve success. Jayjg (talk) 19:51, 26 June 2011 (UTC)

Here's a ref from yesterday:

"While Dr Lempert believes that adults should be free to act on this research if they wish, he believes there is no justification for carrying out the procedure on children."
"To cut off a functioning part of a boys body for no therapeutic reason, simply because the parents have a particular belief, is anathema to normal medical practice, it's an extraordinary exception," he said."


"In addition, Dr Lempert points out, circumcision carries risks; both the immediate danger of haemorrhage and infection, and the long term risk of impaired sexual function."

BBC: Debate circumcision ethics call Pass a Method talk 04:34, 29 June 2011 (UTC)

That's a mass media article, not a peer-reviewed journal article. In addition to that, it's evidence of the views of a single doctor, which is barely a controversy. Jakew (talk) 08:19, 29 June 2011 (UTC)
Whether circumcision is controversial isn't a medical claim, nor is it interesting scientifically. It's a cultural or political claim. As such, mass-media articles seem like much more appropriate sources than peer-reviewed journal articles. LWizard @ 16:10, 29 June 2011 (UTC)
So, as a cultural or political topic, it would be an appropriate subject for sociology or political science journals, right? Jakew (talk) 16:22, 29 June 2011 (UTC)
Sociology or anthropology, I think. LWizard @ 06:52, 30 June 2011 (UTC)

I am not against writing and adding a third paragraph dealing with some social, cultural and ethical issues. The Autralian ref says in summary that it is generally considered ethical. And the ref on sexual function say "The effects on sexual function is debated" Neither of these are controversial. I am also happy with stating that it is a "controversial surgical procedure" in the lead as we have sufficient high quality refs to back this up. Doc James (talk · contribs · email) 13:13, 30 June 2011 (UTC)

I agree with Doc James regarding the inclusion of the word "controversial." According to Merriam Webster.com controversy is defined as a discussion marked especially by the expression of opposing views. According to a 2005 Canadian Medical Association newsletter "Few body parts have caused as much discussion within medicine as the male foreskin."[1] So there's certainly plenty of high quality refs out there within the medical communities.--Sunfox1 (talk) 01:06, 1 July 2011 (UTC)

Your quote mentions neither "circumcision" nor "controversy". Were you directed to or advised about this article by an outside forum, maillist, or similar? Jayjg (talk) 03:34, 1 July 2011 (UTC)
Please stop being deliberately obtuse. That quote is obviously about circumcision and controversy over it, particularly in context. You're also starting to look dangerously paranoid by accosting every new editor as to where they came from. LWizard @ 07:47, 1 July 2011 (UTC)
First, Sunfox1 has already been included in the list. Second, claiming that an editor has a severe mental illness is certainly incivil and may well be taken as a personal attack. I believe you owe Jayjg an apology. Jakew (talk) 08:07, 1 July 2011 (UTC)
The fact that Sunfox has already been accused of being a meatpuppet doesn't make the accusation particularly more acceptable. I apologize that my statement about Jay's behavior was construed as accusing him of being mentally ill; I should have been more clear. I meant to indicate that his behavior is beginning to make it appear as if he is (non-clinically) paranoid. Simply mixing up his wording rather than posting the exact same accusation three times in a row would make his actions appear much more calculated. LWizard @ 16:26, 1 July 2011 (UTC)
I find these continued accusations to be offensive, and unproductive. I have ignored accusations directed at me until now, because I don't want to fuel the fire, derail worthwhile discussions about content, or waste my time defending myself against what I consider to be baseless accusations and childish forum drama, but now I feel that I must speak on this issue. There have been too many accusations, against too many people, for too long.
I should start by saying that I have no knowledge of, involvement in, or interest in any anti-circumcision site conspiracy. I don't know anything beyond what was said here. What prompted me to comment were the unbalanced edits by Jmh649 (Doc James) on June 1st (sorry James, I don't mean to drag you into this). Now that that's out of the way...
Jakew and Jayjg, you are both out of line. You are using the flimsiest piece of evidence as an excuse to continuously harass people with an opposing point of view. Some random new wikipedia user warns you that some activists from some site are coming here, and you think that gives you the right to automatically assume that anyone who disagrees with your views is involved in a conspiracy? If you want to conduct an investigation into meat puppetry, maybe try finding out what site is involved first? Maybe try getting a list of users from the site involved? I'm not sure what the guidelines are for investigating meat puppetry, but I can't imagine that it involves a month-long witch hunt via article talk pages. By making continued accusations with virtually no evidence, all you're doing is creating unnecessary conflict. Circumcision is already a very divisive subject, we don't need any extra conflict here. It's a waste of everyone's time.
Also, have a look at the conduct of some of the people you're accusing (aside from the confirmed sockpuppets of course). As far as I can tell, they are discussing content, and following wikipedia policy (at least until they've been incited by Jayjg). Now look at your own conduct Jayjg and Jakew: disregarding conduct policies (WP:AGF, WP:DONTBITE, WP:HARASS), and inciting conflict. Is this how wikipedia editors and administrators are supposed to act? You both need to have a good long look at WP:FANATIC, because it applies directly to what you're doing here. I think it's you two who should be handing out apologies.
To everyone else: sorry for going so far off topic. I promise that if I need to comment further, it won't be on this talk page. kyledueck (talk) 17:30, 1 July 2011 (UTC)
To all, in summary: an editor warns us that a bunch of new editors will be coming to this article to add anti-circumcision POV. In the following month a bunch of new editors come to this article to add anti-circumcision POV. Please review WP:DUCK. Jayjg (talk) 18:11, 1 July 2011 (UTC)
(Didn't take me long to break my promise, did it? :) A cursory examination of any of the archived circumcision talk pages will show that many people here have an anti-circumcision POV - it's nothing new. Having an article that incorporates a variety of viewpoints will be most valuable to readers, so I don't see different points of view here as a negative, as long as people follow the policies, focus on the content, and treat each other with respect. kyledueck (talk) 19:27, 1 July 2011 (UTC)
Your point is completely irrelevant to the statement it is responding to. WP:MEAT, however, is still relevant. In addition, multiple points of view are indeed welcome in Wikipedia articles (so long as they comply with WP:V, WP:NOR, and WP:NPOV), and are well covered in this one. No-one has ever discouraged that, so it's unclear why you bring it up. And finally, I refuse to ignore the elephant in the room here. Jayjg (talk) 20:59, 1 July 2011 (UTC)

What I think Kyle is trying to say that is correlation does not imply causation. Yes, there have been many new users here upset with the article's current content. Are there particularly more than average? How many have we had this week? If there are more than average, could that by explained by something else, such as increased media attention to circumcision, or the article having gotten into a particularly pro-circumcision state? It is not at all obvious that there are any ducks or elephants around here.

To all, in summary: an editor warns us that a bunch of new editors will be coming to this article to add anti-circumcision POV. Within a week many do, are exposed as sockpuppets, and are banned. For the following month, Jay interrogates every editor who disagrees with him. Please review WP:DICK. LWizard @ 01:06, 2 July 2011 (UTC)

Very amusing, but the actual and accurate summary is still the same: an editor warns us that a bunch of new editors will be coming to this article to add anti-circumcision POV. In the following month a bunch of new editors come to this article to add anti-circumcision POV. Please review WP:DUCK. Jayjg (talk) 02:20, 3 July 2011 (UTC)

To quote WP:MEDSCI, "Finally, make readers aware of any uncertainty or controversy. A well-referenced article will point to specific journal articles or specific theories proposed by specific researchers." this is well documented. Garycompugeek (talk) 01:53, 9 July 2011 (UTC)

What is the relevance of your statement? Which journal articles or researchers have been left out of the lede? Jayjg (talk) 01:33, 11 July 2011 (UTC)

Archive quotes

Why is it that when I quote the archives on why the intro should not be changed, its old meaningless debates,

"Doc please stop deleteing the work of many editors and much debating and properly sourced intro. If you wish to change bits and pieces try to make a small change then listen to others input about it and see where it leads. I shall list below here a few well debated sections in the archives. Please read them. Garycompugeek (talk) 15:39, 11 June 2011 (UTC)

but when Jake does it it's scripture straight from the hand of god? Garycompugeek (talk) 16:19, 2 July 2011 (UTC)

The debates you post are all 3 or more years old. Forces old literature on too Wikipedia is not appropriate. Doc James (talk · contribs · email) 15:43, 11 June 2011 (UTC)"
Once again logic does not degrade over time. Garycompugeek (talk) 21:25, 7 July 2011 (UTC)
What? First of all, the article itself changes over time, so comments may no longer be relevant. Second, medical knowledge changes over time, so again, the comments may not be relevant. And third, what "debate" or "logic" is there in, say, Talk:Circumcision/Archive 28 #Introduction? Jayjg (talk) 01:21, 8 July 2011 (UTC)
We use recent evidence, that is consensus. --Doc James (talk · contribs · email) 20:55, 8 July 2011 (UTC)
Trying to change this article's intro based on a few recent sources and ignoring the majority of sources in the artcicle that are well over 3 years old is WP:Recentism. Garycompugeek (talk) 02:03, 9 July 2011 (UTC)
Articles with medical subjects need to be up-to-date, Gary. It would be absolutely absurd, for example, to give lengthy treatment to 19th century "cures" for heart disease in that article; medical understanding moves quickly and what is needed is the most up-to-date information (of course, that's not to say that we can't discuss older information in a historical context, if historians have written about it). That is what WP:MEDRS says; if you seriously think it needs to be changed then I suggest you raise that issue on the appropriate talk page. Jakew (talk) 08:25, 9 July 2011 (UTC)
Jakew, i consider your conclusion by that particular source to be exaggerated. As long as the notable major medical organizations maintain their original stance, then there's no justification for a mass rewrite of the lead. An additional sentence to the lead would suffice. Pass a Method talk 12:12, 9 July 2011 (UTC)
Correct Pass a Method. The new intro Doc has proposed is giving WP:UNDUE weight to its source. We already give HIV a paragraph in the lead as it stands. Jake don't try to paraphrase me and twist my words. Circumcision and HIV is nothing new and we have plenty of sources in this article and the main one I just listed that downplay its effectiveness. Garycompugeek (talk) 13:47, 9 July 2011 (UTC)
I haven't paraphrased you at all, Gary. You complained that preferring recent sources to those "well over 3 years old" is "recentism". I pointed out that it is strongly encouraged by MEDRS, and for good reason. Again, if you take issue with that, then you need to raise it at the appropriate talk page. Jakew (talk) 15:06, 9 July 2011 (UTC)
But when you delete previous sources based on one new source in this manner, I think it would fall uner WP:SYNTH Pass a Method talk 16:43, 11 July 2011 (UTC)
Sorry, that makes no sense whatsoever. Firstly I haven't deleted anything, and secondly I fail to see why SYNTH prohibits deleting sources. Jakew (talk) 17:18, 11 July 2011 (UTC)

A medical society which recommends circumcision

"The American Urological Association modified their previously neutral recommendation in 2007 and concluded that "While the results of studies in African nations may not necessarily be extrapolated to men in the USA at risk for HIV infection, the American Urological Association recommends that circumcision should be presented as an option for health benefits"[104] ." [9] Doc James (talk · contribs · email) 04:40, 14 July 2011 (UTC)

Summary of policy statements

According to the current version of the lead:

  • Many medical associations from developed countries do not recommend routine circumcision.

I previously changed this to "several", but LizardWizard substituted "many", arguing "The Australian source alone lists 7 medical associations not recommending routine neonatal circ (appendix 2). 9 orgs = all of them = Many, at least."

This argument is problematic for several reasons:

  • Miscounting. Two sources were cited both in the article and by the RACP, meaning that the correct total is 7 (8 including the RACP), not 9. (I've since removed these additional sources from the article, as they were redundant.)
  • Unknown selection principles. The policies listed are obviously not an exhaustive list (the AMA, for example, is not included), and no assurance is provided that it is a representative selection. I do not wish to suggest bias in this particular case, but as a general rule one should be careful when drawing conclusions based on potentially non-representative data supplied by another party, as such data may be biased in the direction of their position. In any case this is a moot point because it's all...
  • Original research. Is it true to say that all 8 sources do not recommend routine circumcision? In Appendix 2 of the cited source, only two of the quoted policies actually refer to "routine" or "routinely performed" circumcision (three if the RACP's policy itself is included). To say that the others do not recommend routine circumcision, then, seems to be original research.
  • Small sample. The statements represent five distinct countries or geographical regions: Canada, USA, UK, Holland, and Australasia. According to Developed country, there are 42 developed countries, so this represents 12% of the total. That is to say, even if it is accurate to summarise the positions in this way, we only have a sample of 12% of developed countries. Can this really be said to be "many"?

I have some concerns about the focus on routine circumcision (at the expense of elective, which most medical associations also discuss) anyway, but if we do discuss associations that don't recommend routine circumcision, then I think we should avoid overstating the case, and it seems clear that "many" is excessive. Are there any serious objections to "several"? Jakew (talk) 19:43, 12 July 2011 (UTC)

I think "several" is better than "many", but don't feel strongly enough to edit war over it. I do think that we should probably insert a blurb discussing the position of the societies regarding "non-routine" circumcision as well, for contextual purposes. Yobol (talk) 19:47, 12 July 2011 (UTC)

I'm confused. What medical organizations besides WHO recommends routine infant circumcision? Garycompugeek (talk) 12:43, 13 July 2011 (UTC)

I don't even understand why you're asking that question, Gary. Why is it relevant? Jakew (talk) 15:14, 13 July 2011 (UTC)
Because if you persist in avoiding strong-ish language like "many", I'm going to suggest that it be changed to something like:

The following medical organizations do not recommend routine neonatal circumcision: AMA, AAP, RACP, BMA, AUA, <...>. The following medical organizations do: (none known).

I think that's an unnecessarily verbose way of getting the point across, but at least it's not original research. LWizard @ 16:29, 13 July 2011 (UTC)
Actually, that would be original research, as explained above. Jakew (talk) 17:27, 13 July 2011 (UTC)
I was going to just reply snarkily about how it could be made even longer, but never mind, I've just hit the jackpot. According to the 2010 RDMA (KNMG) piece, "There is currently not a single doctors’ organisation that recommends routine circumcision for medical reasons." Argument settled, I'll put that in the article. LWizard @ 03:46, 14 July 2011 (UTC)
I've added attribution for the claim, as I think a stronger source (such as a systematic review) would be needed to make such a strong claim by itself. But the source is adequate. Jakew (talk) 08:14, 14 July 2011 (UTC)
The lede should at least make it clear that the statement was made in 2010. Jayjg (talk) 02:22, 17 July 2011 (UTC)
Fair point. Done. Jakew (talk) 08:01, 17 July 2011 (UTC)

POVing the intro again

PassaMethod has apparently decided to POV the intro, by unilaterally adding this paragraph:

The risks that accompany routine circumcision (such as excessive bleeding and infection) outweighs any possible medical benefits of circumcision.[2][3] Loss of the foreskin can result in scarring and abrasion, because the foreskin functions as a protection of the glans.[4][10]

As is fairly obvious, this is merely a selection of sources that speak against circumcision, not (as claimed) an attempt at neutrality. The last source used was particularly ridiculous; a book on "Better Birth", by Denise Spatafora, an "Executive Leadership Coach - Professional Life Coach". PassaMethod, please do not make any more edits to the lede without getting consensus here first. Jayjg (talk) 03:19, 17 July 2011 (UTC)

Agreed, there are serious problems with reliability, neutrality, and even original research here. See also: User talk:Jmh649#reliable sources, NHS BBC. Jakew (talk) 08:00, 17 July 2011 (UTC)

Lead structure

There's a problem with the lead in its layout. Shouldn't the argument for circumcision and the arguments against circucmsision have seperate paragraphs like it did in May?

Also, one complication thats missing from this article is the problem of excessive skin removal which results in hair growing halfway down the penis because it is borrowing skin from the pubic hair area. See: [11] Pass a Method talk 22:34, 5 July 2011 (UTC)

Why should they have separate paragraphs? Jayjg (talk) 02:11, 6 July 2011 (UTC)
According to several sources, paragraphs are supposed to be divided and devoted to new ideas.[12], [13], [14], [15]. The pro-circumcision arguments and anti-circumcision arguments should thus be seperate. I'm gonna seperate the two now. Pass a Method talk 10:23, 6 July 2011 (UTC)
There's no doubt that paragraphs should cover separate subjects, but the mistake that you appear to be making is to presume that the subjects are actually separate. The division that you propose (between "pro-circumcision" and "anti-circumcision") is not necessarily adequate grounds for a paragraph break, as it is frequently appropriate to combine positive and negative things about something: for example, one would not ordinarily insert a paragraph break between "I really like the icing on this chocolate cake" and "but I think there are a few too many nuts in it". The problem is that your division is imposed post hoc upon the actual structure, which isn't about pro- or anti-circumcision arguments as such, but rather an overview of the interesting facts about circumcision. Indeed, the flaws in this division are even evident in the text under discussion, because the sentence before the paragraph break which you inserted could be described as "anti-circumcision".
The problem with splitting the paragraph at this point is that the sentences actually are related, and splitting the paragraph fails to make this clear. Consider the sentence immediately after the paragraph break that you inserted. The "ethical concerns" regarding the implementation of campaigns to promote circumcision are strongly related to HIV, as is clear from the title of the cited source. Indeed, these campaigns to promote circumcision exist because of the protection against HIV.
Given these problems, I suggest that you self-revert. Jakew (talk) 11:38, 6 July 2011 (UTC)
Fair point. What about the last sentence which reads "Medical associations of some developed countries ...." Does that sentence deserve its own paragraph? I think it does deserve its own paragraph because (a) it would look more organized, (b) it might facilitate additions/revisions in the future, (c) structuring an anti-view before a pro-view (or vice versa) in the same sentence or paragraph usually tends to give prominence to the initial viewpoint over the latter. So do you agree to a compromise to separate the final sentence? Pass a Method talk 13:20, 6 July 2011 (UTC)
Conceptually it fits in with the material in the paragraph it is currently in, and in any event a single sentence cannot be a paragraph. Jayjg (talk) 22:12, 6 July 2011 (UTC)

I just reverted the double conflicting intro that Doc did. Doc I appreciate you trying to compromise by leaving the old intro in while adding your new intro however it sure makes for a messy intro that seems to contradict itself here and there. The last paragraph deals with HIV Doc. Why not just add your Krieger ref into that paragraph or the HIV section? Garycompugeek (talk) 20:15, 11 July 2011 (UTC)

