Talk:Medical analysis of circumcision

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[edit] Excessive reversions

This may surprise you, Jayjg, but here are ways other than reversions to handle disagreements over content. Reversion tends to be overkill in that it removes all changes, not merely the one you dislike.

Take your last revert for example. I added some well-cited text about the specific risk of coagulation disorders. You reverted it without comment. This is unacceptable behavior for an editor, and I'm prepared to escalate this issue.

As for the part about infection, it's more than adequately cited and relevant. If you have some objection to it, I recommend that we seek a consensus here about how to improve it. I've already tried to compromise repeatedly, changing the text so that it clearly reveals any potential bias and admits to the limited clinical data, but your response has been to revert instead of improve. Once again, this is unacceptable behavior and I demand better. Alienus 16:49, 15 March 2006 (UTC)

You know that there is no agreement on your adding the controversial information to the page, yet you persist in adding it without that consensus. If you want to add non-controversial stuff, please go ahead, but don't mix your edits and make it difficult for others to respond to them. Also, it is you who have been excessively reverting, using deceptive edit summaries which indicate that you have added new arguments to the Talk: page without actually doing so. If there's one thing that's going to motivate me to revert, it's deception, particularly attempts to mix possibly good edits with edits you know are objected to, and using deceptive edit summaries. Finally, you have been making un-warranted threats in your edit summaries and on this Talk: page. I'm disappointed to see that you have finally come to the talk page only to make such threats, rather than discussing the content. Jayjg (talk) 16:59, 15 March 2006 (UTC)
Oh, and just for your reference, it is you who have violated 3RR, by reverting the CA-MRSA stuff to the article 4 times now in under 24 hours. I'm willing to overlook this, despite your bad faith, but please do not persist in this behaviour. Jayjg (talk) 17:04, 15 March 2006 (UTC)
What you must remember, Alienus, is that an editor must use his judgement when deciding upon the best course of action -- in other words the action that creates the greatest benefit to the encyclopaedia. Sometimes that action involves editing the change, but sometimes a revert is simply best for the encyclopaedia. Does the encyclopaedia really benefit from having unsupported theories of activists included? Or is it better without? Jakew 17:08, 15 March 2006 (UTC)

I'm sure that if you try to report me, we'll both get banned, so feel free. After all, not only are you guilty of gaming the system to try to get me banned, but all of your reverts were in error. The most recent one, for example, reverted perfectly good text without explanation, which is unacceptable. It was also unacceptable in that you reverted without waiting the minute or so it took for me to finish adding the comment in Talk that I promised; that's bad faith. Finally, it was unacceptable in that the text about infection is NPOV and cited from RS. The text is fine, even if you don't like it.

Let me remind you that you are not the sole editor of this article, so your notion of the best course of action is not the only one that matters. You do not get to revert all changes out of hand. This encylopedia benefits when relevant views are expressed, instead of censored by partisans.

The right answer is to reasonably discuss the issue here, not to try to bully people into giving up by reverting each and every change they make, even though they're made in good faith and in accordance to the contents of Talk. So, having said all this, do you have any explanation for why you removed the coagulation text? Likewise, do you have any basis for excluding all mention of the infection problem? Alienus 17:27, 15 March 2006 (UTC)

I'm not sure why you imagine my reverts were "in error" or that I will "get banned" for them. Can you explain what policy would lead to my banning? As for "gaming", it is you who have obviously been "gaming" here; mixing different kinds of edits in different kinds of reverts, in order to garner a total of 5 reverts today and counting, deceptive edit summaries, etc. If you wanted to make non-controversial edits, you should not have combined them with the insertion of clearly inappropriate material. It's typical for people inserting POV or irrelevant material to cry "censorship" when called on it. As for me, I know I'm not the "sole editor" of this article; in fact, I rarely edit it. And finally, regarding the "infection" issue, this has been patiently explained to you; the information is a generic boilerplate concern regarding any and all surgery; there is nothing that uniquely ties it to circumcision, other than some dubious material from an unreliable source. I might add, it is perhaps even less relevant to this article than many other, since a high percentage of circumcisions are not even performed in hospitals. Jayjg (talk) 19:04, 15 March 2006 (UTC)
Look, this is getting ridiculous, so I've taken the next step. [1]. Alienus 18:18, 15 March 2006 (UTC)

Some might say I'm biased in further commenting on this article given my previous comments, but still, as a medical student, I'd like to give my two cents regarding the edit implying clotting disorders like hemophilia might further endanger the patient. While this train of thought might seem plausible, the reference given (the Pediatric Update) does not discuss this issue; it merely states that excessive bleeding after circumcision might indicate a blood clotting disorder. And as such, the edit should be left out -- unless some solid scientific reference can be given. Superdix 22:23, 15 March 2006 (UTC)

Having looked at the references that were inserted about bleeding disorders and antibiotic resistant staph infections, I think it is important to mention this concern. The spread of MRSA has the potential to change our attitude towards surgery and could well change the risk/benefit ratio for circumcision and other procedures. I believe that there are ways of introducing this concern into the article without pushing a barrow. Perhaps those who object to this concern being raised could explain which references they take exception to and why. Michael Glass 13:07, 17 March 2006 (UTC)
Please see the above section 'POV', Michael, in which this is addressed. Jakew 13:20, 17 March 2006 (UTC)

Yes, I've done that and have noted the following facts:

Golden staph is a definite risk for young babies, and there hve been some cases where children were infected at the site of the circumcision wound.
MRSA, an antibiotic resistant strain of golden staph, is a growing concern.
Some have speculated that MRSA may be related to circumcisions. However, this has not been proven.
DOC has expressed concern, although this organisation is seen as too controversial by several editors.

I believe that of the things listed above, the first must be mentioned. I also believe that the second and third points should also be mentioned. Leave out the fourth point. It's not worth arguing about, even though I think it's going too far to brand the organisation as 'extremist'. Michael Glass 02:09, 19 March 2006 (UTC)

Jake has censored the following information about MRSA:
Staphylococcal infections are a growing problem [2] and have affected neonatal nurseries. This has led to speculation that the methicillin resistant strain (MRSA) might be a threat to newly circumcised boys. [3].
Why censor referenced information that golden staph infections are a growing problem?
Why censor referenced information that golden staph infections have affected neonatal nurseries.
Why censor referenced information that this has led to speculation that MRSA might be a threat to newly circumcised boys?
I'm happy to work with Jake to ensure that the treatment of MRSA is fair and balanced. If more information needs to be added to ensure that this is so, I would welcome it. However, I'm not happy to see all information about MRSA removed. 'Nope' is not an argument. Michael Glass 01:27, 28 March 2006 (UTC)

With all due respect, I am starting to doubt that these people have any legitimate reasons for excluding all mention of CA-MRSA. The information is relevant and cited, and you've stated it in an entirely NPOV manner. Nonetheless, they keep reverting it, just as they did when I tried to insert my own version of the same basic idea. At this point, I can only guess that they don't want this information to be made available, which goes against Wikipedia censorship prohibitions. Perhaps it's time for an RFC or even RFA. Alienus 04:58, 28 March 2006 (UTC)

The reason for not including boilerplate that applies to every single surgery has already been explained. Just because something is factual does not mean it is appropriate or relevant. And, if you ever do go ahead with "an RFC or even RFA", I hope you realize your consistent violations of WP:AGF and WP:CIVIL will be part of the evidence. Jayjg (talk) 05:02, 28 March 2006 (UTC)

Don't forget that your hostile reversions and constant stonewalling will be part of the evidence. I'm quite content with my own behavior, thanks, but the focus of any action will be on your violation of WP:OWN. Alienus 05:12, 28 March 2006 (UTC)

I'm puzzled by the reference to 'boilerplate'. We mention bleeding, and bleeding applies to any surgery. We mention infection, and this danger applies to any surgery, too. If golden staph and methicillin resistant golden staph are growing problems in hospitals, and specifically in neonatal wards, then I can't see the problem of mentioning these dangers, especially if we mention that the problem can be controlled by scrupulous attention to hygiene [4].
Here is what I suggest we include in the article:
Staphylococcal infections are a growing problem [5] and have affected neonatal nurseries. This has led to speculation that the methicillin resistant strain (MRSA) might be a threat to newly circumcised boys. [6]. However, scurupulous attention to hygiene can mitigate this problem [7].
:Please consider:
It is in the public interest to draw attention to a growing medical threat.
It is in the public interest to note that MRSA has infected neonatal nurseries.
It is in the public interest to note that there is a way of mitigating this threat.
It is in the public interest to note that there is speculation that methicillin resistant golden staph could be a threat to newly circumcised boys, because it is mentioned in the medical literature.
If anyone has any objection, please explain. Michael Glass 09:19, 28 March 2006 (UTC)
As I explained to you previously, Michael, the Zafar study does not refer to speculation that MRSA might be a threat to newly circumcised boys. The only speculation to which it refers is this: "Authors of these reports speculated that the circumcision site may be particularly susceptible to bacterial growth." This is different from saying that they speculated that it may be particularly susceptible to MRSA in particular. The only relevant information in this study is the fact that they could not find evidence that this is the case with MRSA. Jakew 09:58, 28 March 2006 (UTC)
That answers just one of the four points I raised. So here is something to take into account your objection to this one point:
Staphylococcal infections, both methicillin susceptible and methicillin resistant are a growing problem [8] [9] and have affected neonatal nurseries. This has led to speculation that the circumcision site might be particularly susceptible to bacterial growth. [10]. However, scurupulous attention to hygiene can mitigate staph contamination in wards [11] and though boys have been found to be far more susceptible to infectiions than girls, the lesions have not been found on the circumcision wound [12] [13]. One study found a greater incidence of staph infectiions among circumcised boys, but it was below the level of statistical significance (p>0.10). This study noted that circumcised boys required a great deal of additional handling [14].
Michael Glass 11:52, 28 March 2006 (UTC)
The trouble here, Michael, is that the second sentence now implies that it is growing rates of both types that has led to this speculation. This is misleading. The Zafar report gives no indication of the reason for the speculation, and the speculation does not seem to refer to MRSA. As you comment, the lesions have not been found on the circumcision site. Thus, there is no reason to even refer to MRSA. Jakew 12:56, 28 March 2006 (UTC)
Jake, you're trying to blow off the possible link between circumcision and staph infections just because the doctors didn't find the lesions on the circumcision site. This argument is not valid from a medical standpoint, which Enzenauer et. al. make perfectly clear: "The increased incidence... may be associated with circumcision..." Superdix 21:08, 30 March 2006 (UTC)
No, I have no objection to discussing a possible link between circumcision and staph infections, because that has been discussed previously in reliable sources. A possible link between circumcision and methicillin-resistant staph infections (ie, a different strain, with different DNA, and at least one different characteristic), however, has not, and hence does not belong in Wikipedia. Any argument that it is plausible is original research. Furthermore, if based upon the characteristics of different strains (as studied by Enzenauer, for example), it makes implicit and untested assumptions that are dubious at best. Jakew 10:27, 31 March 2006 (UTC)

Uhm, the reason for the speculation is that CA-MRSA infects open wounds, which means it's logical to ask whether it'll infect the wound from circumcision. What possible alternative to this do you offer? Alienus 18:08, 28 March 2006 (UTC)

Jake, the question of MRSA contamination does not only involve the circumcision wound but can also come from the extra handling that newly circumcised boys need. Please read the Enzenauer study [15]. Also remember that MRSA is simply an antibiotic resistant form of golden staph, not a completely new and different disease. Michael Glass 20:28, 28 March 2006 (UTC)
Michael, the Enzenauer does not refer to MRSA. I am well aware that it is an antibiotic-resistant strain, but since it has mutated, the possibility remains that it has other characteristics that differ, too. It's best to keep an open mind. That's why we need to wait until a study has been published that links the two. Jakew 11:55, 29 March 2006 (UTC)

