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Plastibell

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

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

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

I think this is a good description, and your rationale for the addition makes sense. I can only say be bold. Jakew (talk) 11:23, 29 April 2008 (UTC)
I concur. This is a nice addition to the article. Well done! AlphaEta 14:04, 29 April 2008 (UTC)
Well done. ☺ Coppertwig (talk) 23:50, 29 April 2008 (UTC)

How about a treatment of circumcision techniques in the developing and undeveloped world, where the majority of circumcisions are performed? What do barbers performing circumcision in Turkey use, for example? How about among tribes in Africa? Do we want to know? Blackworm (talk) 05:44, 30 April 2008 (UTC)

I think we do want to know, though reliable sources are difficult to find with the exception of the regular carnage in South African "circumcision schools". The issue is actually on my to-do list and I would be happy to collaborate in the future on putting something together. Johncoz (talk) 05:54, 30 April 2008 (UTC)

Neutrality

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

Every controversial topic will have people that complain about neutrality, so, if that were the standard, they would all be tagged. What we can't have are people coming and putting tags on stuff just because they don't like what's presented in the article. This article is already better sourced than almost all Wikipedia articles, precisely because it is controversial and many people from both sides of the argument have gone over it; therefore it's reasonable to believe that it should be considered neutral. If you can't come up with specific POV problems in the article, then your tag simply becomes an objection to the article in general and that is POV. The way, the truth, and the light (talk) 01:52, 30 April 2008 (UTC)
I agree with The way, the truth, and the light. If you're going to have a tag, the tag should have a link to the specific section of the talk page, and the specific section should state precisely what needs to be fixed in the article to make it NPOV. This section doesn't do that, so the tag is not appropriate. Besides, I think the article is fine. Debate about POV on the talk page is normal and healthy and is part of what keeps the article neutral IMO. Besides, opinions will always vary as to what is neutral. ☺ Coppertwig (talk) 02:04, 30 April 2008 (UTC)
  • I'd like to be able to say that medical associations whole-heartedly recommend circumcision. Unfortunately, they don't (for political and other irrational reasons). - The way, the truth, and the light 17:19, 12 April 2008
  • It doesn't really make an argument for either side, and is essentially a cop out by the AAP to avoid admitting that circumcision is a good idea. The way, the truth, and the light 18:24, 12 April 2008
Needless to say, I don't believe this user is in a position to comment neutrally on this article, despite the fact that that user's side can betray whatever POV they wish and be met with deafening silence from the administrators listening, rather than the blast of WP:RULES and administrative threats anyone apparently opposing that POV receives. Blackworm (talk) 02:29, 30 April 2008 (UTC)
I don't think editors' POVs has anything to with this issue, and the whiff of conspiracy theory you introduce does not help clear the air. The issue here is about drive-by tagging. The aim, after all, is to produce the best possible article, and the application of tags must apply to the content of the article, not the content of its talk page. I look forward to reading any suggestions Cervantes de Leon may have about strengthening this article's NPOV. Johncoz (talk) 03:29, 30 April 2008 (UTC)
What you call conspiracy theory, is documented in the last few archives of this Talk. Again, the fact that the POV tag is always added by editors who perceive a pro-circumcision slant, and immediately removed by editors who express a pro-circumcision slant, should say something about the true level of neutrality of the article. Blackworm (talk) 04:39, 30 April 2008 (UTC)
With respect, I think you've missed my point. Even if the "conspiracy theory" were a fact, drive-by tagging is not the way to deal with the perceived problem. (For the record, I am opposed to routine circumcision and deeply skeptical about mass circumcision in sub-Saharan Africa as a public health measure.) Johncoz (talk) 05:31, 30 April 2008 (UTC)
But "drive-by" implies the user adding the tag leaves the discussion. This was not the case here, with either of the editors who added the tags. Here, the issue is that any tagging "defaces" the article, and apparently editors are held to an illogical standard whereby they must prove the article is unbalanced before they are allowed to tag the article to indicate that they dispute its balance. I see absolutely nothing wrong with this article being perpetually tagged as having its neutrality disputed, if that reflects the reality in the discussion page. Others insist the article is balanced, and by untagging the article are acting as if they insist there is no neutrality dispute -- despite clear evidence that there is. Blackworm (talk) 20:17, 30 April 2008 (UTC)
The relevant policy, to which Jakew referred, is WP:DRIVEBY and states: "Drive-by tagging is strongly discouraged. The editor who adds the tag must address the issues on the talk page, pointing to specific issues that are actionable within the content policies, namely Wikipedia:Neutral point of view, Wikipedia:Verifiability, Wikipedia:No original research and Wikipedia:Biographies of living persons. Simply being of the opinion that a page is not neutral is not sufficient to justify the addition of the tag. Tags should be added as a last resort." (emphases added) Johncoz (talk) 02:18, 30 April 2008 (UTC)
WP:DRIVEBY is not policy. That page also states, In general, you should not remove the NPOV dispute tag merely because you personally feel the article complies with NPOV. Rather, the tag should be removed only when there is a consensus among the editors that the NPOV disputes have indeed been resolved. Blackworm (talk) 02:29, 30 April 2008 (UTC)
The guideline about removal of tags presumably applies to those tags that have been correctly added in the first place (ie in accordance with the guidelines I quoted). In other words, drive-by deletion is no more valid than drive-by addition. In both cases, the action should be discussed on the Talk page first in relation to the specific issues in dispute, and an attempt made to reach consensus for either action. This is particularly so with articles as controversial and exhaustively worked over as this one. Johncoz (talk) 02:47, 30 April 2008 (UTC)
"...until the whole issue is sorted out...." I admire your optimism! Unfortunately, this is a highly polarized issue, and as such, it is unlikely that any one of us will ever be completely satisfied with the neutrality of this article. To simply say that the article is not neutral provides insufficient substance for debate (for either side). We must base our discussion on specific recommendations and reliable sources. If you have any particular concerns, they can be addressed on this talk page. Since I've joined this discussion (about three weeks ago), consensus building been notably civil. Kindest regards, AlphaEta 03:38, 30 April 2008 (UTC)

Tag removed, point taken. In retrospect I am beginning to think that I should have simply kept my mouth shut... Cervantes de Leon (talk) 05:13, 30 April 2008 (UTC)

Do not despair Cervantes de Leon. If you have looked over histories you will see that I have raised this issue and placed tags after making additions to the article and talk page. Logic and perseverance is the key. Any desire to improve the encyclopedia is commendable and regardless of the subject's controversy lets remember not to WP:BITE. Garycompugeek (talk) 15:11, 30 April 2008 (UTC)

Paragraph in lead

In the 4th paragraph of the lead, we currently include three arguments made by 'opponents' of circumcision and one source. We also include one argument made by 'advocates' of circumcision and four sources. What I propose to do is to cut down the 'advocate' sources, so that we cite only one (I suggest Schoen), and to add a small amount of text to describe two other arguments that he makes. The result should be a) a better balanced paragraph, and b) a net reduction in sources (and hence article length and load time). Any thoughts? Jakew (talk) 12:48, 30 April 2008 (UTC)