I have restored the current info on HIV per MEDRS, and left in the paragraph about the controversy. There is clearly no reason to use old, out-of-date reviews except to push a POV here. Yobol (talk) 20:27, 11 July 2011 (UTC)
MEDRS has nothing to do with policy statements, its about science. I'm sure the AMA could care less about MEDRS and if asked about their current policy on circumcision they would say see our last statement. I'm also sure they would issue a new statement if their policy has changed. Therefore if you wish to hide their statement it would be you pushing a POV, not I. Garycompugeek (talk) 19:22, 12 July 2011 (UTC)
I'm quite certain that the AMA does not care about MEDRS, as they are not Wikipedia editors. As we are, we should follow our guidelines, with due weight to the best sources, as our guidelines suggest. Yobol (talk) 19:26, 12 July 2011 (UTC)
So you are saying we should remove any policy statements that are over 3-5 years old based on WP:MEDRS? I'm quite cetain that MEDRS guidelines are in place to keep science up to date and has nothing to do organizational policies. Garycompugeek (talk) 12:55, 13 July 2011 (UTC)
I'm saying old and out of date statements should get less weight. The AMA position is already covered in the lead, just not with the weight you feel is warranted. Yobol (talk) 15:36, 13 July 2011 (UTC)
First you removed the AMA quote based on MEDRS now its UNDUE weight, how many cards do you have up your sleave? Considering no one but WHO recommends routine neonatal circumcision why do you feel the AMA quote is inappropriate? Garycompugeek (talk) 20:24, 13 July 2011 (UTC)
As has been explained many times, the AMA statement is 11 years old, published long before the main findings regarding HIV/AIDS came out. Please don't waste any more of our time on this. Jayjg (talk) 22:00, 14 July 2011 (UTC)
Isn't it sort of original research to assert that these AIDS studies could/should affect the AMA's position? I mean, it certainly doesn't seem like we should debate whether or not that's sufficient grounds for the AMA to change its position. And I don't think it is. So please stop asserting that the AIDS studies make the AMA statement less valid. Unless you can find a reliable source that does so. LWizard @ 06:58, 15 July 2011 (UTC)
I agree with Lizard. Most major medical organizations have maintanied their original positions on circumcision despite the African findings. This suggests that they consider these findings to be unimportant. Also, there are more cases of aids in USA than Europe, despite the European circumcision rates being very low and USA cricumcision rates being higher. I live in Britain and the largest medical organization NHS has maintained their original position: Namely that the "the majority of healthcare professionals now agree that the risks associated with routine circumcision, such as infection and excessive bleeding, far outweigh any potential benefits." Pass a Method talk 09:01, 15 July 2011 (UTC)
I think we can be reasonably confident that organisations will not base their assumptions on such between-country comparisons, since that would demonstrate ignorance of basic epidemiology. Jakew (talk) 09:18, 15 July 2011 (UTC)
Wait, are you both asserting that significant new findings on the prophylactic effects of surgical procedure – supported by the world's leading international authority on international public health – would have no impact on the positions of medical associations regarding that procedure? If you're going to make that kind of prima facie absurd claim, you'd probably need some strong evidence to back it up. Jayjg (talk) 02:27, 17 July 2011 (UTC)
The findings in Africa are considered extremely unreliable. One of the problems is that it takes at least 3 months after infection for HIV antibodies to be detectable. The test required a few months of self-monitored abstinence after the procedure date. Many of the uncircumcised people may have been infected early in this period and many of the other infections, could have been before the trials even began. For example if someone was infected early before the trial up to 3 months prior. It's hard to find any research placing circumcision's effectiveness above good hygiene. The trials are worth mentioning but should not be presented as completely factual. 68.188.128.14 (talk) 03:20, 23 July 2011 (UTC)
Do you have any sources for those claims? Jayjg (talk) 03:27, 24 July 2011 (UTC)

I'm a little bit dissatisfied with the current intro. It seems to emphasize HIV-prevention benefits with several lines in the paragraph. But seems to minimize the opposing POV which only gets one insignificant vague line. For WP:NPOV i think we should give both perspectives an equal amount of lines; i.e. we could have 3 lines for each. Thoughts? Pass a Method talk 15:31, 13 July 2011 (UTC)

If you have other high quality recent reviews, please bring them up. Again, we go by what our sources say, not by some arbitrary standard, per WP:WEIGHT. If other high quality reviews have a different POV, then bring them forward. Per WP:WEIGHT, we explicitly should not give equal weight to sides of a POV just to make things "equal". We let our sources drive the weight. Yobol (talk) 15:36, 13 July 2011 (UTC)

Restraining devices citation

Hi there, completely new here but I thought I'd point out that Citation 27 which is attached to "Restraining Device" links to the abstract of some medical journal rather than anything to do with restraining devices. Not sure I'm up to speed on editing enough to change it myself but I think it would make more sense to link to the restraining device than to the abstract of a medical text. Best Regards SaltireWiki (talk) 03:42, 26 July 2011 (UTC)

Further to the above I've changed the link to an example of the restraint system used.SaltireWiki (talk) 01:32, 27 July 2011 (UTC)
Trouble is, ref 27 is a reliable source, while the source you used instead is not. Further, the article says "For infant circumcision, devices such as the Gomco clamp, Plastibell, and Mogen clamp are commonly used, together with a restraining device". The source you cite says nothing about how commonly the restraint is used; Wiswell's article (which does have its faults) does — the full text includes the words "The infant is typically strapped to a restraining board". Jakew (talk) 07:10, 27 July 2011 (UTC)

Im not entirely sure it is a source in that sense. The link which was there before was the abstract of a medical article which went no further or explained anything. Surely it makes more sense to link to the device itself than to a specialist medical website which requires subscription SaltireWiki (talk) 09:00, 27 July 2011 (UTC)

I don't think cost is a criteria for good Wikipedia sources.--Taylornate (talk) 10:23, 27 July 2011 (UTC)
I'm not entirely sure what you mean by that but I suggest that accessibility has to be a factor in determining how worthy a source is. Someone clicking the link previously was taken to a specialist medical site which required some sort of subscription or membership in order to gain access. All non-members get to see is an abstract of the article Jake refers to without having the text he quotes. If the restraint board, or some variation, is used commonly then there shouldn't be much trouble sourcing something which says that. This would satisfy Jakes' desire to have it's ubiquity confirmed as part of the modern procedure. My link, after some Googling, would seem to provide a good example of the type of restraint system in modern use.SaltireWiki (talk) 13:13, 27 July 2011 (UTC)
Yes, if two potential sources are equally reliable, and both support the relevant claim, then it is generally reasonable to favour the source that is more easily accessible. However, neither of those conditions are true in this case. Jakew (talk) 15:21, 27 July 2011 (UTC)
The preceding linked words mention the types of clamp used and are all linked to their own wiki articles. The restraint doesn't have one and the link which was there went to an abstract. Beyond that membership of the site linked to is required. The claim wasn't in the abstract either so which part of what I said isn't true?SaltireWiki (talk) 16:22, 27 July 2011 (UTC)
Just for clarification this is what is available from the old link Historically, infants undergoing circumcision have not been given analgesia. The rationale was that infants do not feel, localize, or remember pain. In reality, they have all the anatomical and functional components required for nociception, and they react appropriately to painful stimuli. During circumcision boys are agitated, cry intensely, and have changes in facial expression. Their heart rates and blood pressure increase, and their oxygenation decreases. Their serum cortisol, β-endorphin, and catecholamine concentrations rise. Clearly, circumcision is painful. Two options are below this to see more of the article. One is subscription and the other is to purchase the article itself. — Preceding unsigned comment added by SaltireWiki (talk • contribs) 16:33, 27 July 2011 (UTC)
None of this matters, though, because we're citing the full article, which (through the sentence fragment quoted above) supports the statement. Please note that, per WP:V#Access to sources: "The principle of verifiability implies nothing about ease of access to sources [...]" Jakew (talk) 17:02, 27 July 2011 (UTC)

Tweak intro

I have split the 2nd paragraph in two to better represent their topics and readability. I have also removed two HIV paragraphs that are covered in the HIV section for weight concerns plus no need to go into more HIV detail in the intro. The reader can find out more in that section or entire article. Garycompugeek (talk) 19:55, 22 July 2011 (UTC)

That was hardly a "tweak", and there was no consensus to remove the HIV information, which is highly relevant and significant, and clearly belongs in the lead. Please get consensus for this change. Jayjg (talk) 22:29, 22 July 2011 (UTC)
Your response does not address my concerns Jayjg. We mention the link between circumcision and HIV in the lead with the WHO supporting campaigns in high risk areas. Why do you feel we need to go into more detail in the lead? What do you find wrong with splitting the paragraph? Garycompugeek (talk) 23:47, 22 July 2011 (UTC)
Broadly speaking, Gary, the weight is supposed to reflect that in the available sources. HIV is a "hot topic" in recent years, and there is a great deal of research into circumcision and HIV. Using some rough numbers from Google Scholar, for example, 660 of 2260 (29%) of articles published in 2011 relating to circumcision discuss HIV. Searching for "circumcision" and limiting the results to reviews or meta-analyses reveals an even more striking result: 8 of the 20 (40% of) items on the first page of results refer to HIV in the title. It's probably safe to say that more sources have investigated the HIV aspect of circumcision than any other sub-topic. So I don't quite understand why "weight concerns" would necessitate this edit. Jakew (talk) 10:31, 23 July 2011 (UTC)
Sorry Jake but that's not how we determine what goes into the lead of an article. The intro is a brief synopsis of the article itself and has nothing to do with google scholar hits. Plenty of sources in this article criticize using circumcision as an HIV prevention tool and their conclusions. Regardless I'm not taking anything from the article just removing a little less detail from the lead, the information is still in it's appropriate section. Neither of you have commented on paragraph I have split because its topic is not HIV so I have split it again. Garycompugeek (talk) 15:20, 23 July 2011 (UTC)
Ah, I see, so you're concerned that the "intro is a brief synopsis of the article itself". So, why all the weight and emphasis on the "controversy regarding circumcision" paragraph you insist must be there? Where do we find that discussed at length in the article? Jayjg (talk) 02:17, 24 July 2011 (UTC)
Hmmm maybe your right Jayjg, while controversy is scattered throughout the article maybe we should create a small controversy section. Garycompugeek (talk) 13:48, 25 July 2011 (UTC)
I think you've missed Jayjg's point, Gary. He's pointing out that there is a contradiction between your arguments here and those regarding the "controversy" paragraph. How are you able to account for this contradiction? Jakew (talk) 14:19, 25 July 2011 (UTC)
Exactly. Gary, I'd very much like to understand this contradiction in your arguments. Jayjg (talk) 23:52, 26 July 2011 (UTC)
Gary, I think Jake has it right about what the policy is here. WP:NPOV generally applies to every part of Wikipedia and therefore to the lead, and WP:LEAD says "The emphasis given to material in the lead should roughly reflect its importance to the topic, according to reliable, published sources, ... " ☺Coppertwig (talk) 16:22, 24 July 2011 (UTC)
Yeah, but how we interpret that depends which sources we consider. If you we consider only recently-published medical studies, then yes, HIV seems very important because that's an active area of research. If we consider news articles, HIV gets some coverage but circumcision bans would get way more. And if we consider sources not susceptible to recentism, like textbooks, then HIV would get about the amount of coverage in the lead the Gary is suggesting. (I just checked one of the textbooks from my human sexuality class, and it gives HIV 3 paragraphs of an 8-page chapter.) LWizard @ 18:57, 24 July 2011 (UTC)
WP:MEDRS quite clearly indicates the focus should be on recent medical studies, not newspaper articles or school textbooks. Jayjg (talk) 19:51, 24 July 2011 (UTC)
You're assuming that the guidelines for reliable sources about medicine are the guidelines that should control this whole article. Circumcision is very rarely performed for medical reasons (as a percentage of all circumcisions), so those guidelines should be balanced against the general WP:RS guidelines which say "[...] and textbooks are usually the most reliable sources." LWizard @ 01:50, 25 July 2011 (UTC)
Circumcision is a surgical procedure, and is thus in the realm of WP:MEDRS, whatever the reasons for it are in particular cases. Jakew (talk) 08:01, 25 July 2011 (UTC)
By that logic, all the sources regarding eyepatches as used by sailors and pilots need to satisfy MEDRS (since eyepatches can be used medically). MEDRS actually identifies itself as guidelines for sources for information of biomedical information. Circumcision is both a medical and cultural phenomenon, and should contain both medical and cultural information about circumcision. The sources for the medical information need to follow the MEDRS guidelines, but the sources of cultural information do not. Using MEDRS to screen all sources and then concluding that circumcision is only a medical phenomenon and not a cultural one is begging the question. LWizard @ 05:22, 26 July 2011 (UTC)
I understand what you're saying, LizardWizard, but the key difference is that, whatever the reason for its performance, circumcision is a surgical procedure, hence falling within the scope of WP:MED. Now, having said that, I do recognise that not every piece of information concerning circumcision relates to biomedical aspects, and I would not suggest that MEDRS should be applied in every situation. Jakew (talk) 07:34, 26 July 2011 (UTC)

I am not saying HIV should not be in the intro, I just feel we are going into to much detail for the lead. I had proposed the following...

Circumcision reduces the risk of HIV infection in heterosexual populations that are at high risk.[12] The WHO currently recommends circumcision as part of a program for prevention of HIV transmission in areas with high endemic rates of HIV.[19] Ethical concerns remain regarding the implementation of campaigns to promote circumcision.[20]

and trimming this...

Evidence among heterosexual men in sub-Saharan Africa shows a decreased risk of between 38 and 66% over 2 years[13] and in this population it appears cost effective.[14] Evidence of benefit for women is controversial[15][16] and evidence of benefit in developed countries and among men who have sex with men is yet to be determined.[17][18]

This way we mention the link to HIV and WHO's support in high risk areas, followed by a counter concern. More detail is not needed for the intro and can be found in the HIV section. Garycompugeek (talk) 14:26, 25 July 2011 (UTC)

Please review Jake's comment above of 10:31, 23 July 2011 and Coppertwig's of 16:22, 24 July 2011. Jayjg (talk) 23:52, 26 July 2011 (UTC)

Doc why is it "better this way"? The last two sentences are not about HIV. Garycompugeek (talk) 23:42, 1 August 2011 (UTC)

The two are sufficiently related. Scientific evidence of effects and government / professional organizations positions on circumcision. A two sentence paragraph is poor writing style.Doc James (talk · contribs · email) 23:52, 1 August 2011 (UTC)
I disagree. The last two sentences do not relate to HIV. A paragraph may consist of any number of sentences and it's purpose is to highlight changing topics. This separation makes it easy for the reader to scan the intro and see the summation of policies. Garycompugeek (talk) 15:12, 2 August 2011 (UTC)
They are conceptually related, and this has already been discussed in the #Lead structure section above. Jayjg (talk) 21:53, 2 August 2011 (UTC)
They are only related by circumcision and by that logic the entire article should be one massive paragragh. Garycompugeek (talk) 18:43, 3 August 2011 (UTC)
...and they are conceptually related as well, as explained before in the "Lead Section" section, now archived. You haven't put forth a viable reason to split the paragraph. Jayjg (talk) 03:57, 7 August 2011 (UTC)

Jake where have we discussed this? In this section you have stonewalled me regarding the paragragh split and have only chimed in about some of the HIV material being removed from the lead. Inserting a blank space is hardly changing the data's location. Neither you or Doc have put forth a viable reason not to split the paragragh. Garycompugeek (talk) 18:29, 2 August 2011 (UTC)

We discussed it in the #Lead structure section, Gary. Please see the latter part of my comment dated 11:38, 6 July 2011, as well as the following two comments. Jakew (talk) 20:34, 2 August 2011 (UTC)
...of which Gary should be aware, as he commented extensively in that section. Jayjg (talk) 21:54, 2 August 2011 (UTC)
Ok guys I reread what you have pointed out but your comment Jake, (comment dated 11:38, 6 July 2011), refers to splitting the pros and cons third paragraph and I agree with you that they should not be split for comparision purposes. Why should we not split the last to sentences of the second paragragh, that do not relate to HIV like all of the previous sentences in the second paragraph, of the intro? After I split the paragragh no one said anything for a week until Doc recombined them saying "its better this way". Garycompugeek (talk) 18:39, 3 August 2011 (UTC)

Outside opinion: it's clearly better to have the two-sentence paragraph merged into paragraph two (this version) than to have two short paragraphs together in the lede (this version). All these sentences are about health issues, whereas the first paragraph is definition and distribution, and the last paragraph is purely about controversy.

As a side note: are you really edit-warring about this? I'd expect there to be edit wars in this article, but... a paragraph marker? perhaps some tea might be useful. – Quadell (talk) 16:02, 6 August 2011 (UTC)

Sorry but the second paragragh is clearly about HIV and the last two sentences are not related to that topic. Garycompugeek (talk) 16:16, 6 August 2011 (UTC)
Outside opinion here. First of all this section needs to be dropped, "Circumcision reduces the risk of HIV infection in heterosexual populations that are at high risk.[12] Evidence among heterosexual men in sub-Saharan Africa shows a decreased risk of between 38 and 66% over 2 years[13] and in this population it appears cost effective.[14] Evidence of benefit for women is controversial[15][16] and evidence of benefit in developed countries and among men who have sex with men is yet to be determined.[17][18]" Lead sections shouldn't be packed with statistical data, that is the function of the body of the article. Secondly, the "benefit for women is controversial" section is unneeded, as there is a hatnote at the top which clearly says this article is about male circumcision. The crux of the point which needs to be communicated is this: "The WHO currently recommends circumcision as part of a program for prevention of HIV transmission in areas with high endemic rates of HIV.[19]" any statistical data about this can be explained in the article and this sentence can be merged with the first paragraph. As for the second paragraph, this "Ethical concerns remain regarding the implementation of campaigns to promote circumcision.[20]" and this "According to the Royal Dutch Medical Association (2010), no professional association of physicians currently recommends routine circumcision[21]. Some bodies have discussed under what circumstances neonatal circumcision is ethical.[22]" should be merged with the paragraph on the controversy as they are in essence part of that controversy. A sentence about the "ethical implications" could be inserted directly before the final sentence of the second paragraph. Vietminh (talk) 18:15, 6 August 2011 (UTC)
I'm not sure what makes your opinion "outside". In any event, can you explain why, in terms of policy and guideline, you believe "this section needs to be dropped"? Jayjg (talk) 03:56, 7 August 2011 (UTC)

Dangers of Jewish Circumcisions

I would like to propose that the paragraph addressing Jewish circumcision also address the possibility of a mohel transmitting STDS, such as herpes, to a child due to the mouth-penis contact (metzitzah b'peh) that a traditional Jewish circumcision upholds. For sources, you may review the following material:

(IrishKisses (talk) 21:04, 6 August 2011 (UTC))

This issue is already discussed in the main article on Jewish circumcision, Brit milah. Jayjg (talk) 03:52, 7 August 2011 (UTC)

It is on the Brit Milah page but I think a sentence or two should be added to the small article on the circumcision main page to further provide accessible information. (TheDarkSideHasTacos (talk) 17:05, 7 August 2011 (UTC))

Seems a bit too obscure to me. It's a rare complication of a practice that is (as I understand it) performed in only a small minority of Jewish circumcision ceremonies. And it's not a complication of circumcision itself, but rather of an associated act that is sometimes performed as part of the same ritual, so it's far more appropriate to cover the issue at brit milah, as is presently done. Jakew (talk) 17:20, 7 August 2011 (UTC)
By the way, is there any particular reason why you've commented in this section using two different user names? Jakew (talk) 17:22, 7 August 2011 (UTC)

All Jewish circumcisions require blood-saliva contact if they have been performed traditionally. Even when other precautions are taken. And because I wanted my Wiki name to match my Youtuber name. IrishKisses was taken on Youtube by someone else. And I gave my old IrishKisses account for someone else to use because I hadn't updated it in a long time anyway.