Editorializing here, I'd like to point out that Jake has once again raised the bar extra high for information he does not want in the article. Note how Jake brings up unsupported possibilities while demanding specific clinical studies and ignoring obvious implications of existing studies. Two worlds. Alienus 19:33, 29 March 2006 (UTC)

Couldn't agree with you more. Superdix 21:08, 30 March 2006 (UTC)
Folks, read the policies again, please. Specifically, take a look at no original ressearch. Note that it is "no original research", not "not much original research" or "a little original research". Jakew 10:27, 31 March 2006 (UTC)
And rightly, WP:NOR states: "Original research that creates primary sources is not allowed. However, research that consists of collecting and organizing information from existing primary and/or secondary sources is, of course, strongly encouraged..." "...and it is fundamental to writing an encyclopedia". The link between MRSA and circumcision is perfectly valid for one reason, one that is utterly basic to any medical professional. The skin, along with the mucous membranes of the human body, serve as the first line of defense against pathogens, preventing entry of infectious agents (Hole's Essentials of Human Anatomy & Physiology, 9th ed., McGraw-Hill). Now, cut the skin, and it immediately becomes more prone to infections -- including MRSA. Superdix 13:13, 1 April 2006 (UTC)

Jake, the Zafar study is specifically about MRSA. I quote the title: "Use of 0.3% triclosan (Bacti-Stat) to eradicate an outbreak of methicillin-resistant Staphylococcus aureus in a neonatal nursery" Now look at the conclusion: "The nursery has remained free of MRSA for more than 3 1/2 years, attesting to the success of our program." When the authors mention bacterial growth, one of the obvious targets is the MRSA that the whole program was trying to control. You're arguing like a tobacco executive when faced with a study about lung cancer. At this stage we can't show a definite link between MRSA and circumcision wounds but the dots of knowledge are rather suggestive because MRSA and MSSA are quite similar, and the MRSA strains of golden staph are becoming more common. Therefore I think it is in order to mention the speculation of a link while pointing out that there is no direct evidence of a link at this stage. Michael Glass 13:56, 31 March 2006 (UTC) PS. Please look at this link: {http://www.medpagetoday.com/Pediatrics/2005AAPMeeting/tb/1899 Michael Glass 14:04, 31 March 2006 (UTC)}

I agree that you've made a good case for MRSA being relevant to the issue of circumcision, and I can find no reasonable explanation for the continued objections to this text. Therefore, I'm reverting. Alienus 19:03, 3 April 2006 (UTC)
And once again, Jakew reverts again. Jake, Michael Glass has brought solid arguments here that you have yet to find a good reason not to include in the article. The section you reverted is not in any way biased, refers to primary sources and is verifiable. Superdix 08:20, 4 April 2006 (UTC)
And after Jakew ran out of reverts, he handed the job over to fellow cabal member, Nandesuka. Once Nandesuka runs out, Jayjg will come into play. Round and round they go, plotting to keep basic medical facts out of the article because they're too biased to want the article to reflect reality. The cabal never learns. Of course, it doesn't need to. It has no more power than we give it. If we were to respond in kind, by teaming up to revert their reverts, they'd be powerless. Alienus 22:30, 4 April 2006 (UTC)
Michael, I know that the Zafar study is about MRSA. That's not the issue. I have no objection to its inclusion in an article which is about MRSA, or which has an established link to the subject. The issue is why it should be discussed here at all, when there are no reliable sources establishing a link with the topic of this article, which is circumcision. Any talk of 'dots of knowledge' is pure original research. Jakew 10:02, 4 April 2006 (UTC)

[edit] Suggest removal of '2.2.1 Images of Invasive Penile Cancer in Uncircumcised Men'

These links don't work (as of time of writing this comment) and appear out of context. I suggest getting ahold of some pictures that may be freely reproduced, providing one inline in the article on Medical analysis of circumcision as well as in the article on Penile cancer. These links are also getting a disproportionate amount of attention due to the fact that they appear in the contents table. Superdix 02:11, 19 March 2006 (UTC)

I think the links should remain, but they way they are noted is not the same as the link to the picture of the baby suffering from a life-threatening golden staph infection. There should be one consistent way of linking illustrations, and I think the link to the baby's picture is a good model. Michael Glass 06:39, 28 March 2006 (UTC)
Why keep links to stuff that isn't there anymore? Superdix 20:38, 30 March 2006 (UTC)
Good point. I say we should keep the stable links and get rid of the unstable ones. Michael Glass 12:55, 31 March 2006 (UTC)

[edit] Balance

This article should be called "Medical Criticism of Circumcision". There are benefits as well as downsides to being circumcised, or having someone circumcised. This article should contain both, and not simply state the POV of people against circumcision. Dessydes 13:42, 4 April 2006 (UTC)

According to professional medical organizations in Australia, Canada, Great Britain, and the United States the small potential medical benefits of elective, non-therapeutic circumcision do not outweigh the medical risks and harms. If anything the article gives the false impression that there is medical justification for cutting off a normal, healthy part of a child's genitals when there is no medical condition present that requires surgery for treatment. -- DanBlackham 14:20, 4 April 2006 (UTC)
Thanks for that Dan I hadn't noticed that 'til I scrolled down. So why indeed does this article have a NPOV tag? Does it need to be wikified? Does it need some other sort of rewrite? Dessydes 14:49, 4 April 2006 (UTC)
The problem is that circumcision is a very delicate issue, considering it enters bioethical, medical, cultural, religious, esthetic and sexual spheres of interest. Among the people most interested in this article are several pro-circumcision advocates currently denying others the right to publish information that is verifiable and sourced. Furthermore, the article does not do justice to its name. A "medical analysis of circumcision" should reflect the broad consensus of the medical community. This piece of information has been reduced to a paragraph at the bottom of the page, called "Costs and benefits" leading people to think that there is in fact a huge controversy raging today in the medical world, which there isn't. Superdix 16:49, 4 April 2006 (UTC)
Try something for me. Download the policy statements by the AAP, AAFP, AMA, CPS, and RACP. Copy and paste them into a text editor. Now count lines (paragraphs if you prefer) covering a) risks, b) benefits, and c) risk:benefit balance / conclusion. Calculate these as percentages of the total. Now do the same for this article. Compare.
Now try something else. As a reasonably representative sample of medical views on circumcision, search PubMed for 'circumcision'. Score the implicit 'attitude' of the article however you see fit (I'd go from -2 = strongly anti to +2 = strongly pro). Now do the same for this article. Compare.
I think you'll find that the article is quite representative.
Additionally, I'd like to note two things. Firstly, both the BMA and the AMA state that there is considerable debate within their members about circumcision. Do you know something they do not about the medical profession? Secondly, please do not misrepresent disagreement over other issues, and do not attack other editors. Jakew 18:12, 4 April 2006 (UTC)
When people revert edits that are perfectly in line with Wikipedia guidelines, that gives a pretty strong case for them being pro-circumcision advocates. Why would they otherwise revert the edit? What possible interest could they have in keeping this information from the public?
I did not attack anyone in particular, and speak my mind when I feel like it.
Your statistical approach to this doesn't quite cut it, as a recommendation by the various medical associations will have to weigh in much more heavily than single studies. My point is that the position of the medical associations in fact takes into account the studies that are published. Should someone publish a study which shows circumcision in fact provides so huge a benefit that it warrants routine circumcision, the medical associations will change their position on the issue. Which they have yet to do.
Here's something I do know about the medical community. When doctors complete their studies, they swear by some important principles (sometimes referred to as the hippocratic oath):
- beneficience: act in the best interest of the patient
- non-maleficience: do no harm
- autonomy: the patient has the right to refuse treatment
Now, consider circumcision: studies have yet to show that it will be in the patient's best interest to cut off their foreskin. That covers beneficience. Since circumcision is an invasive procedure, and inherently unnecessary, it violates non-maleficience. And if we're talking neonatal circumcision, you take away the patient's chance to refuse the "treatment". Now, if we're talking for cultural reasons, there may of course be more harm in not performing the procedure. But we're not.
The BMA Guidance for Doctors does provide the following information on Circumcision for Medical purposes: "Unnecessarily invasive procedures should not be used where alternative, less invasive techniques, are equally efficient and available." ... "to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate." This pretty much sums up non-maleficience in relation to circumcision. They are in other words reluctant to use circumcision even in medical situations, when alternative treatments are available. Superdix 09:39, 5 April 2006 (UTC)
The edits were not in line with Wikipedia policies, hence they were reverted. All this is discussed above, in the appropriate section. Clearly you disagree with the interpretation of policy, but that does not mean that anyone who disagrees with you is a pro-circumcision advocate. Assuming bad faith does not help, and it makes it hard to work together.
You say: "Your statistical approach to this doesn't quite cut it, as a recommendation by the various medical associations will have to weigh in much more heavily than single studies." We discuss these recommendations in the article. Anyone who agrees with your assessment will doubtless give this fact more weight. The associations themselves spend only a few words on their own recommendations, and considerably more on the studies. The fact that our article's contents has similar proportions to these organisations is evidence of a well-balanced article.
Your ethical analysis is dubious to say the least, and clearly original research. Many reasonable, educated people have concluded that circumcision is in the patient's best interests, and indeed the AAP and AMA both acknowledge that parents are in the best position to make this assessment. If they decide upon it, then it passes the test of beneficience. Since circumcision has not been shown to be harmful, it also passes the test of non-maleficience. Finally, autonomy does not apply when the patient is unable to express a view on the subject of treatment. Here, as with anything else, he relies upon his parents to decide on his behalf.
There is no doubt that others would disagree. You evidently do, and perhaps the authors of the BMA statement do (it's clear that you interpret their statement that way). That's fine. There's disagreement on most other aspects, so why should ethics be any exception? The BMA statement represents one view, which is not binding, and with which many disagree. Jakew 11:02, 5 April 2006 (UTC)
Here's a thought. When a medical association makes a statement, a guide to its members, it needs to include details on relevant studies to show those very members that its conclusion is based on scientific facts and can be trusted. But the message in the statement is not "this study claims this and that study claims that" or even "there is some disagreement over this issue" but rather, "don't go around circumcising unless there are a) strong cultural reasons or b) medical reasons that cannot be solved in any other way". That is their message. Some people here on Wikipedia try to twist every article into their own POV by ignoring the big picture.
While I'd like to publish my "dubious, original research ethical analysis" and call it my own, that would be infringing copyright. The BMA has already come to the same conclusion, which I referenced earlier: "to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate". Therefore, according to BMA, medically, circumcision should not be performed except in cases where no other solution exists. Your arguments on my "dubious, original research ethical analysis" are perfectly valid -- if this were a cultural debate. Which it isn't. Seen from a medical perspective, circumcision is totally unnecessary, and if one is to consider non-maleficience, cutting off a fully functional part of a healthy person constitutes harm. Superdix 12:48, 5 April 2006 (UTC)
The BMA says there is debate about circumcision for cultural or religious reasons. The BMA says circumcision for medical reasons is "unethical and inappropriate" when there are effective non-invasive methods available to treat an existing medical problem with a male's foreskin. -- DanBlackham 04:34, 5 April 2006 (UTC)
No, Dan, the BMA explicitly says: "There is a spectrum of views within the BMA’s membership about whether non-therapeutic male circumcision is a beneficial, neutral or harmful procedure or whether it is superfluous, and whether it should ever be done on a child who is not capable of deciding for himself." Jakew 09:07, 5 April 2006 (UTC)
I think I'm the one who most recently added the POV tag, but Sup has accurately explained my reasoning, so I have nothing to add but an endorsement. And if you think this article is biased, check out circumcision. Alienus 17:44, 4 April 2006 (UTC)
I'm not sure I understand, Dessydes. The article does include extensive discussion of both benefits and risks. Jakew 18:12, 4 April 2006 (UTC)
Look at my second comment Jakew, you'll see that I'm probably agreeing with you. Is there indeed a need for a POV tag? Dessydes 14:31, 5 April 2006 (UTC)

I think that's something the upcoming RFM can help us decide. Alienus 21:36, 10 April 2006 (UTC)

  • Did we read the same article?

