Talk:Circumcision/Archive 24

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This is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.

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Contents 1 Reasons for and against metzitzah 2 shorter article 3 AIDS virus? 4 Question about Reliable Sources 5 Change to sentence referencing PLoS Medicine article in HIV section 6 Circumcision rates in Britain 7 Circumcision rates in Australia 8 Important piece of evidence 9 Blah Blah do not practice circumcision 10 Muslims and Jews 11 HIV qualifiers again 12 Let's have accurate descriptions of edits, please 13 Non-therpeutic 14 Medical analysis of circumcision 15 Association for Genital Integrity 16 Policies of associations 17 Penile Cancer 18 Uncut 19 Illustrations 20 Annals of Epidemiology Article 21 AIDS section 22 Paragraph spacing 23 Phantom reference

Reasons for and against metzitzah

I have removed the comment that metzitzah b'peh is done 'to promote healing.' This comment is tendentious and controversial for the following reasons:

• We have no way of knowing the motivation of every mohel in sucking the blood from the circumcision wound. It might be in the belief that it promotes healing, or that the Talmud commands it, or that custom obligates it or for a thousand other reasons.
• To say 'to promote healing' implies that sucking the circumcision wound has this effect. This is hotly contested by many doctors who assert that it can spread disease.

Therefore this wording is POV and tendentious. I have tried to get over this problem by inviting interested readers to follow a variety of links to a variety of opinions. One is to the website of the Rabbinical Council of America. Another one is to an article in The Jewish Week. The third one is to a press release from a group opposed to circumcision. They complement the first link, which is pro-metzitzah. Here are the four links:

[1] [2][3] [4] Michael Glass 23:30, 15 February 2007 (UTC)

The reason for metzitza is the Talmud in Shabbos, and the reasons there are to promote healing. Whether you or I think it is effective is WP:OR, and that it may spread herpes is already mentioned by the Gesundheit article. Putting in a link farm is completely out of scope, at BEST it belongs in Brit Milah. Please stop trying to push negative implications for metzitzah because you do not like it. -- Avi 01:42, 16 February 2007 (UTC)

Avi, please don't suppress other references. Not once have you even attempted to justify this form of censorship. If you believe that metzitzah b'peh is done to promote healing, so be it. However, we are writing a Wikipedia article, not the Talmud. The form of words that you have chosen can be taken to imply that this is indeed so. This is quite unacceptable because competent medical authorities are strongly of the opinion that metzitzah b'peh can spread life-threatening disease! Faced with this impasse, we need to work out the kind of wording that accommodates both points of view in a non-partisan way, and links with a variety of of views on the subject. Michael Glass 12:03, 16 February 2007 (UTC)

I removed three of the four references because it's tendentious to spam a single sentence with four links (and "prweb" is not really a useful source for anything, frankly). I agree with Michael that saying something like "Some believe that blah promotes healing" is a better wording than "To promote healing." Nandesuka 13:04, 16 February 2007 (UTC)

I disagree. By doing so you are confusing two issues. There is no doubt that it serves to promote the healing of the wound. The issue is does it ALSO open up the possibility of spreading certain diseases. These are two seperate issues, the same way breathing supports life, but is the ONLY way that the flu, rhinovirus, and tuberculosis is spread. We already make clear through the Gesundheit article that metztzah has the danger of spreading Herpes. This is no way shape or form chnages the medical fact that the act of metztzah helps promote the healing of the incision created by the bris. To say otherwise, inmy opinion, is disingenuous and indicative of either a misunderstanding of the process, of the English language, or a desire to cast metztzah in a poor light for outside POV reasons. -- Avi 13:20, 16 February 2007 (UTC)

Can I suggest changing the text to: "sucks blood from the circumcision wound, with the intent being to promote healing?" I think this would avoid the possibility of any such confusion. Jakew 14:24, 16 February 2007 (UTC)

But would Michael be so quick to demand that we place the following phrase in a surgery article. "The intent of performing an appendectomy is to promote the well being of a person suffering from appendicitis" or "The intent of radiation therapy is to promote healing of cancer" Even though nternal surgery carries phenomenal risk of infection and radiation therapy has significant deleterious side affects that sometimes prove terminal? -- Avi 15:37, 16 February 2007 (UTC)

I don't know. Michael was talking about 'belief,' which seems a weak term given Mordechai Halperin's statements. On the other hand, I'd feel uncomfortable with stating the benefit as absolute fact without citing scientific studies in support. It seems simplest, and perhaps a quick resolution, to simply specify the intent. It was, of course, just an idea. Jakew 15:49, 16 February 2007 (UTC)

"There is no doubt that it serves to promote the healing of the wound." I doubt it, or at least I can't imagine why other post circ antiseptic treatments might help much more. Intent fits, however crude. Remember, I'm withholding ritual infection rate information. Whatever's being done isn't enough!TipPt 01:46, 17 February 2007 (UTC)

I have read the above discussion and have revised the article to bring back the links. I hope that they will be respected. It is quite unsatisfactory to remove links and so leave just one or two points of view in this admittedly controversial area. I have also added that though some believe that metzitzah prromotes healing, other have implicated metzitzah b'peh in the spreading of herpes to babies. I have not written or implied anything about the rightness or wrongness of the two positions so I hope that will be staiscfactory to most, if not all. Michael Glass 05:01, 17 February 2007 (UTC)

I note that Jake has removed three of the four links that I supplied. I accept that a link to Wikipedia is not appropriate, because Wikipedia is constantly changing. However, it is unfortunate to remove the other links as well. It isn't just a case of the Jewish view versus the medical view. Metzitzah b'peh is a matter of lively debate in the Jewish community and sometimes in the community generally. This is something that can be gleaned from the other links. I will let it rest for the moment, but I will try again to restore the other links so that interested readers can find out more about the different positions if they want to. Michael Glass 12:53, 17 February 2007 (UTC)

Another attempt of mine to document how and why metzitzah b'peh is controversial has been frustrated and overturned. This time Avi's flimsy excuse is that the paragraph is overloaded - by two footnotes! I did not object when Avi added links to supporters of metzitzah b'peh, as long as this practice is listed as a belief. However, when I try to document the controversy that surrrounds this practice, it gets reverted! This from an editor who will turn round and blast anyone who dares disagree with him and his approach as being biased or worse. I think it is about time that Avi has a good look at himself and his behaviour. I, for one, find it intolerable. All I am asking for is that a statement in the article be verified by appropriate footnotes. That is totally in line with Wikipedia policy. I am willing to discuss what articles will document this best but I won't stand I won't stand the nonsense that footnoting articles overloads them. I am putting those footnotes back. I also am putting Avi on notice that either he respects those footnotes or he comes up with a mighty good reason why they need to be changed. If he cannot abide by these minimum standards, I will take this further.Michael Glass 01:15, 19 February 2007 (UTC)