Adding Apotemnophilia As A Reason For Circumcision

The want to be circumcised for non-medical reasons (such as phimosis) is a form apotemnophilia. I believe it should be added as a reason for circumcision. (TheDarkSideHasTacos (talk) 00:52, 16 August 2011 (UTC))

It would be interesting to see a reliable source for that... Jakew (talk) 07:25, 16 August 2011 (UTC)

The want to remove any body part for a non-medical reason such as appearance is a case of apotemnophilia. If you wanted to amputate a finger or have a lung removed or your foreskin removed because you believe it looks better, it's apotemnophilia. There is often a sexual reason behind apotemnophilia. (TheDarkSideHasTacos (talk) 16:11, 16 August 2011 (UTC))

The source cited for the definition of apotemnophilia in WP's article says that it "is characterized by the intense and long-standing desire for amputation of a specific limb". It does not mention the foreskin and, last time I checked, the foreskin isn't a limb. So, are you able to cite a reliable source or not? Jakew (talk) 16:21, 16 August 2011 (UTC)

http://www.depression-guide.com/apotemnophilia.htm - This overview recognizes the want to be circumcised as a form of apotemnophilia. — Preceding unsigned comment added by TheDarkSideHasTacos (talk • contribs) 16:41, 16 August 2011 (UTC)

I'm not sure that would qualify as a reliable source. Suitable sources for medical topics are, for example, peer-reviewed articles (preferably reviews); see WP:MEDRS for details. Jakew (talk) 17:28, 16 August 2011 (UTC)

Adding Genital Mutilation As An Alternative Name

I suggest that male circumcision have the alternative name of male genital mutilation. There are popular articles which refer to male circumcision as male genital mutilation, male genital cutting, MGM, or MGC. The following links provide publications where male circumcision is referred to as male genital mutilation.

(TheDarkSideHasTacos (talk) 17:03, 7 August 2011 (UTC))

This has been discussed many, many times before. The most recent discussion was at Talk:Circumcision/Archive 67#"Male Genital Mutilation". Jakew (talk) 17:16, 7 August 2011 (UTC)

If it's been discussed, why haven't the names been added? (TheDarkSideHasTacos (talk) 20:23, 7 August 2011 (UTC))

Because the proposals failed to achieve consensus. Jakew (talk) 20:31, 7 August 2011 (UTC)

But there are numerous publications which refer it as genital mutilation. So what's stopping it from having it listed as an alternative name? (TheDarkSideHasTacos (talk) 01:11, 8 August 2011 (UTC))

Look in the archives. There's a detailed discussion here. (And, unless I'm greatly mistaken, it appears that you took part in that discussion, as LovelieHeart (talk · contribs).) Jakew (talk) 08:00, 8 August 2011 (UTC)

Why do you have control of this page actually? I've read about you online. There are entired webpages dedicated to your pro-circumcision beliefs and your actions on wiki and elsewhere. You're pro-circumcision, you belong to circlist, you constantly promote circumcision, and you encourage people to get circumcised. You're biased. So why are you in charge of this page? Wikipedia should be neutral and you're clearly not. (TheDarkSideHasTacos (talk) 08:06, 13 August 2011 (UTC))

Nobody controls this page; it belongs to Wikipedia. Comment on content, not the contributor. Jakew (talk) 08:33, 13 August 2011 (UTC)
You're the top contributor to circumcision topics. You look through every single edit that is made. You are a member of circumfetish websites. I've seen your posts. That's why you won't allow MGM as an alternative name. Someone could give you a thousand sources and you would still dispute it because you're pro-circumcision. You have a sexual fetish and biased as being for circumcision and you've been quite open about it in multiple platforms. (TheDarkSideHasTacos (talk) 08:38, 13 August 2011 (UTC))
And your background is quite required to be discussed because your neutral standpoint is disputed to say the least. Unlike you, I am not pro or anti-circumcision. I am against non-consentual cosmetic surgeries on children. The intentions of the article's author is extremely important and I believe from what I've read from you on circlist and so forth that you are furthering your own agenda rather than promoting neutral information to the public. (TheDarkSideHasTacos (talk) 08:41, 13 August 2011 (UTC))
This talk page is for discussing the content of the Circumcision article. Off-wiki conversations are not to be discussed here, nor are the contributors themselves. Your statement above about your strong POV against the topic of this article does not contribute here - it only undermines the discussion. As Wikipedia editors we are directed to discuss content and make sure our edits are verifiable. Our biases, whatever they are, do not contribute to the discussion. -- Scray (talk) 17:31, 13 August 2011 (UTC)
His biases do contribute because he disputes anything that may make circumcision look bad. I promise you that I could find at least a hundred people who want to see MGM as an alternative term and there are numerous Wiki members who are constantly stopped from editing by Jakew. Jakew has written several published publications that promote circumcision for non-theraputic reasons. He has encouraged parents to circumcise their children, despite the fact that he is not a doctor. He totally ignores anything that may discourage readers from circumcising themselves or their children. (TheDarkSideHasTacos (talk) 18:25, 13 August 2011 (UTC))
TheDarkSideHasTacos, WP:NPA is quite clear: Comment on content, not on the contributor. If you continue to use article talk pages to discuss Jakew, you will be blocked. Please ensure all comments going forward refer only to article content. Thanks. Jayjg (talk) 02:16, 14 August 2011 (UTC)
  • Adding MGM as an alternate is just catering to an unscientific but vocal minority. The comment above by proponent of such nomenclature remonstrates against non-doctors encouraging circumcision (medical advice?) but the comment fails to understand that calling it MGM - when no critical mass of scientific nor medical literature - is just a bunch of non-doctors discouraging circumcision (medical advice to the same extent as encouraging it). Are we going to add alternate designations to Jews in the article to "Christ Killers" just because someone somewhere calls them such. Of course not, for the same reasons. Carlossuarez46 (talk) 20:10, 14 August 2011 (UTC)

We can't prove anyone killed Jesus because we don't have proof that Jesus existed. So comparing circumcision to a man who probably never existed is not a viable argument. There are doctors which are against circumcision. It is simply sexism which prevents Wiki users from accepting MGM as an alternative name. (TheDarkSideHasTacos (talk) 00:52, 16 August 2011 (UTC))

Jayjg. Please refrain from making block threats to users who mention genuine WP:Conflict of interest issues on this article. Biting WP:NEWBIES is unlike the conduct of an admin. I think we might need a new RfC on the inclusion of MGM as an alternative name, because the archives indicate there seems to be an adequate level of community support for this inclusion. Pass a Method talk 07:42, 16 August 2011 (UTC)
You are doing TheDarkSideHasTacos no favors here. If he abuses the Talk: page like this again, he will be blocked. Do not bother responding here. Jayjg (talk) 01:31, 18 August 2011 (UTC)

Thank you, User:PassaMethod. (TheDarkSideHasTacos (talk) 16:14, 16 August 2011 (UTC))

Over the years there has been a clear consensus that MGM is not a synonym for circumcision outside the genital integrity movement, which has an obvious political platform to promote. Wikipedia is not supposed to be involved in promoting political agendas. Whilst consensus can changed, there is no evidence that it has done so here, and no new information that indicates that the term is widely used outside said political movement. -- Avi (talk) 16:20, 16 August 2011 (UTC)

Circumcision of men and women both remove the prepuce. If it is mutilation to remove a woman's prepuce, why is it not mutilation to remove a man's? Circumcision on men and women are performed for the same reasons: appearance, preference, religion, culture, sexual control, and alleged medical benefits. Infection, amputation, necrosis, and death are all risks of circumcision. The only difference is men don't get the same sympathy as women do. The fact that male genital mutilation is now in the media should hold weight in it being an alternative name. But regardless of whether or not MGM is added as an alternative name, I still believe Jakew has a conflict of interest that should be addressed. (TheDarkSideHasTacos (talk) 16:37, 16 August 2011 (UTC))

Dark Side, your sentence "If it is mutilation to remove a woman's prepuce, why is it not mutilation to remove a man's?" is your opinion, to which you are perfectly entitled. Similarly, your opinion is made rather clearly in the above paragraph. You may make any and every logical deduction and hold any opinion you wish. However, Wikipedia does not allow the addition of statements based on the deduction of its editors; it needs to conform to polices and guidelines. Trying to violate circumvent wikipedia policies to push a particular point of view is certainly a violation of our core WP:NPOV pronciple, and I am afraid a reading of the above paragraph may indicate you have some difficulties approaching this topic from the wiki-neutral perspective, which may interfere with your editing this article. [redacted] To reiterate, the consensus as of now (and for the past 5 years at least) remains that the use of the term MGM for "circumcision" is WP:FRINGE and inappropriate to be taken as a world-wide synonym in the lede of the article. The genital integrity movement is discussed rather prominently in the article in a non-confrontational way, and the movement's attempt to equate circumcision and FGM is noted in Circumcision controversies, where it belongs. -- Avi (talk) 16:51, 16 August 2011 (UTC)

Avi, my posts on other site are not anti-circumcision though. They are anti-child circumcision. I've never said anything about a grown man not being able to get circumcised. Also, last I checked, if Jakew can get away being a member of circumcision fetish groups, why can't I get away saying people can get circumcised at 18 on [the internet]? And you went out of your way looking up my posts. I would have given them to you if you had just asked for them because I'm consistent in my views. And I'm not using my opinion as a basis. I am asking a genuine question. If it's mutilation for a woman, why isn't it for a man? Female circumcision has only has only been opposed to for a few years. America used to circumcise women. It wasn't called FGM then but that doesn't mean it wasn't mutilation. Just because the entire world isn't calling male circumcision MGM doesn't make it less of a mutilation. In other countries, female circumcision isn't called FGM. (TheDarkSideHasTacos (talk) 17:01, 16 August 2011 (UTC))

To answer your question as to why everyone outside of genital integritists do not make the equivalence between FGM and circumcision, there is enormous debate elsewhere on the internet, and if you search, I am certain you will find well-stated arguments for both sides. Secondly, everyone is entitled to their opinions. Jakew is certainly not anti-circumcision. You are more than welcome to be anti-infant circumcision. Personally, I believe that circumcision should be allowed for religious reasons but FGM should be forbidden. Of course, that is likely due to my upbringing. Regardless, it is how those opinions shape your on-wiki editing that is the problem. We require that information added to articles be in accordance with out policies and guidelines which include WP:NOR, WP:NPOV, WP:UNDUE, etc. If the only reasons you have to add the equivalence relation to the lede of the article are your own opinions and statements by groups which do not represent mainstream worldwide usage, that is insufficient. "Just because" is not a valid wiki-reason, unfortunately, even if you believe it to be a compelling argument, which many do. -- Avi (talk) 17:11, 16 August 2011 (UTC)

I know Jakew is not anti-circumcision. He gives out pro-circumcision views on numerous websites such as circlist and the gilgal society, groups which exchange circumcision porn (which is why I believe Jakew has a severe conflict of interest). You can't allow infant circumcision for religious circumcisions without impeding upon the infant's right to freedom of religion. If a boy who is Jewish grows up and wants to be a Sikh, Rastafarian, Mormon, Catholic, etc. He may not be able to because circumcision is forbidden in those religions. So you can't use freedom of religion without taking in the child's right to freedom of religion. Considering circumcision does carry a risk of death and Jewish circumcisions can transmit STDS, it's not a safe surgery to subject a child to. But that's not my opinion, that is fact. I know just because is not a valid argument but circumcision carries similar risks in men and women and are performed for the same reason. I don't think the question is why should male circumcision be called MGM. I think the question is why shouldn't it. If circumcision did not have negative side effects and violate a person's body, why are people able to sue their doctors and hospitals for circumcising them as children and win? Because in order to win a case, damages have to be proven. This means legally, damages from circumcision have been recognized in a court of law. (TheDarkSideHasTacos (talk) 17:20, 16 August 2011 (UTC))

This is your final warning. If you abuse the Talk page for this purpose again, you will be blocked. I hope that's clear. Jayjg (talk) 01:31, 18 August 2011 (UTC)
Oh come on. The fact that 1/3rd of all edits to Wikipedia articles and talk pages on circumcision for the past years have all come from the same rabidly pro-circumcision person isn't a valid topic of conversation in attempting to make an article NPOV? Get real. There's no way I can say this that doesn't sound like a threat, but if TheDarkSide gets banned due to his attempts to discuss the source of this article's bias, that will so shake my faith in the Wikipedia community process that I will likely give up on the Wikipedia project entirely (i.e. both editorially and financially). LWizard @ 03:38, 18 August 2011 (UTC)
What I said to TheDarkSideHasTacos applies to you too. WP:NPA is quite clear: Comment on content, not on the contributor. This Talk: page is for the purpose of discussing article content, not other editors. If you continue to use article talk pages to discuss Jakew, you will also be blocked. If you have personal issues with Jakew, feel free to take them to the appropriate venue, which is not here. Please take this seriously, and please don't bother responding here. Jayjg (talk) 20:42, 18 August 2011 (UTC)

There are multiple Wiki users who support the MGM as an addition. In order to have MGM added as an alternative name, what sources and information would I need to provided exactly? Because I've provided scholar publications and they've been ignored so I want to know precisely what I would need so I don't have to go through this debate. (TheDarkSideHasTacos (talk) 17:38, 16 August 2011 (UTC))

At the risk of being repetitive and annoying (sorry 8-) ), I must reiterate your above post is nothing more than your opinion, and thus cannot be used to justify the circumvention of wikipedia policies. I am sorry if this frustrates you, that is not the intention, but the policies are there to protect wikipedia. There are plenty of places where you can engage in debate and try to convince others of your opinion and where they can try to convince you of theirs. An encyclopedia is not one of them, though. As long as the equivalence is restricted to the minority of genital integritists, it is inappropriate to be gievn equal weight to the centuries-old and well-established definitions. -- Avi (talk) 17:33, 16 August 2011 (UTC)

Dr. Bertran Auvert says

For information, Dr. Bertran Auvert says:

This type of measure could it be applied in France or Belgium?

No, it makes no sense. The situation is very different in our latitudes. As for the homosexual communities in our countries, there is currently no study on the protective effect of such intervention. And in regard to heterosexual couples, the benefit of such a measure cost it creates (it should be circumcised almost the entire male population of the country to reduce somewhat the risk of transmission) is unimaginable. This can not be in any way a public health measure to us. The recommendations of the World Health Organization (WHO) and UNAIDS in relation to this intervention are clear. They are limited to regions where the prevalence of the disease transmitted by heterosexual transmission is important. Basically, this is sub-Saharan Africa.

In french :

Pour information, le professeur Bertran Auvert indique :

Ce type de mesure pourrait-elle être appliquée en France ou en Belgique ?

Non, cela n’a aucun sens. La situation est très différente sous nos latitudes. En ce qui concerne les communautés homosexuelles dans nos pays, il n’existe à l’heure actuelle aucune étude sur l’effet protecteur d’une telle intervention. Et en ce qui concerne les couples hétérosexuels, le bénéfice d’une telle mesure par rapport au coût qu’elle engendre (il faudrait circoncire quasi l’ensemble de la population masculine du pays pour réduire quelque peu le risque de transmission du virus) est inimaginable. Ce ne peut donc être en aucun cas une mesure de santé publique chez nous. Les recommandations de l’Organisation mondiale de la Santé (OMS) et d’Onusida en ce qui concerne cette intervention sont claires. Elles se limitent aux régions du monde où la prévalence de la maladie véhiculée par voie hétérosexuelle est importante. En gros, il s’agit de l’Afrique subsaharienne.

http://archives.lesoir.be/sida-l-ablation-du-prepuce-permet-de-limiter-la_t-20110727-01HJEW.html?query=circoncision&firstHit=0&by=10&sort=datedesc&when=-1&queryor=circoncision&pos=1&all=139&nav=1 — Preceding unsigned comment added by Lulu ze (talk • contribs) 15:18, 24 August 2011 (UTC)

Penile cancer

The IP who added material to the penile cancer section did not supply full citations, though from the data (s)he did supply (s)he probably meant PMID 16488287 and PMID 8664788. I would submit, however, that Schoen is not the best of sources, as it is some 15 years old now. The most recent review, and an excellent source, is PMID 21695385. This concluded that "Men circumcised in childhood/adolescence are at substantially reduced risk of invasive penile cancer, and this effect could be mediated partly through an effect on phimosis." Jakew (talk) 17:56, 24 August 2011 (UTC)

Proposed merger with Genital Mutilation

We refer to "Female Circumcision" as "female genital mutilation" but not for the male case. I don't think religion should be given a trump card for neutrality in this case. 2.24.128.8 (talk) 16:07, 6 September 2011 (UTC)

The proposal is completely unrealistic. Genital mutilation redirects to genital modification and mutilation, which is an overview article about all procedures modifying the genitals (male or female). This article is about circumcision. So if we merged them at circumcision we'd have a lot of unrelated material (such as genital piercing) at that article, which would be very poor structuring. On the other hand, if we merged them at genital modification and mutilation, we'd have an absolutely enormous section about circumcision, which again would be poor structuring. It's not practical. Jakew (talk) 16:14, 6 September 2011 (UTC)

Then I propose renaming either this article to "Male Genital Mutilation" or renaming the equivalent female one to "female circumcision" — Preceding unsigned comment added by 2.24.146.102 (talk) 09:31, 7 September 2011 (UTC)

Wikipedia follows what reliable sources actually say, not what some editors would like. Johnuniq (talk) 11:22, 7 September 2011 (UTC)
Are you saying that there are reliable sources as to why this discrepancy of language is not a discrepancy, or simply that this it is a discrepancy not addressed by reliable sources? The difference seems important. --Saerain (talk) 05:16, 12 September 2011 (UTC)
Removal of the penile foreskin is called one thing. A variety of procedures involving cutting of the female genitals are called something else. There's no more of a discrepancy than there is between mole removal and tonsillectomy. Different things are called different names. Jakew (talk) 10:17, 12 September 2011 (UTC)
I support a gender neutral naming and we have sources referring to it as MGM. // Liftarn (talk)

This is a great hypocrisy and completely biased on the male side. I have been trying to balance out the two sides for years and faced great resistance on the male side. This article should be titled MGM like its female counter part or they should both be male and female circumcision. Why is it genital mutilation for a female but not for a male? Garycompugeek (talk) 13:32, 7 September 2011 (UTC)

While the term is used by a number of unreliable partisan websites, only a tiny number of reliable sources refer to anything as MGM. Google Scholar reports 510 articles using that phrase, and it is unclear what fraction of those use the term to mean circumcision. In contrast, there are 112,000 matches for "circumcision". To propose a non-neutral name that's also barely used by reliable sources is wholly contrary to applicable policy. Jakew (talk) 13:36, 7 September 2011 (UTC)
  • Once again, a few people have their preferred agenda and care not a whit about what reliable scholarly sources use as NPOV naming. This debate comes up every so often in such a tiresome rehash of things long ago decided and not likely to change that any thinking Wikipedian would not raise it again. In fact, to my mind, it's purely disruptive and may be blockable: Wikipedia:Disruptive_editing#Blocking_and_sanctions. Carlossuarez46 (talk) 07:38, 9 September 2011 (UTC)
    • It certainly seems to waste an awful lot of time... Jakew (talk) 08:46, 9 September 2011 (UTC)

Wow and apparently a few people don't know what talk pages are for also. What you really should be asking yourself is "Why are certain things continually brought up on this page?". Garycompugeek (talk) 13:11, 9 September 2011 (UTC)