Would you mind providing more detail here? How about a draft version of the paragraph so that the details of your changes can be considered? Beejaypii (talk) 13:18, 30 April 2008 (UTC)
Sure. I'm proposing to change this:
  • Opponents of non-medical circumcision condemn infant circumcision as being medically unjustified, an infringement upon individual bodily rights, and a cause of sexual impairment,[9] while advocates of circumcision regard it as a worthwhile public health measure.[10][11][12][13]
To something like this (as a rough draft):
  • Opponents of non-medical circumcision condemn infant circumcision as being medically unjustified, an infringement upon individual bodily rights, and a cause of sexual impairment,[9] while advocates of circumcision regard it as a worthwhile public health measure, with few complications and no effects on sexual health.[10]
(See 'Discussion and conclusions' in Schoen's paper.)
As you can see, the result is that we dedicate an equal number of references to both 'sides', and a roughly equal number of words. Jakew (talk) 13:30, 30 April 2008 (UTC)
I agree with the thrust and reasoning of Jakew's draft. However, I think a slight rewording of the Schoen position is required if we are not to misrepresent. I suggest "a worthwhile public health measure, with a low complication rate if "properly done" and no adverse effects on sexual performance."
Second, regardless of the wording we need to change non-medical (which actually implies ritual) to non-therapeutic.Johncoz (talk) 14:50, 30 April 2008 (UTC)
I think the following version would be more balanced (I'm incorporating Johncoz's suggestions here too):
  • Opponents of non-therapeutic circumcision condemn infant circumcision as being medically unjustified, an infringement upon individual bodily rights, and a cause of sexual impairment,[9] while advocates of circumcision regard it as a worthwhile public health measure, consider it to have a low complication rate when "properly done", and consider it to have no effect on sexual performance.[10]
Isn't this more balanced? What do the editors here think? Beejaypii (talk) 16:08, 30 April 2008 (UTC)
I think there are rather too many "consider it"s. If we were to add them to 'opponents', we'd have something like: "condemn infant circumcision as being medically unjustified, consider it to be an infringement upon individual bodily rights, and consider it a cause of sexual impairment". In my view, this adds bulk without much benefit, as it is quite obvious that these are arguments. I'd suggest that we could also remove the quotes around "properly done" - they aren't needed for two words. Jakew (talk) 16:18, 30 April 2008 (UTC)
Just to elaborate slightly, when I read the above, I can't help but notice the different language structure. We say what opponents think in straightforward terms, but when it comes to an advocate it is as though the author is desperately trying to distance himself from it as far as possible (I'm not saying that's the case, this is just my impression as a reader). That seems to be the function of "consider it" at every opportunity, and the apparent scare quotes. As a style of writing, this is reasonable enough, but coming so soon after the description of the opposite position, the contrast is striking. This doesn't seem very balanced at all. In the presentation of the views of opponents, I think it is perfectly clear that we're simply listing a few arguments they make, not endorsing them. I tried to copy the same presentation style for the views of advocates, and I think that's quite reasonable. However, let's distance ourselves (or not) equally from both positions. Jakew (talk) 16:42, 30 April 2008 (UTC)
The current construction uses "condemn" and "regard". The easiest solution is to alter both to claim, since that is the actual status . Adjusting for reasons of symmetry and style, this could give us:
"Opponents of non-therapeutic circumcision claim infant circumcision is an infringement upon individual bodily rights that is medically unjustified and a cause of sexual impairment.[9] Advocates of circumcision claim it is a worthwhile public health measure that has no adverse effect on sexual performance and a low complication rate when "properly done".[10]
Are we getting close? Johncoz (talk) 17:00, 30 April 2008 (UTC)
That's looking much better, but let's delete the quotes around "properly done", so that it reads "...a low complication rate when properly done". Jakew (talk) 17:17, 30 April 2008 (UTC)
Agreed. On reflection they look like scare quotes (which was not my intention) and hence editorialising. Johncoz (talk) 17:21, 30 April 2008 (UTC)
Jakew, I don't agree that it is "perfectly clear that we're simply listing a few arguments they make". In the first part of the paragraph, describing the stance of circumcision opponents, each of the arguments; "medically unjustified", "infringement upon individual bodily rights", and "cause of sexual impairment" is represented by a phrase which is functioning as a complement of the verb condemn, there's no ambiguity there. However, in the "advocates" part of your version, though the first argument "a worthwhile public health measure" is fulfilling an equivalent function with respect to the verb regard, the other two arguments, "with few complications and no effects on sexual health" are functioning as post-modifiers of the noun phrase "a worthwhile public health measure". It's like the difference between "X condemns Y because X think it's A, and thinks it's B, and thinks it's C" compared with "X regards Y as A, which has characteristic B, and has characteristic C". This is why I've added the "consider it"s: to show, without ambiguity, that "few complications" and "no effects on sexual health" are arguments of advocates, and to replicate, as closely as I have been able at this attempt, the structure of the "opponents" part of the paragraph, whilst at the same time trying to avoid clumsy ( to my idiolect at least) phrasing such as "while advocates of circumcision regard it as a worthwhile public health measure, as having few complications and as having no effects on sexual performance.[10]". Perhaps that example is not so bad after all. How about this version:
  • Opponents of non-therapeutic circumcision condemn infant circumcision as being medically unjustified, an infringement upon individual bodily rights, and a cause of sexual impairment,[9] while advocates of circumcision regard it as a worthwhile public health measure, as having a low complication rate when properly done, and as having no effect on sexual performance.[10]
You may have tried to "copy the same presentation style for the views of advocates" but I think you should have tried to replicate the grammar and semantic style. As for the scare quotes, I was simply incorporating the change suggested by Johncoz as he wrote it, so please be assured that they were only "apparent" scare quotes. By the way, I never suggested that your version endorsed any of the arguments, I implied that it was not balanced.
Finally, you have suggested that my writing gives you the impression that I, "the author" am desperately trying to distance myself as far as possible from circumcision advocacy. I don't understand what you are trying to achieve with such a suggestion, and I think it's counterproductive. I will continue to assume good faith and not respond in kind. Beejaypii (talk) 18:18, 30 April 2008 (UTC)
Beejaypii, I think that Johncoz's suggestion of 17:00, 30 April 2008 is the best so far (minus the quotes). It seems the most balanced and least awkward. Are you happy with it?
As for my comments about the impression I received, I was trying to show why the paragraph seemed poorly balanced, not to criticise you personally. I included my parenthetical remark to help make that clear. Evidently I didn't make it clear enough, and I'm sorry if you were offended. Jakew (talk) 18:28, 30 April 2008 (UTC)
I accept your explanation for the personal criticism I perceived, and I wasn't offended (I don't offend easily), it was more a combination of surprise, disappointment, and irritation.
I think that Johncoz's suggestion is getting there. However, doesn't Schoen simply claim that there's a "lack of effect of circumcision" on "sexual performance", not the more specific "no adverse effect"? Beejaypii (talk) 18:50, 30 April 2008 (UTC)

(unindenting) I'm not particularly fussed about the inclusion of "adverse". The full par from Schoen is:

Moreover, about 70 million circumcised US males currently attest to the lack of effect of circumcision on either emotional health or sexual performance, and no objective studies indicate otherwise. As a matter of fact, evidence indicates that women in Middle America have a sexual preference for circumcised men, mainly from the standpoint of aesthetics and hygiene.

The second sentence seems to imply a benefit effect. And indeed, Schoen and his co-thinkers (ie the most prominent "advocates") regularly make claims outside of the peer-reviewed context about the positive benefits of circumcision on sexual performance. Johncoz (talk) 19:11, 30 April 2008 (UTC)

I don't believe it neutral to characterize circumcision as being properly done, and similarly object to the non-neutral language used here. One could argue that "properly done" is the advocates' view, but then consider the statement circumcision opponents reject circumcision when done improperly, for example when there is no immediate medical need. Further, "properly done" is far too vague and may simply be defined as "done in such a manner as to minimize complications," making the logic circular. I suggest removing the phrase "when properly done" altogether. The quotes originally around "properly done," in fact, served the purpose of properly attributing the view to the advocates, and Jakew's objection to them now causes the statement to violate WP:NPOV.
"Sexual impairment" should be changed to "reduced sexual pleasure." Most circumcised men and their partners would deny that the men are "sexually impaired" and thus reject the criticism, when the true criticism is that, for example, these men will never know what it is like to have 7-15 more square inches of sexually sensitive skin a normal penis has.
Also, the phrase "among many other reasons" should probably be added to the statements of both sides, since the debate on circumcision consists of many other aspects besides the few listed. It is unfortunate that attempts to expand on the circumcision controversy (or indeed to present circumcision as controversial at all) have been blocked by editors here, and we are stuck with a rigid limit of half of one sentence to summarize all the positions of all circumcision opponents, while entire sections continuously extol the purported benefits of the cutting without the context a discussion of the controversy would provide. Blackworm (talk) 19:52, 30 April 2008 (UTC)

Perhaps an altogether different approach would be better balanced. Great controversy exist regarding circumcision. Proponents view it as either a religious and cultural obligation and/or health benefit while opponents challenge the medical benefits and view circumcision as barbaric genital mutilation. Garycompugeek (talk) 21:10, 30 April 2008 (UTC)

I'm not calling for a comprehensive treatment of the controversy in the lead. I'm calling for it to appear somewhere. By the way, the words "mutilation" and "barbaric" are, to my understanding, banned from this article as somehow inherently violating WP:NPOV, even when correctly attributed or quoted. Blackworm (talk) 22:01, 30 April 2008 (UTC)
Blackworm, the current proposed text of the paragraph is not supposed to be neutral but represent the main claims made by advocates and opponents as reflected by two prominent (dare I say iconic) representatives (Schoen and Milos). In that light, I think the rendering of Schoen is fine, since it cleaves very closely to the wording of the source. With Milos, you are probably correct about reducing sexual pleasure being closer to the source.
Garycompugeek, the problem is that many who oppose routine infant circumcision would nonetheless reject a charactarisation of "barbaric genital mutilation". The current strategy for this paragraph seems safer for a lead summary.
There is, however, a bigger issue. Less than 10% of males globally have been circumcised for non-religious reasons (according to WHO). This clearly makes non-therapeutic medical circumcision a distinct minority position. So we probably need to re-balance our now overly balanced formulation. Taking all this into account, I arrive at the following draft:

"Opponents of non-therapeutic circumcision claim infant circumcision is an infringement upon individual bodily rights that is medically unjustified and adversely affects penile sensitivity and sexual pleasure.[9] Advocates of circumcision claim it is a worthwhile public health measure that has no adverse effects on sexual performance and a low complication rate when properly done.[10] Globally, fewer than 10% of males have been circumcised for non-religious reasons."

Johncoz (talk) 01:57, 1 May 2008 (UTC)

Your suggestion mixes up two unrelated issues, Johncoz. It's like saying, "globally the majority of humans do not have fresh, clean water, so fresh clean water is a distinct minority position." The problem is, of course, that having fresh clean water is not itself a position at all - we cannot assume that people have actually decided to have (or not to have) clean water, and even if they have we can't know their thought processes. Similarly, we can't assume that people being circumcised or not, or having circumcised their son(s) or not, will have a position one way or the other, or indeed that they will have a position at all. Jakew (talk) 11:33, 1 May 2008 (UTC)
I agree with Jakew that needlessly complicates the statement further. Move the last sentence to the Prevalence section and I will support the rest. Garycompugeek (talk) 12:37, 1 May 2008 (UTC)
There were no assumptions. The paragraph is about medicalised non-therapeutic circumcision. It summarises the arguments for and against, and estimates its global incidence. Seemed straightforward to me. But I'm happy to move it, if that's the consensus. Johncoz (talk) 12:58, 1 May 2008 (UTC)
Ok, removing that statement and again making the number of claims equal, how about this?
  • Opponents of non-therapeutic circumcision claim infant circumcision is an infringement upon individual bodily rights that is medically unjustified and adversely affects sexual pleasure.[9] Advocates of circumcision claim it is a worthwhile public health measure that has no adverse effects on sexual performance and a low complication rate when properly done.[10]
Jakew (talk) 21:19, 1 May 2008 (UTC)
Fine by me Johncoz (talk) 21:29, 1 May 2008 (UTC)
I think the phrase "has no adverse effects on sexual performance" is problematic. The source does not claim that circumcision has "no adverse effects", it claims that "about 70 million circumcised US males currently attest to the lack of effect of circumcision on either emotional health or sexual performance" (which is, incidentally, a logically unimpressive argument in my opinion - it's basically: lots of US males have been circumcised therefore it has no effect). So, the source claims a "lack of effect" but not "no adverse effects": a phrase which, though logically correct, implies that there could be non-adverse effects, i.e. neutral or positive effects, whereas the source effectively rules this out with the unqualified "lack of effect". Furthermore, Johncoz, when the source states that "evidence indicates that women in Middle America have a sexual preference for circumcised men, mainly from the standpoint of aesthetics and hygiene." this is akin to suggesting that circumcision is good because evidence indicates that some women think it is, hygienically and aesthetically (another unimpressive argument in my opinion) and makes no claims about effects on sexual performance. Beejaypii (talk) 16:32, 2 May 2008 (UTC)
We could probably cite an alternative source, in which Schoen makes his arguments more clearly. For example, in this paper, Schoen states:
  • "Anecdotally, some have claimed that the foreskin is important for normal sexual activity and improves sexual sensitivity. Objective published studies over the past decade have shown no substantial difference in sexual function between circumcised and uncircumcised men.8 Indeed, circumcised men were found to have more varied sexual activity, and a study in Middle America showed that women preferred circumcised penises, mainly for reasons of improved hygiene.9"
If we cite this source instead, and replace "performance" with "function", it would seem to be a fair summary. Would you agree? Jakew (talk) 16:42, 2 May 2008 (UTC)
I almost agree. I think we would also need to add "substantial" before "adverse effects". I think it's an important nuance. What do you think? Beejaypii (talk) 16:51, 2 May 2008 (UTC)
Fine with me. Jakew (talk) 17:02, 2 May 2008 (UTC)
Actually, at second reading, I think this source is also problematic. Schoen again does not claim "no adverse effects", he claims "no substantial difference in sexual function". Is that the same thing? And "more varied sexual activity" does not tell us anything about whether the effects of circumcision are positive, negative or neutral, it simply tells us that it can result in "more varied sexual activity", and such behaviour could, for example, be interpreted as a quest for sensations lost through circumcision. Beejaypii (talk) 17:15, 2 May 2008 (UTC)
I'd hazard a guess that Schoen isn't suggesting such an interpretation, Beejaypii. Nevertheless, will "no substantial effects" (ie., without "adverse") alleviate your concern? Jakew (talk) 17:20, 2 May 2008 (UTC)
And I would hazard a guess that Schoen chose his words very carefully. Anyhow, I think "no substantial effects" is faithful enough to the source material. Are you going to make the change or shall I? Beejaypii (talk) 17:35, 2 May 2008 (UTC)
Ok. All done. Jakew (talk) 18:27, 2 May 2008 (UTC)