As read today, the article seems quite balanced, presenting evidence for both sides very clearly... as a matter of fact, I almost see no acknowledgement of the dispute... merely conclusions of studies quoted; Could this different perspective be due to reversions and different revisions? Am I reading the same article as Dessydes? I see this article as the epitome of NPOV. It left me a slanted conclusion... pro circumcision; which seems to be the correct one, given my understanding of the different studies and data quoted. In fact, although my mind was made up from the start, the article kept me guessing throughout the read, as to where the data would lead. Bravo to each of you... your battles to keep it neutral are proving quite a success! This is democratic process in action. Isn't this what is being sought? There is no slant... just the data. The data says what it says.Daniel 19:25 May 28 2006 (EST)

[edit] Bratu et. al. study

The study I cited under infections is called "Community-associated methicillin-resistant Staphylococcus aureus in hospital nursery and maternity units" [16]. Jakew quickly reverted this edit, which I anticipated. Here's the text in question: (p. 811) "In the pediatric population, risk factors associated with MRSA infections include premature birth or low birth weight, chronic underlying diseases, prolonged hospitalization, invasive or surgical procedures, indwelling catheters, and prolonged use of antimicrobial agents (22–25)." Jakew, why is this not relevant in an article trying to cover all medical aspects of circumcision? Are you trying to tell me that because the article doesnt list every possible invasive or surgical procedure, then actually, that sentence does not refer to any invasive or surgical procedure? Superdix 20:13, 5 April 2006 (UTC)

This reliable source very clearly mentions the risk of CA-MRSA for any "invasive or surgical procedure". Now, if someone here thinks that circumcision isn't in this category, it's up to them to support this claim. Since they can't, you have fully justified the inclusion of CA-MRSA text in the article. Any attempt to revert this well-cited and entirely relevant text would be in conflict with Wikipedia rules and therefore unacceptable. Alienus 20:21, 5 April 2006 (UTC)
Superdix, Wikipedia is not supposed to include original research: 'any new interpretation, analysis, or synthesis of published data, statements, concepts, or arguments that, in the words of Wikipedia's co-founder Jimbo Wales, would amount to a "novel narrative or historical interpretation".'. That article doesn't even mention circumcision, so any interpretation of it or inclusion in a discussion of circumcision is original research by definition.
In the context of this article, we are supposed to summarise what others have written, in reliable sources, about the medical aspects of circumcision. That is all. Jakew 21:10, 5 April 2006 (UTC)
I did summarise what others have written. And nothing else. In fact, you can read out the exact same meaning in the original text. Now, let me get this straight: you claim that by linking the general description of risk factors, "invasive or surgical procedures", to circumcision, where one cuts off a portion of a boy's penis, I am conducting original research? Bending Wikipedia policy to match your own opinion doesn't do anyone much good. Does anyone know where I can take this further? Superdix 07:16, 6 April 2006 (UTC)
You understand my 'claim' correctly. There is an exception, however. If you can find an article (in a reliable source) in which Bratu's study has been discussed in the context of circumcision, then it would not be original research, since the synthesis would not be novel. Please note that there is no exception in the policy for syntheses that you believe to be correct, or even obvious. If you think that there should be, Wikipedia Talk:No original research would seem a good place to start. Since changing policy is a fairly big step, you'll need considerable support, so you might also like to propose it on the WikiEN-L mailing list. Jakew 13:36, 6 April 2006 (UTC)
I wasn't talking about changing Wikipedia policy. The fact that circumcision is a surgical and invasive procedure is a fact, not a "novel narrative". I wanted to take your interpretation of this particular issue to someplace where it could be judged by a non-biased population. If you know of any such place, let me know. Superdix 15:25, 6 April 2006 (UTC)
Superdix, the statement that circumcision is a surgical procedure is not novel. I agree with you there. Nor is the fact that Bratu reported that surgical procedures are risk factors. The novelty comes from the synthesis of the two, which as far as I can tell hasn't been done previously in reliable sources.
I really don't understand why there should be any disagreement here - how can you read "any new interpretation, analysis, or synthesis of published data, statements, concepts, or arguments" and not see how it applies? It is a synthesis of published data (Bratu) and a concept (that circumcision is a surgical procedure) that is new. How could it possibly not apply? Jakew 16:27, 6 April 2006 (UTC)
I refuted this earlier. If everyone knows that dogs are mammals and a source mentions that some disease affects all mammals, there is nothing WP:OR about saying that dogs are affected by this disease. It's an obvious syllogism, not an interpretation, analysis or synthesis. It is as obvious that circumcision is a invasive or surgical procedure as it is that dogs are mammals; it would take a lobotomy to avoid noticing this, and it would take specific evidence to rule out what basic logic has ruled in.
Moreover, we all know that there is nothing novel about noting the connection between CA-MRSA and circumcision because there's a press release from DOC that brings it up. You've tried hard to suppress this press release on the theory that it's not reliable, but that's an abuse of WP:RS. The release is reliable on the matter of what DOC thinks, regardless of whether it's true. Likewise, the clinical study is reliable about the risk of invasive and surgical procedures (not excluding circumcision) with regard to CA-MRSA.
In short, the cabal is using its own novel reinterpretation of Wikipedia rules in an attempt to wikilawyer a justification for censoring simple, incontrovertible facts. Not one of you can, even for a moment, deny that there are reliable source that support the link, so you're just playing games instead of doing the right thing. I'm disgusted by the cabal's action and will do whatever is necessary to overcome their attempt to WP:OWN this article and twist it to their WP:POV. Alienus 17:21, 6 April 2006 (UTC)
Your refutation is incorrect. If a source mentions that some disease affects all mammals, but nobody has mentioned dogs specifically, it would indeed be original research to state that it affects dogs. In practice, it is unlikely that a reliable source would make such a sweeping statement without reviewing literature including effect on dogs, so this situation would be unlikely to arise.
Secondly, the press release from DOC is not a reliable source, and thus for our purposes, does not exist. We cannot. To do otherwise would make NOR effectively meaningless, since any editor could, for example, post a message on a bulletin board and then claim that the research is no longer original to Wikipedia. WP:V spells this clearly: "Facts, viewpoints, theories, and arguments may only be included in articles if they have already been published by reliable and reputable sources."
It was explained very early on that there was no problem with the inclusion of MRSA in the article, provided that an article could be found in a reliable source linking the two. Unfortunately, nobody has actually been able to find such a thing. The sensible thing to do in such a situation is to forget about it, at least until such time as such an article does appear. Sadly, it appears that some individuals have become true believers, determined to see that what they hold to be 'true' goes in the article, rather than that which is verifiable and not original. Our policies are sufficiently well-designed that WP:CITE and WP:RS cannot be circumvented without falling violating other policies. This is a good thing. It helps keep our encyclopaedia credible. It's a pity that others don't see things that way. Jakew 18:10, 6 April 2006 (UTC)
Jake, I remember you once told me "wikipedia doesn't need to be dumbed down". Well, that's exactly what's happening here. You're using your own interpretation of policies to exclude information thay *any* medical professional will tell you is true. If one were to find circumcision somehow is a procedure sent from heaven, protected from any and all infections, then that would obviously exclude the Bratu et. al. study. What you are in essence saying, is that by generalizing risk factors to "all invasive or surgical procedures", the information they provide can't be used in any setting. You also fail to acknowledge an utterly basic medical fact, namely that cutting in the human body makes it prone to infections. I'll give you the reason why the study doesn't list every type of surgery in the article: the knowledge that one can generalize on the subject of infections is taught in the first year of medical school. You need to start reading these scientific articles from a medical point of view.
Again, I ask people to direct me to someplace where one can try wikipedia policy interpretation, in this case, Jake's, to some kind of "court". Does such a place exist? Superdix 15:08, 7 April 2006 (UTC)
Superdix, please read verifiability. Specifically, note that "the standard for Wikipedia is verifiability, not truth". It doesn't matter whether you're right. What matters is that readers can verify that this is relevant to circumcision by consulting reliable sources. I have no intention of arguing that cutting the body makes it prone to infection. Nor have I intention of arguing that MRSA is a form of infection. However, unless MRSA has been discussed in reliable sources as a medical risk of circumcision, it does not belong in this article. Jakew 15:51, 7 April 2006 (UTC)
Sup, as it happens, I was just talking about this with Jakew. The next step is a request for mediation.
To be frank, I've been through one and it didn't settle much of anything, because it was focused on what could easily be judged from surface appearances. Nonetheless, it's what comes next. Only after we try this can we justify the step after that, which is likewise full of problems. Welcome to lawsuits, Wikipdia style!
Anyhow, please follow that link to read up on what's involved and let me know if you're interested in trying this. We'd probably need Michael Glass and anyone else who's part of this to buy into it as well. Alienus 15:25, 7 April 2006 (UTC)
Excellent. Looks like a good place to get an unbiased opinion on the "Bratu et. al. in Medical analysis of Circumcision" case. You seem to know how we should go through with the procedure, just let me know where to summarize my arguments. Superdix 16:26, 7 April 2006 (UTC)
Exactly so. If there are reliable sources which specifically list CA-MRSA risks associated with circumcision, then they might be relevant. However, WP:NOR does not allow the use of primary sources to produce a new interpretation, analysis, sythesis, etc. The article listed no-where mentions circumcision; please find one that does. Jayjg (talk) 21:18, 5 April 2006 (UTC)

With all due respect, your objections are laughable. The article indicts all invasive and surgical procedures performed on infants. as being a CA-MRSA risk. It is not original research to notice that circumcision is an invsasive, surgical procedure performed on infants. You would need to show that the article explicitly rules out circucmision. Since you can't, any attempt to remove the text on CA-MRSA will be reverted. If you don't like this, go file the appropriate request. Alienus 21:25, 5 April 2006 (UTC)

Please respect Wikipedia policy, particularly WP:NOR. Jayjg (talk) 21:42, 5 April 2006 (UTC)
I do, which is why I will revert any attempts at censorship. Thank you for understanding. (unsigned by Alienus)
Alienus, you seem to be unclear on the meaning of the word "synthesis." Nandesuka 21:43, 5 April 2006 (UTC)
Nandesuka, you seem very clear on the meaning of the word "cabal". You, Jay and Jake consistently oppose the reasonable attempt to insert well-cited, highly-relevant material that conflicts with your not-so-hidden agenda. This is not something you can keep up indefinitely, which is why it's crumbling now under the weight of new voices. Told you so. Alienus 21:59, 5 April 2006 (UTC)
I am fairly clear that you use "cabal" to mean "any two or more people who disagree with you on some subject." I have no intention to stop opposing inserting original research in Wikipedia any time soon, no matter how much you may desire that. Nandesuka 22:18, 5 April 2006 (UTC)

I guess I was wrong; you don't even know what a cabal is even though you're part of one. No, the defining aspect of a cabal is their agreement to support each other, regardless of what's reasonable. Consider how the three of you are chiming in to create a mock consensus against the mention of CA-MRSA, even though there is sufficient evidence to support it. In any case, your interpretation of WP:NOR is simply mistaken, so I'm not bound by it. Alienus 22:23, 5 April 2006 (UTC)