That's not hard to understand. There's a large and well-organized anti-circumcision movement, and believers in its doctrines often come to Wikipedia to promote their beliefs. Jayjg (talk) 21:37, 9 September 2011 (UTC)
and yin to its yang is the pro circ movement... yes folks there is much controversy regarding circumcision. Our job as writers\editors is to present a balanced picture of the pros and cons and do our best to work together regardless of our personal POVs. It is my hope that we can all have more logical discourses on this page and respect each other a little bit more. Garycompugeek (talk) 14:41, 12 September 2011 (UTC)
Sorry, that's nonsense. There is no organized "pro-circ" movement, creating FaceBook pages and campaigns, multiple fora, and dozens of websites on the topic, and one doesn't find all sorts of editors, new or otherwise, coming to this article to add pro-circumcision beliefs to it. Jayjg (talk) 02:49, 13 September 2011 (UTC)
Exactly. As is evidenced by the fact that nobody has proposed to rename the article as "male genital enhancement". Or, as perhaps a better example, the "surgical vaccine". But, of course, if anyone did propose to rename the article in those ways, they would encounter much the same reaction: we don't use fringe, non-neutral terminology. Jakew (talk) 09:37, 13 September 2011 (UTC)
So your both saying no one is in favor of circumcision and there are no pro circumcision websites, are you kidding me? Garycompugeek (talk) 17:40, 13 September 2011 (UTC)
No, Gary. Please read Jayjg's comments again. Jakew (talk) 18:41, 13 September 2011 (UTC)

It would be inaccurate to name these two articles to match. Only one form of female "circumcision" is actually analogous to male circumcision. If this article were renamed Male Genital Mutilation, we would have to include numerous other tangential topics related to mutilation & modification of the male genitals. Conversely, renaming Female Genital Mutilation as Female Circumcision would be a poor idea as "female circumcision" is not a precise term for the scope of that article. "Circumcision" is a recognizable, precise, and neutral term, and it is the medical term for the procedure. Let's keep it as the title of this article.Mattmatt1987 (talk) 01:16, 13 September 2011 (UTC)

Just to add some food for thought; Even if Circumcision were considered a non-neutral term, this would be as clear a case of WP:POVTITLE as I could ever imagine. More importantly, the title of the Female genital mutilation article is a wholly separate issue from this article's title. Vietminh (talk) 16:25, 13 September 2011 (UTC)

No progress on gender neutral views of circumcision will ever be made with pro-circumcision people running this page. It's far easier to leave Wikipedia be and just educate the public that Wikipedia shouldn't be trusted for medical advice because anyone can edit it. Then the religion factor comes into and few people, for fear of being labeled antisemitic, will not criticize anything that could remotely be deemed Jewish. It's more progressive and effective to use medical studies, case files, and statistics as reasons not to subject their children to dangerous surgery. Not Wikipedia. For example, if people curious about circumcision, they can read in the New York Times about three cases of circumcision of infants leading to gender reassignment, lawsuits against doctors for circumcision, and other reliable circumcision information. The New York Times has a long history of reporting deaths and complications of circumcision that is available in their archive for people to read. So let the pro-circ people have Wikipedia. It doesn't really matter. (TheDarkSideHasTacos (talk) 17:04, 20 September 2011 (UTC))

So tell me, does the New York Times refer to the practice as circumcision or as genital mutilation?--Taylornate (talk) 18:02, 20 September 2011 (UTC)

No, it doesn't. Usually the New York Times mentions it as circumcision or brit milah when speaking about lawsuits and deaths. But it also has articles which refer to FGM as female circumcision. My guess is they're keeping it politically neutral. Circumcision really shouldn't need to be called genital mutilation to get people's attention. People should simply have the common sense to view it in a negative light. I view the terms MGM, FGM, and circumcision with equal disgust so it doesn't matter to me whether or not sources called it specifically MGM or FGM.(TheDarkSideHasTacos (talk) 20:48, 20 September 2011 (UTC))

Positions of medical associations - Germany

The Robert Koch Institute, the Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung/BZgA) und Deutsche AIDS-Hilfe (DAH) have issued a joint statement on circumcision and HIV. The report (Positionspapier) "Circumcision and HIV" ("Beschneidung und HIV") is from 2007 and the conclusion is: Circumcision has been shown to reduce the risk of HIV infection and it will probably be used for prevention in countries like Botswana, Lesotho, Swaziland, and Tanzania... but the Robert-Koch-Institute, the BZgA and the DAH do not recommend circumcision for prevention of heterosexually acquired HIV infection in European men (because the HIV prevalence rate is <1% and thousands of men would have to be circumcized to reduce the risk of HIV infection). You can download the report "Beschneidung und HIV" here: [16]

Is this worth mentioning in the article? --Sonicyouth86 (talk) 20:17, 27 September 2011 (UTC)

Erectile Dysfunction - ED

Three new studies report that circumcision is a risk factor for ED, and two have measured it with statistical significance. Two found about the same high risk factor. With these new articles showing a strong correlation I don't think we can any longer say "Reports... have been mixed." These new studies should be included. They are:

Worsened erectile functioning - Bailey RC, Egesah O, Rosenberg S. Male circumcision for HIV prevention: a prospective study of complications in clinical and traditional settings in Bungoma, Kenya. Bull World Health Organ. 2008;86(9):669-77.
Circumcised men 4.53 (p = .006) times more likely to develop ED - Bollinger D, Van Howe, RS. Alexithymia and circumcision trauma: A preliminary investigation. Int J Men’s Health, 2011;10(2):184-95.
Circumcised men 4.88 (p < .001) times more likely to develop ED - Tang WS, Khoo EM. Prevalence and correlates of premature ejaculation in a primary care setting: A preliminary cross-sectional study. J Sex Med, 14 Apr 2011, Available online at: http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2011.02280.x/abstract

Frank Koehler (talk) 12:55, 22 September 2011 (UTC)

Results have been mixed, Frank. That's pretty much indisputable, and I don't see how cherry-picking some studies with one particular finding has any relevance. We shouldn't really be citing primary sources at all in this article. Jakew (talk) 13:06, 22 September 2011 (UTC)
There was no hand-picking involved and I object to your insinuation and ask for an apology. These are the latest three I could find. Two were published just months ago. As time goes on, the trend being revealed is "less mixed." At the very least, these three recent studies should be cited along with the other 7 primary sources already given.Frank Koehler (talk) 18:26, 28 September 2011 (UTC)
I've no way of knowing your intent, but even if what you presented had been accurate, it would have been a remarkably non-representative selection. Looking at studies published in 2008 or later, you missed, for example, Cortez-Gonzalez' finding of a statistically significant improvement in erectile function following circumcision, Kigozi's finding of no significant difference, Frisch's finding of the same.
And looking at this in more detail, Bollinger and Van Howe found an association with ED drug usage, but not with ED itself. Their Table 3 shows multivariate and univariate associations between circumcision and ED; the confidence interval for the univariate association includes 1.0, and is thus non-significant, the values for multivariate are missing (it states merely "NS" [not significant]). Regarding Tang et al, the association of 4.88 appears to be between circumcision and premature ejaculation (not erectile dysfunction): "Multivariate analysis showed that [...] circumcision (adjusted OR 4.881, 95% CI 2.346, 10.153) [...] were predictors of PE." Jakew (talk) 19:58, 28 September 2011 (UTC)

Legal issues

A recent edit (diff) added some text at Circumcision#Legal issues regarding South African law. I did not revert the addition because it appears to be verifiable, although the wording needs work and of course a source is required. I expected Google to find plenty of sources but apart from long primary sources (PDFs), and sites that may be dubious, a quick search yielded only [17], Legal aspects of HIV/AIDS: a guide for policy and law reform, Lance Gable et al, World Bank Publications, 2007, ISBN 9780821371053. I don't know how much the section in this article should be expanded, and am presenting this for anyone interested, as it appears suitable for the article. Johnuniq (talk) 10:52, 29 September 2011 (UTC)

It might be worthwhile to note that SA have restricted the practice of circumcision, but the essential claim made in the edit is dubious at best. The Act makes exceptions for both "medical" and "religious" reasons. There's disagreement over whether prophylaxis against HIV in particular counts as a "medical reason"; some sources argue that it does, and that infant circumcision for such a purpose is therefore legal (a detailed, albeit self-published, example being this). To my knowledge no court or other appropriate authority has settled this issue. I would therefore suggest that, if we do discuss the issue, a substantial rewrite is required, perhaps along the lines of: "In South Africa, the 2005 Children's Act prohibited circumcision of boys under 16, except when performed for religious or medical reasons." (As a minor point, I think there's a mistake in Lance Gable's book, which refers to the "2006" Act while citing the act as "Children's Act, No 38 of 2005". The latter date is correct, and I think this is just a typo.) Jakew (talk) 12:01, 29 September 2011 (UTC)
I think the act is dated 2005, but was amended in 2006 in the terms mentioned in the above book; also I see some chatter about it being proclaimed in 2010 (I'm not sure about any of this). The quantity of pro/anti waffle on the net exceeds my patience level; for some reason, I can't find any news commentary. Johnuniq (talk) 09:32, 1 October 2011 (UTC)

HPV

I have revised the HPV section to include a meta-analysis and systematic review by Larke et al (PMID 21965090). Since there is a recent, up-to-date review, there seemed no good reason to cite primary sources as well. I therefore decided to remove the primary sources from this section. It doesn't flow very well, though, and would probably benefit from further editing. Jakew (talk) 12:41, 4 October 2011 (UTC)

Potentially useful article

A commentary in the current issue of JAMA entitled The Medical Benefits of Male Circumcision seems germane. -- Scray (talk) 01:40, 7 October 2011 (UTC)

I'm just trying to work out the best way to use it, if any. I suppose we might replace Schoen (ref 24 in the current version) with this. Any thoughts? Jakew (talk) 09:37, 8 October 2011 (UTC)
Could it not be used in addition to Schoen? Jayjg (talk) 02:45, 10 October 2011 (UTC) Are you proposing further additions to the intro section of this article Jayjg? Sunfox1 (talk) 02:22, 11 October 2011 (UTC)

Stats

Are there any statistics from a survey telling what percentage of males circumcised as infants are happy or unhappy with their circumcisions? Pass a Method talk 22:34, 7 October 2011 (UTC)

The only reliable source is probably Schlossberger et al[18]; a few published on the web (which don't meet RS requirements) are SizeSurvey.com, JackinWorld, and Badger. Jakew (talk) 08:29, 8 October 2011 (UTC)

World Health Organization overstates real circumcision rate among non-Muslims

"Global estimates by the World Health Organization (WHO) suggest that 30 percent of males are circumcised, of whom 68 percent are Muslim.[9]" Male circumcision: Global trends and determinants of prevalence, safety and acceptability" (PDF). World Health Organization. 2007.

This "estimate" by the WHO has become gospel in the Circumcision article, but the "estimate" itself has no sourcing to back up its figure; moreover, it's stated in the passive voice, merely "suggesting" a percent, as the Circumcision article itself "suggests." That's not the only problem with the WHO's "suggested estimate." The world's population is 7 billion -- 3.5 billion males. According to WHO, 30% of those 3.5 billion males are circumcised, approximately 1,050,000,000 males. The Muslim World has 1.6 billion people -- that is 800,000,000 males; and according to WHO that's about 68% of the circumcised males in the world, leaving 400,000,000 non-Muslim males in a state of circumcision. Since a minority of English-speaking countries circumcise their males, even if all 154,000,000 American males were circumcised (sic), WHO has to tell us where we are to find the other 246,000,000 circumcised males among the non-Muslim world population. Accordingly, the WHO statistic is worthless and overstates the real circumcision rate in the non-Muslim world. Joe Circus (talk) 02:47, 2 November 2011 (UTC)

If you have better estimates, please present them. Presenting original research such as this to try to debunk the WHO really has no place here. Yobol (talk) 03:40, 2 November 2011 (UTC)
An analysis of purported data most certainly is NOT original research. Joe Circus (talk) 04:30, 2 November 2011 (UTC)
Doing your own calculations from your own estimates and coming to a novel conclusion is the very definition of original research. As I said, if you have other sources that make estimates, bring them up for discussion. Your own back of the envelope calculations are not appropriate here. Yobol (talk) 04:32, 2 November 2011 (UTC)
That's a very superficial reading of my data analysis. Joe Circus (talk) 04:34, 2 November 2011 (UTC)
On a non-OR note, what does the passive voice have to do with it? I see one passive in the sentence you quote ("are circumcised"), but I don't see what it's got to do with anything, or how it could be expressed in the active voice without extremely awkward rewording. garik (talk) 06:21, 2 November 2011 (UTC)
The passive voice to which I referred was WHO's passive voice, as clearly stated in my comment: This "estimate" by the WHO has become gospel in the Circumcision article, but the "estimate" itself has no sourcing to back up its figure; moreover, it's stated in the passive voice, merely "suggesting" a percent, as the Circumcision article itself "suggests." Since no one apparently has read the WHO article to which I refer, here is the WHO statement (page 6), in the passive voice: "Approximately 30% of males are estimated to be circumcised globally, of whom an estimated two thirds are Muslim." It's not even a thinly-sourced "estimate." It has no source except for hearsay, accounting for its use of the passive voice. WHO's so-called "estimate" is worthless for an encyclopedia. Joe Circus (talk) 16:06, 2 November 2011 (UTC)
Such a figure can only ever be an estimate, Joe. It would be logistically impossible and financially impractical to perform a survey of all approx 3.5 billion males in the world. There's nothing wrong with an estimate, as long as it is presented as such (and it is). Jakew (talk) 16:12, 2 November 2011 (UTC)
"Approximately 99% of scholars who use the passive voice for an "estimate" do so to avoid responsibility for the purported statistic, i.e., the passive voice is well known to be the refuge for weasel words." Joe Circus (talk) 17:40, 2 November 2011 (UTC)
What source are you quoting from, out of interest? Jakew (talk) 17:59, 2 November 2011 (UTC)
But you're quoting from the summary at the start of the article, Joe, where it's perfectly appropriate not to go into the details of the estimate (and perfectly reasonable to express it in the passive voice). If you've read the report to which I understand you to be referring, you'll know that Section 1.3 goes into detail about how they arrived at it, includes about eight different sources (from what appear to be peer-reviewed journals), and two tables of detailed information. They also note (with explanation of how) that they are likely to be underestimating precedence. And you'll be pleased to see that every verb but "circumcise" is in the active voice. garik (talk) 19:26, 2 November 2011 (UTC)


Here's the WHO's disclaimer: "Using these assumptions, we estimate that approximately 30% of the world's males aged 15 years or older are circumcised." I've looked at their references and find no such assumptions confirmed in their hodge-podge of antiquated anthropological fieldwork. Curiously, the WHO has disowned this article from its website, as it can only be found with the search tool -- not available to anyone actually perusing WHO's material on circumcision. That's an obvious vote of no-confidence in the purported "study" that's become the backbone of the Circumcision article's exaggerated statistics. Indeed, the passive voice expressed their uncertainty with precision. Joe Circus (talk) 20:17, 2 November 2011 (UTC)
That's odd. I found it without any difficulty here. Jakew (talk) 20:33, 2 November 2011 (UTC)
Pray tell us why WHO doesn't list the referenced article under their Health Topics here One has to do some elaborate link-chasing to post that obscure link from WHO's website. WHO's passive voice -- "Approximately 30% of males are estimated to be circumcised globally, of whom an estimated two thirds are Muslim." -- falls under the category of hedging: A particularly awkward and ambiguous form of the passive voice occurs when an author uses it as the receiver rather than the first-person pronouns I or we: It is concluded that the treatment is effective. These types of passive-voice sentences are a form of hedging. read it also here Joe Circus (talk) 02:29, 3 November 2011 (UTC)

"Hodge-podge of antiquated anthropological fieldwork"? Are we reading different documents? The one I have bases its estimate on data from three sources, all of them dating from 2006, one year before this report was published. How are these antiquated? And of course you're not going to find support for the WHO's assumption "that all Muslim and Jewish males in this age group are circumcised". They're very clear that this is an idealisation to be applied when they extrapolate from the data they draw from these sources. This is perfectly legitimate practice. As Jakew has pointed out to you, it's entirely reasonable to make an estimate here, and to make an estimate you need to make assumptions, or idealisations (your apparent implication that using the word "assumptions" is indicative of bad practice is just odd). That's the point of estimates. In fact, the fact that they state their assumptions clearly and refer to them as precisely that is excellent practice. It's exactly what they should be doing and quite the opposite of hedging. Sure the estimate won't get it exactly right. As I said, that's why they call it an estimate. In the absence of a worldwide census asking about circumcision, an estimate is really the best we're going to get. Although if you have a more reliable source with a more reliable estimate, then please do provide it. That would be great.

Incidentally, I would also direct you here. Just because some people might use the passive to hedge, that doesn't mean that every use of the passive is a form of hedging, or even bad. As Geoff Pullum puts it, "the passive is very often exactly the right way to frame a clause in a particular context, and all competent authors use passives frequently". In any case, given that the WHO document states very clearly, "We have estimated the global prevalence of circumcision..." (etc.), I think that to accuse them of hedging on the basis of the use of the passive voice in the summary is rather ridiculous. Don't judge a paper by its abstract, particularly not on such circumstantial evidence as a passive. garik (talk) 04:11, 3 November 2011 (UTC)

In any case, I don't know why I've let myself get drawn into this discussion, which appears to be pretty much irrelevant to improving the article. If you can provide a more reliable estimate from an equally good (or better) source than the WHO, then I can't see why anyone would object. Otherwise this discussion is pointless. garik (talk) 04:21, 3 November 2011 (UTC)
Indeed. We've established that the statement is supported by a reliable source; analysis of that source is by definition original research. I agree that it's probably time to stop this discussion. Jakew (talk) 09:20, 3 November 2011 (UTC)
What's this recurrent desire to cut off a discussion before it can accomplish anything? Joe Circus (talk) 00:09, 4 November 2011 (UTC)
I deny the purported consensus that accepts the WHO statistic as Gospel. It vastly overstates the Human subjects. Joe Circus (talk) 15:50, 4 November 2011 (UTC)
"Consensus that accepts the Who statistic as Gospel"? "Vastly overstates the Human subjects"? What are you talking about? The matter is very simple. The Who's estimate is the best estimate we have. If you have a better one from an equally reliable source, let us know. Otherwise, further discussion is pointless. garik (talk) 00:43, 5 November 2011 (UTC)
It would be more accurate to state that circumcision is practiced in a minor part of the world and that no verifiable statistical model exists to count the number of its Human subjects. Joe Circus (talk) 16:29, 5 November 2011 (UTC)
What source(s) would you propose to cite in support of that? Jakew (talk) 16:48, 5 November 2011 (UTC)

Off-topic detail added to lead

Beejaypii has repeatedly changed a sentence in the lead from:

  • Circumcision is also used therapeutically, as one of the treatment options for [...]

To:

  • Circumcision is also used therapeutically. Most conditions affecting the foreskin can be treated without recourse to surgery, but circumcision is a treatment option for [...]