The words "properly done" aren't in the source, and further violate WP:NPOV unless quoted. The word "advocate" or "advocacy" is not in the source. The complication rate being "low" is not in the source. I believe this needs more work. Blackworm (talk) 18:51, 2 May 2008 (UTC)

You are correct Blackworm, these words/phrases are not in the source (well, the new source at least - they were in the original source). As for the reference to advocates (and, for that matter, opponents), perhaps we could avoid both these terms. Also, I can't find infringe in the Milos paper, but violate is there, and I think the direct quote "interferes with normal sexual functioning" is better than the more narrow interpretation "adversely affects sexual pleasure". What do you think of this:
Some oppose infant circumcision, believing that, amongst other things, it violates individual bodily rights, is medically unjustified, and "interferes with normal sexual functioning."[9] Others advocate infant circumcision, believing, for example, that it has multiple medical benefits, no substantial effects on sexual function, and a low complication rate when properly done.[10]
We will need to restore the original pro source, and retain the current one, for this version - both are referenced. Beejaypii (talk) 21:32, 2 May 2008 (UTC)
I like your version better, though it doesn't address "properly done." It also seems to suffer from the same kind of imbalance Jake refers to above (author distancing themselves from one position, use of scare quotes). I don't see any reason for the quotes there. Unlike "properly done," there is a qualifier ("believing that"), thus it is clear that it is a belief. We should also present Schoen's view that another reason to circumcise males is because women prefer it. I suggest:
Some oppose infant circumcision, believing that it violates human rights, is medically unjustified, and interferes with normal sexual functioning, amongst other negative consequences. Others advocate infant circumcision, believing that it has multiple medical benefits that outweigh any risks or harms, that it has no substantial effect on sexual function, that women prefer it, and that it has a low complication rate when performed by an experienced operator.[10] Thoughts? Blackworm (talk) 17:29, 5 May 2008 (UTC)

"Excluding majority Muslim countries ..." and NOR

The sentence "Excluding majority Muslim countries and Israel, prevalence in Latin America[115] and Eurasia[81] is generally less than 20%[116] with the notable exceptions of the Philippines, which has a prevalence greater than 80%,[117] and South Korea, which is approaching that level" has been under discussion, most recently at NOR/N. It seems unlikely a consensus can be formed to support the current construction, although there is no dispute over its accuracy.

Consequently, I have drafted an alternative that circumvents the perceived problem: "Prevalence is near universal in the Middle East and Central Asia, but is generally low across the rest of Eurasia, being primarily a function of Muslim adherence, with the notable exceptions of the Philippines and South Korea. Prevalence in Latin America is universally low." Supported by two references: WHO for the first sentence and Drain for the second. Johncoz (talk) 20:53, 1 May 2008 (UTC)

I think this is a tremendous improvement, Johncoz, but a small problem remains: the WHO document, as far as I can tell, doesn't actually mention Eurasia. The document does support the statement when "Eurasia" is replaced with "Asia", but it doesn't make any general comments about the prevalence in Europe (I don't know whether this is due to lack of solid data, or whether it is a simple oversight). I would propose instead something closer to the breakdown in the WHO source, such as "Prevalence is near universal in the Middle East and Central Asia, but is generally low across the rest of Asia. In Europe, circumcision is generally associated with religion or immigration. Prevalence in Latin America is universally low." Jakew (talk) 21:16, 1 May 2008 (UTC)
The problem, Jake, is we don't actually say what the prevalence is in Europe in your formulation. I would say the WHO map supports the statement "generally low across the rest of Eurasia", and constitutes as valid a verifiable source - without OR - as a prose statement. Johncoz (talk) 22:31, 1 May 2008 (UTC)
Johncoz, the source doesn't describe the prevalence either, and interpretation of maps is best left to sources. That's why we need to either a) find another source, or b) state what the source actually says. Jakew (talk) 22:50, 1 May 2008 (UTC)
Here's a possibility from Drain et al.: "Only 4 of 18 (22%) developing countries in Europe and Central Asia had a high male circumcision prevalence". We could express that as something like "In Europe, few developing countries have a high male circumcision rate." Jakew (talk) 23:08, 1 May 2008 (UTC)
Jake, we do not need to interpret the map, we are reading it. Of the 38 countries that can be identified, 32 are yellow ie prevalence of <20%, while six are orange ie prevalence 20-80%. None is red (>80%). This in not an interpretation, it is a fact taken directly from the map and requires no other ability than to be able to count (Just as reading a sentence presupposes the ability to read). It is not even necessary to know the names of the countries or other extraneous data. (At an even simpler level, anyone who simply looks at the map can see that excluding the Mid-East and Central Asia, Eurasia is overwhelming yellow).
And talking about "developing countries in Europe" (whatever they are) still does not say anything at all about European prevalence as such, which we all agree is "generally low", as shown on the map. Johncoz (talk) 23:29, 1 May 2008 (UTC)
Johncoz, we've been over this before, both on this page and at WP:NOR/N, and while it would be misleading to say that a consensus emerged, it is clear that there is significant disagreement with the notion that one can make anything more than the simplest statement about a map.
If you want to say something about European prevalence as a whole, then find a source that makes such a statement. If not, let's use what is available. Jakew (talk) 23:35, 1 May 2008 (UTC)
Jake, what we have discussed over the past week is the legitimacy of reconciling the map with other data (specifically the proportion of various populations who are Muslim) to support the original construction. I have conceded that correlating these two sources should be abandonded, since most see it as OR, specifically a violation of WP:SYN. What is proposed here is something much more straightforward, namely reading our source (the map) and making the "simplest" of statements. I honestly do not understand the objection, and which content policy it is based on. Johncoz (talk) 23:57, 1 May 2008 (UTC)
I think it's OK to count the number of countries on a map. I think that's within what Blueboar meant by ". If the map is published by the WHO, then it is not OR for us to bluntly state what is shown on the map." at WP:NORN. ☺ Coppertwig (talk) 02:30, 2 May 2008 (UTC)
Coppertwig, as I read that discussion, I asked if others thought that my impression ("if China is listed as <20%, we can state that, but we shouldn't interpret or try to generalise from the data as a whole") was reasonable, and Blueboar agreed that we could make blunt/straightforward statements, but "Avoid any analysis...". (We also discussed the synthesis problem, which dominated the discussion.) I may be mistaken, but that is my understanding.
The apparent problem here is that we disagree on what constitutes "interpreting" or "analysing" a map. There's some confusion caused by WP:NOR's use of the terms "primary" and "secondary" source, but what is clear, I think, is that we should cite a source for interpretation or analysis of data (ie., it should be the source's interpretation or analysis, not ours).
I think it's safe to say that we all agree that a statement about a single country is a straightforward statement. However, I think that problems occur when one starts counting countries. In addition to the possibility of errors, discussed previously, one problem is deciding which countries to count. Do we count those in a continent (and if so, what definition is used, and how well are the boundaries defined)? Do we count, say, those intersecting the Greenwich meridian? As I see it, while there's nothing inherently wrong with making this decision, it is fundamentally interpretive.
Also - and it helps to imagine the map as a table here - if counting rows that meet certain criteria isn't analysis, then is calculating a mean analysis? How about a confidence interval for that mean? Is it acceptable to calculate summary statistics for two continents and use, say, a t test to compare the two? Although there seems to be broad agreement about making statements about a single row, it seems very hard to decide where interpretation or analysis begins once one starts thinking about groups of rows, and I think it makes sense to err on the side of caution.
Finally, it is incredibly difficult to source a general statement about the overall prevalence in Europe, and when a statement is so hard to source I think it makes sense to ask why that might be, and whether we should be cautious. I can only speculate, but one reason may be that there is insufficient data to be confident (for example, consider "Our findings ... support the notion that the prevalence is low in Europe" (emph added) PMID 17881413). WHO indicate that the map represents estimates ("National prevalence of male circumcision was estimated using DHS data where available. For other countries, estimates were made from other published sources"), after all. Should we be make a more confident statement than any of our sources? Jakew (talk) 11:58, 2 May 2008 (UTC)
None of which stopped us actually listing the 32 identifiable low prevalence European countries, (and 6 medium prevalence) in the Prevalence of circumcision article, based solely on the WHO map. Johncoz (talk) 13:27, 2 May 2008 (UTC)
These are what I would call blunt or straightforward statements about the map. It's like saying, "Shakespeare wrote 'Give thy thoughts no tongue'": there's a 1:1 relationship to a "statement" in the source (sorry - I couldn't resist this example in the context of NOR discussion). But if we say "In Shakespeare's plays, X sentences begin with the word 'give'", it's no longer a straightforward statement, and we're now asking the reader to perform some research in order to verify the statement (and again, the research is no more than counting). If you think of the map as a table, for each country listed in prevalence of circumcision we're basically quoting a single row of that table. This doesn't involve making a decision about which groups of rows to select and performing any computations on those groups. Jakew (talk) 13:48, 2 May 2008 (UTC)

I agree with Johncoz and Coppertwig and don't think this is the big deal extrapolating from it. The fact is circumcision rates are low in Europe and the map supports that statement. Garycompugeek (talk) 14:16, 2 May 2008 (UTC)