With all due respect, there is a HUGE difference between commenting on the intent of an established, and well documented, lifesaving medical procedure … as opposed to commenting on the motivating intent of what is NOTHING more than a dubious religious ritual, the true origins of which are lost in pre-history. Just one word: Commonsense! .. and don’t try telling me that “dubious” is simply a point of view, or original research. The raction to Michael's edits just goes to show that some, here, are blinded by a wholly irrational, and quite obsessive, need to promote what they themselves believe in. Orpingtonian 08:34, 22 February 2007 (UTC)

...cornified...wtf?

shorter article

People say this article should be shorter. I agree. The HIV and HPV (which is like 40 paragraphs) should be removed. This is taking up ALL THE SPACE. Someone w/not an entire penis typed all that in probably in the spirit of Pro-Circ bias. We will gather together and edit out all this non-essential studies. Lets just say if we chop off our hands we wont get arthritis in the hands and be done with it. I have to wonder about so called self-proclaimed "nerds" who don't know what bias is.—Preceding unsigned comment added by 24.167.107.118 (talk • contribs)

AIDS virus?

The second paragraph of the quite appallingly biased section 5.2 (HIV) states:

“Research by the World Health Organization published in the US Public Library of Science Medicine journal in July, 2006, showed that men who had been circumcised had a significantly lower risk of infection with the AIDS virus, and calculated that if all men were circumcised over the next 10 years, some two million new infections could be avoided”

Overall bias aside, the authour somewhat betrays ignorance of the subject by referring to the “AIDS virus” … when there is no such thing in existance. AIDS is merely a syndrome (thought to be) caused by the Human immunodeficiency virus (HIV).

The paragraph should read:

“Research by the World Health Organization published in the US Public Library of Science Medicine journal in July, 2006, showed that men who had been circumcised had a significantly lower risk of infection with the Human immunodeficiency virus (HIV) ......”

For the sake of retaining credibility, the paragraph should perhaps also be edited to reflect the fact that the 'calculation' referred to (which used data from using data from UNAIDS, not the study itself) actually stated “three million HIV infections could be averted in Africa by 2026” (which was 20 years into the future, not 10).

It would perhaps also be prudent to balance the information in this section with the facts that these studies looked solely at MEDICAL circumcisions - not ritual circumcsions – and that WHO explicitly stated:

“Countries or health care institutions which decide to offer male circumcision more widely as an additional way to protect against HIV infection must ensure that it is performed safely by well-trained practitioners in sanitary settings under conditions of informed consent, confidentiality, risk reduction counselling and safety.”

It also fails to make any mention of the fact that Bertran Auvert himself, the director of the South African study, noted that 31% of those circumcised in the trial complained of pain and that 15% had subsequent problems with their penis .. and that these problems could well have lead to a reduction of sexual activity, that could - rather than the circucision - therefore quite possibly explain the reduced transmisiion of HIV.

Orpingtonian 13:03, 17 February 2007 (UTC)

I see a couple of other issues with the way this study is referenced:

First, it was not conducted by the WHO but by an interdisciplinary team of nine researchers from several institutions, two of whom are affilliated with the Stop TB Department of the WHO and one of whom is affilliated with Family and Community Health department of the WHO. The other six are not affilliated with the and the WHO is not named among the funding institutions nor did it release the articles findings as a report.

Second, the portion that reads "Research conducted by...and published in...showed that men who had been circumcised had a significantly lower risk of infection with the AIDS virus" is misleading at best and incorrect at worse. The only research conducted by this team was a statistical modelling of data from another separate study which had shown that men cirumcised had a significantly lower risk of infection (with the virus of course, not the syndrome which results). The fact that one of the authors of this study is also an author of the other study does not mean that we can say that the research done in one study was also done in the other. This is standard academic protocol for discussing multiple researches by a given individual.

How about something like "Research published in the Public Library of Science Medicine journal in July, 2006, calculated that if all men in sub-Saharan Africa were circumcised over the next 10 years, two million new infections could potentially be avoided." ? In accordance with the controversial nature of this article, I will await discussion before making any changes.Zandrous 13:41, 18 February 2007 (UTC)

Could we make that “Controversial research published in the Public Library ............."?. I don't think that there is any real dispute about the fact that it is controversial .. and that is, and will continue to be, the subject of much heated scientific debate, is there? Surely it is reasonable to highlight the fact that it is controversial. Orpingtonian 15:15, 18 February 2007 (UTC)

Only if you have a source that claims it is controversial. If you or I think it is controversial, that is original research and editor commentary. The issues raised above may be well and true, but the fact that they were raised by an editor, and not a wiki-acceptable source, makes them original research and unacceptable for addition to the article without an outseide source. —The preceding unsigned comment was added by Avraham (talk • contribs) 15:46, 18 February 2007 (UTC).

I am sorry, Avraham, no offence intended; but that comment is nothing short of preposterous and only goes to hint at your own lack of objectivity and determination to forward your own beliefs and POINTS OF VIEW (and demanding much lesser standards of edits that support your own view). You certainly don’t have to search very hard to find the controversy about the conclusions, the questioning of the (almost total lack of) proper scientific methodology, the quality of the very obvious assumptions made and the idea of widespread unnecessary and pointless genital mutilation of infants.