The statement that most conditions affecting the foreskin can be treated without surgery is certainly true, but it's off-topic in the context of this article, which isn't about conditions affecting the foreskin and their treatment; it's about circumcision. This addition unnecessarily lengthens the lead, which is already rather long, adding no relevant detail. Jakew (talk) 13:24, 31 October 2011 (UTC)

The statement that "most conditions affecting the foreskin can be treated without recourse to surgery" is obviously about circumcision: it increases the precision of the definition of circumcision - which includes its role in the world - by clarifying that it is not the primary treatment for most conditions affecting the foreskin.
I think you're being misled by syntactical issues rather than content issues. It's quite possible to paraphrase the statement you oppose with something like "Circumcision is not the primary treatment for most conditions affecting the foreskin, but it is one of the treatment options." The sense is essentially synonymous. Do you consider that paraphrase not to be about circumcision? Beejaypii (talk) 14:13, 31 October 2011 (UTC)
Your first paragraph is illogical, Beejaypii: if something else is a "primary treatment" (which isn't quite the issue that we were discussing) for a condition, that isn't a statement about circumcision, but rather a statement about that something else. (It's also a statement about the condition, but it clearly isn't a statement about circumcision.)
The paraphrase you offer is a statement about circumcision, just about, but there are several problems with it. First, it doesn't seem to be supported by the source. Second, even if it were sourced, it's dubious from a neutrality perspective, since this seems to depend on the physician. Finally, it's of dubious value: there are a huge range of ailments for which it's not a treatment at all (athlete's foot, for example); information about how it is used is of more value than how it isn't. Jakew (talk) 16:18, 31 October 2011 (UTC)
Sorry. I quoted one part of the statement only. assuming you'd have the insight to take the rest as given In a typical text, sentences do not exist as isolated components with no relation to the other sentences around them. The first part of the change I introduced "Circumcision is also used therapeutically" establishes the use of circumcision to treat conditions as the topic under discussion. The part which I reproduced, devoid of its readily available context, and which seems to have caused your brain's language parser such problems, references that topic, pragmatically if not linguistically. Beejaypii (talk) 16:30, 31 October 2011 (UTC)
Care to try again, without the personal attacks? Jakew (talk) 16:32, 31 October 2011 (UTC)
I apologise. I failed to assume good faith by jumping to the conclusion that you were feigning an inability to realise what I actually meant. I can see now how my partial quote would cause problems. My bad. I'll strike out the phrases I think offended you. Beejaypii (talk) 16:51, 31 October 2011 (UTC)
Ok, one point at a time:

The paraphrase you offer is a statement about circumcision, just about

Instead of making an empty assertion could you be more specific? What do you mean by "just about"?

...it doesn't seem to be supported by the source

Again, what do you mean? Obviously, it's a paraphrase so it's not going to be identical to the source word for word. But that's not an issue in this discussion.

Second, even if it were sourced...

Again, not the issue.

...it's dubious from a neutrality perspective, since this seems to depend on the physician.

I have no idea what point you're trying to make here, given the environment in which we're conducting this discussion - Wikipedia.

...there are a huge range of ailments for which it's not a treatment at all (athlete's foot, for example)

The context establishes that it's "conditions affecting the foreskin" under discussion, not every possible medical condition in the world, which would be ridiculous of course. Beejaypii (talk) 17:30, 31 October 2011 (UTC)
"Just about" is a reference to the fact that it's of little value, as I explained. Regarding the lack of support by the source, the source doesn't say anything about primary treatments, so we could not do so (I'm making the working assumption that you intended to suggest it as an alternative wording). Regarding neutrality, it seems reasonable to point out that physicians differ in their preferred treatments; some will doubtless employ circumcision as primary treatment for phimosis while others will not. So we should be wary of making overly broad statements. Finally, I do not intend to suggest that the sentence could imply every possible medical condition; my point is that statements about what circumcision isn't used for are of inherently limited value. It's like saying "Beejaypii isn't interested in the architecture of Malaysia" — possibly true, but a statement such as "Beejaypii is interested in Blackburn and Circumcision" is a more informative statement. Jakew (talk) 18:28, 31 October 2011 (UTC)
You wrote "The paraphrase you offer is a statement about circumcision, just about". Again, in what way is it "just about" about circumcision? The statements you wrote after that discuss: its source, its neutrality. Can I assume you've abandoned the tactic of arguing, effectively, that non-metaphorical statements (as in this case) are somehow not about the real-world entities/phenomena they reference as grammatical subjects and objects etc?
"...it seems reasonable to point out that physicians differ in their preferred treatments; some will doubtless employ circumcision as primary treatment for phimosis while others will not." Well, unsourced, that would obviously be original research (I find it very difficult to believe you didn't realise I would point that out.) Furthermore, my addition to the article states "Most conditions affecting the foreskin can be treated without recourse to surgery, but circumcision is a treatment option for..." That's "can be" and "is a treatment option".
"...we should be wary of making overly broad statements." Well, surely, simply stating that circumcision is a treatment option for certain conditions, without qualification of any sort, is broader than making the same statement but qualifying it by also pointing out that most of the conditions can be treated without it?
Your final analogy (and that's being kind), strangely based on my username and some of my interests on Wikipedia, woefully misrepresents the issue at hand (it wouldn't be difficult to gain the impression that I'm being treated with contempt here, being kept occupied with arguments such as these, though I'm sure that's not the case). You're a systems analyst according to your user page. If you have programming skills, and the sense of logic that entails (and I know what I'm talking about, having been an applications programmer for six years in the 1980s), I don't see how you can possibly be unaware of the weakness of the analogy you've formulated. Again, I'm trying hard not to assume that my time is being deliberately wasted. Beejaypii (talk) 19:37, 31 October 2011 (UTC)
As I've already explained, "just about" was a reference to the argument that followed. I'm not sure what you expect to achieve by asking this question again, nor by mis-characterising my arguments...
I agree with you that, in the absence of a source, my summary is original research. I'm a little mystified by this comment, though, since your "paraphrasing" is likewise original research (it doesn't make a lot of sense to introduce OR and then complain when somebody else introduces OR in response). Since I made this point initially by saying "even if it were sourced", I thought it obvious that we were discussing hypothetical scenarios in which appropriate sources had been identified.
Stating that circumcision is a possible treatment is probably the most accurate, neutral statement that can be made about it. It is not a statement that is, or is likely to be disputed.
Finally, the purpose of the analogy is to show that, for any given X and Y, there are an almost infinite number of "X is not Y" statements, but far fewer possible "X is Y" statements. Consequently, the latter are more informative. I'm not trying to waste your time. I'm trying to help you to understand. Jakew (talk) 20:03, 31 October 2011 (UTC)

HIV

Beejaypii, please get consensus for these changes. Removing large sections of the consensus lede, based on the rather pointy claim that they "apparent HIV protection results from the absence of the foreskin, which is not the main topic of this article" is not editing in good faith. Jayjg (talk) 23:32, 31 October 2011 (UTC)

Actually, from a purely theoretical point of view (as opposed to proselytizing for HIV protection), Beejaypii has correctly noted ONE of many fatal flaws, academically speaking, in this purported "article." Joe Circus (talk) 04:44, 1 November 2011 (UTC)
Um, no. It's a patently absurd argument. Jakew (talk) 09:31, 1 November 2011 (UTC)
No your circular logic is absurd Jake. So Jayjg if someone makes an edit you don't agree with they are not editing in good faith? HIV is NOT the focus of this article and circumcisions effects are negligible at most, certainly not the weight given to it in the lead. Garycompugeek (talk) 15:30, 1 November 2011 (UTC)
A completely unsubstantiated assertion from Jakew there: it's really an indirect way to insult the person who formulated the argument, implying they've come up with something absurd, which I don't think anyone would describe as anything other than derogatory. It's interesting coming from someone who attempts to argue, essentially, that a set of treatment "options" cannot be referred to (properly sourced) because physicians in the real world might not all make the same choices.
And consider this. The second of the following assertion models would contribute additional information, compared to the first, about X:
  1. X is a member of the set of two or more Y's. X is a Y in relation to A, B, C, D, E, and two or more F's
  2. X is a member of the set of two or more Y's. Most of the set A-? for which Y's can be used do not require a Y which is X, but X is a Y in relation to A, B, C, D, E, and two or more F's
Critical note: in example 2, "Most of the set A-? for which Y's can be used do not require a Y which is X" can be reformulated as "X as a Y is not a requirement for most of the set of A-? for which Y's can be used"
Beejaypii (talk) 19:04, 1 November 2011 (UTC)
Can I suggest that you re-read WP:AGF, Beejaypii? If you wish I'd be quite happy to expand on my criticism; you only have to ask. Jakew (talk) 20:11, 1 November 2011 (UTC)
"I'd be quite happy to expand on my criticism; you only have to ask." If you don't want to voluntarily, and constructively, participate in the debate any longer then don't do so. There's no compulsion. Beejaypii (talk) 20:46, 1 November 2011 (UTC)
I thought the absurdity self-evident, but apparently not to all. Your argument is essentially that absence of the foreskin is not the main topic of this article. There are multiple problems with this argument. First, it should be perfectly obvious that absence of the foreskin is the direct and immediate result of circumcision; I presume that you do not intend to deny that, since such an argument would be truly ridiculous. So I must assume that you're creating a distinction between "circumcision" and "the absence of the foreskin" (ie., the state of being circumcised). The question is, is such a distinction meaningful and useful? If Wikipedia had separate articles about the act of circumcision and the state of being circumcised then yes, it might be a useful distinction since it would help us to decide where to place certain pieces of information. But that's not the case: we have one article about the procedure and its consequences (as well as other information). So the distinction seems to serve no purpose. Second, your argument is unsupported by most (if not all) of the cited sources, which attribute the reduction in HIV not to "absence of the foreskin" but to circumcision. For example, the first cited source (Krieger 2011) states: "Level 1 evidence supports the concept that male circumcision substantially reduces the risk of HIV infection." Similarly, the third (Siegfried 2009) states: "There is strong evidence that medical male circumcision reduces the acquisition of HIV by heterosexual men by between 38% and 66% over 24 months." So relevance is established and verifiable, and your argument of irrelevance appears to be original research. Jakew (talk) 21:42, 1 November 2011 (UTC)
Then I assume you won't be standing by this, from above:
" but it's off-topic in the context of this article, which isn't about conditions affecting the foreskin and their treatment; it's about circumcision."
Presumably, if the article isn't about conditions affecting the foreskin and their treatment, it's even less about conditions not affecting the foreskin but which are perhaps less likely to be contracted in the absence of a foreskin. Beejaypii (talk) 22:08, 1 November 2011 (UTC)
What some deem to be "self-evident" in this "article" would not pass muster as street-corner scholarship. Authentic scholars would hold themselves to a higher standard. Joe Circus (talk) 22:13, 1 November 2011 (UTC)
The article is about circumcision, Beejaypii. So if circumcision is used as treatment for a condition affecting the foreskin, that fact is directly related to the subject of the article. Similarly, if circumcision reduces (or increases) the risk of a condition, that's directly related to the subject of the article. On the other hand, if something other than circumcision is used as treatment for a condition, that information isn't directly relevant to the subject of this article. Likewise, if something other than circumcision increases or decreases the risk of a condition, it isn't directly relevant to the subject. Jakew (talk) 22:32, 1 November 2011 (UTC)
Agree with Jayjg and Jakew, the original sentence where it is noted that it is a treatment "option" clearly denotes that it is not the only treatment. Discussion about other treatments of those diseases is OR and certainly does not belong in the lead. I note that there is yet another attempt to remove the material about HIV from the lead as well; as it is one of the most studied medical consequences of circumcision, calling the effect of circumcision on HIV "peripheral" is frankly mind-boggling. Yobol (talk) 23:58, 1 November 2011 (UTC)

Really Yobol? So let's hypothetically say your circumcised, you would have unprotected sex with someone HIV positive? Garycompugeek (talk) 00:23, 2 November 2011 (UTC)

Gary, whether or not an editor would "have unprotected sex" with someone is not relevant here. What is relevant, however, is that the effects of circumcision on HIV transmission are one of the most studied and significant medical findings regarding circumcision in the past two decades. Excising it from the lede would be a flagrant violation of WP:UNDUE and WP:LEDE. The fact that is actually being done here as a tit-for-tat by Beejaypii (aided and abetted by you) because he was annoyed with Jakew for removing an insertion of Beejaypii's is, in addition, an outrageous violation of WP:POINT.
Beejaypii, you tipped your hand with this edit summary: Doesn't belong in the lead: apparent HIV protection results from the absence of the foreskin, which is not the main topic of this article. Now there's no way of backing down from your real motivation, no way of disguising your bad faith, and no way of avoiding sanctions if you continue. Jayjg (talk) 01:58, 2 November 2011 (UTC)
Jay, are you saying that this discussion is all about "gotcha"? Joe Circus (talk) 02:52, 2 November 2011 (UTC)
Jayjg we have plenty of sources in this article and Circumcision and HIV that play down or discredit the preventative effects of circumcision and HIV. It's inclusion in the lead is a flagrant violation of WP:UNDUE weight. Garycompugeek (talk) 13:06, 2 November 2011 (UTC)
Gary, 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. If reliable sources give it that much weight, it's only appropriate that we do the same. Jakew (talk) 14:11, 2 November 2011 (UTC)
Garycompugeek, please familiarize yourself with our talk page guidelines so you do not venture off on hypothetical questions about my behavior that have nothing to do with improving the article. Thanks. Yobol (talk) 03:37, 2 November 2011 (UTC)
A rhetorical question makes a point that some people cannot understand in any other way. Joe Circus (talk) 04:25, 2 November 2011 (UTC)
Actually, this particular question does not appear to have any value in actually improving the article and is therefore against our talk page guidelines. If he wants to talk about the sources, that would be great. If he wants to talk about my behavior, he can keep it to himself. Please do not encourage others to violate our guidelines. Yobol (talk) 04:28, 2 November 2011 (UTC)
I stand by my point. Joe Circus (talk) 04:32, 2 November 2011 (UTC)
Afraid to have an honest conversation about this aren't you Yobol? I'm not sure how discussing content in the article is off topic, plus we use hypotheticals all the time on discussion pages for reality checks Garycompugeek (talk) 13:06, 2 November 2011 (UTC)
That's enough, Gary. We are not here to discuss other editors' sexual behaviour. Jakew (talk) 14:11, 2 November 2011 (UTC)

Jayjg, you wrote:

"Beejaypii, you tipped your hand with this edit summary: Doesn't belong in the lead: apparent HIV protection results from the absence of the foreskin, which is not the main topic of this article. Now there's no way of backing down from your real motivation, no way of disguising your bad faith, and no way of avoiding sanctions if you continue."

Actually, the main topic of this article, as stated in the first sentence of the lead, is "Male circumcision is the surgical removal of some or all of the foreskin (prepuce) from the penis." That sounds like the definition of an act of surgery to me, and not its consequences. Therefore, "apparent HIV protection results from the absence of the foreskin, which is not the main topic of this article", as the edit summary in question, doesn't seem to have anything to do with bad faith. It seems quite logical. As for my "real motivation", you can only make assumptions about that, not actually being me or being able to read my mind. I'd appreciate it if you'd refrain from jumping to conclusions of bad faith, and conclusions about the motivation behind an edit (and publishing those conclusions), just because you don't happen to agree with it. Beejaypii (talk) 09:20, 2 November 2011 (UTC)

Much as I've tried to find a good-faith explanation, it seems a rather obvious WP:POINT violation, I'm afraid, made all the more obvious by your (Beejaypii's) attempts to use one issue to gain leverage for your point of view re another. Jakew (talk) 09:25, 2 November 2011 (UTC)
I disagree with your and Jayjg's assessment of Beejaypii's behavior. If you are so sure then take it up with ANI. In my opinion its more bluster and bravado scare tactics to try and intimidate those who do not agree with you. Garycompugeek (talk) 13:06, 2 November 2011 (UTC)
ANI is usually a last resort, Gary. It's not to be used as a substitute for dealing with problems in an ordinary way. Jakew (talk) 14:11, 2 November 2011 (UTC)
I suspect you haven't noticed the word Jayjg at the beginning of the contribution you're responding to Jakew (mine), in view of the fact that you've responded in the first person to a comment aimed at another editor. However, if you're so eager to respond to the comment, perhaps you'd like to justify the prominence, in the lead, of information documenting a potential effect of the outcome of carrying out the surgical procedure which is defined as the main article topic. HIV related sources, when using phrases such as "circumcision reduces..." etc, cannot possibly be using the term in the narrow sense of carrying out the surgical procedure, as the article defines it, but must be using it in the sense of real or hypothetical instances of the procedure being carried out, in terms of its potential effects. The HIV protective effect deserves substantial prominence in an article dealing with the medical effects of circumcision, or in an analogous article section, but here the significant prominence it currently enjoys in the lead seems undue: it effectively relegates the statuses of the actual procedure (and topic of the article), the methods of carrying it out (obviously directly related to the main topic), its use as a direct and immediate treatment for foreskin disorders (phenomena which are obviously intrinsically bound to the main article topic) for example, and it effectively promotes the status, in relation to the article topic, of a condition which may be prevented, in some cases, by the outcome of the procedure which constitutes the article topic, at some point remote in time (to a lesser or greater extent) from the point at which that procedure has been carried out. Beejaypii (talk) 14:42, 2 November 2011 (UTC)
This is getting to be an absurd gamesmanship. We state what the state of the art medicine states. Multiple reviews have found that it reduces the risk of HIV in certain populations, so we report it as such. Just because you, for reasons I do not understand, do not believe it deserves such prominence, does not mean you can arbitrarily change its prominence in the medical literature, and therefore the WP:WEIGHT we give it in our article. Yobol (talk) 14:54, 2 November 2011 (UTC)
That completely fails to address the issues relating to the definition of the topic subject I've raised. And what you qualify as "absurd gamesmanship" I would qualify as asking difficult questions/raising difficult issues. Beejaypii (talk) 15:38, 2 November 2011 (UTC)
I have already addressed what I can glean as an "issue" from your long posts. That you are trying to substitute your own judgment over the judgment of the medical community, who based on multiple reviews, thinks this is an important issue for the topic of circumcision makes me think there is gamesmanship afoot. Yobol (talk) 15:41, 2 November 2011 (UTC)
Again, could you try to address the issues instead of speculating about the motives of another editor and making broad statements which don't address the issues raised? Beejaypii (talk) 16:10, 2 November 2011 (UTC)
The important issue is this: how much weight do reliable sources about circumcision give to HIV? And the answer is: quite a lot. Jakew (talk) 16:14, 2 November 2011 (UTC)
It seems to me that the broader issue that Beejaypii & Garycompugeek have raised is the unusual importance given to African field research for an English-speaking audience. Joe Circus (talk) 16:17, 2 November 2011 (UTC)
Actually, I don't think they've mentioned it, but again the question is whether it is proportionate when compared with English-language reliable sources. Jakew (talk) 16:26, 2 November 2011 (UTC)
Perhaps someone would like to justify the prominence, in the lead, of information documenting a potential effect of the outcome of carrying out the surgical procedure which is defined as the main article topic. HIV related sources, when using phrases such as "circumcision reduces..." etc, cannot possibly be using the term in the narrow sense of carrying out the surgical procedure, as the article defines it, but must be using it in the sense of real or hypothetical instances of the procedure being carried out, in terms of its potential effects. The HIV protective effect deserves substantial prominence in an article dealing with the medical effects of circumcision, or in an analogous article section, but here the significant prominence it currently enjoys in the lead seems undue: it effectively relegates the statuses of the actual procedure (and topic of the article), the methods of carrying it out (obviously directly related to the main topic), its use as a direct and immediate treatment for foreskin disorders (phenomena which are obviously intrinsically bound to the main article topic) for example, and it effectively promotes the status, in relation to the article topic, of a condition which may be prevented, in some cases, by the outcome of the procedure which constitutes the article topic, at some point remote in time (to a lesser or greater extent) from the point at which that procedure has been carried out. Beejaypii (talk) 17:35, 2 November 2011 (UTC)
The pertinence of HIV to circumcision is backed up by the references in the text. Thus it is WP:DUE. Defining the topic more narrowly does not make sense as this is not how the term is used generally.--Doc James (talk · contribs · email) 17:40, 2 November 2011 (UTC)
Well said, Beejaypii...! One might say that deaf ears will never hear anything that disturbs their opinion. Joe Circus (talk) 17:43, 2 November 2011 (UTC)
We discuss the health effects of medications prominently in articles about medications. The same for procedures we should and do discuss their health effects.Doc James (talk · contribs · email) 17:46, 2 November 2011 (UTC)
I discuss prominence in the lead, above. Could you address that? Beejaypii (talk) 18:16, 2 November 2011 (UTC)
It has already been addressed. To quote Jakew's comment of 14:11, 2 November 2011 (UTC), "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. If reliable sources give it that much weight, it's only appropriate that we do the same." Perhaps you could address that. Jayjg (talk) 00:29, 3 November 2011 (UTC)
So you've made that point in the Introduction to the AIDS articles? Joe Circus (talk) 02:40, 3 November 2011 (UTC)
Yes it looks like circumcision attributes much more weight to HIV than HIV does to circumcision. Garycompugeek (talk) 03:06, 3 November 2011 (UTC)
Good. It should, since that's what reliable sources do. Jakew (talk) 09:16, 3 November 2011 (UTC)
"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. Beejaypii (talk) 11:22, 3 November 2011 (UTC)
As others have pointed out, Wikipedia generally does not take such a narrow approach to drugs and surgeries; it is typical for articles on these topics to cover consequences. Jakew (talk) 12:16, 3 November 2011 (UTC)
That fails to address the issues. I'm talking about prominence in the lead. Why respond with a general comment about article coverage? Beejaypii (talk) 12:22, 3 November 2011 (UTC)
The lead is supposed to be a short overview of the important points in the article. Thus, due weight for the article and due weight for the lead are tightly linked. Jakew (talk) 12:26, 3 November 2011 (UTC)
And that supports the current prominence of the HIV related issue in the lead in what way? Beejaypii (talk) 12:32, 3 November 2011 (UTC)
To save going around in circles, I invite you to read my previous explanations. Jakew (talk) 12:45, 3 November 2011 (UTC)
There's a roughly 300-word contribution by me above. Please point me to the previous explanations of yours which specifically address the points I make. If the issues I raise are not addressed directly I think I'll be entitled to assume that my points are valid and that the current relative prominence of the HIV issue in the lead is something which needs to be addressed through editing that selfsame lead. Beejaypii (talk) 12:57, 3 November 2011 (UTC)
These points have already been addressed, and we are going around in circles. Jakew (talk) 20:30, 3 November 2011 (UTC)
No, you're going round in circles by repeating pretty much what you said seven and three quarter hours ago. Either address the specific points I've made or point out where those specific points have already been addressed. Beejaypii (talk) 22:43, 3 November 2011 (UTC)
See my post dated 21:42, 1 November 2011 (UTC) and Doc James' post dated 17:40, 2 November 2011 (UTC). Jakew (talk) 09:29, 4 November 2011 (UTC)
See my post dated 15:30, 1 November 2011 (UTC) Garycompugeek (talk) 12:56, 4 November 2011 (UTC)