The standard for Wikipedia is verifiability, not truth, and we're not concerned with determining facts for ourselves (and indeed, due to our editing model, we can't). Instead, we are concerned with finding reliable sources about a subject, and summarising what they have concluded about a subject.
Here are some verifiable statements:
  • WHO states that in Europe, circumcision is generally associated with religion or immigration.
  • Drain et al. state that in Europe, few developing countries have a high male circumcision rate.
  • Klavs et al. report data supportive of the notion that the prevalence is low in Europe.
All of these are directly verifiable. I'm also attributing each statement to make it clear who is performing each analysis. Compare with the following, which correctly attributes each and every interpretation:
  • WHO state that prevalence is near universal in the Middle East and Central Asia. WHO also present a map showing circumcision prevalence by country, and we, Johncoz, Coppertwig and Garycompugeek, have agreed that this map shows that the prevalence is generally low across the rest of Eurasia.
See the problem? Jakew (talk) 16:03, 2 May 2008 (UTC)
Actually, Jake, I don't. Here is WHO map. Apart from a small orange splot on the Balkans, Europe is overwhelmingly entirely yellow, ie low prevalence. All but the totally colour blind can see that at a glance. To say so is to make a blunt factual statement about what the map shows and does not involve any interpretation or analysis. Johncoz (talk) 20:07, 2 May 2008 (UTC)
Johncoz, if you read the above statement you'll see that it already includes your name. I know that you believe it to be true, but that doesn't stop it from being an analysis. Even if I were to add my own name, the problem would still be the same: we need to be able to cite someone else's interpretation or analysis, not ours. Jakew (talk) 21:06, 2 May 2008 (UTC)
Jakew please don't semanticlly bandy words. Your analogy is poor. Our job as editors is to interpret the data and list sources to back up those interpretations. If all we ever did we was quote scientific data much of our readers would be unqualified to understand and/or interpret it. You throw analysis and synthesis as roadblocks because this does not support your POV. This discussion is getting unnecessarily tedious for you seem to be alone in your position. Garycompugeek (talk) 21:25, 2 May 2008 (UTC)
You're incorrect, Gary. Our job is not to interpret data. It is to report on published interpretations of data, as is clearly stated in WP:NOR: "All interpretive claims, analyses, or synthetic claims about primary sources must be referenced to a secondary source, rather than original analysis of the primary-source material by Wikipedia editors." There is a significant difference there, and it is very important. Jakew (talk) 21:34, 2 May 2008 (UTC)

Jake, while I admire your tenacity, the fact remains circumcision prevalence in Europe, as shown on the map, is "generally low". An educated reader (without specialist knowledge) would be able to verify this simply by looking at the map. This makes it a bare fact, a blunt statement, an accurate description about what the map shows. And I really cannot fathom why you would want to challenge this, even after rereading your arguments. Look at the map again - Europe is overwhelmingly in yellow! Johncoz (talk) 22:35, 2 May 2008 (UTC)

Of course, I don't speak for Blueboar. That's my opinion/interpretation.
Jake, let me draw your attention to the following segment of WP:SYN: "Summarizing source material without changing its meaning is not synthesis; it is good editing." What blunt statements do you think we could make about the European part of that map, Jake? How does it serve the reader to avoid saying that Europe is generally yellow on that map? I think we can say that most European countries have less than 20% prevalence. Policies need to be applied with balance and common sense. ☺ Coppertwig (talk) 22:54, 2 May 2008 (UTC)
Coppertwig, I'm quite aware of that part of WP:SYN, and as you may note, I have proposed several secondary sources, and I have summarised each of them. The difficulty with non-prose sources, such as tables or maps, is that they lend themselves poorly to summarising, or - more accurately - it is very difficult to summarise data without analysing it. That's why secondary sources are so important.
I would say that something like "WHO estimate that prevalence is less than 20% in France" is a blunt statement about the map.
Here's how I see the problem. A number of editors insist on the inclusion of a specific claim about the prevalence of circumcision in Europe. The claim is based upon the editors' own analysis of source material, and is not the interpretation of a reliable source. Extensive searches have been unsuccessful in identifying a source that would support the exact claim. Although verifiable secondary sources have been proposed that have commented on the prevalence of circumcision in Europe, these have been rejected on the apparent basis that they don't state what the editors wish to state.
Now I don't feel comfortable about saying "well, it's obviously right, so presumably it hasn't occurred to anyone". Sure, that's possible, but there may be a very good reason why nobody has made such a claim. For example, maybe there's too little data. A possibility (and this is just a possibility) is that parts of the WHO map are based on estimates that the authors considered to be of very poor quality, and as such they did not feel sufficiently confident in their data to make a general statement about Europe in the text. Maybe they didn't intend for their map to be used in such a way. We don't know. We can't know. Wikipedia could give the wrong information, and lose a lot of credibility, if we make a statement that isn't fully supported by the facts. Our core policies are designed to protect the encyclopaedia from that, and when it proves difficult to make a statement adhere to these policies, that's usually (albeit not always) a sign that we need to stop and reconsider. Maybe the statement doesn't belong in a tertiary source. Maybe we ought to modify it.
So we serve the reader by being cautious and precise, and making sure that all statements are verifiable. We also avoid the risk of a wrong statement, or presenting data as being more certain than it is.
It's not as though there aren't alternatives here. There are. And I'm afraid that I don't understand how the reader suffers by us saying (for example) "Klavs et al. report data supportive of the notion that the prevalence is low in Europe" rather than "the prevalence is low in Europe". The only apparent "problem" is that we're not making a more definite statement, but nobody has yet explained why we should. Jakew (talk) 23:56, 2 May 2008 (UTC)

Jake, some comments

  • It is completely out of scope to speculate on why reliable sources present the data the way they do. That is a real Pandora's box. The map is a reliable source, full stop.
  • Wikipedia cannot "lose credibility" if it accurately summarises the data in a cited reliable source, in this case the map.
  • The low prevalence of circumcision in Europe is a verifiable conclusion taken directly from the source - no reasonable person can deny this. Johncoz (talk) 00:33, 3 May 2008 (UTC)
No, Jake has a good point. It's perfectly valid for Wikipedians to discuss (on the talk page) reasons why a source may or may not be reliable. It seems reasonable to suppose that the reliablity of the data may vary from one part of the map to another. How about Jake's proposed sentence about Klavs et al.?. (Where is the full reference to Klavs et al?) If we can say that, we don't need to reference the map. However, the word "notion" has dismissive connotations. How about "Klavs et al. report data suggesting that the prevalence is low in Europe" or "Klavs et al. report data consistent with a low prevalence in Europe"? (When we get the reference and see what they actually say we might find better words.) ☺ Coppertwig (talk) 00:52, 3 May 2008 (UTC)
My understanding is the WP policy determines the category of "reliable source" by publication status, not content (which would require an independendent evaluation of its "truth"). If sources conflict, then we balance our coverage proportionately. In any case, the WHO map is a reliable source by any definition, and as regards Europe there is no source that contradicts our summary of it (though some sources contradict data for particular countries, eg Slovenia). Johncoz (talk) 01:20, 3 May 2008 (UTC)
Johncoz, it shouldn't be terribly surprising that no sources contradict the claim, because no sources make the claim either. We'd have the same problem if an editor wished to cite, say, the NHANES dataset in support of a claim that circumcision protected against heart disease (if the claim hasn't been made in the literature, there's no way of finding alternative views). What's being proposed here is that we ignore WP:NOR's requirement for a secondary source for interpretive claims. We can't consider such a proposal unless we're willing to think about the consequences of doing so, and to do that we have to consider issues such as whether the map is reliable enough to support our claim. Jakew (talk) 11:27, 3 May 2008 (UTC)
Coppertwig, the abstract for Klavs et al. can be found at PMID 17881413. To quote: "Our findings ... support the notion that the prevalence is low in Europe". I've also listed two other possible sources in my post dated 16:03, 2 May 2008. Jakew (talk) 11:27, 3 May 2008 (UTC)

Coppertwig why does it "seems reasonable to suppose that the reliability of the data may vary from one part of the map to another." to quote you? As Johncoz states above that philosophy leads to pandora's realm. The WHO map source is superior to Klavs reference. Garycompugeek (talk) 03:32, 3 May 2008 (UTC)