The authors of the study themselves - who include epidemiologists from the World Health Organization, UNAIDS, the University of California, South Africa and France - ALL warn that MUCH better data will be needed before the report(s) and figures can be used to make ANY public health policy decisions .. in particular, they say, better information is needed on HIV prevalence (UNAIDS prevalence estimates have a margin of error of up to 30%) and information on the prevalence of circumcision, the age at circumcision and the safety of current circumcision practices. Try reading: [Williams BG et al. The potential impact of male circumcision on HIV in sub-Saharan Africa. PloS Medicine 3 (7): e262, 2006] & [Auvert B et al. Impact of male circumcision on the female-to-male transmission of HIV. IAS Conference on HIV Pathogenesis and treatment, Rio de Janeiro, abstract TuOa0402, 2005] .. and it is controversial as hell according to:

1: the CDC, who say “As CDC proceeds with the development of public health recommendations for the U.S., individual men may wish to consider circumcision as an additional HIV prevention measure, but must recognize that circumcision 1) does carry risks and costs that must be considered in addition to potential benefits; 2) has only proven effective in reducing the risk of infection through insertive vaginal sex; and 3) confers only partial protection and should be considered only in conjunction with other proven prevention measures (abstinence, mutual monogamy, reducing number of sex partners, and correct and consistent condom use).” (http://www.cdc.gov/hiv/resources/factsheets/circumcision.htm)

2: Marilyn Milos, a nurse who is executive director of NOCIRC in San Anselmo, said that while the trial results were interesting, "anybody who believes that circumcision will protect them from HIV is obviously making a deadly mistake. (http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2006/12/14/MNGDIMVHF81.DTL&type=health)

3: another PLS article (http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030074), which cites [(2005) Male circumcision as a preventive method? Study was controversial from day one. AIDS Alert 20:101–102] and [Alanis MC, Lucidi RS (2004) Neonatal circumcision: A review of the world's oldest and most controversial operation. Obstet Gynecol Surv 59:379–395.] Orpingtonian 17:00, 18 February 2007 (UTC)

As I said, if you have reliable/verifiable sources speaking about that very study, which you seem to, then it is perfectly acceptable to add that to the discussion. The fact that YOU or I may not like a given study, or WE think that there are problems with it, may be well and true, but unacceptable to wikipedia until WE are published in a third-party source. The fact that Jake IS published in a third-party source makes that letter an acceptable reference. The fact that Jake may think circumcision is the best possible method to preventing who-knows-what is NOT acceptable license for him to add it to the article. Do you understand the difference? -- Avi 17:22, 18 February 2007 (UTC)

The fact that you (Orpingtonian) are engaging in original research is somewhat obvious. The study concerned (our ref 92), as noted in the article, was published in July 2006. In support of your claim that it is controversial, you offer:

1. the CDC, who do not cite our ref 92 at all.
2. Milos, in an article about the two NIH studies (and that did not mention our ref 92).
3. A January 2006 article, citing a 2005 and a 2004 article. All of these articles clearly predate the study and thus cannot possible dispute the findings. Jakew 17:44, 18 February 2007 (UTC)

Try again. 92 *IS* mainly based on the work done in the study commented on by the CDC and Milos (it even shares authors). The PLS article is specifically about (and thanks the authors of) the study on which 92 is based and extrapolated from. 92 REPEATEDLY refers to the work and 92 DOES include ALL the qualifications listed above. Orpingtonian 17:57, 18 February 2007 (UTC)

If 92 is controversial, then please cite a published work saying so explicitly. Otherwise any original argument that it is controversial, based upon work cited or whatever, is by definition OR. Jakew 18:53, 18 February 2007 (UTC)

Look, the very fact that the comment refers to the "AIDS virus" shows the staggering lack of comprehension going in here. There is NOTHING even remotely original in 92 and it is just a rehash of the work that I have already shown is controversial and to which the authors themselves (along with the WHO UNAIDS) have attached so many riders as to render it totally meningless. Trying to promote it as anything else is a pretty desperate fraud. Go ahead and keep it if you are really so desperate to promote the totally barbaric mutilation of tens of millions of infant males, without even so much at hinting at the widely published cautions that go with that. Orpingtonian 19:31, 18 February 2007 (UTC)

Okay, adding the word 'controversial' apppears to be too controversial...how about the rewrite I proposed above, namely "Research published in the Public Library of Science Medicine journal in July, 2006, calculated that if all men in sub-Saharan Africa were circumcised over the next 10 years, two million new infections could potentially be avoided." Does anyone see any issues with that? I think it addresses the substantive issues that Orpingtonian raised with the sentence as it's now written. Zandrous 12:35, 19 February 2007 (UTC)

Seems basically ok to me, though I think the journal calls itself PLoS Medicine. Jakew 12:39, 19 February 2007 (UTC)

Sounds good to me too. -- Avi 23:27, 19 February 2007 (UTC)

It still doesn't really cover it, but it will do for now. I’m just knocking up a letter to the BMJ to comment of the controversial nature of this preposterous ‘study’ .. I am told they will publish ;) Orpingtonian 23:57, 19 February 2007 (UTC)

If you get published in a reliable source, good for you . And add it to the article, properly cited, of course ;) -- Avi 07:56, 20 February 2007 (UTC)

Great, I'll make the change. And then I'll get back to preparing a chapter for a scholarly volume (my second) and a presentation for a peer-reviewed research conference (my seventh) but I won't go self-citing them here, nor would I ever consider compromising my professional integrity by submitting academic work with the intention of generating a reliable source for a wikipedia article because I actually believe that wikipedia is not should not be a soapbox. If active editors find my work in the natural course of sourcing articles, all the better for all of us. Forgive my sharp comments, long observation of this page has led me to become somewhat cynical about the process.Zandrous 10:44, 20 February 2007 (UTC)

Question about Reliable Sources

Is a letter to the editor (which is not subject to peer review) of a journal (which is peer reviewed) a reliable source? I am thinking particularly about reference 101 which cites a letter by someone with no formal training or credentials in the discipline of the journal (as far as I know) criticizing a published study on technical grounds. Given that the published study passed peer review and the letter criticizing it did not, is it fair to say in our article that the study has been criticized on techincal grounds? Shouldn't we find a peer-reviewed source that does so, and if one is lacking, notate that it has been criticized by a non-expert or a researcher from an unrelated discipline? I must say I feel a bit awkward bringing this up since the letter happens to be from a wikipedian who is very active on this page. But I also feel that it's very important to keep up the standards for sources on this page.Zandrous 14:00, 18 February 2007 (UTC)

The letter is published in a reliable source (unlike some of these websites like "National Organization of Restoring Men". The link followed goes to the letters section, which allows the reader to make their own decision. Anyway, most peer-reviewed journals do not publish crackpot letters; regardless, the source is an acceptable one, so the reference should be as well. -- Avi 15:49, 18 February 2007 (UTC)

"The letter is published in a reliable source (unlike some of these websites like "National Organization of Restoring Men")". Point of view .. and a pretty dubious one at that. Orpingtonian 16:47, 18 February 2007 (UTC)

Last I checked, peer-reviewd journals are acceptable sources. You differ? -- Avi 17:18, 18 February 2007 (UTC)