Yes, I've seen them Jakew. Therefore I repeat my request: either address the specific points I've made or point out where those specific points are addressed. To make it easier:

"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. Beejaypii (talk) 12:21, 4 November 2011 (UTC)

There's really no need to repeat yourself endlessly. The basis of your argument seems to be that the article is narrow in scope; hence why I cited posts that address this specific issue of narrow vs broad scope. Jakew (talk) 12:32, 4 November 2011 (UTC)
Wow very deep Jake. Beejaypii I feel a broader audience is necessary and an RFC is called for. Garycompugeek (talk) 13:02, 4 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, 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. Beejaypii (talk) 18:27, 6 November 2011 (UTC)

Why would you do that, when there is clearly neither a consensus nor a rationale for doing so? When will these pointy edits cease? Jayjg (talk) 18:38, 6 November 2011 (UTC)
I've started an WP:RFC on the issue. Jayjg (talk) 18:50, 6 November 2011 (UTC)
Firstly, it isn't clear there isn't a rationale, unless of course you'd like to enlighten me by addressing the specific points for which I've repeatedly invited a response. Secondly, I wrote the following earlier in the discussion:

If the issues I raise are not addressed directly I think I'll be entitled to assume that my points are valid and that the current relative prominence of the HIV issue in the lead is something which needs to be addressed through editing that selfsame lead.

Nobody responded to that either, so I made the assumption described and edited accordingly. Does that explain things for you?
As for the WP:RFC, it was obviously going to be the next step. Beejaypii (talk) 18:56, 6 November 2011 (UTC)
Additionally, Jayjg, would you mind explaining exactly why you think my edit was pointy? I've read the behavioural guideline in question myself and I don't understand how you've arrived at that conclusion. Beejaypii (talk) 19:39, 6 November 2011 (UTC)

Humor in Circumcision

So many jokes about circumcision in movies & on television. A section for the culture of humor that has evolved around circumcision would be enlightening. Someone said that circumcision is a one-ring circus -- Wikipedia should tap that humor to broaden its approach. Joe Circus (talk) 03:28, 24 October 2011 (UTC)

If no one objects to a "Circumcision Jokes" addition to this article, I'll make a compilation of the best jokes and edit the article with the new section "Circumcision Humor in Popular Culture" and appropriate references. Joe Circus (talk) 18:38, 27 October 2011 (UTC)
I'm concerned that such a section would be unencyclopaedic. It would be necessary to adhere to the advice in WP:POPCULTURE. Jakew (talk) 19:26, 27 October 2011 (UTC)
I'm pretty confident that jokes would not assist this article as they would not add to an understanding of the topic. It could be argued that jokes would provide some insight into attitudes in society, but that would need scholarly referencing and would be a topic for another article. Johnuniq (talk) 22:56, 27 October 2011 (UTC)
I agree with Jakew and Johnuniq on this; it doesn't seem encyclopedic, nor would it add to the understanding of the topic. Do articles on other types of surgery have "Humor in popular culture" sections? I haven't seen any. Jayjg (talk) 03:44, 28 October 2011 (UTC)
I for one fail to see any humor in circumcision. Garycompugeek (talk) 14:21, 28 October 2011 (UTC)
There's a culture of humor that's evolved in the last 30 years or so... perhaps an older generation of readers can't appreciate it, but it's not going away soon. Here's a sample for consideration:
http://www.awordinyoureye.com/category%20jokes%20bris%20and%20mohel.html
SETH ROGEN'S CIRCUMCISION JOKES The "Knocked Up" actor has been making penis gags since a mohel - someone who performs the Jewish circumcision ritual of Brit milah - hired him when he was a teenager. Seth, 26, told E!: "My first break was when I did stand up comedy at a lesbian bar for the first time, and it went well. Soon after that I was hired by a mohel to write jokes. He saw me perform and he wanted his circumcision ceremonies to be funny. He approached me - I was 15 years old - and he said to me, 'I'll pay you $50 an hour to write circumcision jokes for me.' So, I did it. See - I've been writing d**k jokes since day one." http://news.celebritywonder.com/2009/03/26/Seth_Rogen_s_Circumcision_Jokes.html
There's a classic standup routine on YouTube as well: http://www.youtube.com/watch?v=vY3Be9MxTSw In summary, there is indeed a cultural phenomenon taking place that should rightfully have a place in this article. Joe Circus (talk) 20:07, 28 October 2011 (UTC)
There should be no further discussion of this until the points raised above are addressed. In particular, scholarly sources are required, not just an editor's selection of youtube and other jokes. Johnuniq (talk) 22:49, 28 October 2011 (UTC)
The problem with an edict that declares further discussion off-limits is that it would appear to discourage the critical thinking & scholarship necessary to create a section on Circumcision Humor in Popular Culture. Certainly there's no dearth of scholarship on the role of Humor in Society -- it would be inappropriate to discourage a discussion that might lead to a discovery of, or scholarship in, the role of humor in circumcision as well. Joe Circus (talk) 02:01, 2 November 2011 (UTC)
This is a case where Wikipedia is way behind the curve. EditTalk (talk) 03:10, 9 November 2011 (UTC)

Problematic "compromise"

PassaMethod has imposed a "compromise"[19], in which he has moved the HIV paragraph from the lead to a subsection of "modern procedure".

The consequences of this are as follows:

  1. HIV is now discussed in two separate sections: section 3.4 (the "Sexually transmitted diseases" subsection of the "Medical aspects" section) and the new section 1.1 (the "HIV" subsection of the "Modern procedure" section). This doesn't make sense. How does the reader possibly benefit by splitting coverage in this way?
  2. The placement of section 1.1 is inexplicable. "Modern procedure" describes how circumcision is done (surgical techniques, in other words). But the newly-added "HIV" subsection isn't about how it is done at all. It's about why it's done and what are the consequences of doing it.
  3. The last two sentences of the "HIV" section do not belong here. Along with the sentence beginning "The WHO currently recommends circumcision as part..." (which is relevant to HIV as well), they act as a summary of section 7, "Positions of medical associations".
  4. Per WP:LEAD, "The lead should be able to stand alone as a concise overview. It should define the topic, establish context, explain why the topic is interesting or notable, and summarize the most important points—including any prominent controversies." But the lead no longer even mentions one of the most important and notable points about circumcision.

While I appreciate the intent to compromise, this "compromise" received no discussion and has too many serious problems. I encourage PassaMethod to self-revert. Jakew (talk) 10:22, 8 November 2011 (UTC)

I've reverted, because given that the RFC above is about whether or not to retain the information in the lede, it's disingenuous to claim that removing it from the lede is a "compromise". PassaMethod, please do not try to unilaterally impose a new lede until the RFC actually closes. Jayjg (talk) 11:43, 8 November 2011 (UTC)

"WHO currently recommends circumcision..."

Regarding the intro. Does WHO recommend circumcision for adults or for infants? I see a major difference between the two because with the former you give consent, but with the latter it is without consent and often irreversible. It's pretty strange this is not clarified. Pass a Method talk 01:49, 9 November 2011 (UTC)

Amen! What an embarrassing question! EditTalk (talk) 02:40, 9 November 2011 (UTC)
"Embarassing question?" In what way? Also, why have a large number of new IP and usernamed editors suddenly shown up here to comment? I count three in the last eight hours alone. Oh wait, no need to ask - yet another off-wiki campaign on some anti-circumcision bulletin board has brought them all here. Care to enlighten us as to which one it is this time? Jayjg (talk) 02:53, 9 November 2011 (UTC)
so this is your life to track the article? okay with me. newcomers not welcome? wow, let's hold the line with personal attacks. there's a ton of people out here who despise the current article for its misinformation. EditTalk (talk) 03:00, 9 November 2011 (UTC)
FYI: So long as off-wiki coordination produces results like this, the newcomers will not be taken seriously by regular editors. People who use Wikipedia for any kind of battle or advocacy are not welcome. Anticipating a reply which might be made (please do not make it), if someone acts like a good editor, they are treated as a good editor. Anyone wanting to contribute to Wikipedia needs to invest some time in learning how things work here. Johnuniq (talk) 03:21, 9 November 2011 (UTC)
FYI please submit proof of off wiki canvassing or strike your comments and start assuming good faith.Garycompugeek (talk) 15:50, 9 November 2011 (UTC)
Here are a few:
-- Avi (talk) 16:34, 9 November 2011 (UTC)
I have diligently went through each link you have provided Avi and see no proof that anyone currently involved in discussion on this page is linked to discussions on said links. Just because people have animosity towards wikipedia's circumcision article does not mean they are directly involved in our discussions. If proof is established then that user or users will be dealt with according to wikipedia policy but until then stop perpetuating this charade. Garycompugeek (talk) 17:43, 9 November 2011 (UTC)
Given the pattern of off-site canvassing that Avi has so clearly demonstrated, Gary, it seems entirely reasonable to suppose that strange or unusual patterns of editing might be related to it. Don't you think? Jakew (talk) 18:16, 9 November 2011 (UTC)
7 billion people on the planet Jake. I'm sure a few of them are unhappy with a controversial topic like circumcision. Just because you can do a google search and easily find discussion boards against circumcision is certainly no proof that they are the same people in this discussion. Am I to assume every time someone shows up with a different view point than my own that they are part of a secret cabal off wiki? This article is in the top 100 hits in Wikipedia. You have no idea how many stalkers regularly visit this page and chime once in a while, not to mention Circumcision is listed in Request for comment. If I hear anymore mention of this without proof there will be repercussions. Garycompugeek (talk) 01:20, 10 November 2011 (UTC)
Are you guys suggesting I want my son to get AIDS because he's intact? California Mom (talk) 18:44, 9 November 2011 (UTC)
G-d forbid, not at all. My point is solely to show that there exist various organized operations to edit the Circumcision article on the English Wikipedia project in a fashion which will emphasize and underscore the position of people who are fundamentally opposed to circumcision (intactivists, genital integritists, etc.) The request was to "submit proof of off wiki canvassing," and that has been done—no more, no less. -- Avi (talk) 19:16, 9 November 2011 (UTC)
As an aside, being that you have just joined wikipedia today, and that this is your second edit, how did you find out about this particular issue and talk page? -- Avi (talk) 19:19, 9 November 2011 (UTC)
The word is getting around that this article is slanted toward circumcision. I didn't realize one had to belong to a certain club to join the discussion. EditTalk (talk) 22:36, 9 November 2011 (UTC)
Do you mean to say that outside Wikipedia word is getting around that there is an article on Wikipedia that is slanted toward circumcision?--Taylornate (talk) 22:42, 9 November 2011 (UTC)
Here's my opinion as a new mom. Circumcision is like spanking because it's a punishment. I'm just glad that I was born a girl. Anyway, hardly anyone in California spanks or circumcises their kids anymore. You guys arguing about AIDS don't have a clue. California Mom (talk) —Preceding undated comment added 16:28, 10 November 2011 (UTC).
You might find WP:NOTFORUM helpful, California Mom. Jakew (talk) 17:23, 10 November 2011 (UTC)
How is a discussion about editorial direction a forum? aids prevention in this article is a red herring. EditTalk (talk) 18:45, 10 November 2011 (UTC)
This talk page isn't for people to post their personal opinions about circumcision. It's for discussion about the article. Jakew (talk) 19:28, 10 November 2011 (UTC)

Hey, mate, saw a lot of personal opinion in you posting all those links about off-wiki trespassers. If a gang of Brits hijacked the editorial direction of this article, where would it be discussed? Aussie1947 (talk) 20:16, 10 November 2011 (UTC)

California Mom, you speak for a lot of people. Thank you for your humanity. Wikipedia values this article at the bottom of the pile, as you can see from its "Class B Rating for emphasizing religious views." http://en.wikipedia.org/wiki/Talk:Circumcision/Comments From Wikipedia, the free encyclopedia
I was bold and rated it as a class B page for these reasons; It is not NPOVed, the section layout heavily emphasizing religious views. It is too much text(122Kbytes), the article should probably be split if possible.
Retrieved from "http://en.wikipedia.org/w/index.php?title=Talk:Circumcision/Comments&oldid=96529201"
Off-wiki-gal (talk) 21:30, 10 November 2011 (UTC)
That comment was dated 09:27, December 26, 2006‎. Approximately five years have elapsed since then; it seems likely that at least some of the issues no longer apply. In any case it's difficult to see the relevance of such comments to this increasingly chaotic section. Jakew (talk) 22:21, 10 November 2011 (UTC)
good try at deflection from the still-current low value that wikipedia puts on this article for the reasons as stated. (It is not NPOVed, the section layout heavily emphasizing religious views.) we've got some new blood who are going to straighten it out. personal attacks on new editors, such as your insulting characterization, "increasingly chaotic section", indicate a peculiar point of view about the benefits of collaboration. do you know the identity of the young guy who advertised his photo in the link you posted in the group above? https://www.facebook.com/pages/Circumfetishists-Edit-Wiki-Circ-Article-etc/136694003065683 Off-wiki-gal (talk) 23:40, 10 November 2011 (UTC)
Another editor actually got it off track by linking to all those websites. The discussion here, mates, is whether the emphasis on HIV protection advocates a pro-circumcision bias in the article. I for one vote that HIV does not belong in the introduction. Aussie1947 (talk) 01:46, 11 November 2011 (UTC)
Emphasis on HIV is tabloid sensationalism: shock and scare the reader. EditTalk (talk) 05:58, 11 November 2011 (UTC)
So when all these recent medical studies and papers and the World Health Organization emphasize HIV, is that "tabloid sensationalism: shock and scare the reader"? Please make responses that are related to verifiable facts, rather than personal opinions. Jayjg (talk) 18:04, 11 November 2011 (UTC)

(unindenting) To return to the original question ("Does WHO recommend circumcision for adults or for infants"), the answer is "both":

[Recommendation 7.2]: "Such countries should consider scaling up access to male circumcision services as a priority for adolescents, young men, and as indicated by the local epidemiology and other considerations, older men at particularly high risk of HIV."
[Recommendation 7.3]: "Since neonatal circumcision is a less complicated and risky procedure than circumcision performed in young boys, adolescents or adults, such countries should consider how to promote neonatal circumcision in a safe, culturally acceptable and sustainable manner."