Wait a second: the Klavs study is only about Slovenia, so it isn't much use -- unless perhaps in its introduction it summarizes other studies? I assume the map may be based on various sources from various countries; if there were one Europe-wide or worldwide survey we probably would have heard of it. Various sources will probably vary in quality. However, if we're making a general statement that prevalence is low in most of Europe, the precise level of reliability for each country is not that important. OK, I'm back to my earlier position: we should be able to make a "blunt" statement describing the map, such as "the WHO map shows low (<20%) prevalence in most of Europe". ☺ Coppertwig (talk) 13:19, 3 May 2008 (UTC)
Coppertwig, I'm afraid that I don't have the full text of the Klavs study - I just found that quote when using Google Scholar to find some possible sources. But the wording ("supports the notion") suggests that the prevalence is thought to be low in Europe but that there is no way to be sure. The levels shown on the map are estimates (as the legend states), and it may be that the estimates for Europe are poorer than those for elsewhere (which may be why WHO comment in the text on - I think - every continent but Europe). In fact, there's no rational reason why we should believe that the map is "better" than the Klavs study, since it is possible that both are just representing "best guesses" about Europe in different ways. If the map were a prose source, we could probably judge the level of confidence from the wording in the text, and retain the nuances of language in our summary. Unfortunately, it isn't a prose source.
Bearing this in mind, and temporarily setting WP:NOR aside, let's explore what we could say about the WHO map:
  • The proposal being discussed is: "Prevalence is ... generally low across the rest of Eurasia". This is problematic because it states more than the map does (it doesn't capture the fact that these are estimates).
  • Now consider: "Prevalence is ... estimated to be generally low across the rest of Eurasia". This is problematic because the reader needs to know who made the estimate.
  • Now consider: "WHO estimates that prevalence is ... generally low across the rest of Eurasia". This is problematic because the implication is that WHO have stated as much.
  • Now consider: "WHO presents a map of estimated prevalence levels, in which the level is shown to be generally low across the rest of Eurasia". This is getting better, but the sourcing problems are now beginning to become apparent.
  • Finally, consider: "WHO presents a map of estimated prevalence levels, from which the level is judged by Wikipedia editors to be generally low across the rest of Eurasia". In this statement, it is absolutely clear: a) what the source is, b) what statements about confidence are made in the source, c) what the source says and doesn't say, and d) who is interpreting the map. Now, because of that clarity and transparency, we've found a statement that is unsuitable for inclusion in the article. And that's indicative of a problem.
So again, what's wrong with any of the following statements? "WHO states that in Europe, circumcision is generally associated with religion or immigration. Drain et al. state that in Europe, few developing countries have a high male circumcision rate. Klavs et al. report data supportive of the notion that the prevalence is low in Europe." Jakew (talk) 14:27, 3 May 2008 (UTC)
What's wrong with this statement: "WHO presents a map of estimated prevalence levels, in which the level is shown to be generally low (< 20%) across the rest of Eurasia"? (assuming we've already mentioned the parts where the WHO map is orange or red). That's not a judgement by Wikipedians: it's a clear yellow colour on the map that anyone can see.
The only problem with the statements you suggest is that (a) Klavs may be looking at Slovenia only and extrapolating to Europe, and (b) without the Klavs statement, we're not providing sufficient information about Europe. ☺ Coppertwig (talk) 15:55, 3 May 2008 (UTC)
I would think that, if we were to ignore NOR, the statement you quote is probably the least bad of the available options.
As for your comments about Klavs, I have some questions for you. First, how do we know that WHO aren't extrapolating from limited data? Second, is extrapolating from limited data a bad thing (that is, when it happens, is it better for the reader to know or not)? Third, if the only interpretive source that provides "sufficient" information has to extrapolate on the basis of one country, then might that say something about the available data, and more to the point, if the reader was provided with statements with such limitations, might (s)he reasonably make a conclusion for him/herself about both the prevalence in Europe and the amount and reliability of data available? Fourth, should "sufficient information" be judged by the availability of reliable secondary sources, or should it be judged by what we wish to say? Jakew (talk) 17:25, 3 May 2008 (UTC)
Ah. Maybe the WHO map is based on Klavs (for the European part). Now you've got me leaning towards your Klavs statement again. (I don't agree with you that we would be violating NOR in the version I suggested.) ☺ Coppertwig (talk) 20:28, 3 May 2008 (UTC)
I'd guess that both are based on a common source, possibly Drain (WHO's ref 53). But I'm only guessing, of course. Jakew (talk) 20:35, 3 May 2008 (UTC)
I have no problem with Coppertwig's formulation: "WHO presents a map of estimated prevalence levels, in which the level is generally low (< 20%) across the rest of Eurasia, ..." and continuing "and states that "there is generally little non-religious circumcision in Asia, with the exceptions of the Republic of Korea and the Philippines." Johncoz (talk) 20:44, 3 May 2008 (UTC)
BTW, their prevalence data for most of Europe cannot be based either on Klavs (published a year later, this Feb) or Drain, which does not deal with most of Europe. It is clearly projected from DHS estimates of Muslim pop., supplemented by some other unknown sources Johncoz (talk) 20:56, 3 May 2008 (UTC)
... which is why I said "other unknown sources". Whatever their methodology, our job is to accurately represent their conclusions Johncoz (talk) 21:35, 3 May 2008 (UTC)
Not quite, no. Our job is to accurately represent the conclusions of reliable sources. However, that doesn't mean that we have to represent every single reliable source (which is sometimes impossible). In particular, when a source itself summarises some information, but not all, then there is no obligation that says "we must try to extract this information in any way we can from this particular source". It may be better to summarise a different source instead. Jakew (talk) 21:56, 3 May 2008 (UTC)
Drain do report some findings re Europe, Johncoz, which they summarise as: "Only 4 of 18 (22%) developing countries in Europe and Central Asia had a high male circumcision prevalence". By the way, you might find it interesting to take a look at the number of DHS surveys that have been performed in European countries. Jakew (talk) 21:03, 3 May 2008 (UTC) (edited 21:20, 3 May 2008 (UTC))
This is not really relevant to the wording (could we agree on that, please), but for the record I said for "most of Europe". As it turns out, their text statement misrepresents their own data. Here is their table, in which you can see that no European countries have high prevalence. The countries they deal with are Moldova, Russia, Ukraine, Georgia (all low prevalence), Bosia, Macedonia, Albania and (confusingly) "Yugoslavia". It is the last that clearly misled the WHO authors into misclassifying Slovenia, for instance. Johncoz (talk) 21:16, 3 May 2008 (UTC)

I have revised the draft with its citations here. The text says: Circumcision is near universal in the Middle East and Central Asia. WHO presents a map of estimated prevalence in which the level is generally low (< 20%) across the rest of Eurasia, and states that "there is generally little non-religious circumcision in Asia, with the exceptions of the Republic of Korea and the Philippines".[1] Prevalence in Latin America is universally low.[2] Is this acceptable? Johncoz (talk) 21:51, 3 May 2008 (UTC)

I'm afraid that I'm not comfortable with citing the map, for reasons discussed at length. Once we agree on the sourcing, I suspect that the wording will be relatively easy to agree. Jakew (talk) 21:56, 3 May 2008 (UTC)
But Jake, we devote an entire subarticle to prevalence in which we happily cite the map literally hundreds of times without caveat. The WHO document is a "reliable source", by any reading of WP policy, and that includes the map. There is no ground that I can see for rejecting the current formulation. Johncoz (talk) 22:04, 3 May 2008 (UTC)
Johncoz, I have been thinking about the prevalence article, and I think that we do need to make some changes. As a minimum, I think we need to make it clearer that the WHO estimates are estimates. I'm not entirely sure of the best approach yet, and if you want to open a discussion at that article's talk page, I'll look forward to discussing it with you.
On the subject of this article, even though you disagree that making general statements about the map violates NOR, you must surely agree that WP:NOR#Primary, secondary, and tertiary sources prefers an interpretive source. Besides, this is a logical approach that naturally follows from the principle of NOR: since this article must compress information into a comparatively small space, it makes sense to summarise sources that have already compressed information, rather than compressing a larger amount of information ourselves. So if we had two prose sources, one of which said "Prevalence in country X is N1. Prevalence in country Y is N2...", and the other gave an overview, we'd prefer the latter. Jakew (talk) 22:43, 3 May 2008 (UTC)
On the prevalence article, I did foreshadow exactly that ("For a general article on circumcision it should provide a short snapshot of the findings in the main prevalence article (which also needs some work).") at 20:03, 24 April, and would be more than happy to collaborate. On sources, of course I would prefer a succinct summary from a reliable and unchallenged secondary source. However, we have what we have, partly because the low prevalence in Europe is an accepted fact, I suspect. So, we do the best we can with the reliable source we have, clearly flagging it as an estimate. Might I suggest that my current formulation is more agreeable to your position than the existing text, so we make the substitution. Then, if you wish to pursue an alternative formulation after we do over the prevalence article, we will revist the matter. Johncoz (talk) 23:06, 3 May 2008 (UTC)
Johncoz, this isn't a choice between your proposal or the existing text. There are other options. Will you please examine the last paragraph of my post dated 14:27, 3 May 2008? Jakew (talk) 23:13, 3 May 2008 (UTC)
I have read it, Jake, more than once. But its muddiness only makes sense if one wanted to avoid all mention of the WHO map (which apparently you do). The map however is our best source for overall estimates (which are what is required for this "snapshot") and its use in the way suggested does not violate any WP guidelines. Like it or not, it qualifies as a reliable source, and it is not contradicted by any other source at the level of generality we are citing it. Johncoz (talk) 23:32, 3 May 2008 (UTC)

You will never be able to satisfy Jakew on this Johncoz. I believe you still have consensus regardless of one editor. Garycompugeek (talk) 03:50, 4 May 2008 (UTC)

Muddiness is a good word, Johncoz. The feeling that I get from the prose sources is that this is a muddy issue, and I think that it's a mistake to try to "protect" the reader from this through over-clarification. I also, as you know, have some serious concerns about this usage of the map, though I recognise that you don't share this viewpoint.
There is, of course, another possibility here, which is worth discussing. It's not ideal, but it may be an acceptable compromise. It includes a reference to the map and a quoted opinion from which the reader can get a feel for the level of certainty.
  • Prevalence is near universal in the Middle East and Central Asia.[WHO] WHO states that "there is generally little non-religious circumcision in Asia, with the exceptions of the Republic of Korea and the Philippines".[WHO] In Latin America, prevalence is universally low.[Drain] WHO presents a map of estimated prevalence in which the level is generally low (< 20%) across Europe,[WHO] and Klavs et al. report findings that "support the notion that the prevalence is low in Europe".[Klavs]
Thoughts? Jakew (talk) 11:38, 4 May 2008 (UTC)
Great, I hope we can get consensus on that. A minor point, not enough to break consensus over: Because of the geographical proximity of Asia and Europe, I would move Latin America out from between them, probably putting it at the end. ☺ Coppertwig (talk) 13:18, 4 May 2008 (UTC)

Surely excluding Muslim-majority (or even -minority) countries surely makes statements about Asia meaningless. For that matter, identifying incidence as proportions of national populations is also rather meaningless given the vast disparities in the latter. There are, after all, some 160 million Muslims in Pakistan, 154 million in India, 127 million in Bangladesh, 15 million in Malaysia and 204 million in Indonesia. Masalai (talk) 05:54, 7 May 2008 (UTC)

Wording about Jewish law.

This is only a small point, but I thought that it would be better to bring it to the talk page before making any change that may have religious implications that I may be unaware of. One sentence about Jewish law reads:

Under Jewish law circumcision is a mitzva aseh ("positive commandment" to perform an act) and is obligatory for Jewish males.

This strikes me as unnecessarily ponderous. The same thing could be more simply expressed as:

Under Jewish law circumcision is a commandment (mitzva aseh) and is obligatory for Jewish males.

'Positive commandment" commandment to perform an act" is implied in the word 'commandment'. Michael Glass (talk) 11:26, 4 May 2008 (UTC)

Sounds good to me. It may still be a bit redundant: don't "commandment" and "obligatory" mean the same thing? ☺ Coppertwig (talk) 13:13, 4 May 2008 (UTC)

For some clarification, mitzvos come in two forms, requirements to perform an action (positive commandments/mitvos aseh) and injunctions against various actions or states of being (negative commandments/mitzvos lo sa'aseh). The translation of mitzvah as commandment is pretty much accepted, so the positive qualifier, to me, seems to be necessary to be precise. Perhaps a more streamlined sentence would be

“Under Jewish law circumcision is a mitzva aseh (positive commandment) and is obligatory for Jewish males.”