So, we're at the point where cabal members take turns reverting good text, with the hope of tricking people into violating WP:3RR. Don't be tricked. Your fourth revert in a 24 period is grounds for automatic banning by their patron admin. However, reverts that do not approach this limit are acceptable and welcome. If only the cabal actually accepted the consensus in Talk, but this is simply not the case, so here we are. Alienus 22:32, 5 April 2006 (UTC)

Please review WP:NOR once again. You need a source that ties CA-MRSA to circumcision, not just a general reference about CA-MRSA. Also, please desist from continuing violations of WP:CIVIL. Jayjg (talk) 22:44, 5 April 2006 (UTC)
Sure, as soon as you review WP:OWN and actually read what WP:CIVIL says. You'll find that you are in violation of the former and I am not in violation of the latter. However, your continued false accusations do put you in violation. Alienus 22:53, 5 April 2006 (UTC)

As promised, the cabal reverted in bad faith, taking turns to keep their individual count low. This is how they operate, in violation of WP:OWN. Now, if you actually want to see medical facts in the article, it's up to you to fight this cabal. Remember, they only get 3 reverts each in a 24 hour period, so it all comes down to numbers. Alienus 22:53, 5 April 2006 (UTC)

You seem to misunderstand the purpose of the Talk: page. The purpose of the Talk: page is to generate consensus regarding article content, based on Wikipedia policy. Its purpose is not to insult those who disagree with you, while trying to incite them into edit wars. Jayjg (talk) 22:59, 5 April 2006 (UTC)

There is a consensus: you're just not part of it and never will be, which makes you irrelevant. Only reasonable people, who might change their minds when presented with evidence, have opinions worth caring about. Therefore, those of us who form the consensus will wind up reverting censorship by the cabal. This is a prediction, not a call to action.

On a side note, if I have a source that mentions that all mammals are warm-blooded, I do not need a specific source to mention that dogs are warm-blooded, only a source that mentions that dogs are mammals. In other words, a syllogism is not original research, it's basic logic. Because you pretend otherwise, your conclusion is simply false. Alienus 23:07, 5 April 2006 (UTC)

This is remarkable. So a consensus only exists among people if they agree with you? Jakew 13:36, 6 April 2006 (UTC)

I'm beginning to wonder if editing Wikipedia is turning me into a bigot. I came into this rather apathetic about specific religious affiliations, but now I'm starting to note disturbing patterns. For some time now, it has been clear that the people who most fervently and unreasonably modify articles so as to denigrate abortion correlate strongly with self-avowed Catholicism. Now, this makes sense, because Catholic doctrine claims that abortion is a horrible sin and nobody should ever do it (or be allowed to). Lately, I'm starting to notice a similar correlation among those who most fervently support circumcision in what are supposed to be neutral articles; they seem to be far more likely to be Jewish than random chance allows. I find this particularly puzzling because Jewish doctrine claims that circumcision is a special covenant that only applies to Jews and does not require it of everyone else. And yet we just had a random Jewish admin revert my text. How odd. I still don't have any bias against either Catholics or Jews, but I am starting to wonder if these religions tend to breed zealots over their respective hot-button issues. So far, I don't have anywhere near enough data to safely generalize, but I do have enough to wonder, so I'm sharing that here. Alienus 23:26, 5 April 2006 (UTC)

I'm sure next you'll be telling us "Some of my best friends are Jews or Catholics." Perhaps you should consider, per Occam's Razor, the possibility that many editors simply don't like original research in Wikipedia articles. Nandesuka 00:03, 6 April 2006 (UTC)
A more relevant observation in response to this rambling tirade would be "what, pray tell, does this have to do with the article?" Tomertalk 03:13, 6 April 2006 (UTC)
There's no tirade here, just an observation about bias. Calling it a tirade is uncivil, but around here, it just blends in. Alienus 04:17, 6 April 2006 (UTC)
Sounds good... Tomertalk 05:05, 6 April 2006 (UTC)
That comment is extremely disturbing. I submit that if you're forming paranoid theories based upon whether those who disagree with you are Jews, then Wikipedia is the least of your problems. I would strongly encourage you to focus on what people say, rather than who they are, and in particular refrain from - yes, I have to agree - bigoted statements like that. Jakew 13:36, 6 April 2006 (UTC)
Once again, it would be helpful if you actually read what I wrote prior to reacting.
When someone states an obvious fact, we don't need to delve into their motives to explain their actions. That their statement is factual is explanation enough. It is only when the statement is nonfactual do we wonder what errors, including biases, might have led to their utterance.
Understanding why people say (and perhaps even believe) falsehoods is important if we are ever to convince them to accept the truth. To recognize that people have biases due to their their religion or (more generally) culture is not itself a bias, it is a recognition of the flaws of others.
For example, if I said "Orthodox Jews think pork is unclean" or somesuch statement, this would not be anti-semitic, nor would it say anything positive or negative about pork. Rather, it's a factual statement about the subjective judgements of others, recognizing a Jewish bias against pork that is independent of its various health benefits. Likewise, it is factually true that Jewish culture favors circumcision, so when a random editor shows up to help hide details about circumcision risks, the fact that they identify as Jewish is not irrelevant; it is explanatory.
Now, it may well be that their actions are best explained by some other error, such as a misunderstanding of WP:NOR, or even a bias that is independent of this particular religious and cultural source. Perhaps, perhaps not. With more evidence, we could pin down the source of their error. With the evidence thus far, we have at least reason to suspect this particular source.
Perhaps more to the point, we initially presume an absence of bias, but when background details come to light that suggest the likelihood of bias, we would be wrong to ignore them. If someone argues passionately but stupidly for concealing facts about the safety of abortion, their commitment to Catholicism may well explain why an otherwise reasonable person is acting so unreasonably. Perhaps this understanding can be used to remind that person of their possible biases and help them be more rational. Or perhaps it guides us into recognizing that any further effort would wasted. Either way, it can give us valuable information.
If failing to ignore the biases and bigotries of others is bigoted, then call me a bigot, but don't expect me to care. Alienus 17:09, 6 April 2006 (UTC)
Why should numerous editors, several of whom are very well-regarded, necessarily be biased just because they disagree with you? Is it really so implausible that they should be correct in their understanding of policy, or perhaps that it is a matter on which reasonable, unbiased people may disagree? Jakew 18:17, 6 April 2006 (UTC)
I won't even touch the issue of who it is that regards them so well, but will address the fact that we're talking about 3 people who have a long history of working together to maintain ownership of this article, with occasional support from outsiders whose objectivity is likewise in question. Alienus 18:28, 6 April 2006 (UTC)

Shouldn't it be more like "some of my favorite penises are circumcized"? When looking at these religiously-based biases, I think it comes down to what religionists hold sacred, and therefore above all inquiry. Try explaining to a "loyal and obedient" Catholic that an early abortion is safer than carrying a pregnancy to term, and you'll see all sorts of mental gymnastics as they try to find excuses not to accept the facts. It's nearly as bad as explaining to a pro-circumcision zealot that such surgery does carry the risk of infection. Alienus 02:56, 6 April 2006 (UTC)

Alienus, from a Jewish perspective, circumcision is not a covenant between Jews and God, Jewish circumcision is. This perspective has nothing to do with medical analysis of circumcision. The problem you're running into here is not Jewish fanaticism, it's "Wikipedia NPOV/NOR fanaticism". Your edits demonstrate that you have a very strong anti-circumcision bias which you seem, thus far, at least, incapable of setting aside when editing circumcision-related articles...not only this one, but Circumcision as well. If you approach your passionate interest in the subject of circumcision full of vim and vigor, and give undue weight to propaganda in the process, in your personal life, that's your prerogative... However, being a competent WP editor requires you to approach the subject dispassionately. You'll find that other editors who share your opposition to circumcision (in great part Michael Glass comes to mind) have gained a modicum of respect in editing these articles, specifically because they do their best to avoid blatantly inserting their well-known POV into these articles. Tomertalk 03:13, 6 April 2006 (UTC)

Actually, that was part of my point; Judaism does not endorse circumcision for non-Jews. It would be helpful if you read my "tirade" before you complained about it. Anyhow, my edits -- here and elsewhere -- demonstrate that I oppose censorship and partisanship. Sadly, I've seen lots of that on this topic. I'm actually rather apathetic about circumcision. You'll never see me rhapsodizing about my penis and how wonderful/horrible/whatever it is. I do, however, dislike it when zealots remove factual information that happens not to help their cause. In short, your analysis of me is as clueless as it is uncivil, and has less than nothing to do with the cabal that owns this article. Alienus 04:17, 6 April 2006 (UTC)

and, "whatever"... Tomertalk 05:05, 6 April 2006 (UTC)
I changed my mind. It actually does make sense for someone to object to the mention of circumcision risks on the basis of Judaism. The scenario I was failing to consider is that there are people reading this article who are secular Jews and might therefore be swayed into avoiding circumcision for their own boys. In other words, even though someone might not care whether non-Jews get circumcized or not, they'd still be motivated to defend circumcision so as to convince Jews to accept it as medically neutral. Alienus 18:28, 6 April 2006 (UTC)

[edit] Excessive quote from ACS

Michael, you've once again included several paragraphs from the ACS statement. There are two problems here. Firstly, there are five paragraphs quoted from the ACS, versus two representing the views of other organisations. This is disproportionate, undue weight, and adds little value to the article. Secondly, while fair use allows short quotations, this is excessive and may overstep the boundaries of copyright legislation. Let's cut the text to one quoted paragraph from each. Jakew 12:03, 6 April 2006 (UTC)

Jake, the problem with your edit is that it removes some very important information about penile cancer. Your edits have deleted important information and warnings:
  • The large variations in penile cancer rates throughout the world strongly suggest that penile cancer is a preventable disease.
  • The best way to reduce the risk of penile cancer is to avoid known risk factors whenever possible.
  • Some recent studies suggest that circumcised men tend to have certain other lifestyle factors associated with lower penile cancer risk: they are less likely to have many sexual partners, less likely to smoke, and more likely to have better personal hygiene habits.
  • Most public health researchers believe that the penile cancer risk among uncircumcised men without known risk factors living in the United States is extremely low.
  • The current consensus of most experts is that circumcision should not be recommended as a prevention strategy for penile cancer.
  • Penile cancer is much less common in Israel, where nearly everyone is circumcised, than in the United States where only some men are. However, this comparison does not take into account other known risk factors such as the number of sexual partners, smoking, or personal hygiene. ::*::*::*::*Furthermore, the risk of penile cancer in Denmark, where very few men are circumcised, is no higher than that in the United States.

Now you say that you cut the quotations because they were excessively long. However, as you have neatly excised the points which go against your ideas, this argument may appear to others as disingenuous, or even a blatant attempt at censorship.