Was the letter peer-reviewed BEFORE publication? If not, then I think it is a back door entry and simply exploits a flaw in Wiki policy .. but that is just a (my) point of view ;) Orpingtonian 17:42, 18 February 2007 (UTC)

I understand that peer-reviewed articles are reliable sources, but this letter is not peer-reviewed, even though it appeared in a scholarly journal. Not everything that appears in a scholarly journal is peer-reviewed, ie letters and book reviews typically are not. My main concern is that the letter (which was not peer-reviewed) is being cited here as a critique of Fleiss et al (that was peer-reviewed). Is this is the only critique of Fleiss et al anywhere in print? Can't we find a more reliable source than someone who has no qualification in anything related to medicine, physiology, or biology? If not, shouldn't we at least qualify the sentence to make clear that Fleiss et al has been criticized by an avocational researcher with no formal training or credentials in medicine, biology, physiology, or any related fields? Lots of unqualified people write lots of letters about lots of things, but having a letter printed doesn't automatically make it a suitable source for an encyclopedia. Zandrous 12:28, 19 February 2007 (UTC)

Looking at this, it appears to me that

1. You can't include a qualifier like "non-expert" without a reliable source for it.
2. The editor of the specialist journal concerned - Sex Trans Infect - thought it worthy of publication.
3. The claim isn't particularly extraordinary.

-- Jayjg ^(talk) 16:01, 20 February 2007 (UTC)

Change to sentence referencing PLoS Medicine article in HIV section

I made this edit (after discussing it above) for the following reasons:

First, it was not conducted by the WHO but by an interdisciplinary team of nine researchers from several institutions, two of whom are affilliated with the Stop TB Department of the WHO and one of whom is affilliated with Family and Community Health department of the WHO. The other six are not affilliated with the WHO and the WHO is not named among the funding institutions nor did it release the article's findings as a report.

Second, the portion that reads "Research conducted by...and published in...showed that men who had been circumcised had a significantly lower risk of infection with the AIDS virus" is misleading at best and incorrect at worse. The only research conducted by the team that authored this article was a statistical modelling of data from a different, separate study which had shown that men cirumcised had a significantly lower risk of infection (with the HIV virus of course, not the Acquired Immune Defiency Syndrome which may result from infection). The fact that one of the authors of this study is also an author of the other study does not mean that we can say that the research done in one study was also done in the other. This is standard academic protocol for discussing multiple researches by a given individual, even when published in the same journal on separate occasions.

I hope that clears it up. Please feel free to discuss! Does anyone prefer the earlier formulation, and if so why? Zandrous 17:39, 20 February 2007 (UTC)

Circumcision rates in Britain

I have changed the reporting on Rickwood to put the information on circumcision rates in chronological order (as in Rickwood's paper). I have also included more information about why Rickwood thought that too many children were being circumcised (a misdiagnosis of phimosis) as this particularly applied to children under 5. Michael Glass 22:29, 20 February 2007 (UTC). I then reordered the section to put the general survey of sexual attitudes before the survey of children. Michael Glass 22:53, 20 February 2007 (UTC)

Circumcision rates in Australia

Jake certainly did improve the article by quoting figures from the Sydney Morning Herald. There are, in fact, two reprints of the article, one on CIRP [5] and one on Circumcision Info [6]. The quality of the article can be judged by the fact that both CIRP (anti circumcision) and Circ Info (pro circumcision) saw fit to quote it.

Jake's footnote linked the article to Circ Info but attributed the link to CIRP. Now the wording is essentially the same on both websites, but the layout and presentation of the article on CIRP is far superior, with properly justified paragraphs and links to the Royal Australasian College of Physicians etc. By contrast, the layout on Circumcision Info is confusing because the paragraphs are centred instead of justified.

Because the layout on the CIRP site in this instance is far superior to the alternative, and because the footnote had attributed the reprint to CIRP I changed the link in line with the footnote. I realise that pro circumcision editors do their best to avoid quoting from CIRP but in this instance the superior layout of the CIRP reprint tips the balance in its favour. Michael Glass 12:07, 21 February 2007 (UTC)

Oops. Well spotted.

I partly agree and partly disagree with you, Michael. I'd prefer the version without the links (because it is truer to the original text), but the layout of the CIRP version is more readable.

I don't know about "pro circumcision editors," but I don't have a big problem with linking to reprints at CIRP (or elsewhere), provided of course that the original is otherwise unavailable and that the reprint is faithful to the original. However, CIRP's original (non-reprint) content does not conform to WP:RS - it is no more reliable than any random web page - and must not be cited. The same would be true of circumcisioninfo or any other privately-maintained site, regardless of their position. Jakew 12:50, 21 February 2007 (UTC)

Just one point of clarification, Jake. You say you prefer the version without the links because it is truer to the text. Are you saying that the transcription is more accurate or are you saying that providing links is a problem? Michael Glass 13:37, 21 February 2007 (UTC)

I'm saying that providing links is a problem if they were not present in the original. Jakew 15:12, 21 February 2007 (UTC)

Cirp has this policy of using yellow highlighting for text that demonstrates detriments of circumcision and policy statements that are against circumcision tendencies, but does not highlight or make any other corresponding text emphasis for statements that oppose their bias. That is what makes me uncomfortable quoting from cirp, unless we absolutely HAVE to. I know of no other site that bias the data the way CIRP does. -- Avi 15:14, 21 February 2007 (UTC)

There is no yellow highlighting in the text quoted, so the above comment is not relevant to this particular discussion. As for other sites, I believe that CIRCS occasionally uses hotlinks. Take the list of references in this article [7]. Understandably, the links are to pro-circumcision articles. While I understand the concern, the main thing is that the wording is accurate. In any case, we do have a disclaimer in the article Michael Glass 07:06, 22 February 2007 (UTC)

In this particular example, perhaps, but as a general statement, CIRP lets their bias show obviously and explicitly, and that makes it less of an impartial and a source that one must use more carefully, in my opinion. -- Avi 15:17, 22 February 2007 (UTC)

Important piece of evidence

Three independent and randomized studies show that circumcision cut if half the chances of acquiring HIV. I have included this information in the intro section since I think this is worth mentioning there and since there is irrefutable data proving it. Two of the studies were recently published on The Lancet (one of the most repected medical journals) and are defenetely a reliable source of information. Parents (and other readers) should be aware of this and deserve to have the information easily accessible. I included references to an editorial at The Lancet and two of the studies. The other two references after the sentence might have to be removed. The way the sentence was written before, saying that people that defend circumcision "argue" that there are medical benefits makes it sound as if there are none. This is not in agreement with the literature. Waisberg 15:32, 23 February 2007 (UTC)waisberg

Why do you say "parents" need to know this? Surely you aren't suggesting infant circumcision to reduce AIDs in children? Isn't this about adult, or at least, sexually-active adolescent males? And shouldn't the point be emphasized that even for adult males, the information ONLY applies to UNprotected sex? And that circumcision doesn't protect ALL, but only half of all such cases? Tmangray 23:14, 23 February 2007 (UTC)

Dr Peter Piot, executive director of UNAIDS, proposed that the "focus should be on infants first, then adolescents, and adult men." Presumably, he reasons that infants will one day become adults.