Would that be acceptable? -- Avi (talk) 14:22, 4 May 2008 (UTC)

Is there a source for this statement? Also, it doesn't seem that the view that it is obligatory for Jewish males is universal. We trust that the enduring Jewish values of ethics and education will lead more Jews to the realization that circumcision does not serve the best interests of the child or the community of Jews. [1], Judaism is divided on the matter of converts. Reform Judaism does not require it, Orthodox and Conservative movements do.[2] Perhaps a slight rewording would address this? Blackworm (talk) 17:23, 4 May 2008 (UTC)

I was talking from the Orthodox perspective. -- Avi (talk) 23:44, 4 May 2008 (UTC)

Source would be Genesis 17:12 (cf Leviticus 12:3). -- Avi (talk) 23:53, 4 May 2008 (UTC)
I don't think we should cite the Bible directly, at least not without a secondary source confirming the interpretation.
I still don't see any difference between "positive commandment" and "obligatory": it still sounds repetitive.
I did some web searches and found these [3] [4]
Based on what Avi and Blackworm said, how about "Under Orthodox Jewish law, circumcision is a mitzva aseh (positive commandment) and is obligatory for Jewish males." ? ☺ Coppertwig (talk) 03:14, 5 May 2008 (UTC)

A better source for the Orthodox law would be Shulchan Aruch, Yoreh Deah, 260:1. -- Avi (talk) 03:42, 5 May 2008 (UTC)

Thanks, Avi. I was hoping you could provide that sort of information. Here it is at Wikisource: wikisource:Shulchan Aruch/Yoreh Deah/260, "It is a positive commandment (mitzvah) for the father to circumcise is son. And this mitzvah is greater than all the other positive mitzvahs".☺ Coppertwig (talk) 12:08, 5 May 2008 (UTC)
From a cursory reading of Shulchan Aruch, it doesn't seem this source is universally accepted as "Orthodox Jewish law" (but it's close). The source makes no mention of Orthodox Jewish law, so we'd need a secondary source recognizing Shulchan Aruch as law, and then we can attribute the view to that source. But all this misses a point; the goal of the sentence in the lead should be to show circumcision's role in Judaism, not just Orthodox Judaism. (I'm not sure why Avi would wish to present the Orthodox perspective as representative of all Jews.) How about: In the Hebrew Bible, male circumcision is a commandment from God. That, at least, is immediately verifiable. We could perhaps follow it with a sentence on prevalence of circumcision among Jews (I believe one of the WHO sources estimated it at 98%).
In browsing the source, I also found this interesting item: We don't circumcise the son of a man without his knowledge but if the father refuses to circumcise his son the bet din [court] circumcises him against the fathers wishes.[5] This could possibly be summarized later in the text as, Shulchan Aruch, recognized by an overwhelming majority of Orthodox Jews as law, requires a father to circumcise his son, and if the father refuses, calls on the rabbinical court to circumcise against the father's wishes. It provides a nice contrasting view to that of medical organizations and many governments, serving WP:NPOV well. Blackworm (talk) 16:56, 5 May 2008 (UTC)
It should be noted, however, that since the destruction of the temple some 1930 years ago, I believe that there really has not been a rabbinic court authorized to be able to perform the circumcision, for technical reasons relating to being in the diaspora etc. And, I admit, I am not 100% certain that it has never been done; two millenia is a LONG time. As for the Shulkhan Arukh being one of the key links in the chain for Orthodox transmission over these millenia, I believe that is appropriately handled here Shulchan Aruch, but if necessary, we can get a source. I would contest, however that the "forced circumcision" not be placed in, although I do need to check the Shach and the Taz (primary commentators on the Shulkhan Arukh) there and see what they say. Thanks. -- Avi (talk) 18:40, 5 May 2008 (UTC)
If this law (and thus, Shulchan Aruch) was subsequently rejected by a substantial portion of Orthodox Jews (or the leaders?) then that merits mention too. Could you expand on your reasoning behind wanting to not present the law that states the rabbinate court must overrule the father's wishes and circumcise? Again, it seems a notable counterpoint to the view held by medical organizations and many governments. I don't see why it should be considered a "forced circumcision," as I see it as simply the common, everyday surrogate consent (a widely accepted concept) being assigned to the court, rather than to the parents. Blackworm (talk) 01:54, 6 May 2008 (UTC)
As I understand Avi's point, Blackworm, this "notable counterpoint" has not been invoked for some 2,000 years, for the very practical reason that said rabbinic court has not had the rather important property of existence. Hence, as "notable counterpoints" go, this seems fairly low on the list. And to propose including it alongside "active" (if that's the correct term) Jewish law seems to rather miss the point. Jakew (talk) 11:37, 6 May 2008 (UTC)

(<-)The Shulchan Aruch is still the baseline for almost all Orthodox tradition, Blackworm, but there exists the difference between the theoretical and the practical. Theoretically, a non-circumcised Jew may not take part in the Paschal lamb. However, as there has been no Paschal lamb for 1930+ years, it is practically a non-issue. Similarly, there are theoretical powers given to authorized rabbinic courts; however, I do not know of any incidents of forced circumcisions against the parents' wills, as I do not believe any rabbinic court in the diaspora has the legal authority to perform such action. However, under a theocratic government in the land of Israel (which last occurred 1930+ years ago) the court would be authorized to impose the circimcision, the same way it is authorized to perform capital punishment on idolators and eminent domain on people who do not pay their debts. So, while it is a legal truth, its presence in this article would be WP:UNDUE in my opinion since it has been a theoretical point for many centuries. -- Avi (talk) 13:48, 6 May 2008 (UTC)

Jake, as now I understand it, rabbinic courts still exist, but they do not currently have the authority to enforce this particular law on anyone (similar to the laws of a government in exile). Avi, you've convinced me that its mention in this article seems undue. It would be much better suited to circumcision and law, or perhaps history of male circumcision if the former has no treatment of the legal history of circumcision. Perhaps we should return to focusing on a good, sourced, lead paragraph statement (I probably shouldn't have introduced this tangent here). Blackworm (talk) 20:19, 6 May 2008 (UTC)

Circumcision Myths

I have noticed in reading History of male circumcision under the section "Male circumcision to prevent masturbation" many childhood myths. Aside from religious mandates it seems circumcision was as the forefront of preventing masturbation (This being what I was taught as a child). It was beleived the foreskin and clitoris provided pleasure during masturbation. Considering this is the english speaking wikipedia and that circumcision being one of the major drives behind in the US and other places to "control 'masturbatory insanity'" is it fair to regulate it to one section in an stub article? Garycompugeek (talk) 22:47, 5 May 2008 (UTC)

Prevention of masturbation was one of many reasons proposed for circumcision in the late 19th and early 20th centuries, but it doesn't seem to warrant major coverage. To give you an idea of its significance as assessed by one historian, in David L Gollaher's 253-page book, "Circumcision: A history of the world's most controversial surgery", the index lists two pages for "masturbation" (there is also some additional treatment under insanity). Jakew (talk) 23:11, 5 May 2008 (UTC) (edited 23:17, 5 May 2008 (UTC))
I disagree. It's frequently cited in sources. All it would take is a short list of reasons given, say from this source: In a recent historical survey, Dunsmuir and Gordon cite prevention or cure of impotence, phimosis, sterility, priapism, masturbation, venereal disease, epilepsy, bed-wetting, night terrors, "precocious sexual unrest" and homosexuality as among the contradictory benefits urged by Victorian and Edwardian physicians in Britain and the USA, without offering any firm suggestions of their own as to the relative weight of these factors. I suggest a list format by date, allowing us to add "cervical cancer, penile cancer, HIV, and other STDs" under the late 20th century heading. Blackworm (talk) 01:45, 6 May 2008 (UTC)
This is already covered in the history of male circumcision article. It would seem to be unnecessary to import it here. In addition, a list such as you suggest is blatantly an attempt to discredit medical analysis of circumcision by comparing it to obsolete fears about masturbation. The way, the truth, and the light (talk) 01:51, 6 May 2008 (UTC)
The reasons listed *are* the medical analysis of circumcision of the time, so I don't see how its neutral presentation is necessarily an attempt to discredit it. Present it, and let the reader decide whether it's discredited. There is substantial overlap between the analysis then and now, too. My seeking to present the entire analysis without focusing on masturbation was an attempt to be neutral, not the opposite as you accuse. Blackworm (talk) 02:02, 6 May 2008 (UTC)
So, in your view, does the current content of this article focus too much on masturbation? To quote:
Jakew (talk) 11:15, 6 May 2008 (UTC)
How could one sentence focus to much on masturbation. This issue is out of balance. As I have stated above this was a much weightier issue then you apparently want to give credence too. The way, the truth, and the light objects about any truth that does not paint circumcision in a beneficit light. True medical benefits of circumcision concerning transmission have only recently been acknowledged. The truth is we have followed blind ignorance and myth for much of circumcisions history. I propose a section of 'Circumcision Myths' and more weight given circumcision being done to prevent masturbation. Garycompugeek (talk) 12:44, 6 May 2008 (UTC)
A very poor idea, for several reasons. First, a section entitled "circumcision myths" is almost sure to violate WP:NPOV (and possibly WP:NOR), since it represents either a) the viewpoint of Wikipedia editors that statement X is a myth about circumcision, or b) the viewpoint of a reliable source that statement X is a myth (which is inherently problematic, because it excludes other reliable sources arguing that statement X has merit). Second, any such material is likely to be already included, under a less POV heading, and is given appropriate treatment. For example, the historical idea of circumcision to prevent masturbation is already included, as I've shown, in the appropriate section. Finally, as noted above, and as Blackworm's quote clearly shows, circumcision to prevent masturbation was but one of several reasons given at the time, and it would be inappropriate to give it more weight in the article.
Regarding your comments about The way, the truth, and the light, I suggest that you review WP:CIVIL and WP:AGF. Jakew (talk) 14:02, 6 May 2008 (UTC)

(edit conflict)

So you would have me believe that there are no misunderstandings concerning circumcision? There are myths on both sides of the issue. Concerning your last statement - I have been completely WP:CIVIL. "blatantly an attempt to discredit medical analysis of circumcision by comparing it to obsolete fears about masturbation" to quote The way, the truth, and the light, is not assuming good faith. In fact you accusing me of this is also not assuming good faith. Just because circumcision to prevent masturbation creates doubt about medical analysis is not a reason to exclude it. Garycompugeek (talk) 15:46, 6 May 2008 (UTC)