Now I will give you the benefit of the doubt. I take it that your concern about copyright is as pure as the driven snow, and that you are not trying to suppress information. I therefore ask you to suggest an acceptable way to putting back the information that you excised, without an overlong quotation. Michael Glass 13:37, 6 April 2006 (UTC)

Michael, we do not have to repeat or reword every single thing they say. We summarise. Now, of these points, the first two, while useful general information about penile cancer, are irrelevant to circumcision. The fourth is already noted in the article, where we state the lifetime risk, and it is not necessary to repeat it. The sixth is presented with an acknowledgement that it is of limited value, as the seventh illustrates. This leaves only the third and fifth as potentially contributing anything to the article. How about focusing on those? Jakew 14:21, 8 April 2006 (UTC)

Jake, this answer is quite different from what you wrote originally. I believe the fuller account is important to give the background to the issue. I'll deal with this later, though. Michael Glass 15:49, 8 April 2006 (UTC)
There are two issues, neither of which actually supports Jake's actions.
The first is whether we're exceeding fair usage by quoting too large a section. I don't think we are, actually. I've seen longer quotes in scholarly work, without uproar. Howevever, even if we were, then the solution would not be to remove the text outright but to replace direct quotes with paraphrases that quote parts of sentences as needed. A little more work, but certainly better than losing information.
The other issue is whether we're giving undue weight. I have no idea where he gets this, but his argument seems to hinge on word count, which is only indirectly relevant. Consider that if we spent a whole paragraph in an article that explained how evolution works, then ended it with "The Right Reverent Billybob Smith has proven evolution to be false by calling upon the holy spirit". In such a case, we would be giving undue weight to Billybob even though he's getting very little word count. In any case, if we actually were giving too many words, we could either trim the words a bit by using paraphrasing, as mentioned earlier, or we could add more quotes to the other side for balance. Removing the existing text is still not justified.
In the interim, barring a clear sign that we are in violation of fair use, we should simply restore the text so that we can slowly work on trimming it down without losing its content. Alienus 14:16, 6 April 2006 (UTC)

I am trying to get a response from Jake about how to restore important information that he cut from the article. He has raised two problems: that the quote from the ACS is too long; and that the quotation gives undue weight to the views of the American Cancer Society. Jake has not taken up my invitation to explain how to restore the information in a way that he finds acceptable, and has reverted once again. I find this quite frustrating and appeal to him to explain why he is behaving in this way. Simply saying that the ACS is given too much weight is an assertion, not an argument. Objecting to the length of a quotation strikes me as a pretext for censorship, and not a genuine reason. Michael Glass 02:14, 8 April 2006 (UTC)

I think you're correct here. In particular, the claim that it's "too long" is unsubstantiated and just plain arbitrary, to the point where even the assumption of good faith cannot protect it. I've been through similar frustrations here, as have others. At this point, it looks like we're going to wind up filing an WP:RFM to get outside mediation. You're welcome to join us. (As a side note, Jake is attacking me with an irrelevant and highly personal RFC.) Alienus 02:27, 8 April 2006 (UTC)

[edit] Rfc against me

Editors of this article may be interested in User:Jakew/Alienus_RFC. If you have an opinion, I encourage you to participate. Alienus 03:15, 7 April 2006 (UTC)

[edit] Reverting

Michael, I'm reverting your changes for the following reasons:

  1. You removed "In general" from the sentence referring to a growing problem. Neither of the links ([17] and [18]) mention circumcision, and it is misleading not to say so.
  2. You included "MRSA (methicillin resistant) and MSSA (methicillin susceptible) strains". Only one of these, however, has been linked to circumcision, and there is no cause to mention MRSA explicitly.
  3. Furthermore, you misrepresent the Zafar study, which discussed only resolution of MRSA, and did not mention MSSA at all. It is a stretch to include that study at all, but to misrepresent it is unacceptable.
  4. The addition of needless detail from which "no conclusion could be drawn" does not help the reader, nor inform him of anything useful about the subject. It might in a vague way provide a little circumstantial evidence to help make the case for a MRSA-circumcision connection, but this is an encyclopaedia, not a soap box, and it is not our role to make cases.
  5. Finally, the links to the ACS on prostate cancer are pointless. A reader of this article wishes to learn about circumcision. Telling him that they do not discuss circumcision in that context is one thing (though borderline OR). Giving him links to pages in which they do not discuss circumcision is pointless (it is not even of value in terms of evidence, since it is logically impossible to prove a negative). Jakew 14:07, 8 April 2006 (UTC)

Jake, Thanks for your note, though I could do without the discourtesy of being accused of misleading and misrepresenting the evidence. Please assume good faith, in accordance with Wiki policy.

  • "In general" does not clearly mean what you intended. I will change my version to accommodate your concern there.
  • The different strains of golden staph have infected neonatal wards. Please read the links I have added to the article.
  • You have accused me of misrepresenting the Zafar study. Zafar said:
In our study, however, none of the MRSA infections were at the circumcision site, although many were in the genital region.
My summary:
However, lesions caused by methicillin-resistant strains were not found at the circumcision site, although many were in the genital region [18] [19].
As you are not satisfied with this, I will change it to bring it even closer to Zafar's wording.
  • Although Zafar drew no conclusions from the greater incidence of MRSA infection amongst the boys who were circumcised, Enzenauer {http://www.cirp.org/library/complications/enzenauer2/] did suggest a reason for the greater rate of staph infection amongst circumcised boys:
Circumcision, which is performed on approximately 90 per cent of male infants born in our hospital, may be a factor. Circumcision, by its very nature. requires more staff-patient "hands-on" contact, both during the procedure and during preoperative and postoperative care.
It might be helpful to add this to the article.
  • Adding links about golden staph infections is sensible when that is what we are discussing, especially when there are other links that discuss the possibility of a link between MRSA, MSSA and circumcision.

Finally, I wish to thank you once again for your detailed notes. This has enabled me to modify the text in response to your concerns and is far better than simply reverting what I have written. Michael Glass 15:18, 8 April 2006 (UTC)

Michael, please don't be offended. When I say that something misrepresents the evidence, it does not necessarily mean that was your intent.
I agree that the different strains have affected neonatal wards. However, only one of the strains has been linked to circumcision in reliable sources, and that is the only one worth discussing in this article.
As for the Zafar study, the problem comes from saying that "curupulous attention to hygiene can suppress these infections in wards". Zafar reported on successfully controlling MRSA specifically, and we should not generalise. As noted, though, MRSA is off-topic for this article.
As for the Enzenauer quote, yes, I agree that it might be helpful to add this. I've done so.
I agree that adding links about S aureus is sensible, provided that it either discusses circumcision or a strain that has been linked to circumcision.
Jakew 18:15, 8 April 2006 (UTC)

Jake, I believe you're mistaken about the relevancy of MRSA and that Michael is correct to mention it. In support of this, I remind you of studies that show CA-MRSA is a risk to infants who have been operated on, which necessarly includes circumcision. Alienus 18:18, 8 April 2006 (UTC)

And I remind you, Alienus, of the policy on original research, which explicitly rules out such interpretation. Jakew 19:27, 8 April 2006 (UTC)
Once again, Jake, that is your interpretation of a Wikipedia policy. Alienus, let's get that RFM on this issue. The exclusion of information regarding the risk of MRSA when getting circumcized is unacceptable. Superdix 22:19, 8 April 2006 (UTC)
Sup is right, Jake. You need to distinguish between Wikipedia policy and your interpretation of it. The former is not up for debate, but the second has proven itself to be quite questionable. In particular, you seem eager to interpret policy in such a way that just so happens to support your POV. I am not, at this moment, claiming bad faith, as this could be accounted for by your unconscious bias.
Anyhow, an RFC is in order (and I suspect that any results might impact on that threatened RFA aimed at me). Let me look up the details on how to put this through. Alienus 08:10, 9 April 2006 (UTC)

Jake, please look at the Hoffman report [19]:

In Aug 1998, a 150-bed naval hospital in eastern North Carolina identified an outbreak in the newborn nursery. Cases were newborn males who had undergone a circumcision procedure and post-discharge required antimicrobial treatment for severe pustulous diaper rash. A total of 36 cases were identified from Aug to Jan 1999. All 17 cases that were cultured grew methicillin-sensitive, erythromycin-resistant Staphylococcus aureus.

Do we agree that this was an outbreak among newborn males who had undergone a circumcision procedure? Do we agree that this was MSSA?

Extensive environmental culturing of the nursery unit and circumcision procedure equipment did not reveal an inanimate reservoir for the S. aureus. Initial infection control measures (Aug) to review aseptic technique and instrumentsterilization procedures were ineffective.

Do we agree that no inanimate reservoir for the staph was found? Do we agree that initial infection control measures were ineffective?

In Jan additional control measures included enforcement of glove wearing for all diaper changes and limited post-circumcision care to one healthcare worker (HCW) per newborn. In Feb all HCWs (MDs, RNs, LPN and corpmen) were cultured by anterior nasal swabs and hand swab cultures. Fourteen (14) HCWs had positive cultures identified with S. aureus. Pulse field gel electrophoresis (PFGE) were performed on 13 of the 17 case isolates. All 13 case isolates were identical. All 14 HCWs identified with S. aureus were compared to the >13 cases by PFGE, and 3 HCWs (2 RN, 1 LPN) matched identically. One of these HCWs had a chronic cough, and a second had concealed dermatititis. This suggests that these DCWs were disseminators in light of the prolonged nature of the outbreak. Antimicrobial decolonization was instituted for the HCWs and there was one additional case in Mar. In conclusion, HCWs identified by DNA testing may have represented the reservoir of infection in this outbreak.

Do we agree that the infection of golden staph came from the staff? Do we agree that this report came from a reliable source?

If we are in agreement on all these points, why did you cut a link to this report? See [20]

If you had a reason for cutting this link, please explain. If it was done in error, would you be so kind as to put back the link? I believe that it is relevant to the article. Michael Glass 04:10, 9 April 2006 (UTC)

Michael, my reason for removing the link was that it did not support the claim that "golden staph (Staphylococcus aureus) infections may be more common in circumcised infants". It is an original interpretation of Hoffman's findings. In contrast, Enzenauer explicitly raised that possibility, so no interpretation is necessary and it directly supports the text. I hope that this clarifies things. Jakew 09:52, 9 April 2006 (UTC)

Jake, cases of MSSA were in newborn males who had been circumcised. Note that this statement is unqualified. It didn't say that most cases were in that group, or the majority of cases were in that group. I think we can take it that all cases of MSSA in this outbreak were in newborn males who had been circumcised. I think we can take it that no newborn females were infected and no uncircumcised newborn males were infected. As these babies weren't infected it is evidence that golden staph infections may be more common in circumcised infants. The idea that this is an original interpretation is a bit like claiming that circumcision is not an operation. Michael Glass 12:48, 9 April 2006 (UTC)

Unless there is a study stating that the proximate cause of the infection was circumcision, doing this sort of synthesis violaties the principle of no original research, in my view. For example, I am sure that none of those babies are smokers. Clearly, a failure to smoke enough tobacco is correlated with contracting MSSA. The contrast with the Enzauer quote -- where we are quoting a reliable source who is doing the synthesis, rather than us -- is instructive. Nandesuka 13:51, 9 April 2006 (UTC)
While being funny, your comparison of this issue to tobacco smoking is also ridiculous. Consider this:
  • It is a fundamental medical fact that cutting the human body makes it prone to infections.
  • Since medicine is science, it proves this link, between surgery and infection, through empirical data.
  • On the basis of this, physicians and other scientists are able to generalize. This is not particular to medicine, but is used in all fields of science.
  • Empirical studies have never shown that any particular type of surgery is somehow protected from infection.
Refusing to take any of the above into account when reading articles on MRSA means that one ignores the issue from a medical point of view, the very view we are trying to cover in this article. Superdix 14:23, 9 April 2006 (UTC)
All good points, and I'll toss in one more. As some of the studies point out, the infection risk doesn't even have to come from the actual surgery but from all the extra handling of the infant that is required after this surgery. In short, there is no original research here and any claim to the contrary is baffling. Let's see how this RFM pans out and if we need to shake the tree more. Alienus 14:26, 9 April 2006 (UTC)
With respect, you are mistaken. Yes, physicians and other scientists are able to generalize. For purposes of editing this article, neither you, I, nor Michael are physicians or scientists. We are editors of an encyclopedia, and specifically an encyclopedia which, as one of its three founding principles, absolutely and categorically forbids original research. It is fine for us to quote physicians and scientists who do such synthesis. It is fine for our readers to perform such synthesis after reading our articles. It is absolutely unacceptable for us to perform such synthesis on behalf of our readers. This is a founding principle of Wikipedia. Editors who do not like this should look for an encyclopedia that permits and encourages original research, because this one doesn't. Nandesuka 14:30, 9 April 2006 (UTC)