As for your other questions, there is little evidence that the protection is restricted to unprotected (ie condom-free) sex, and we cannot impose qualifiers that are not present in the sources. The WHO state that circumcision "should always be considered as part of a comprehensive prevention package, which includes correct and consistent use of male or female condoms, reduction in the number of sexual partners, delaying the onset of sexual relations, and HIV testing and counselling." Jakew 08:55, 24 February 2007 (UTC)

The correct quote, Jakew, is this: "Male circumcision should never replace other known effective prevention methods and should always be considered as part of a comprehensive prevention package, which includes correct and consistent use of male or female condoms, reduction in the number of sexual partners, delaying the onset of sexual relations, and HIV testing and counselling." Skipping the first part of the sentence clearly distorts its whole meaning. veffari March 9, 2004 Veffari 03:33, 10 March 2007 (UTC)

With respect, Veffari, both quotes are correct. The part I omitted is implied by the part I included. Think about it. Jakew 10:11, 10 March 2007 (UTC)

Dear Tmangray, in response to your question about why parents need to know about the effect of circumcision on HIV susceptibility, the answer is quite clear to me. Ultimately, circumcision is a parental decision, which will afects the life of their son. The reason why people choose to circumcise their kids vary from purely religious to purely medical. According to the AAP doctors should give as much information as possible to parents to allow them to make an informed decision and, as pointed by another editor, kids eventualyy become adults... Waisberg 15:26, 24 February 2007 (UTC)waisberg

I'm not sure this belongs in the intro, as the article deals with circumcision generally, and the studies really only address circumcision in sub-Saharan Africa. Apart from that I have a few suggestions: I suggest changing the word "randomized" to "clinical" because although volunteers were randomly assigned to the intervention or control groups in these experiments, participants were not drawn randomly from the general population, meaning that these studies did not utilize random samples (they used purposive samples). This might seem like a nominal point but it is a very important distinction in terms of research design. I would also suggest adding the words "adult" and "sub-Saharan Africa" to indicate that the studies only involved men circumcised as adults in sub-Saharan Africa; two of the three reports specifically say that results may not be generalizable beyond the study groups. And I would suggest replacing "halved" with "reduced" or "significantly reduced" since this more closely reflects the language of the sources.Zandrous 16:33, 23 February 2007 (UTC)

The sentence used is a verbatim copy of a sentence in the cited editorial of The Lancet. Although I am not an epidemiologist I trust their use of the epidemiological terms is correct. In relation to your comment that the aforementioned citation does not belongs to the intro, I would like to disagree. The introduction has to briefly touch on the definition of the term circumcision, its history and its medical implications (since circumcision is a medical intervention). Right now, the intro tends to be biased against circumcision since it only cites sources which are positioned either against it or have a neutral point of view. The only sentece in favour of it was the one saying that people in favour of it were so because they argued about the possibility of medical benefits. The medical benefits, even though the studies were performed in sub-saharan Africa are still true. Most drugs released on the market nowadays are first tested in Africa anyway and many drugs in the past were only tested in US and Europe but were still considered safe for worldwide use. 201.78.168.187 17:56, 23 February 2007 (UTC)waisberg

Rather than relying on an editorial, wouldn't we be more encyclopedic to rely on the study results themselves? These were the sources to which I referred in my above comment. As to the term 'randomized' there are different degrees of randomization, with different implications for the results of an experiment. I think that it is important to avoid ambiguity wherever possible, hence my desire to avoid the ambiguity of the unqualified term 'randomized' in the introduction where it is unclear to the reader whether the sample was randomly drawn or participants randomly assigned without more explanation than is appropriate in the introduction. Balance in the intro is desirable of course, but the Lancet sources say that the medical benefits of circumcision as an HIV intervention have so far only been demonstrated among adults in sub-Saharan Africa. If this page has taught me anything about wikipedia it is to be very careful about limiting ourselves to what is actually said in a source and avoiding any original extrapolation or synthesis beyond that. Do other editors have opinions on these points?Zandrous 13:58, 24 February 2007 (UTC)

Dear Zandrous, in spite of the small differences in randomized designs, the cited studies are considered by most cientists and medical doctors as being randomized. This is possibly the reason why the scientist writing the Lancet's editorial chose to use this term. Furthermore, the intro section doesn't need to discuss in detail academic terms. The citation is as precise as possible and therefore I have limited myself to what was actually said (is it possible to be more limited than to cite the original source without modifications?). No extrapolation beyond the cited source (Lancet's editorial) was made. Anyway, why on earth would you not be interested in making the information about HIV and circumcision as widely known as possible? Don't you trust the three published studies or their results? In my opinion, there is no other medical intervention (including vaccines) so far that could have a more profound impact on HIV transmission in the world (specially in Africa) than circumcision alone. Waisberg 15:30, 24 February 2007 (UTC)waisberg

That's your opinion though. Unfortunately the study doesn't cover drug use or the other methods of contracting AIDS (or even the primary method of contracting AIDS), merely recording the incidence in a specific sample (are we to presume these are all heterosexual men practising an exact amount of sex with the same number of partners without protection?). Whilst 'random' for all intents and purposes it's also scarily pseudo science statistics. Having read the full study with the Kenyan one being 22 circumcised persons with AIDs, the Uncircumcised 45 or somesuch (out of a sample of 1390'ish for each) in a country with an AID's incidence of 25% of all males between the ages of 19-28 the fact only 3% and 1.5% contracted the disease during a 2 year period is somewhat of an anomoly in itself surely? I think the fact the Lancet published the article is all well and fine, but until the figures are fully interpreted and indeed the fact of the study made explicit it's difficult to say with any authority what the true effects of circumcision is. Without having 1000 men of both circumcised and uncircumcised having identical bouts of sex with an Aids infected female this is likely not achievable. I have no objection to its use as a cited reference regarding its potential impact on AIDS contraction when having unprotected sex, I'd be wary of its use as a 100% spot on appraisal for people in all situations of life and/or using it as an argument for circumcision of all males. In the end having protected sex with single partners is 100% better than medical intervention of any variety.--Koncorde 16:45, 24 February 2007 (UTC)