(Source) Jakew (talk) 10:43, 11 November 2011 (UTC)

It looks to me as if WHO, in the two extracts you quote above Jakew, recommend that a) certain countries should consider scaling up access to male circumcision services b) those countries should also consider how to promote neonatal circumcision. That isn't actually WHO recommending that the surgical procedure circumcision be carried out. In fact, the only passage I've found in the whole text which comes close to that is:
  • 10.2 If medically indicated, male circumcision should be provided to all men irrespective of HIV status.
And ever there the word provided is ambiguous. I suspect, and I may be entirely wrong, that WHO have been extremely careful not to prescribe the procedure themselves. Beejaypii (talk) 23:38, 11 November 2011 (UTC)

Listen, you guys, as a loving Mom, I can tell you that your introduction seems designed to encourage parents to circumcise their little one to prevent Aids when he grows up. No one cares about your who document... that's for third-world people... I don't know anyone who's ever consulted who for medical advice. Get real, guys! California Mom (talk) 15:55, 11 November 2011 (UTC)

"Third world people" are no less important; Wikipedia needs to discuss issues regardless of where those most affected live. Please see Wikipedia:Neutral point of view/FAQ#Anglo-American focus. Jakew (talk) 16:23, 11 November 2011 (UTC)
Ca Mom, I don't know who's ever consulted Wikipedia for medical advice, either. In fact WP even tells you not to (see above). I think that any educated person wouldn't rely on the internet for such data and advice (care to sample any of the various mushrooms that the internet says aren't poisonous, either?). Your comment is not relevant to the content of the article, which is supposed to be encyclopedic not constitute medical advice. Carlossuarez46 (talk) 18:05, 11 November 2011 (UTC)
I suggest that the above disclaimer be prominently displayed at the top of the article. Other editors have been kind enough to post links in this section that indicate some people had a pro-circumcision agenda that wormed its way into the article. Ca mom, I agree with you and other editors about the pro-circ bias with the AIDS scare in the introduction. How come there's nothing from any national medical societies that affirms the AIDS paranoia? EditTalk (talk) 18:32, 11 November 2011 (UTC)
If you think that medical articles should display a more prominent disclaimer, it's probably best to propose that at WT:MEDMOS. Jakew (talk) 18:42, 11 November 2011 (UTC)

Note: several editors involved in the above discussion turned out to be sockpuppets of Joe Circus (talk · contribs). Jakew (talk) 19:14, 11 November 2011 (UTC)

I've struck through the comments of the sockpuppets of the blocked editor. Jayjg (talk) 21:18, 11 November 2011 (UTC)
I've done the same with the newly-identified socks. Jakew (talk) 10:00, 12 November 2011 (UTC)

So, continuing the discussion, you posted the following above, Jakew:

To return to the original question ("Does WHO recommend circumcision for adults or for infants"), the answer is "both":
[Recommendation 7.2]: "Such countries should consider scaling up access to male circumcision services as a priority for adolescents, young men, and as indicated by the local epidemiology and other considerations, older men at particularly high risk of HIV."
[Recommendation 7.3]: "Since neonatal circumcision is a less complicated and risky procedure than circumcision performed in young boys, adolescents or adults, such countries should consider how to promote neonatal circumcision in a safe, culturally acceptable and sustainable manner."
(Source) Jakew (talk) 10:43, 11 November 2011 (UTC)

It looks to me as if WHO actually recommend that a) certain countries should consider scaling up access to male circumcision services b) those countries should also consider how to promote neonatal circumcision. That isn't actually WHO recommending that the surgical procedure circumcision be carried out. In fact, the only passage I've found in the whole text which comes close to that is:

  • 10.2 If medically indicated, male circumcision should be provided to all men irrespective of HIV status.

And even there the word provided is ambiguous. I suspect that WHO have been extremely careful not to prescribe the procedure (the topic of this article) themselves. If that's the case, it's misleading to state "The WHO currently recommends circumcision..." supported by the text in question. Oh, and my points about the undue prominence in the lead of the HIV info still stand. Beejaypii (talk) 23:38, 11 November 2011 (UTC)

That seems a distinction without a difference, Beejaypii, but if you wish we can reword along the lines of "...recommends the provision and promotion of..." Jakew (talk) 10:06, 12 November 2011 (UTC)
You're suggesting that there's no difference between "WHO recommends circumcision..." and "WHO recommends that X should consider promoting circumcision" or "WHO recommends that X should consider increasing access to circumcision services"?
And while we're discussing this section of the lead, consider the following two sourced statements:
  • "There is weak evidence that circumcision has a direct protective effect on HIV infection in women."
  • "There is also no evidence that MC protects women with HIV-positive partners or that it offers protection during anal intercourse."
Are those two statements accurately and honestly summarised by "Evidence of benefit for women is controversial"? I'd say "no". The structure of the summarising sentence implies that there IS evidence of benefit but it's controversial in some way. Two sources, one asserting weak evidence, and the other asserting no evidence, have been summarised with an assertion that the evidence is controversial. That assertion presupposes the existence of the evidence ("Evidence of benefit for women is..."), directly contradicting one of the two sources, and implying that the controversy cannot be related to the existence, or not, of the evidence (because its existence is presupposed in the summarising statement) but must be related to some other aspect of the nature of that evidence. Beejaypii (talk) 12:29, 12 November 2011 (UTC)
I can't think of any situation in which someone would recommend promoting something unless one believed that the thing being promoted is desirable. However, I'm quite happy to consider alternative phrasing if you'd like to suggest something (or maybe comment on my suggestion?). Regarding your next point, I don't see a problem here: if there's controversy over whether there's evidence, surely that means the evidence is controversial? Anyway, again, if you'd like to propose an alternative phrasing, that's probably the most productive way forward. Jakew (talk) 19:49, 12 November 2011 (UTC)
It's the existence of the evidence which is controversial, according to the two sources referenced. One source claims there is weak evidence, the other claims there's no evidence. That cannot be adequately expressed with "Evidence...is controversial".
"I can't think of any situation in which someone would recommend promoting something unless one believed that the thing being promoted is desirable." Really? How about if you have what you believe to be strong evidence that a medical procedure will have a particular effect but you can't rule out the possibility that the effect might not be as the evidence suggests, long term, due to other factors (like human behaviour for example). In other words you're not entirely sure that the thing you might otherwise recommend directly will actually have a desirable outcome. Might you not then recommend that, based on the evidence, other decision making entities consider offering the medical procedure more widely and that they fully inform potential circumcision candidates? That way you ensure the burden of responsibility is largely transferred away from yourself, just in case. That's speculation of course, but it's an example of the type of situation you couldn't think of.
Anyway, if the WHO don't actually recommend circumcision they surely have their reasons for doing so - perhaps legal and/or ethical (it would be naive to think that an organisation of their standing would not take great care over such matters). I don't think it's the place of this article to sidestep that by attributing something to them that they haven't expressed, unless you can find somewhere where they do express it directly of course (I doubt you will).
As for your suggestion, "Recommends the provision and promotion of...", it still doesn't quite do it, because WHO recommend that those things be "considered". Also, I think the document you cited in this discussion isn't the current source for that part of the lead. Beejaypii (talk) 23:02, 12 November 2011 (UTC)
I await your suggestions with interest. Jakew (talk) 09:15, 13 November 2011 (UTC)
My suggestion is that the prominence of the HIV information in the lead be significantly reduced in view of the fact that it's not intrinsically related to the main article topic because what relationship to the main topic it has is dependent on so many other factors. In fact, that's why it's difficult to summarise the relationship in the lead, unless it's very concise: so much has to be covered as soon as any level of undue detail is introduced. I suggest something along the lines of "Furthermore, due to research suggesting that circumcised men have statistically less risk of acquiring HIV infection in specific circumstances, circumcision is currently being promoted as an additional strategy in the context of comprehensive HIV prevention packages." That seems to concisely summarise the HIV issue, in keeping with its prominence in the article as a whole (i.e. very little prominence), and drawing attention to the fact that circumcised status and other factors are the key, and not just the surgical procedure itself. The issue of evidence for a protective effect for women, either non-existent, or "weak" if it does exist, doesn't seem notable enough for mention in the lead. Furthermore, inaccurate assertions that circumcision is being directly recommended by WHO are avoided. In addition to making this change I suggest removing the whole of the current paragraph three from the lead: controversy surrounding circumcision is concisely summarised in paragraph four, so the non-HIV related portion of paragraph three can also be removed. Beejaypii (talk) 12:53, 13 November 2011 (UTC)
Might I request some suggestions that actually address the issues you raised, rather than using them as leverage to do something else? Jakew (talk) 13:44, 13 November 2011 (UTC)
Like this, for example:
  • Circumcision reduces the risk of HIV infection in heterosexual populations that are at high risk.[12][13] Evidence among heterosexual men in sub-Saharan Africa shows a decreased risk of between 38 percent and 66 percent over two years[14] and in this population it appears cost effective.[15] The existence of evidence of benefit for women is controversial[16][17] and evidence of benefit in developed countries and among men who have sex with men is yet to be determined.[18][19] The WHO currently recommends consideration of provision and promotion of circumcision as part of a comprehensive program for prevention of HIV transmission in areas with high endemic rates of HIV.[20] Ethical concerns remain regarding the implementation of campaigns to promote circumcision.[21] According to the Royal Dutch Medical Association (2010), no professional association of physicians currently recommends routine circumcision.[22] Some bodies have discussed under what circumstances neonatal circumcision is ethical.[23]
Jakew (talk) 14:05, 13 November 2011 (UTC)
Firstly, my suggestions did address the issues, just not in a way you approve of it seems:
"The issue of evidence for a protective effect for women, either non-existent, or "weak" if it does exist, doesn't seem notable enough for mention in the lead. Furthermore, inaccurate assertions that circumcision is being directly recommended by WHO are avoided."
The notion that the problems with the two phrases under discussion were actually tied to the problem of emphasising an issue in the lead which depends on so many other factors for its relevance to the article topic occurred to me whilst considering my response.
Your suggestions have increased the size of the HIV section in the lead, and there are still problems. Is it accurate to qualify the existence of weak evidence, or very little evidence (I've seen that in a relevant source I'm sure) versus no evidence (of benefit for women) as "controversial"? That could mean there's evidence some consider strong but some consider invalid, for example. Additionally "Circumcision reduces the risk of HIV infection in heterosexual populations that are at high risk." From what part of the two relevant sources does that come? It's not Krieger, because that review suggests the evidence is conclusive. That's not the same as absolute, unqualified absence of doubt, but the current phrase in the lead suggests it is. So is it from Tobian and Gray? Well, they talk about "substantial evidence" but certainly don't make absolute assertions of the sort found in the lead at the moment. I think I can see how the phrase in question found its way into the lead. Someone has read "This review evaluates the scientific evidence suggesting that male circumcision reduces HIV infection risk in high-risk heterosexual populations" and "The evidence from these biological studies, observational studies, randomized controlled clinical trials, meta-analyses, and cost-effectiveness studies is conclusive", from Krieger, and, applying a bit of OR, concluded that there's no room for doubt. Unfortunately, just because a source refers to evidence as "conclusive" that does not mean that the proposition supported by that evidence is incontrovertible fact. The lead is misleading, in yet another respect.
As a speculative and rhetorical aside, if careful examination of just a few phrases in the lead raises issues such as these, to what extent is the entire article afflicted with subtle misrepresentation of sources etc? Beejaypii (talk) 20:59, 13 November 2011 (UTC)
Well, feel free to suggest alternative wording at any time. I see no problem with the way it is currently phrased, so there's no hurry as far as I'm concerned. Jakew (talk) 21:12, 13 November 2011 (UTC)
My suggestion is that prominence of the HIV information is reduced in the lead because, due to its indirect relationship to the main article topic, it doesn't deserve such prominence. So much additional intermediate detail has to be covered to summarise the HIV issue accurately and honestly in the lead precisely because the factors upon which it depends for its relationship to the main article topic have to be addressed. The HIV issue is also taking prominence over issues which are indeed intrinsically related to the main article topic, and which appear in the article body, but currently aren't mentioned in the lead, and that despite the HIV issue's own relatively low prominence in the article as a whole. That's my position. Therefore I suggest that the following concise summary of the HIV issue be added to the end of the second paragraph of the current lead:
"Furthermore, strong evidence that circumcised men have statistically less risk of acquiring HIV infection, in specific circumstances, has led to the promotion of circumcision as an additional strategy in the context of comprehensive HIV prevention packages."
Paragraph three can then be removed entirely, leaving space for information about other aspects of the main topic which are currently absent from the lead, or simply leaving the lead much more concise. Beejaypii (talk) 21:59, 13 November 2011 (UTC)
In other words, this:
Male circumcision is the surgical removal of some or all of the foreskin (prepuce) from the penis.[1] The word "circumcision" comes from Latin circum (meaning "around") and cædere (meaning "to cut"). Early depictions of circumcision are found in cave paintings and Ancient Egyptian tombs, though some pictures are open to interpretation.[2][3][4] Religious male circumcision is considered a commandment from God in Judaism.[5][6] In Islam, though not discussed in the Qur'an, male circumcision is widely practised and most often considered to be a sunnah.[7] It is also customary in some Christian churches in Africa.[8]
Global estimates by the World Health Organization (WHO) suggest that 30 percent of males are circumcised, of whom 68 percent are Muslim.[9] The prevalence of circumcision varies mostly with religious affiliation, and sometimes culture. Most circumcisions are performed during adolescence for cultural or religious reasons;[10] in some countries they are more commonly performed during infancy.[9] Circumcision is also used therapeutically, as one of the treatment options for balanitis xerotica obliterans, paraphimosis, balanitis, posthitis, balanoposthitis and urinary tract infections.[11] Furthermore, strong evidence that circumcised men have statistically less risk of acquiring HIV infection, in specific circumstances, has led to the promotion of circumcision as an additional strategy in the context of comprehensive HIV prevention packages.
There is controversy regarding circumcision. Arguments that have been raised in opposition to circumcision include that it adversely affects penile function and sexual pleasure, is justified only by medical myths, is extremely painful, and is a violation of human rights.[24] Those raised in favour of circumcision include that it provides important health advantages which outweigh the risks, has no substantial effects on sexual function, has a low complication rate when carried out by an experienced physician, and is best performed during the neonatal period.[25]
With an appropriate reference or two at the end of para two, of course. Beejaypii (talk) 22:04, 13 November 2011 (UTC)

I'd heard that certain creeps on this page declare everyone a sock puppet who disagrees with them -- what a shame. You don't want discussion at all, do you? Offwikigal2 (talk) 23:45, 11 November 2011 (UTC)

  • Actually I have nothing to do with this page, but I blocked the accounts (and you) because they are technically confirmed sockpuppets. Discussion is fine, but abusing multiple accounts is not. The rule is one editor, one account. If you cannot follow this then don't expect to edit here. WilliamH (talk) 00:21, 12 November 2011 (UTC)
  • Please also note that if you continue to sockpuppet when your main account's block is up, or continue to attack other editors, then your main account will be blocked or banned. Jayjg (talk) 16:34, 13 November 2011 (UTC)

I suggest making a table similar to one at Talk:Haida Gwaii#Metrics to establish most common name, listing type of source (web, book, news, scholarly article etc.), percentage which mention or emphasize HIV or AIDS, and brief description of analysis, e.g. Google search for "circumcision" first 20 hits. ☺Coppertwig (talk) 19:43, 13 November 2011 (UTC)

International Journal of Epidemiology

According to a study in International Journal of Epidemiology[20][21] circumcised men have harder reaching orgasm and their partners too as well as vaginal pain. Add to article? // Liftarn (talk)

It's already discussed in Sexual effects of circumcision#Ejaculatory function, along with other studies. It shouldn't be included here, as it's a primary source. We should rely upon secondary sources instead, and we should really reduce the number of primary sources cited in the article. Jakew (talk) 13:54, 15 November 2011 (UTC)
Agree with Jake but thanks Liftarn for coming to the talk page and discussing with us beforehand. Garycompugeek (talk) 14:09, 15 November 2011 (UTC)
It's published in a peer reviewed scientific journal so as a source it's top notch. As for being a primary source the primary source would be the persons in the study while the study itself is a secondary source. // Liftarn (talk)
Please see WP:MEDRS#Definitions. Jakew (talk) 16:43, 15 November 2011 (UTC)

Norway

A suggested law proposal has been issued by Norway's government, so that free circumcisions can be provided at public hospitals. Link, [22]--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 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)

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."[23]. 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."[24] 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[25][26] 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,[5] and among high-risk populations it appears cost effective.[6] The WHO currently recommends circumcision as part of a comprehensive program for prevention of HIV transmission in areas with high endemic rates of HIV.[7] According to the Royal Dutch Medical Association (2010), no professional association of physicians currently recommends routine circumcision.[8]

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,[5] and among high-risk populations studies find it cost-effective.[9]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.[7] Ethical concerns remain regarding the implementation of campaigns to promote circumcision.[10] According to the Royal Dutch Medical Association (2010), no professional association of physicians currently recommends routine circumcision.[8] Some bodies have discussed under what circumstances neonatal circumcision is ethical.[11]

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.[12][13] Evidence amongheterosexual men in sub-Saharan Africa shows a decreased risk of between 38 percent and 66 percent over two years[5] and in this population it appears cost effective.[14] Evidence of benefit for women is controversial[15][16] and evidence of benefit in developed countries and among men who have sex with men is yet to be determined.[17][18] The WHO currently recommends circumcision as part of a comprehensive program for prevention of HIV transmission in areas with high endemic rates of HIV.[7] Ethical concerns remain regarding the implementation of campaigns to promote circumcision.[19]According to the Royal Dutch Medical Association (2010), no professional association of physicians currently recommends routine circumcision.[8] Some bodies have discussed under what circumstances neonatal circumcision is ethical.[20]

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. This is just verification of the co-occurrence of one term together with either of two other terms in 10 results out of over 50000.
books 2% Google Books search for "circumcision hiv" as fraction of search for "circumcision"
literature reviews (any time) 29% PubMed search for "circumcision hiv" as fraction of search for "circumcision". Using "limits" restrict to reviews. Only demonstrates the fraction of biomedically related sources which reference the term "HIV" from amongst sources of the same kind which reference the term "circumcision". Also suffers from similar newsworthiness problems as the news search results below.
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. Only demonstrates the fraction of biomedically related sources which reference the term "HIV" from amongst sources of the same kind which reference the term "circumcision". Also suffers from similar newsworthiness problems as the news search results below.
"reliable source" books
recent books (since RCT's) 6% Since 2005. Google Books search for "circumcision hiv" as fraction of search for "circumcision"
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. Just a test of recent newsworthiness. Says nothing about the importance of HIV to the topic of circumcision compared to non-controversial, established aspects of the topic.
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."[21] 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[27] [28]. Twenty four were positive[29] [30] [31] [32] [33] [34] [35] [36] [37] [38] [39] [40] [41] [42] [43] [44] [45] [46] [47] [48] [49] [50] [51] [52]. 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

"There is strong evidence that circumcision reduces the risk of HIV infection in heterosexual men" promotes confusion about the discredited HIV studies. — Preceding unsigned comment added by Mock The Knife (talk • contribs) 16:41, 20 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)

  •  Done - Your edit seems more or less reasonable so I have done it - we don't usually link to words like that - at least not to my experience but in this case it seems to be beneficial to disambiguate from the joke and to add detail for the reader. You are not "warned" but I will drop a note on your talkpage. Youreallycan (talk) 00:05, 21 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)

Space in the lede is at a premium, and should be about circumcision. The parenthetical note "(recorded words and actions of the prophet Muhammed)" would not be appropriate there, as readers can click on the word "sunnah" instead if they with to know more. Jayjg (talk) 18:27, 20 December 2011 (UTC)


Review article being removed

We have content supported by review articles being removed. Not sure why? Doc James (talk · contribs · email) 00:33, 21 December 2011 (UTC)

The content was not supported by the articles. Concluding that "weak evidence" and "no evidence" is a controversy is OR and not NPOV. Additionally, describing evidence as "yet to be determined" is similarly not NPOV, implying, as it does, that the evidence will be determined at some point. Additionally, you blindly reverted the edit I made to the bit about the WHO's recommendation, which was additional clarification. It seems as if you reverted without checking what you were reverting, and by your own admission ("Not sure why?") without really knowing why you were reverting it. Beejaypii (talk) 00:51, 21 December 2011 (UTC)
This is called paraphrasing which is essential due to issues of copyright infringement. Have made it closer to the refs in question to address the concerns here. Also the lead is just an overview thus returned to bit on economics to how it was before. The rest of the details can be discussed in the body of the article.Doc James (talk · contribs · email) 01:16, 21 December 2011 (UTC)
"This is called paraphrasing" I know what paraphrasing is thanks. I've edited the reference to the economic evaluations because, as addressed in a previous edit summary, the simple present tense in English can be interpreted to indicate habitual, repetitive action (e.g. "People live in houses", "Studies find..."). The cited source looked at five economic evaluations. That does not support the global, non-specific statement "Studies find..." Beejaypii (talk) 01:39, 21 December 2011 (UTC)

We currently have "and a review of five economically evaluative studies found they concluded it is cost effective in this population" why not just "and concluded it is cost effective in this population"? A "a review of five economically evaluative studies" is not needed as everything in the lead is a review.Doc James (talk · contribs · email) 01:42, 21 December 2011 (UTC)

Your suggestion does not make sense. I think you mean to suggest a change to "...and a review of five economically evaluative studies concluded it is cost effective in this population." If that's what you mean, I don't think the source supports it. The source concludes:

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. 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.