I recently ran into a guy named Ndru01 who wanted to add large, rambling sections about his private New Age religion to a half-dozen articles. That is original research. What's happening here is nothing of the sort. If we applied your arbitrarily high standards across the board, Wikipedia would be empty. Your interpretation contradicts both the letter and spirit of the rule, and I note that it is only invoked by you when there's some unquestionably sound text that you want to nonetheless remove. In other words, you're not doing the right thing, either. This is why we need an RFM. Alienus 14:33, 9 April 2006 (UTC)

To quote WP:NOR:
In order to avoid doing original research, and in order to help improve the quality of Wikipedia articles, it is essential that any primary-source material, as well as any generalization, analysis, synthesis, interpretation, or evaluation of information or data, has been published by a reputable third-party publication (that is, not self-published) that is available to readers either from a website (other than Wikipedia) or through a public library...
(emphasis added). I understand that you believe that it is obvious that circumcision caused some MSRA infections. That's not good enough to merit inclusion. If it is obvious, then find a reputable third party source that says it. I'm happy to engage in an RFM, but keep in mind that no RFM is going to allow us to violate WP:NOR. Ever. Hope that helps. Nandesuka 14:35, 9 April 2006 (UTC)

Imagine a source that contains the following two sentences: "All men are mortal" and "Socrates is a man". Is it ORIGINAL RESEARCH to write that Socrates is a man mortal and cite this source in support? What if another source, which is contested, makes the point that these two statements form premises of a syllogism whose conclusion is that Socrates is a man? Does this second source, which is exercising logic but not doing any empirical gathering of data, have to have a PhD in Greek History in order to be considered reliable?

It looks like you're saying that anything other than mindlessly cutting and pasting is OR. If so, then let's erase this article completely and start from scratch. Otherwise, you're arbitrarily raising the bar for the text you disagree with, which is a violation of WP:NPOV, a higher standard than WP:NOR. Alienus 14:57, 9 April 2006 (UTC)

I think you meant to ask whether it is original research to write that Socrates is mortal. The answer is yes, if no reputable sources have stated this previously. The policy is so clear on this that it's surprising that you should be asking. If the second source fails to meet the criteria of WP:RS it doesn't matter one bit what it says or how logical it is. A PhD is not required, though publication in a reputable source is.
Secondly, no, articles don't have to contain text directly from other articles. Rephrasing is fine. New conclusions, however, are not.
Finally, the standard applies equally to all text. If unreliable sources are used elsewhere in the article, if original research is included, or if text is not neutral, fix it or point out the problem text. I doubt that you'll be able to find much, if any, because it's pretty good. Jakew 15:30, 9 April 2006 (UTC)

I must say, this is one of the most ridiculous things you've said so far, and you've said quite a lot. Thank you for expressing your errors so clearly. It'll help in the RFM. Alienus 15:37, 9 April 2006 (UTC)

First off, let me make clear in advance of what I'm about to say: I am not calling you, personally, or indeed any contributor to the article, a kook.
Now that that's out of the way: every single kook on Wikipedia claims that their original research is merely syllogistic in nature. Every single one. Without exception. Some of them even use the exact same example that you brought up. WP:NOR was created precisely to deal with this situation. As a tertiary source, Wikipedia articles should provide citations to reliable primary and secondary sources that make the syllogism for us. We must not synthesize them ourselves. Nandesuka 16:16, 9 April 2006 (UTC)

And when a kook does it, feel free to take them to task for it. However, it has nothing to do with this. Alienus 16:33, 9 April 2006 (UTC)

The only thing we point out is that circumcision is an invasive, surgical procedure. There is nothing 'novel' about that. If you disagree, please say so. In the words of Alberts et. al.: "Pathogens cross protective barriers to colonize the host": "Wounds in barrier epithelia, including the skin, allow pathogens direct access to the interior of the host. This avenue of entry requires little in the way of specialization on the part of the pathogen. Indeed, many members of the normal flora can cause serious illness if they enter through such wounds. Anaerobic bacteria of the genus Bacteroides, for example, are carried as harmless flora at very high density in the large intestine, but they can cause life-threatening peritonitis if they enter the peritoneal cavity through a perforation in the intestine caused by trauma, surgery or infection in the intestinal wall. Staphylococcus from the skin and nose, or Streptococcus from the throat and mouth, are also responsible for many serious infections resulting from breaches in epithelial barriers. (Alberts et. al., Molecular Biology of the Cell, 4th. ed., New York: Garland Science, pp. 1434-1435).
Again, I wish to show you that medical texts generalize for a reason, namely that all surgery bears with it the risk of infection. This I have given several references to.
There is nothing worth publishing about "Child Infected With MRSA After Circumcision" because the general risk of infection with any surgery is very well documented. "Child Not Infected With MRSA After Pouring Cultivated Methicillin-Resistant Staphylococcus Aureus Strains Over Circumcision Wound" would, however, be worthy of publishing, because it would contradict the established fact that all surgery carries with it the risk of infection. Superdix 17:18, 9 April 2006 (UTC)
Yes, all surgery carries the risk of infection, and there are no shortage of texts identifying infection as a specific risk of circumcision. This is stated in the article. On to infection by specific pathogens, many articles have documented, for example, MSSA infections due to circumcision (we cite a couple), so obviously something was considered worth publishing. This is also true of other pathogens. However, no reputable article has linked MRSA to circumcision. I would also point out that those dealing with circumcision and infection in general (eg, medical association's policy statements) have not seen the need to single out MRSA for discussion.
So, to summarise, we have a situation here in which a) no reliable sources have linked circumcision to MRSA, yet b) reliable sources have linked circumcision to other pathogens, c) circumcision can only be linked to MRSA via a novel synthesis prohibited by WP:NOR, and d) the only precedent for any linkage between the two is unrealiable anti-circumcision propaganda (and Wikipedia is not a propaganda vehicle). Jakew 09:58, 10 April 2006 (UTC)
Or, in plain English, you cannot deny the truth or verifiability of the CA-MRSA issue and you admit that the only reason this infection isn't mentioned specifically in the context of circumcision is that it would be redundant restate the obvious, yet you would like to use this as an excuse to exclude all mention. I understand completely, and so will the mediator. Alienus 12:29, 10 April 2006 (UTC)
If you have such difficulty assuming good faith, one wonders whether mediation has a hope. Incidentally, your comments imply that you expect a mediator to arbitrate. They don't. Jakew 13:35, 10 April 2006 (UTC)

Well said. I get the impression that Jakew is abusing the fact that medical texts speak generally where generality is appropriate. If CA-MRSA is a risk any time the skin is cut, then there'd be no reason to ever explicitly point out that it's a risk for one particular sort of cutting, since it's a risk for all. Essentially, Jakew is playing word games by pretending that you need a PhD to know that surgery involves cutting. He's using whatever excuse is available to stonewall the inclusion of something whose truth and verifiability is not in the least bit controbersial. I'm very disappointed by his actions; they undercut his credibility entirely. Alienus 19:05, 9 April 2006 (UTC)

If generality is appropriate, why do you want to go into specifics? We already state that infection is a risk. Why do you want to discuss one specific pathogen, which is covered by the general case and no reputable organisations have seen fit to single that out for discussion? Jakew 09:58, 10 April 2006 (UTC)
Resistant staphylococcus strains deserve extra attention because they have the potential to kill a normal, healthy human being in a situation where a similar infection with the non-resistant strain could be easily treated with medication. This is also the reason why they are frequently referred to as superbugs. Superdix 13:18, 10 April 2006 (UTC)
Strange, then, that none of the reputable medical organisations have given MRSA such 'extra attention'. Jakew 13:35, 10 April 2006 (UTC)
That's fascinating, but how does it justify your policy of repeated censorship? I just don't see the connection. Alienus 21:30, 10 April 2006 (UTC)

[edit] Original Research is seeing shells and guessing eggs, not in seeing and noting the shells.

What Waskett et al are saying is that we can't see shells and guess eggs. That would be original research.

OK. Let's not guess eggs, but let's just note the appearance of the shells. So let's just note the following from the Zafar study:

In our study, however, none of the MRSA infections were at the circumcision site, although many were in the genital region. No conclusions could be drawn to explain the fact that only male infants were infected with MRSA in this outbreak. [21]

Let us note the outbreak of MRSA at St Catherine's Hospital on Long Island [22] quoting the part that described the pattern of infection: 'All of the infected babies were boys who were circumcised at the hospital, though their infections were not in the wounds but on the skin on different parts of their bodies, their mothers said.'

Let us note the preliminary study by Fortunov et al, also noting that this paper has been presented in a medical conference but has not yet been published in a peer reviewed journal [23]. Let's also quote this part:

Although both MRSA and MSSA occurred predominantly in boys -- about 73% in each group -- after further analysis the investigators observed an infection peak only in boys infected with MRSA.
In both groups, putulosis in the groin, upper thigh, and sacral area - areas covered by diapers - was a common presentation. Both groups had invasive infections, including shock, musculoskeletal infections, urinary tract infection, perinephric abscess, bacteremia, and empyema. There was one death, in a child with MRSA.
"Interestingly 10 of the 12 invasive infections, including the death, occurred in male infants," Dr. Fortunov said. She and colleagues had no explanation for this.

Once again, I am not asking for us to see shells and guess eggs, just to note the shells. My objection is not to the ban on guessing eggs; it's to the hiding of the shells. Michael Glass 13:07, 10 April 2006 (UTC)

I object to your attempt to censor the fact that all of the infected infants were nonsmokers. Nandesuka 13:39, 10 April 2006 (UTC)
(edit conflict) Good point. Jakew 13:56, 10 April 2006 (UTC)
The problem is, Michael, that without 'eggs' there is nothing to warrant discussion of 'shells'.
Let me give you an example 'shell'. For sake of argument, assume it is properly sourced.
"Bloggs found that 85% of Asian men were circumcised, and 20% had heart attacks before the age of 50."
What is the best way to approach this as an editor? Without an 'egg' to give it context, we can interpret it one of two ways. Firstly, we could decide that it is an irrelevant piece of information that adds nothing to the article, and the article would be better without it. Secondly, we could decide that it implies that circumcision was protective against heart attacks. Let's suppose that Bloggs presented these data seperately and did not draw such a conclusion (perhaps he overlooked it, or perhaps he had data to the contrary - it doesn't matter). The way in which it is stated, and the implication, is original research. We must either find another author who explicitly stated a connection, or delete the sentence. To leave the 'shell' implies an 'egg'. Jakew 13:56, 10 April 2006 (UTC)

Jake, removing the shells implies a cover-up.