(unindenting) Perhaps you'd prefer Kevin De Cock's (Director of the WHO HIV/AIDS Department) opinion: "These findings are a very important contribution to HIV prevention science. Male circumcision has major potential for the prevention of HIV infection."[8]

Also, you need to check your facts. The adult HIV prevalence in Kenya is 6.7%, and in Uganda 4.1%.[9]

Finally, you may find the following explanation of RCT methodology helpful: [10] Jakew 17:10, 24 February 2007 (UTC)

I know what's said, I've read much of the fall-out from this study being published, I just question its application. As for the 25% claim, I have to admit it's based on something I read only the other day via [11] but it refers to a specific age group of 18 to 24, rather than the whole population. Unfortunately it doesn't refer to its source.

And I understand the methodology, I just don't trust it and/or believe it's infallible (or indeed proof positive) without seeing who or what is included in this sample and exactly what they have already ironed out of this sample prior to monitoring.--Koncorde 17:27, 24 February 2007 (UTC)

Waisberg, in response to your points... First, I maintain that it is more encyclopedic to cite the studies themselves (primary source) rather than an editorial about the studies (secondary source). Do you disagree? Second, precisely because academic terms don't need to clutter up the intro I thought that the word "randomized" which (as Jakew's helpful link points out) has a specific meaning in terms of these trials would be better in the section on HIV rather than the introduction which I believe benefits from less specialized terminology rather than more. Third, what you or I am interested in doing insofar as the dissemination of information (ie, your question as to why on earth I would or would not be interested in making the information about HIV and circumcision as widely known as possible and your question about whether I do or do not trust the three published studies or their results and your opinion that there is no other medical intervention (including vaccines) so far that could have a more profound impact on HIV transmission in the world (specially in Africa) than circumcision alone) isn't rightly part of wikipedia as I understand it. Especially our opinions, with all due respect to yours. Whatever any of us might personally think or feel about the issues herein or the veracity of source material that is reliable and verifiable is frankly immaterial to the encyclopedic project represented by wikipedia. My only agenda is a readable, user friendly article that conforms to wikipedia policy and relies on primary sources (like the studies themselves) over secondary and tertiary sources (editorials and statements about the studies) wherever possible.Zandrous 23:23, 24 February 2007 (UTC)

To quote: "Wikipedia articles should rely on reliable, published secondary sources wherever possible."Wikipedia:Reliable sources#Types of source material Jakew 10:54, 25 February 2007 (UTC)

Yes but "Wikipedia relies heavily upon the established literature created by scientists, scholars and researchers around the world. Items that fit this criterion are usually considered reliable" and I don't believe that an editorial "has been thoroughly vetted by the scholarly community" when compared to an article that has passed through peer-review. Do you believe that it's more desirable to cite the editorial that advances an interpretation of the study findings rather than the studies themselves? I do not. I also maintain that it is poor editing at best and Orginal Research at worst to imply that the authors of these studies have suggested that their findings apply anywhere other than the region in which the studies were conducted. If I missed that part, I apologize, please cite the article accordingly to reflect that.Zandrous 11:40, 25 February 2007 (UTC)

To quote Gray et al., "The consistency of epidemiological evidence from three randomised trials and multiple observational studies presents a compelling case for the promotion of male circumcision for HIV prevention in populations where circumcision is infrequently practiced and where HIV transmission is mainly due to heterosexual intercourse." Jakew 13:40, 25 February 2007 (UTC)

Please reference the correct investigation sponsors. The publisher of clinical study results is not the sponsor. For example, the sponsor of the most recent studies in Kenya and Uganda which is being referenced frequently, was The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH) The co-principal investigators of the Kenyan trial were Profs. Robert Bailey (University of Ilinois at Chicago), and Stephen Moses (University of Manitoba, Canada). Funding was provided by the NIAD and the Canadian Institute of Health Research. Sponsors and funding sources are vital information as it indicates possible prejudices in the process. (For example trials sponsored by a drug manufacturer create a conflict of interest.) In the case of these trials, the sponsors and funders are reputable and recognized as public health leaders. However, some might question Dr. Bailey's impartiality due to his previously published work supporting circumcision. (ed. note, All of Bailey's work has passed peer review and is generally accepted by clinicians.) james 27-02-2007

Blah Blah do not practice circumcision

Do we really need to list every major religion that does not practice circumcision? It seems unnecessary.70.21.217.11 21:38, 23 February 2007 (UTC)

thats what happens when you give liberals access to wikipedia

Muslims and Jews

As it stands, the article lists Jews, Christians and Muslims and then follows with other religions and traditions. This could well be seen as ethnocentric, as the clear majority of circumcisions are performed on Muslims (600 million males or more), while Christians are under no religious obligation to circumcise and Jewish males comprise only about 6 or 7 million overall. I suggest the following order should be considered: Muslims, Jews, Christians and other religions and traditions. What do others think? Michael Glass 07:51, 25 February 2007 (UTC)

Hardly ethnocentric; it's a question of listing the Abrahamic religions in the order they historically emerged. Masalai 11:04, 25 February 2007 (UTC)

The numbers rather than the history, become relevant when we are examining the prevalence of circumcision worldwide. On a worldwide basis, Muslims do the most circumcising. Other notable circumcising countries are the United States, the Philippines and Sourh Korea. To put this in persepctive it's important to mention the areas where circumcision is less prevalent, notably China, India, Latin America and Europe. Michael Glass 01:25, 26 February 2007 (UTC)

Not if the Muslim requirement is a result exclusively and only because of the Jewish requirement. -- Avi 01:31, 6 March 2007 (UTC)

HIV qualifiers again

Again I have found that the following qualifiers (in italics) have been added to the HIV section: "significantly reduced risk of HIV transmission (from female to male only) during unprotected heterosexual intercourse."

These qualifiers are not in the sources. For example, the WHO state that "Together the three studies, which enrolled more than 10 000 participants, provide compelling evidence of a 50 to 60% reduction in heterosexual HIV transmission to men."