(Outdent.) I agree with Jakew that "Circumcision Myths" is inappropriate. Gary's first post here left the impression that the subject isn't addressed at all, and as Jakew points out, it is. The current edit seems fine to me. Jake, I don't believe the current content focusses too much on it; the source gives a good amount of attention to it, quoting the main advocating physician as listing it second in a list, and explaining at length how a great deal of other disease was attributed to masturbation at the time: Since the Enlightenment, doctors in Western Europe and America had identified masturbation as a cause of illnesses. In the course of the nineteenth century it was linked to madness, idiocy, epilepsy, and from these to a multitude of other psychological, behavioral, and pathological conditions. Again, I think the current edit on the topic is appropriate. Finally, I'd like to ask Jake why Gary's comments about The Way are incivil, but The Way's comments about me are not worthy of his reproach. Surely incivility and lack of good faith are not dependent on one's apparent position with respect to circumcision? If they are related in your eyes, Jake, perhaps you should keep the "policy reminders" to yourself rather than only attacking "one side" with them. Blackworm (talk) 15:20, 6 May 2008 (UTC)

Perhaps my childhood preconceptions are lending undue weight to this issue however I will not press it if no one else agrees. Garycompugeek (talk) 16:02, 6 May 2008 (UTC)
In answer to your question, Blackworm, I do think that TWtTatL's comment above was inappropriately worded, and I would suggest that a more civil phrasing might be something like "a list such as you suggest would only serve to discredit..." Ultimately, however, it's not as egregious as a statement that boils down to "you always object to statements that I perceive as factual yet do not support what I perceive to be your point of view", which cannot be rephrased as a comment about the subject, and is simply nothing more than an accusation of bad faith. In short, "you are a POV pusher" is far worse than "this seems to be POV pushing" (see Wikipedia talk:NPOV dispute#Consensus needed), and although not exactly the same, this seemed too close to the former. Jakew (talk) 16:36, 6 May 2008 (UTC)
Semantics. Bottom line is EVERYONE needs to assume good faith/be civil and remain focused on the issues at hand. This article is very contentious and draws ire easily. Garycompugeek (talk) 19:29, 6 May 2008 (UTC)

Getting back to the article, Gary, you said is it fair to [relegate discussion of masturbation] to one section in an stub article -- but it seems you missed the mention in this article in the section referenced above. Does this address your concern? Blackworm (talk) 20:22, 6 May 2008 (UTC)

Thank you Blackworm. Not exactly. I am happy that we mention it but feel it should illustrate one of the main reasons for circumcision for earlier time periods. I grew up being taught this so I may be giving undue consideration? Garycompugeek (talk) 20:58, 6 May 2008 (UTC)
If you are older, it's possible that your perspective differs from younger editors as far as the temporal relevance (i.e., whether it's "current," "recent," or "historical"). The WP term is "recentism" and it's a subject of some debate. I could see how hearing from editors that certain views one grew up with are "obsolete" would trigger the "WTF" reflex in that circumstance. I feel the same about the view that the word "uncircumcised" is a pejorative insult, for example (grew up with it, still see it now, read it in the dictionary, and yet have editors flatly denying the view and continuing to use the word in the article). Anyway I think you may be right about undue consideration, and keep in mind that you would be the welcomed exception to the rule if you actually questioned whether your upbringing and culture causes you to see undue bias (one way or another) with regard to circumcision. Blackworm (talk) 21:56, 6 May 2008 (UTC)
In reply to Garycompugeek's "So you would have me believe that there are no misunderstandings concerning circumcision?" Opposing the inclusion of a myth section is not the same thing as claiming there are no misunderstandings. I also oppose the inclusion of a myth section for reasons described well by Jakew, and I assume that misunderstandings exist. If a large enough number of people have the same misunderstanding to make it notable enough to include mention of here, then perhaps we're not talking about "a piece of information about which there is no serious dispute" (WP:NPOV). Even if there were some things that could quite legitimately be included in a "myths" section, there would undoubtedly also be things that some people think should certainly be included there while others think they should certainly be excluded. Putting, in effect, a strong assertion into a section heading leaves little flexibility. Talking about each case where it comes up in the article, on the other hand, allows words to be carefully tailored to each situation. Besides, a "myths" section would throw together bits of information from diverse aspects of the topic, rather than allowing each to link organically into the section in which it is relevant, enhancing the overall cohesion of information in that section.☺ Coppertwig (talk) 09:04, 12 May 2008 (UTC)

Vandalism

On checking the history I noticed that some anonymous moron has been vandalising the article. We have more to do with our time than reversing the work of vandals. I propose that the article be protected from editing by anonymous users permanently. What do others think? Michael Glass (talk) 09:09, 8 May 2008 (UTC)

I do not believe this would be possible going contrary to basic wiki policies. There are many controversial articles that draw much more vandalism than this article. If it gets out of hand an admin will protect for a given amount of time and/or block IP's. Garycompugeek (talk) 12:59, 8 May 2008 (UTC)

Kenya Report

I added this since Bailey's study let the WHO policies, on this: University of Illinois epidemiology professor. Dr. Robert Bailey's research in Kisumu, western Kenya reported that "infection rates were cut by 60% among men who were circumcised." Funded by the U.S. Institutes of Health and the Canadian Institutes of Health Research, it led the World Health Organization to include circumcision in its prevention policies.iht.com, Male circumcision as anti-AIDS weapon --Florentino floro (talk) 09:28, 23 May 2008 (UTC)

You added it to "Hygiene, and infectious and chronic conditions". Please look at the section entitled "HIV and other sexually transmitted diseases", where we already include coverage of the HIV issue, and document the three trials (including Bailey's). Jakew (talk) 11:21, 23 May 2008 (UTC)


Highly Biased Article

There are plenty of medical sources to refute most of what is trying to be presented in this article. The HIV argument is loaded with poor sampling methods from African dominated regions where lack of sexual protection is practiced- also in Scandinavia, where circumcision is bearly practiced, there is one of the lowest rates of sexually transmitted desease, while in the US, where there is much practice of circumcision, there is one of the highest rates of HIV in the Western world, not to mention impotencey. HIV has to do with sexual practices, not circumcision or lack of it. Circumcision also can have biases from within the medical world too becuae it is a money-making endeavor for certain doctors, while the pediatric society today clearly states that there is no medical benifit for the practice what so ever- it is simply a cultural preference. Circumcision also removes the frenulum, the male equivilent to the female clitorus, it turns a sensitive internal gland into a less sensitive external element, not to mention, it is a human rights violation of mutilation, which is completely against the law for females. Circumcision destroys the natural gliding mechanism of the intact organ. No where in the world of medical science do we ever hear of amputation of normal healthy tissue to improve upon what nature has created- it doesn't exist. This is a highly biased article that is not simply talking about what circumcision is, but rather promoating an agenda for it that is not at all proven by medical science to be benificial. The majority of men, documented to have had the proceedure later in life, overwhelming expressed regret, a lack of sensation, and loss of sexual variety. not to mention the need for artificial lotions to aid in self stimulation. This article needs to be flagged- it is highly biased Chiboyers (talk) 00:10, 29 May 2008 (UTC)

Feel free to add additional information if you can cite reliable sources. OhNoitsJamie Talk 00:13, 29 May 2008 (UTC)
I reverted an addition to the lead, on account of the fact that it gave undue weight to a single observational study from 1997. Additionally, presenting it as a "complete contrast" to the WHO, CDC, etc., statements was original research. To criticise reliable secondary sources (CDC, etc) one would need other secondary sources; see WP:MEDRS#Using primary sources to "debunk" the conclusions of secondary sources. This may be difficult, however, as prevailing scientific opinion (as may be verified through a brief browse of PubMed) seems to reflect the high-quality evidence (meta-analysis of RCTs) now available (see WP:MEDRS#Assess the quality of evidence available). Jakew (talk) 13:13, 29 May 2008 (UTC)


This Article Is Controlled By A Biased Agenda

I just cited a reliable source from the University of Chicago that was removed by this Jakew, a problematic poster that several people above have commented on. I can also provide further reliable sources that refutes that circumcision wards off desease, HIV/AIDS, and all other related myths. When this page has been noted by several people and tagged that there is a bias, and this Jakew takes it upon himself to remove the tag and change the page undemocratically, we have a problematic page governed by an agenda that wishes to suppress all views and factual evidence that is in contrast to a certain perspective that some favor. There are countless reliable sources from the scientific community that states that circumcision has no medical benifit what so ever. There are sources from the Jewish community that even questions the validity of this ancient ritual in the modern world. There is no fully agreed upon scientific position, in the Western World, what so ever that proves, without a doubt, that circumcision ever had any true benefit what so ever. The overwhelming testimonials from men that had circumcision done late in life express regret, loss of sensation, and a sense of mutilation. ALL of this can be sourced, which would be a waste of time to do as Jakew, and others of his perspective, will continually remove it and watch over this page in desperation to cover up FACTS and not allow a balanced discussion of this topic. Any logical person can see this article is unbalanced, and when a person has to removed valid sourced information to only promote one agenda, something is wrong. Look at how long this talk page is. If this article was correctly balanced, we would not have a need for so much talk- pages that have this much on Wikipedia are pages that continually have unbalanced articles attached to them. Putting effort on balancing a flawed article controlled by an agenda always is a wate of time when valid points not liked are continually removed and desperately argued against. Those who want a balanced perspective should look into the matter themselves, instead of having facts and knowledge repressed on Wikipedia by those with an unbalanced agenda.Chiboyers (talk) 15:23, 29 May 2008 (UTC)

Jake please try to work with other editors on the talk page before reverting everything YOU do not like. Garycompugeek (talk) 16:38, 29 May 2008 (UTC)