Boys who are circumcised are being infected with MRSA, the infections of MRSA peak about a fortnight after birth, infections often occur in the nappy/diaper area, that there is widespread concern that MRSA is becoming more common. Yes, it is true that MRSA infections haven't been observed on the circumcisiion wound itself, as MSSA infections have, and this must be noted, but everything else seems to point to some association with the circumcision or with the extra handling that the boys need after circumcision or some constitutional weakness of the boys. We can't go further than the evidence goes, but we can record the evidence. That's the point I'm making. Michael Glass 14:48, 10 April 2006 (UTC)

As Nandesuka points out, you could just as easily claim that failing to note that all of the infected infants were nonsmokers implies a cover-up.
Now, you've made a case, with some strengths and weaknesses. This is all very well, but Wikipedia is not the place for it. Things that seem to point to something do not belong in an encyclopaedia that prohibits original research. Things that others have identified as pointing to something, however, are not a problem, provided that they have done so in reliable sources. Jakew 14:59, 10 April 2006 (UTC)

The fault with this argument is that it treats these points as making a case. It doesn't. There's not enough evidence at the moment, but the evidence that is there is important. We know that there is a connection between MSSA and circumcision. Because MRSA is another strain of golden staph, there has to be concern that MRSA has the same potential. Also if 'unreliable' sources are making claims about a danger, this is another reason to note the points that have been made about MRSA in the reliable sources. This isn't a pro-circumcision or anti-circumcision concern, it's a public health concern, and it is moderate and responsible to list the evidence but refrain from going any further. Michael Glass 16:09, 10 April 2006 (UTC)

Michael, as you say, there isn't enough evidence at the moment, and until there is, we shouldn't include it in the article, just as we shouldn't hint at a protective effect against heart attacks. This is an encyclopaedia, not a public health bulletin. Jakew 20:23, 10 April 2006 (UTC).

Jake, once again you have seen the question in terms of propaganda. It's not a matter of hinting; it's a question of evidence. I'm not arguing for a verdict, or the hint of a verdict. I'm arguing for the presentation of the evidence; I'm arguing against the suppression of the evidence: that is all. Michael Glass 21:29, 10 April 2006 (UTC)

Yeah... that doesn't actually follow. If there isn't enough evidence to state that there's a connection but more than enough evidence for it to be suspected, then we should say that it's suspected. It looks like you'd rather hide the whole thing away, presumably because you think it gives ammo to the anti-circ people. This (apparent) motive is, of course, POV. I say we should say what we know and not put a spin on things due to our own biases.
And, Jake, let's be frank: you are extremely biased. How many grown men go for a circumcision (aside from religious conversion)? Those few have a powerful desire to convince themselves that they did the right thing when they went under that knife. And what better way than to try to convince all of us by hiding evidence to the contrary? There's even text on your user page which analyzes your motives, with similar conclusions.
And before you start spamming my page with nebulous threats and complaints about civility or assuming good faith, please remember that civility does not mean avoiding all issues that might be unpleasant, nor does good faith require us to ignore the obvious. I'm writing this to explain why I think you're mistaken on this issue, and furthermore, why I think you're too biased to be able to see this mistake clearly. This constant debating isn't helping you any, only cementing your thoughts. Frankly, I think you need an extended wikibreak away from all circumcision-related articles until you regain some objectivity. Alienus 21:29, 10 April 2006 (UTC)
No, civility means being civil, and you're being downright rude. Jakew 10:25, 11 April 2006 (UTC)
Clearly, you have no idea of what constitutes civility. Alienus 03:48, 12 April 2006 (UTC)
If it is "suspected" by a reliable source, then it will be trivial to find a reliable source that says that they suspect it. If it is merely "suspected" by User:Michael Glass and User:Alienus, then it doesn't belong in an article on Wikipedia. Nandesuka 00:50, 11 April 2006 (UTC)

Right, we've been down this road before. Apparently, you've arbitrarily decided to boycot DOC. Alienus 02:48, 11 April 2006 (UTC)

DOC don't meet the criteria of WP:RS, as has been explained above. If they did, then this conversation would not have arisen, since we could simply have cited DOC. If you try to evade WP:RS, you should expect to be frustrated. Jakew 10:25, 11 April 2006 (UTC)

Like I said, we've been down this road before, and you're simply abusing WP:RS by taking an insanely narrow interpretation. It's one thing to quote DOC on what is medically true, another to quote them on what people suspect. Weaker claims have a lower burden, but you would like to raise the bar high so that your pro-circ text can waltz under it why anything deemed anti-circ has to hurdle it. This is deeply POV, which is why you're under fire now. Alienus 03:54, 12 April 2006 (UTC)

[edit] Prostate Cancer

To put prostate cancer in context it is important to record that rates in the United States are very high compared with most other countries, that these rates vary widely in Europe and even more world-wide. Once again, this is not original research, it is simply drawing attention to important information.

The wording talked about an 'association' between prostate cancer and circumcision. This sounds a bit original researchy to me, especially as this thinking is not reflected in the American Cancer Society, so i replaced it with more neutral language.

There is a problem with references to abstracts, especially when the information referred to is not in the abstract. I have tried once more to point out that the reference is to the original article and not to the abstract. If anyone can think of a better way of doing this, I would welcome it. Michael Glass 14:48, 10 April 2006 (UTC)

Feel free to add rates of prostate cancer in various nations to the main article on the subject. However, this article is about circumcision, and these are clearly not relevant to that subject. Consequently, I've reverted this change.
The term 'association' has been used by some of the authors we cite, so it is certainly not original research. One could argue that it is POV, I suppose.
I don't think that you've really improved the article by adding all the abstract indicators. It should be clear to any reader who wants to verify the information that an abstract of an article may not contain all data presented in it. I suppose, at a stretch, the link might imply that it may be found online. The obvious solution here is to properly reference the article using Wikipedia's referencing system ({{cite web}} etc), thus clearly separating links from citations. It's no small task, and anyone willing to do so will certainly hear a distant round of applause from England... Jakew 15:14, 10 April 2006 (UTC)

The prostate cancer incidence rate [24] in Washington, Seattle,, USA is 131.5 per 100,000 while for Jews in Israel it's 23.9 and for non-Jews it is 10.4 and in Hanoi, Vietnam, it is 1.2. These huge differences completely dwarf a study of a couple of hundred people that finds a difference of 50% or less. It puts things in context. That's why the information should be accessible for an encyclopedia that can be read all over the world, and why it is relevant in this article. Michael Glass 16:32, 10 April 2006 (UTC)

Can you find an example of anyone making this argument in a WP:RS? Jakew 20:20, 10 April 2006 (UTC)

Your request is an abuse of WP:RS and WP:OR policies. Please be WP:NPOV. Alienus 21:33, 10 April 2006 (UTC)

Care to explain how I'm violating any of these policies? Jakew 10:19, 11 April 2006 (UTC)

Jake, if you looking for an authoritative source to tell you that prostate cancer rates vary in different parts of the world try this webpage of the American Cancer Society and The Journal of the National Cancer Institute - Cancer Spectrum. For further information, try [25] and [26] and do a Google search]. Information about prostate cancer rates in different parts of the world needs to be in the article to put the other information into perspective. Michael Glass 00:14, 11 April 2006 (UTC)

Michael, I'm looking for an authoritative source that states that differences "completely dwarf", or otherwise give any meaningful perspective on the studies cited in the article. Jakew 10:19, 11 April 2006 (UTC)

Why is everyone trying to add information about prostate cancer to an article about circumcision? Has a WP:RS linked the two in some way? Jayjg (talk) 22:59, 11 April 2006 (UTC)

I have rearranged the information and abridged it. I hope that this will satisfy all parties. The information added is well sourced and puts the question of prostate cancer in a world-wide perspective. Michael Glass 08:00, 12 April 2006 (UTC)

I have reduced it further. If you want to put prostate cancer in a worldwide perspective, I suggest doing so at prostate cancer. The only justification for including any such information is to clarify that the 1 in 6 figure given is not universally applicable.
I have also reworded a rather sweeping OR statement, and removed some spectacularly pointless links to pages that do not discuss the subject. Jakew 09:16, 12 April 2006 (UTC)

While I appreciate Jake's efforts to compromise, I cannot agree with his version, as it still deletes important information about the worldwide incidence of prostate cancer and the links to the websites that verify it. It is important to recognise that the World Wide Web is truly world-wide, and Wikipedia articles should take this into account. A link to the article on prostate cancer is a great idea, but it is no substitute for a cross-cultural focus in this article itself. Michael Glass 14:13, 12 April 2006 (UTC)

Michael, we don't need a cross-cultural focus in the article. It's about medical aspects of circumcision, not a cross-cultural analysis of prostate cancer. Having said that, can you find a source giving the global range of rates (eg., "ranges from 1 in 45 in Iceland to 1 in 3 in Cambodia")? A brief note of such a range would be ok in my view, though a lengthy discussion is ridiculous. Jakew 15:02, 12 April 2006 (UTC)

Jake, please look at [27]. That answers your question about incidence rates in different countries. Now look at what I have written:

Rates of prostate cancer vary widely across the world. It is least common in South and East Asia, more common in Europe - though the rates vary widely between countries - and most common in the United States [28]. In the USA, prostate cancer is the second most common cancer in men, where the lifetime risk of developing it is 1 in 6 and rising.[29]. According to the American Cancer Society, prostate cancer is least common among Asian men and most common amongst Black men. with figures for European men in between [30] [31]. However, these high rates may be affected by increasing rates of detection [32].

It's basically two sentences longer than your version, and it's fully referenced. Do those two sentences skew the whole article into a cross-cultural analysis? How do two sentences become a lengthy discussion? Is the excision of those two sentences that important to you? If so, why?

No, Michael, it's excessive detail about something that is not relevant to the subject. We do not need four sentences to discuss the incidence of prostate cancer, which itself is only background information. We do not need to include five links that have nothing to do with circumcision, which is the subject of the article.
If you think that the article needs to have this information, to 'put it into perspective', as you put it, then ask yourself whether other authors might have done so when discussing circumcision. If they have, then cite them. If not, the information probably doesn't belong in the article. Jakew 15:56, 12 April 2006 (UTC)

Jake, we need a wider perspective here than what you propose. I think you need to ask yourself why the American Cancer Society doesn't mention circumcision in relation to prostate cancer. Ask yourself why you are happy to include the differing rates of prostate cancer in Blacks and Asians in the United States but not in the rest of the world? Why does your viewpoint have to be so centred on the United States? Why have you slipped back into straight reverts instead of working on a consensus? Michael Glass 16:21, 12 April 2006 (UTC)

Michael, I have no idea why the ACS doesn't mention prostate cancer, but the fact that they can't even get their story straight on penile cancer suggests to me a certain lack of organisation and familiarity with the evidence. With such contradictory statements, I'm not prepared to even try to guess why they say what they do on other subjects (that's just a private opinion, I'm not suggesting its inclusion in the article). Jakew 16:41, 12 April 2006 (UTC)

Only the most extreme pro-circumcision advocates suggest a relationship between prostate cancer and circumcision. None of the professional medical organizations even mention prostate cancer in their policy statements on circumcision. The fact it is mentioned in the Wikipedia article is an indication of a pro-circumcision bias. -- DanBlackham 20:04, 12 April 2006 (UTC)

I find it interesting that DanBlackham believes that MSSA and MSRA should not be mentioned in this article, since no professional medical organization mentions them in their policy statements on circumcision. You learn something new every day. Nandesuka 22:07, 12 April 2006 (UTC)
No, Nandesuka, I do not believe that. Please do not misrepresent what I believe. -- DanBlackham 09:27, 13 April 2006 (UTC)
I was trying to assume good faith, since the alternative is that you only care what professional medical organizations say they agree with your preconceived notions. Nandesuka 12:36, 13 April 2006 (UTC)