Furthermore, none of the sources cited establish that circumcision only reduces the female to male transmission risk. To do that, a study would have to test whether the male to female transmission risk is reduced. A study is currently underway to test that, but it has not yet completed. In the meantime, the studies tell us that it reduces the female to male risk. If/when we have data showing that this is the only transmission mechanism that is affected, we can add that information. Jakew 16:51, 25 February 2007 (UTC)

The aforementioned comments must be taken within the context of the WHO's actual published statement of 13-Dec-2006. "Male circumcision reduces the risk of becoming infected with HIV, but does not provide complete protection." James 27-Feb-07

Let's have accurate descriptions of edits, please

When an editor says he's moved material from one article to another, one would expect it to appear in the other article. Unfortunately, this did not happen with some material about metzitzah b'peh in this article. Moving is one thing; removing is another. Please don't say you moved something if all you did is remove' it. Michael Glass 01:18, 26 February 2007 (UTC)

I guess you're probably referring to this edit of mine, Michael. At the time of writing the edit summary, it was indeed my intent. However, when I looked at brit milah I found that the section Brit milah#Recent controversy contained very similar text already. Indeed, the text from "In September 2005" onwards was actually identical. I therefore decided that, for all intents and purposes, someone had already done the work I intended to do.

I apologise for the unintentionally misleading edit summary, however. Jakew 10:05, 26 February 2007 (UTC)

Non-therpeutic

The introduction to the AMA's position states (emphasis added is my own):

This report is confined to circumcisions that are not performed for ritualistic or religious purposes. In this case, the term "non-therapeutic" is synonymous with elective circumcisions that are still commonly performed on newborn males in the United States.

– American Medical Association, http://www.ama-assn.org/ama/pub/category/13585.html

Leaving out that their entire policy (and by extension, all the other organizations that base themselves ON the AMA) only refers to non-therpeutic, purely elective circumcision is a gross misrepresentation of their platform, a true misquote, and something that must be corrected immediately due to WP:V, WP:RS, WP:ATT, and WP:NPOV. -- Avi 16:09, 26 February 2007 (UTC)

Medical analysis of circumcision

At the moment this article contains much material on medicine and circumcision. As there is another article on the medical analysis of circumcision it may be better to leave most medical analysis to that article, especially as this article is very long. Michael Glass 01:42, 27 February 2007 (UTC)

It is a medical issue, so there ought to be some discussion. However, you're right that we should avoid duplication. Ideally, each issue should be summarised here and the detail should go into that article. However, summarising proves to be a problem. Jakew 10:48, 27 February 2007 (UTC)

Association for Genital Integrity

While I agree that it is preferable to use primary sources for information, I think it is over the top to put an unreliable tag on information, just because it comes from the Association for Genital Integrity. In this case, the AGI does quote its sources of information for both sets of figures, so I very much doubt that the AGI plucked the figures out of the air. Please see [12], and [13]. My solution is to attribute the information to the AGI. That is fair enough, and avoids the POV accusation that just because the AGI is anti-circumcision it is automatically untrustworthy. Michael Glass 22:03, 27 February 2007 (UTC)

Michael, courtchallenge.com does not conform to WP:RS, so we cannot use it as a source. It's as simple as that. We can't work around policy by adding a little disclaimer - these should be used when we have a source that conforms to policy but isn't authoritative. I added the 'unreliable' tag there so that people would be aware of this and would find usable sources instead. I don't intend to argue over the tag, so I've just removed the unverifiable text. Jakew 22:20, 27 February 2007 (UTC)

Jake, you know the material is verifiable, because the Association for Genital Integrity quoted its sources. One is an article by Wirth in Pediatrics in 1980 [14]. Another is from Canadian statistics. The fact that something is more difficult to verify doesn't mean it is unverifiable. If it's working around policy to add a little disclaimer, then why didn't you return to the big disclaimer that you put in before? Also, please explain why, in your opinion, courtchallenge.com does not conform to Wikipedia policy. The Association for Genital Integrity was a good enough resource for the Montreal Gazette [15]. The AGI keeps detailed statistics, with attribution for example, this [16]. So how come you are suddenly not prepared to accept their word? Michael Glass 23:39, 27 February 2007 (UTC)

Science and in particular medicine, is characterized by change brought about by new research and developments in its practice. As such, relying upon studies performed in excess of ten years of completion, in a topic that is undergoing constant rapid research developments, is not a generally acceptable practice upon which to base a conclusion. The accepted practice is to first determine if the study structure, valuations and context is indeed relevant to the current issue. Clinical study techniques and related accuracy has significantly changed in the past ten years. That is why many studies are often repeated or updated, particularly as they relate to medical subjects. james 27-02-2007

Michael, in terms of Wikipedia, 'verifiable' means that it cites a reliable, published source.

Courtchallenge.com may cite sources, but so too do many internet web pages, and there is no guarantee that the sources are accurately represented just because they are cited. (For that matter, there's no guarantee that they actually exist.) Wirth's article is fairly easy to obtain, and I am more than happy to cite that in the article, once the content is checked. "Source: Provincial and territorial ministries of health, Statistics Canada" appears impossible to check, however.

It seems reasonable to cite the Montreal Gazette article you found.

As for courtchallenge.com, it has numerous problems. It's a self-published, partisan source with no apparent editorial oversight. Jakew 10:50, 28 February 2007 (UTC)

Thanks for explaining what your policies are, Jake. I'm happy to quote the Montreal Gazette and the Wirth article. However, when you describe others' websites as being self-published, partisan and with no apparent editorial oversight, others might apply that description to your own website. Also, you put Wikipedia in the paradoxical position of being able to quote the Montreal Gazette (which acknowledges The Association for Genital Integrity as its source) but not the Association directly! Michael Glass 03:52, 1 March 2007 (UTC)

That is exactly the procedure that needs to be used when the primary source is not acceptable/reliable. See WP:RS. -- Avi 06:36, 1 March 2007 (UTC)

I don't see much point in discussing 'partisan', Michael, but yes, any original (non-reprint) content on my website would not constitute a reliable source for Wikipedia. Self-published and no editorial oversight. Since no such content is cited, though, I'm puzzled as to why you raise the issue. Jakew 11:26, 1 March 2007 (UTC)

Policies of associations

I re-entered the information in a summary paraphrase in the flow of the article, with extensive citations in the footnotes, as opposed to the text. This leaves the information where it belongs without threatening to overwhelm the article. -- Avi 19:47, 28 February 2007 (UTC)