They aren't concluding that circumcision is cost-effective; they're concluding that five studies found it was and therefore "it may be seen as a promising..." And consider the study authors' own discussions of the limitations of their review and the studies they reviewed:

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.

It's hardly surprising they hedge their bets by preceding their conclusions with "on these grounds" instead of just asserting "we conclude that circumcision is cost-effective"; I don't think they do that anywhere, so we shouldn't attribute that to them in the article. Beejaypii (talk) 02:06, 21 December 2011 (UTC)

Learn from the Dutch

Wikipedia could learn something from the KNMG physicians’ federation, which represents over 53,000 physicians and medical students. KNMG member organisations include the Koepel Artsen Maatschappij en Gezondheid (Umbrella organisation for physicians and health – KAMG), the Landelijke vereniging van Artsen in Dienstverband (National society of employee physicians – LAD), the Landelijke Huisartsen Vereniging (National society of general practitioners – LHV), the Netherlands Society of Occupational Medicine (NVAB), the Nederlandse Vereniging voor Verzekeringsgeneeskunde (Netherlands society of insurance medicine – NVVG), the Orde van Medisch Specialisten (Order of medical specialists – OMS) and the Dutch Association of Elderly Care Physicians and Social Geriatricians (Verenso).

"There is no convincing evidence that circumcision is useful or necessary in terms of prevention or hygiene." http://knmg.artsennet.nl/Publicaties/KNMGpublicatie/Nontherapeutic-circumcision-of-male-minors-2010.htm — Preceding unsigned comment added by Mock The Knife (talk • contribs) 18:00, 21 December 2011 (UTC)

We already cite the KNMG's statement in the Netherlands section. Jakew (talk) 18:18, 21 December 2011 (UTC)

From the Introduction: "According to the Royal Dutch Medical Association (2010), no professional association of physicians currently recommends routine circumcision." That's a misdirection from the core position of the KNMG, "There is no convincing evidence that circumcision is useful or necessary in terms of prevention or hygiene." The current statement doesn't offer a counterbalance to the "strong evidence" in favor of circumcision that Wikipedia promotes in the Introduction. — Preceding unsigned comment added by Mock The Knife (talk • contribs) 17:27, 22 December 2011 (UTC)

The first example uses the KNMG as a secondary source for summarising the positions of many other organisations. The latter is just the viewpoint of one organisation, and probably isn't important enough to be cited in the lead. Jakew (talk) 19:40, 22 December 2011 (UTC)

Recent change to lead

I reverted a recent change to the lead, as it seemed to paint a misleading picture of the literature.

The first problem was "There is weak to no evidence of benefit for women". This doesn't seem to be a neutral reflection of the literature. Hallett et al[53] wrote:

Next we conducted a meta-analysis of data from the two independent observational cohorts19 36 on the long-term effect of male circumcision on male-to-female HIV transmission. The overall fixed-effect point-estimate hazard rate was 0.54 (95% CI 0.31 to 0.96) (p1⁄40.04), indicating 46% reduction in transmission rate from 2 years after the operation. [...] Our meta-analysis of the best available cohort data suggests that male circumcision reduces the chance of male-to-female HIV transmission with a latent interval of at least 2 years,18 19 and that this substantially amplifies the potential impact of circumcision interventions in populations.

Larke et al[54], wrote:

Although at a population-level, widespread male circumcision will benefit women by reducing their risk of exposure to HIV, there are insufficient data to know whether circumcision directly reduces risk of women becoming infected with HIV.

A second problem was the statement that there is "no evidence of benefit in developed countries and among men who have sex with men". The most recent Cochrane review[55] stated:

Current evidence suggests that male circumcision may be protective among MSM who practice primarily insertive anal sex, but the role of male circumcision overall in the prevention of HIV and other sexually transmitted infections among MSM remains to be determined.

For these reasons, I reverted the change. Jakew (talk) 09:54, 21 December 2011 (UTC)

Yes I would agree with that.Doc James (talk · contribs · email) 11:11, 21 December 2011 (UTC)

I've changed the lead again. I've rephrased the bit about benefit for women because the sources don't qualify the situation as controversial so we shouldn't. I've also changed the WHO's recommendations bit to accurately reflect the source and not a subtitle sub-heading in that source, as described elsewhere on this talk page. Finally, I've changed the reference to the review of economic evaluations based on arguments provided in the section above, which seem to have been ignored when that part was recently reverted. Beejaypii (talk) 13:03, 21 December 2011 (UTC)

Strictly speaking the sources don't describe the situation as disputed, either, but I think this edit is okay.
We've discussed the WHO recommendations sentence at length, and you've failed to convince myself or others that it needs to change. The present text is verifiable.
"a review of five economically evaluative studies found they concluded it is cost effective in this population" is needlessly verbose. To make a conclusion about cost-effectiveness, a study would have to evaluate economic aspects, so "economically evaluative" is redundant. "A review of five studies found they concluded it is cost effective in this population" is awkward and seems to unnecessarily distance itself from the statement. The review's conclusions are not disputed in any way, to my knowledge, so why not just assert its findings? "Studies concluded it is cost effective" is more concise; alternatively "several studies have concluded it is cost effective" would also work. Jakew (talk) 14:41, 21 December 2011 (UTC)
Beejaypii, it appears that the additional wording reflected concerns that you may personally hold regarding the results of the studies, but which are not mirrored in the relevant literature. Also, it seems odd that you would consistently try to remove or seriously shorten the WHO material, and then turn around and try to lengthen it with words that add no significant information. Jayjg (talk) 16:23, 21 December 2011 (UTC)
How can we say it is cost effective based on this source quote from above? "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." Garycompugeek (talk) 20:31, 21 December 2011 (UTC)
We're not saying that it's cost-effective. We're saying "in this population studies rate it cost effective", "a review of studies found it is cost effective in this population", or "a review found it is cost effective in this population". Or, to include the suggestions above, "... studies concluded it is cost effective" and "... several studies have concluded it is cost effective". Jakew (talk) 21:16, 21 December 2011 (UTC)
I agree Gary, and I was just about to post more on this topic when I got an edit conflict with your contribution. Here's my contribution.
Jakew, I think you may agree then that "disputed" is more objective and neutral than "controversial"?
As for the economic evaluations, the current version of the lead states "...and a review found that it is cost effective..." No it did not. The review found that five economic evaluations concluded it is cost-effective. That's not the same thing:

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. 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.

They aren't unconditionally concluding that circumcision is cost-effective; they're only concluding that the five studies found it was, and therefore "On these grounds...it may be seen as..." And consider the study authors' own discussions of the limitations of their review and the studies they reviewed:

There are number[sic] of limitations associated with these studies. Most of these studies did not considered[sic] 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.

It's hardly surprising they hedge their bets by preceding their conclusions with "on these grounds" instead of just asserting "we conclude that circumcision is cost-effective"; I don't think they do that anywhere, so we shouldn't attribute that to them in the article.
Your suggestion, Jakew, namely "several studies have concluded it is cost effective" lacks precision where precision is possible, but has the merit of not attributing an unqualified conclusion where there is not one. Beejaypii (talk) 20:37, 21 December 2011 (UTC)
My lack of objection, Beejaypii, is not because of a preference for the term "disputed" but, rather, because I don't think it particularly matters. The edit doesn't seem to do any real harm, and consequently it seems a waste of time to bother debating it.
Regarding the review, the words "on these grounds" are not followed by any reference to cost-effectiveness, and thus are clearly irrelevant.
The most important point here, I feel, is that the review clearly states that all studies find that circumcision is cost-effective. Now, given that the lead is supposed to be a short summary, what is the most concise way to express that information? Choosing such a short summary may lack detail, but detail must be balanced against brevity. Jakew (talk) 21:16, 21 December 2011 (UTC)
What are you talking about? "On these grounds" is an anaphoric reference (a reference to something mentioned previously in the text):
"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. On these grounds..."
What do you think "these grounds" refers to there?
The point still stands. The review did not find that circumcision is cost effective, it found that the five studies concluded that it was - unless you care to ignore the review authors own expression of their conclusions, and their own admission of the weaknesses of their review and the studies they reviewed. Additionally, it does not matter what you feel to be the most important point; what matters is what the source claims and what this article claims it claims. Finally, it's not just about detail and brevity, it's about accuracy and not creating a misleading impression. Beejaypii (talk) 23:12, 21 December 2011 (UTC)
The quote you've used says "All published economic evaluations". Are there economic evaluations that disagree? Jayjg (talk) 23:17, 21 December 2011 (UTC)
You need to read the source carefully. Although they haven't expressed it very well, I think you'll find they are referring to the five studies they evaluated. Beejaypii (talk) 23:47, 21 December 2011 (UTC)
... which they describe as "All published economic evaluations". Jayjg (talk) 00:03, 22 December 2011 (UTC)
Like I said, you need to read the source carefully. In particular, read the section where they describe how they whittled it down to just five sources. I do think the source is badly written in some respects however, and there is room for doubt - which is probably yet another debate.
No matter what they are referring to, the source still does not claim, without qualification, that circumcision is cost effective, as Jakew was trying to argue above, and as the current version of the lead ("...a review found it is cost effective in this population...") misleadingly states. The review found that five studies (depending on the interpretation of the phrase "All published economic evaluations" of course, though that still doesn't affect the point I'm making) concluded that circumcision is cost effective and "On these grounds...it may be seen as..." To present that as "...a review found it is cost effective..." is to turn a qualified conclusion about other conclusions into a direct assertion about a characteristic of the phenomena in question, which is to misrepresent the source and misleadingly strengthen the conclusions attributed to it. The same is true where the WHO's detailed body text assertion "Male circumcision should always be considered as part of a comprehensive HIV prevention package.." - which leaves the final decision to those directly responsible for such decisions - is ignored in favour of a section sub-title, "Male circumcision should be part of a comprehensive HIV prevention package", which is obviously devoid of detail and direct context, being primarily a structural element of the text - since when do sub-headings take precedence over detailed body text? And the sub-heading doesn't even contradict the body text, it only represents the bit of the body text describing the context in which HIV should "be considered". Beejaypii (talk) 16:01, 22 December 2011 (UTC)
Are there published economic evaluations that come to a different conclusion? The lede currently states "According to the Royal Dutch Medical Association (2010), no professional association of physicians currently recommends routine circumcision". Should we similarly examine its sources/methodology and modify its words in an effort to downplay or qualify this conclusion too? Jayjg (talk) 17:54, 22 December 2011 (UTC)

(unindenting) So, "studies concluded it is cost effective" seems a reasonable summary of "All published economic evaluations offered the same conclusion that AMC is cost-effective". It's also one word shorter than the current text ("a review found it is cost effective"). Shall we change it? Jakew (talk) 16:39, 22 December 2011 (UTC)

It's the most accurate summary of the source and the most brief proposal yet, so it's hard to imagine a valid reason not to. Jayjg (talk) 17:50, 22 December 2011 (UTC)
That seems reasonable Jakew. However, I'd change "concluded" to "have concluded": the former (simple past tense) seems too final and chronologically remote - almost as if the chapter is closed on that issue - whereas the latter (present perfect) maintains the link with the present better.
It has occurred to me, however, that the question remains of why this bit about cost-effectiveness is even in the lead. It seems to answer a question which hasn't even been posed. The article is about the surgical procedure circumcision, not economic considerations in the fight against HIV. I should say, though, that I'm not too concerned with this at the moment.
As for the WHO recommendations, perhaps someone would like to address the issue of prioritising a sub-heading over body text, as is the case with the WHO source?
Finally, why isn't there anything about foreskin restoration in the lead, and only one mention in the article body? It's a sub-topic which seems to have significant prevalence in reliable sources, and that's the justification used for inclusion of the HIV information in the lead (even though it's really more a measure of newsworthiness than importance, and degree of direct relevance, to the main topic)? Beejaypii (talk) 18:45, 22 December 2011 (UTC)
Okay, I think we've rough consensus for "studies have concluded it is cost effective".
Regarding the WHO recommendations, both versions (those with and without "consider") are verifiable, but since the former is shorter, it makes sense to use it. It is in any case the clear intent of the body text anyway, so there's no real conflict that I can see.
Regarding foreskin restoration, very few reliable sources mention it. I found only three at PubMed, and only 207 at Google Scholar (that's about 0.2% of the 112,000 for circumcision). Jakew (talk) 19:36, 22 December 2011 (UTC)
Yes, I think we have rough consense for "studies have concluded it is cost effective".
I'm going to accept the current version of the lead summary of the WHO recommendations, at least for now, because I think your "foreskin restoration" search raises some important issues and I'd prefer to discuss those.
The principle of performing PubMed and other searches to establish relative importance of a sub-topic to the main topic is particularly problematic. Firstly, only sub-topics which are currently newsworthy and being discussed will return significant results: non-controversial sub-topics, whose principles are widely accepted, simply won't be the focus of much discussion and won't return significant results. These kinds of searches do not, therefore, provide an indication of the relative degree of importance of a sub-topic by comparison with another sub-topic where one of those sub-topics is currently newsworthy and the other isn't.
Secondly, in terms of execution, the search principle lends itself well to searches for sub-topics which can be comprehensively referenced via a single term (as is the case with "HIV", which is an unambiguous and highly prevalent abbreviation) but is much more difficult to perform where a concept may be referred to using a variety of words/phrases, as is the case with foreskin restoration, which, to cite a few examples, could be referred to as "restoration of the foreskin", "uncircumcision", "restoring the foreskin", "preputial restoration", "foreskin restoring", "restore the prepuce" and even highly contextual variations such as "restore what they've lost", etc.
Thirdly, a search for co-occurring terms reveals nothing about the basic nature of the relationship between the concepts represented by those terms, aside from an indication, via prevalence of co-occurrence in sources, that there is a relationship.
Finally, why just use PubMed as a dedicated journal search facility, with its biomedical restrictions, why not other academic search facilities such as ScienceDirect? After all, not all sub-topics of circumcision are necessarily medical, e.g. history and religion for starters. Any attempt to establish relative importance of a sub-topic must take as many aspects as possible into account surely? Beejaypii (talk) 13:53, 23 December 2011 (UTC)
  1. ^ Blackmer, Jeff (2005). "A communication from the CMA" (PDF). {{cite journal}}: Cite journal requires |journal= (help)
  2. ^ circumcision NHS coices retrieved 15 july 2011
  3. ^ Foreskin functions retrieved 15 July 2011
  4. ^ Better Birth: The Ultimate Guide to Childbirth from Home Births to Hospitals (2009) Denise Spatafora
  5. ^ a b c Cite error: The named reference Cochrane2009 was invoked but never defined (see the help page).
  6. ^ Uthman, OA (2010 Mar 10). Van Baal, Pieter H. M. (ed.). "Economic Evaluations of Adult Male Circumcision for Prevention of Heterosexual Acquisition of HIV in Men in Sub-Saharan Africa: A Systematic Review". PloS one. 5 (3): e9628. doi:10.1371/journal.pone.0009628. PMC 2835757. PMID 20224784. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)CS1 maint: unflagged free DOI (link)
  7. ^ a b c Cite error: The named reference WHOpr0307 was invoked but never defined (see the help page).
  8. ^ a b c Cite error: The named reference KNMG was invoked but never defined (see the help page).
  9. ^ Uthman, OA (2010 Mar 10). Van Baal, Pieter H. M. (ed.). "Economic Evaluations of Adult Male Circumcision for Prevention of Heterosexual Acquisition of HIV in Men in Sub-Saharan Africa: A Systematic Review". PloS one. 5 (3): e9628. doi:10.1371/journal.pone.0009628. PMC 2835757. PMID 20224784. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)CS1 maint: unflagged free DOI (link)
  10. ^ Rennie, S (2007 Jun). "Male circumcision and HIV prevention: ethical, medical and public health tradeoffs in low‐income countries". Journal of medical ethics. 33 (6): 357–61. doi:10.1136/jme.2006.019901. PMC 2598273. PMID 17526688. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  11. ^ "Circumcision of infant males" (PDF). Royal Australasian College of Physicians.
  12. ^ Krieger, JN (2011 May 18). "Male circumcision and HIV infection risk". World journal of urology. doi:10.1007/s00345-011-0696-x. PMID 21590467. {{cite journal}}: Check date values in: |date= (help)
  13. ^ Tobian, A. A. R.; Gray, R. H. (2011). "The Medical Benefits of Male Circumcision" (PDF). JAMA: the Journal of the American Medical Association. 306 (13): 1479–80. doi:10.1001/jama.2011.1431. PMID 21972310. {{cite journal}}: Unknown parameter |month= ignored (help)
  14. ^ Uthman, OA (2010 Mar 10). Van Baal, Pieter H. M. (ed.). "Economic Evaluations of Adult Male Circumcision for Prevention of Heterosexual Acquisition of HIV in Men in Sub-Saharan Africa: A Systematic Review". PloS one. 5 (3): e9628. doi:10.1371/journal.pone.0009628. PMC 2835757. PMID 20224784. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)CS1 maint: unflagged free DOI (link)
  15. ^ Larke, N (2010 May 27–Jun 9). "Male circumcision, HIV and sexually transmitted infections: a review". British journal of nursing (Mark Allen Publishing). 19 (10): 629–34. PMID 20622758. {{cite journal}}: Check date values in: |date= (help)
  16. ^ Eaton, L (2009 Nov). "Behavioral aspects of male circumcision for the prevention of HIV infection". Current HIV/AIDS reports. 6 (4): 187–93. doi:10.1007/s11904-009-0025-9. PMID 19849961. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  17. ^ Kim, HH (2010 Nov). "Male circumcision: Africa and beyond?". Current opinion in urology. 20 (6): 515–9. doi:10.1097/MOU.0b013e32833f1b21. PMID 20844437. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  18. ^ Templeton, DJ (2010 Feb). "Male circumcision to reduce the risk of HIV and sexually transmitted infections among men who have sex with men". Current opinion in infectious diseases. 23 (1): 45–52. doi:10.1097/QCO.0b013e328334e54d. PMID 19935420. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  19. ^ Rennie, S (2007 Jun). "Male circumcision and HIV prevention: ethical, medical and public health tradeoffs in low‐income countries". Journal of medical ethics. 33 (6): 357–61. doi:10.1136/jme.2006.019901. PMC 2598273. PMID 17526688. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  20. ^ "Circumcision of infant males" (PDF). Royal Australasian College of Physicians.
  21. ^ http://www.ajpmonline.org/content/aboutinfo
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