Please see this post in the above section, Gary. Jakew (talk) 16:45, 29 May 2008 (UTC)
Thank you Jake I didn't see your above post however I do not agree with your conclusions. Original research? The Title of the source article is "Research shows circumcision has little effect on spread of disease". Chiboyers post is from a respected peer reviewed source and placed after the WHO source to show balence and contradiction. Garycompugeek (talk) 17:08, 29 May 2008 (UTC)
Original research was but one of the problems I noted, Gary, and as I explained the problem is of presenting it as a "complete contrast" to the WHO's conclusions, for which one would need to cite a reliable source that contrasts the two. If that were the only problem, it could be addressed by rephrasing the text. However, I also noted some more serious problems, including use of the primary source to contradict the secondary sources, and undue weight problems caused by citing a single observational study. Given that there have been more than 40 observational studies and 3 RCTs, the majority of which have found a protective effect, we need to be careful that our coverage is representative (we've discussed this before; see eg., #HIV, #Dubious edits, and #new study). Jakew (talk) 17:22, 29 May 2008 (UTC)
Showing multiple sources to discredit the WHO source would be WP:UNDUE on the other side however one more blended as a meta would be perfect balance if it can be found. Still I find the source credible and its placement correlated properly to above statement. Minor word changing can be hashed out. We should not pick and choose sources but let the reader weigh content themselves. Garycompugeek (talk) 19:22, 29 May 2008 (UTC)
Gary, allow me to quote from WP:NPOV#Undue weight:
"NPOV says that the article should fairly represent all significant viewpoints that have been published by a reliable source, and should do so in proportion to the prominence of each. Now an important qualification: Articles that compare views should not give minority views as much or as detailed a description as more popular views, and will generally not include tiny-minority views at all. For example, the article on the Earth does not mention modern support for the Flat Earth concept, a view of a distinct minority."
Now, bearing this in mind, it is clear that the correct balance is that our coverage of various viewpoints is in proportion to the prominence of those viewpoints in reliable sources. That is, we would only give equal coverage to the ideas that circumcision was and was not protective if those views were equally prominent in the literature. So, let's take a look. (At the time of writing, PubMed lists 485 papers including the keywords "circumcision" and "HIV", so obviously this is just a selection.)
  • A meta-analysis published in 2000 (preceding the RCTs) reported that "Twenty-seven studies were included. Of these, 21 showed a reduced risk of HIV among circumcised men, being approximately half that in uncircumcised men (crude RR = 0.52, CI 0.40-0.68)."[6]
  • A systematic review published in March 2005 (also preceding the RCTs) stated that "[the] review includes a comprehensive assessment of the quality of all 37 included observational studies [...] Although most studies show an association between male circumcision and prevention of HIV, these results may be limited by confounding, which is unlikely to be adjusted for. [...] Therefore, the results of the three randomised controlled trials underway will provide essential evidence about the effects of male circumcision as an intervention to prevent HIV infection."[7]
  • (The RCTs were then published.)
  • WHO, UNAIDS, et al. state in their joint recommendations that "The partial protective effect of male circumcision is remarkably consistent across the observational studies (ecological, cross-sectional and cohort) and the three randomized controlled trials conducted in diverse settings. [...] The efficacy of male circumcision in reducing female to male transmission of HIV has been proven beyond reasonable doubt."[8]
  • The CDC state that "Several types of research have documented that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex."[9]
  • The first meta-analysis of RCT evidence reported: "to summarize the protective effects seen in the trials, we conducted a random-effects meta-analysis of results of these three trials, following the recommendations of the QUORUM statement for reporting trials as appropriate [19]. There was no evidence of heterogeneity between the trials (P=0.86), and the summary rate ratio was 0.42 (95% CI 0.31–0.57; Fig. 2), corresponding to a protective effect of 58% (95% CI 43–69%), identical to that found in the observational studies (58%, 95% CI 46–66%) [14]." (Weiss et al., AIDS. 2008 Mar 12;22(5):567-74)
So, to consider WP:UNDUE, if we had space to do so in this article, it might be reasonable to include all of the primary sources (ie., individual studies). But we don't. If we were to include a few selected primary sources (and I'm not suggesting that we should), we'd need to include a representative selection, and per the above, that would mean mostly including studies that found a protective effect. But the thing is, there's actually no need to include primary sources at all, and we should prefer secondary sources where possible; see WP:PSTS, WP:V, WP:MEDRS#Some definitions and basics, and WP:MEDRS#Using primary sources to "debunk" the conclusions of secondary sources. So if we want to give an overview of the findings of observational studies, it would be far better to say something like "A meta-analysis published in 2000 reported that 21 of the 27 observational studies included showed a protective effect." But once we WP:MEDRS#Assess the quality of evidence available, it becomes clear that the RCT evidence is of such a stronger methodology that this information is largely outdated. It certainly doesn't belong in the lead, and the current text in the HIV section ("Before there were any results from randomized controlled trials, reviews of observational data differed as to whether there was sufficient evidence for an intervention effect of circumcision against HIV.") covers it perfectly well. Jakew (talk) 21:03, 29 May 2008 (UTC)
I don't like it Jake. PubMed is a great source but primarily American sources. The majority of the world male population is not circumcised and that majority is not in the US. Are we accurately reflecting world opinion or just American opinion? Garycompugeek (talk) 13:19, 30 May 2008 (UTC)
Gary, PubMed isn't just American. It's a database containing records for articles appearing in numerous journals, published in (according to PubMed) more than 80 countries. (To browse through some of those journals, go here.) As such, it's an excellent guide to the scientific literature. Jakew (talk) 13:35, 30 May 2008 (UTC)
I agree that PubMed is an excellent guide to the scientific literature however it is "primarily American sources" and as such maybe unbalanced concerning circumcision. This is not about PubMed but a valid peer reviewed source directly contradicts the WHO source. You contest that it is an extreme minority (world is flat) viewpoint because of PubMed however I maintain this viewpoint maybe more mainstream worldwide than you realize. Garycompugeek (talk) 14:08, 30 May 2008 (UTC)
I don't understand, Gary. Where do you get the idea that it is "primarily American sources" (is this a quote from somewhere?).
Also, no, it's not about PubMed per se (although Laumann's study can be found in PubMed). It's about two issues: first, whether Laumann does contradict the WHO source, and second, whether it is representative to include Laumann in the lead section.
The first issue is one of original research: since neither Laumann's study nor the news article currently cited in the article refer to the WHO source, it is merely the opinion of certain WP editors that it contradicts the WHO source. Furthermore, neither Laumann's study nor the news article actually refer to HIV/AIDS (the study does include HIV in Table 2 — 1.9 per 1000 in circumcised men and 5.4 per 1000 in uncircumcised men, though not statistically significant — but it is not discussed in the text).
As for an "extreme minority/Flat Earth" viewpoint, no, that's not what I'm saying. At the time Laumann's study was published (1997), there were only observational studies, and if you look at the first meta-analysis I cited above, you'll see that 21 of 27 observational studies included in that (2000) review found a protective effect. Put another way, 6 of 27 (roughly 20%) observational studies did not find a protective effect. So at the time, it wasn't an extreme minority viewpoint, but it was a minority viewpoint.
Now, of course, the situation is different. We not only have observational studies, but we have experimental evidence too (in the form of RCTs). And if you read the systematic review I cited, you'll see that although it expressed doubts about the reliability of observational studies, it emphasised the importance of RCTs (consistent with WP:MEDRS#Assess the quality of evidence available). Jakew (talk) 14:47, 30 May 2008 (UTC)
Jake I'm not saying this is the end all conclusion and to be frank, as I've stated before after reading lots of raw data, I agree and understand that a circumcised penis is less sensitive/tender making it harder to contract VDs. (castration would go even further but no one seems to be recommending that) I digress, the point I'm trying to make is unless this is the only source in the World dissenting then sure lets leave it out otherwise we can reword it a bit and leave it in as GOOD balance. Garycompugeek (talk) 17:03, 30 May 2008 (UTC)
Gary, while I have no problem with including it where there is space to do so (eg. medical analysis of circumcision), there is a serious problem of undue weight in including it in this article, and in particular with including it in the lead section, where space is even more limited. To give this study an appropriate amount of weight, we would need to include it alongside discussion of other observational studies, in addition to the secondary sources that have summarised them. In the current version of the lead, we dedicate a paragraph to the WHO & CDC, which are secondary sources summarising multiple observational and RCT studies. We then dedicate a second paragraph to one of the 40 or so observational studies that is among the relatively few that found no effect. Jakew (talk) 17:35, 30 May 2008 (UTC)
      • Nonsense, I can provide even many more valid medical sources, not just U of C, that demonstrates that there is absolutely no proven scientific position between circumcision and HIV/AIDS prevention. Lack of safe sex is the overwhelming conclusion for the spread of HIV/AIDS, as is the case with Africa. I can even provide countless studies of men who have experienced circumcision later in life discussing the effects of a loss of frenulum, the general lack of a fuller sensitory experience and the overall need to have to have more aggressive sexual experiences in order to achieve sensual pleasure. The desire for more circumcised men to participate in anal sex as a response to the need of having to have more pressure placed on the shaft to feel gratification, vs. those who are not and achive great satisfaction from the just arousal of the frenulum alone. I can provide research that demonstrates that the masterbatory practices of those who are not circumcised are far more gentle in their approach to receiving stimulation, and I can even provide research that examines how circumcision has altered sexual interaction bewteen men and women; a circumcised man needs more agressive back and forth motions to arouse the shaft vs the uncircumcised male who will feel great pleasure from a rolling internal motion that is both stimulating to her g-spot and his frenulum, thereby also keeping a closer-bonding contact with her clitorus, vs, the more "banging" needed motion by the circumcised man, causing a conflict between what gives him pleasure and what gives her pleasure. I can provide materials that discussed how the glandular head looses its glass-like surface from being altered into an external element- I can also provide alternative sourcing that says circumcision has caused more penile cancer at the location of the circumcision scar, than in any man who is left intact. I can also provide overwhelming evidence in the greater numbers of Americans who are choosing to not "buy into" the myths about circumcision which was at a height in the 1970's at nearly 90% occurance and, today, American circumcision is at only about 40%. I can provide studies that examined the cultures of Italy, France and Spain, noted for their attention towards love-making, and those cultures general lack of circumcision. We can go on and on- not to mention that circumcsion was promoted by US hospitals throughout the 20th century based on almost no scientific/sexual research into the medical and sexual effects of the practice- and that the U.S. has the highest impotency rate in the Western world, today, where circumcision was greatly practiced. I am not trying to make anyone feel bad here, but even on the most general surface of the subject, one has to question why a history of genital mutilation is not accepted for females and deemed "barbaric", but in the case of a male, it was accepted as OK- that very position alone is disturbing- one is actually going to blindly follow the myth that a male needs bodily modification of natural healthy tissue in order to be "improved". My goal here is not to spend my time, day in and day out, like Jakew, watching over this article to promote a particular agenda- my goal was that this article needs to be flagged for a bias, and that it is inaccurate to present a pro-circumcision argument as a medical fact , that is all I have to say, and I will move on from this subject nowChiboyers (talk) 22:31, 29 May 2008 (UTC)
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