Jake, I'd like you to consider the possibility that the American Cancer Society's poisition on circumcision might be closer to American medical orthodoxy than yours is. As the United States is generally more pro-circumcision than elsewhere it suggests that your position is more extreme than perhaps you realise. Of course you are entitled to your own opinions and judgments, but consider that perhaps you need to give more wieght to the position of others. In this case, i suggest that you look at the evidence of the differing rates of prostate cancer around the world. This might help to put your own views about prostate cancer in that wider perspective that I have been discussing. This is not a case of discounting your views, but simply putting them in a wider context. Do you remember the wonderful scene in Gone with the Wind when Scarlett O'Hara went to get medical help for her sister-in-law in childbirth. The doctor wouldn't come, couldn't come! The camera drew back, and suddenly we saw not one but thousands of men in desperate need of medical attention. It's one of the most moving images of the whole movie. So this is all I'm asking you to do: hold to your insights, but be prepared to see them in a wider context. Michael Glass 23:29, 12 April 2006 (UTC)

[edit] Nandesuka and DanBlackham

It's time for you both to sign on to the RFM. If you can participate here, you can come join us there. We're waiting for you. Alienus 23:33, 12 April 2006 (UTC)

[edit] Circumcision to reduce HIV risk

How exactly did they found that "Circumcised men had 70% less chances of being infected with AIDS"? Did they make 100 HIV negative circumcised men f**ck 100 HIV positive women, and exactly the same thing with other 100 normal men and then while, say, 50 normal men got AIDS only 15 circumcised became infected? Someone please add details to this section telling HOW they got to the 70% number, because simply stating that "there was a 70% risk reduction" means nothing at all since someone will not contract AIDS from someone who is not an HIV positive, be he circumcised or not. Cuzandor 19:34, 15 May 2006 (UTC)

Presumably, they compared the infection rate of two groups of men; the first intact, the second circumcized. Assuming nothing else distinguishes them, any difference would be significant. Al 19:44, 15 May 2006 (UTC)
More or less right. They took roughly 3,000 men, then assigned each man at random to either the intervention (circ) or control (non-circ) group. They performed the necessary circumcisions, and then monitored the men for 21 months, at three intervals. The elegance of this design is that characteristics such as, say, religion (or an HIV+ girlfriend) that might have otherwise acted as a confounding factor, are evenly distributed across the two groups. Any differences are due solely to the intervention. Jakew 21:00, 15 May 2006 (UTC)
Oh, there's still room for error, despite the design you praise. Consider that, given the nature of circumcision, it does not seem amenable to a traditional double blind. This leads to the possibility of error caused by people acting differently due to knowledge of their (or their partners') circumcision status.
There are also other factors to rule out, such as men finding fewer or different sexual partners due to their altered penises. For example, if women think circumcized men are safer, it may be that those women who are more concerned about the risk of HIV+ are more likely to seek out circumcized men. These women might, not coincidentally, be more likely to use condoms regardless, to limit the number of partners, and to question potential partners more carefully about their sexual history and commitment to fidelity. It doesn't take a lot of imagination to poke holes in the reliability of such studies, raising questions that a study would have to be designed to address.
Of course, the real question is whether the limited protection offered by this surgery is sufficient to justify the negatives. After all, the protection does not approach the levels offered by a typical vaccine, so all that cutting might not make a difference in the end. If anything, it might even encourage men to be more careless in the long term, due to their false feeling of invulnerability. In short, this is a complex issue that cannot be settled by this study alone. Al 21:41, 15 May 2006 (UTC)
You are correct. Behaviour can indeed change as a result of the intervention. This is why the researchers monitored and controlled for such factors in the statistical analysis. Jakew 10:03, 16 May 2006 (UTC)
Certainly, 70% protection is shy of the 80% that's usually treated as a minimum standard for vaccine efficacy (although acceptable standards for vaccines really depend on the reproduction number of the disease itself, which kind of complicates the issue). But it's not half bad, compared to our existing tools (abstinence programs, which normally only delay the start of sexual activity by a year or so; condoms, which are generally not used regularly by people in long term relationships, besides causing all kinds of political trouble with religious types; and partner reduction, ie encouraging people to be faithful to one long-term partner, or at least sleep around less, which is bloody difficult to do). Also, given the poor outlook for HIV Vaccines at the moment (we're at least 10 years away still, and it could be a lot longer), we need to look at other options. Offering free circumcision in a safe medical environment could be one of these, if the other two trials whose results are due out this month confirm the results of the first. Procrastinator supreme 05:35, 15 June 2006 (UTC)
I'm skeptical of their ability to do so, particularly when it's the behavior of non-participants that is at issue. Al 11:54, 16 May 2006 (UTC)
I agree. Cuzandor 17:02, 16 May 2006 (UTC)

[edit] User:84.69.230.138

The recent changes by User:84.69.230.138 have led to the duplication of a paragraph. I'm not going to remove it now because a strict (read: bad faith) interpretation of WP:3RR could be used against me by anyone sufficiently partisan. Instead, I ask that someone else do the clean-up. If not, I'll look into this article later and do it myself. Al 20:01, 27 May 2006 (UTC)

[edit] Removal of MSSA discussion

I'm assuming your removal of the MSSA paragraph was a mistake, Jakew. Superdix 12:20, 2 June 2006 (UTC)

[edit] The staph connection was peer-reviewed 40 years ago!

Staph infection in circumcised infant boys is double the rate in non-circumcised boys. Thompson DJ, Gezon HM, Rogers KD, et al. "Excess risk of staphylococcus infection and disease in newborn males." Am J Epidemiol 1965;84(2):314-28, at p. 323. This needs to be in the article; apparently it was removed after someone chopped the discussion of the controversial discussion of methicillin-resistant strains. 71.132.130.229 12:28, 2 June 2006 (UTC)

Feel free to restore it, as it appaears to be a reliable source. Al 15:02, 2 June 2006 (UTC)

[edit] So please lets discuss.

Why do you revert proper inclusion of meatal stenosis?

Why do you insist on biased language (re operator)?TipPt 19:51, 27 August 2006 (UTC)

[edit] HPV and cervical cancer

It seems to me that this section needs a thorough going over. It informs us that horse serum has a carcinogenic effect on mice, which I think would qualify for the Monty Python award for facts from medical research. The theorising of Wolbarst strikes me as having little relevance today. However, if a new vaccine does have a protective effect it should be mentioned. To protect women from HPV it would sound more logical to offerhem an effective vaccine rather than circumcising the men. Therefore the devalopment of this vaccine should be mentioned.

Apart from disputes about what should be included, the expression in this section needs to be worked on. Some parts strike me as unnecessarily clumsy.

Finally, I would urge Jake, Bobby70 and Nandesuka to talk about the issue on the talk page rather than constantly reverting. When charges of 'original research' are made, it is not good enough to make a wholesale revert and assume that the other person knows what you are getting at. Perhaps Jake could explain here why he feels Bobby70's contribution is original research, Nandesuka could explain why Bobby70's contribution is tangential and Bobby70 could explain why his proposed edits are relevant and important. Michael Glass 01:48, 23 March 2007 (UTC)

I have now reorganised the passage. Can someone else please supply the extra citations? In particular, I would dearly like to know whether the carcinogenic effect of horse or human smegma has ever been replicated in mice or humans or both. Monty Python, I am sure, would also like to know. Michael Glass 10:16, 24 March 2007 (UTC)

HPV vaccine is extremely relevant to circumcision because it is going to provide protection against HPV infection, which in turn will provide protection against cervical, penile, and anal cancers. Circumcision, assuming that it offers protection, will no longer be necessary.

[edit] circumcision and BPH

I reverted the addition of BPH(Benign Prostatic Hyperplasia) as a late complication of circumcision. The reference added to that claim is problematic. even if the prominence of the journal is ignored, the study looked into the prevalence of LUTS(lower urinary tract symptoms). LUTS does not equal BPH, many conditions may cause such symptoms. If a reference is found, in which BPH was noted in larger numbers in circumcised men, please undo my rervert.Derwig 15:57, 23 March 2007 (UTC)

[edit] Circumcision and HIV

Jake:

The material you tried to put up represents only one viewpoint. That is an obvious violation of the NPOV rules. You have to allow all viewpoints.

http://en.wikipedia.org/wiki/Wikipedia:Neutral_point_of_view

"The neutral point of view is a means of dealing with conflicting views. The policy requires that, where there are or have been conflicting views, these should be presented fairly. None of the views should be given undue weight or asserted as being the truth, and all significant published points of view are to be presented, not just the most popular one. It should also not be asserted that the most popular view or some sort of intermediate view among the different views is the correct one. Readers are left to form their own opinions."

"As the name suggests, the neutral point of view is a point of view, not the absence or elimination of viewpoints. It is a point of view that is neutral – that is neither sympathetic nor in opposition to its subject.

"Debates are described, represented, and characterized, but not engaged in. Background is provided on who believes what and why, and which view is more popular. Detailed articles might also contain the mutual evaluations of each viewpoint, but studiously refrain from stating which is better. One can think of unbiased writing as the fair, analytical description of all relevant sides of a debate. When bias towards one particular point of view can be detected, the article needs to be fixed."


If you want to post that material, then you have to allow other viewpoints to be posted as balance. You should know better. Bobby70 11:07, 26 March 2007 (UTC)

Bobby, the Kenyan and Ugandan studies were already mentioned in the text, though the coverage was outdated. My edit simply gave updated information on the same trials. Your "reversion" cannot be justified on grounds of NPOV. (edited slightly)
Your earlier edit was problematic from an NPOV viewpoint, because instead of discussing studies at the appropriate points you bunched only those with one particular conclusion together in order to support the OR claim regarding recent studies. Jakew 12:26, 26 March 2007 (UTC)
Gentlemen: The present section on AIDS, as well as being outdated, is a dog's breakfast of studies that have been superseded by the Cochrane review, and, of course, the randomised trials that have recently been completed. I think we would be better to begin with the studies that led up to the Cochrane review, the Cochrane review's findings and then the randomised controlled files that followed, together with the comments, both positive and negative. I think we also need to touch on other means of spreading HIV such as medical procedures done without proper sterilisation. Take, for instance, Dr. John Ssemakula's testimony to the US Senate [33]. We also need to consider other means of HIV control, if only to put circumcision in its proper context. Michael Glass 10:53, 27 March 2007 (UTC)
I agree with you in part, Michael, though some of your suggestions are beyond the scope of the article. I'd certainly agree that it's a mess, and currently getting worse.
I would propose something like:
  1. Brief paragraph giving overview of section.
  2. Notable early work (eg AJ Fink's letter, Simonsen's study, etc)
  3. Reviews and meta-analyses preceding the RCTs: notably Van Howe 1999, Weiss 2000, Cochrane 2003, and Cochrane 2005. There is no need to discuss individual studies covered by these reviews.
  4. It's probably unnecessary to discuss observational studies of m->f transmission post-dating these reviews. However, it may be of interest to discuss observational studies of HIV transmission through ritual circumcision and studies of the effect on m->f transmission.
  5. RCTs & some comments about them.
  6. Current recommendations.
Jakew 12:41, 30 March 2007 (UTC)
Jake, I can see that there is a lot of overlap between our views of what should be done with this section. The only substantial difference that I can see is the one about other methods of HIV transmission. I believe that it is essential to touch on means of transmission of HIV, if only to put circumcision in its proper context. One absolutely essential piece of information to consider, for instance, is the Brewer study, which found that circumcision could actually spread HIV infection, no doubt because proper hygienic procedures were not followed. A policy of universal circumcision in Southern Africa would have no impact on HIV spread by poorly cleaned medical equipment or by surgical procedures that failed to adhere to infection control. Indeed, if HIV is spread by unhygienic circumcision procedures, any protective effect of circumcision may be partly or completely destroyed. In this regard, the Brewer study is a timely warning. I urge you to intervene and stop this valuable study from being used in an edit war between Jayig, Avraham and Bobby70. Michael Glass 04:28, 31 March 2007 (UTC)
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