The Assoc statements belong in a sub. You edited away critical points to be pro-circ. Until the sub is in place, leave the statments as they were.TipPt 15:46, 8 March 2007 (UTC)

Thanks for your thoughts. The consensus was otherwise. Jakew 18:21, 8 March 2007 (UTC)

Penile Cancer

I have reworked the section on penile cancer. From what I have been able to find, neonatal circumcision appears to reduce the risk of penile cancer but it does not eliminate it, and there are other risk factors to be considered, such as infection with the papilloma virus, cigarette smoking and a history of a large number of sexual partners. The American Cancer Society, the American Academy of Pediatrics and the American Medical Association are worth quoting. However, I have my doubts about Kochen and McCurdy, because their calculations are based on the faulty assumption that neonatal circumcision eliminates the risk of penile cancer. As this assumption is unsustainable, their whole calculation falls down. I will leave the study there for the moment. However, if no-one comes up with a good reason to keep it, I'll delete it. Michael Glass 03:32, 1 March 2007 (UTC)

Michael, YOUR making that decision/interpretation about the "calculation falling down" is original research. You need to find someone ELSE who does, and use them. Also, you removed it completely, I am restoring the old edition and you should then add your new information without removing the old one unless there is a reliable counter. -- Avi 06:33, 1 March 2007 (UTC)

Abraham, I am very annoyed at your edit and your description of it. First, I did NOT remove information. I rearranged the information and added more information about cases of penile cancer in circumcised men. What you did was do a revert which removed the extra information that I had added. Then you had the nerve to turn round and accuse me of removing information! Everything about Kochen and McCurdy was in my version, and if you had troubled to READ my version before you reverted it, you would have seen that for yourself. I spent hours of work putting in proper references and now you come along and destroy all that without even reading what I had written! How would you feel if someone treated you and your work like that? I am not asking you to agree with what I have added, but I do exprect that you READ before you revert. Please act like an editor, not a vandal. Thank you! Michael Glass 11:07, 1 March 2007 (UTC)

Abraham, I restored the information that you managed to delete without reading. I hoped that this time you would have the chance to read it. However, Jake removed it on the grounds that it was redundant, because it was implied elsewhere. Now I happen to believe that the direct evidence of this is not redundant, especially when the Kochen and McCurdy study is in the very same section. While that study, which is based on false assumptions' is in the section then the direct evidence that shows that their assumptions are false must remain in the article. To put it crudely, facts must have at least equal time with bullshit.

Now, about the Kochen and McCurdy calculation falling down. Their calculation is based on the assumption that infant circumcision eliminates all risk of penile cancer. It doesn't. There are cases in the medical literature of men contracting penile cancer even though they were circumcised. One study calculated that uncircumcised men were at 3.2 times the risk of getting penile cancer. That means that on those figures, for every 16 cases of penile cancer in uncircumcised men we can expect 5 cases in circumcised men. This evidence is accepted by the medical associations. As it is clear that cases of penile cancer occur in circumcised men, their calculation is based on a false premise. That is why I say that their calculation falls down. As for your accusation that it is original research, I agree. It's as much original research as the boy who called out that the Emperor had no clothes. Michael Glass 12:05, 1 March 2007 (UTC)

For what it's worth, Michael, I personally agree that K&M's data is erroneous, but your argument (and my agreement) is still original research. We do not need to 'prove' that circumcised men can get penile cancer, since that is implicit in the text describing the AMA and AAP position. Nor do we need to give preferential treatment to Maden's findings over the half dozen or so other studies to investigate the issue. Citing reliable, secondary sources (AAP, AMA, etc) is more than sufficient for the summary in this article. Jakew 12:16, 1 March 2007 (UTC)

Jake, thanks for your opinion. We both agree that the data is erroneous, so why not remove it from the article? We may not do 'original research' but we don't have to be automatons and leave something misleading in the article simply because it's there. I believe the K&M study should be removed, but I am not prepared to remove it unless there is some kind of consensus. In the mean time, there should be clear information that enables the astute reader to see that the study is based on false assumptions. The best way to do that is to put the facts first, the medical policies next and K&M last. Now you have argued against specific information, because it's implied in the medical policies. I assert that this is not only wrong but dangerous. If you read the links that i have provided you will find that a proper diagnosis and treatment was delayed because a man and his medical adviser believed that penile cancer couldn't, wouldn't happen in a man who had been circumcised in infancy. His medical advisers, like Kochen and McCurdy, assumed something that was wrong. Please read this article [17]. That's why I'm insisting that the information be listed in the order that I have put it down in. That is why I am recommending that Kochen and McCurdy be removed, because its presence in the article helps to perpetuate a dangerous medical myth. Michael Glass 12:49, 1 March 2007 (UTC)

Unfortunatley, your assertion is worth about as much as mine is here in wikipedia, which means nothing, as unless YOU have been published in an acceptable source, you cannot re-write articles because of your opinion/understanding of a matter--regardless of how strongly you feel. That is NO how wikipedia works. K&M is cited. If you have a reliable source that seems to refute K&M or calls into askance its methods you my quote that. YOUR OWN opinion MAY NOT be used, per WP:NPOV and WP:ATT, and is considered a form of vandalism. Sorry. -- Avi 13:10, 1 March 2007 (UTC)

Indeed. By all means cite criticism of K&M, but don't remove it or present information in a novel narrative intended to 'show' that K&M is incorrect. Wikipedia is required to repeat and summarise only what has already been published in reliable sources. Jakew 14:37, 1 March 2007 (UTC)

Abraham's comments would carry more weight if he took the time and the care to check what he wrote for spelling errors and typos, and also if he took the time to READ what others contributed before reverting or deleting their work. As for preaching to others about inserting their own opinions, he should also try to practise what he preaches! Articles are written and rewritten all the time on Wikipedia. Because I pushed for a rewrite of the penile cancer section Jake stopped doing reverts and started looking at the published research and the result is much better. I note the removal of direct links to articles published on the net, which I think is regrettable. The fact that he spotted things in the research that I missed is to his credit, but it is not to his credit to insinuate that other editors were dishonest. It is also, as he knows, against Wikipedia policy. I'm all for adding reliable information, but not for removing it unless it's obviously faulty. K&M is faulty, but at least it is now in a context where it is not so likely to mislead. Michael Glass 19:57, 1 March 2007 (UTC)

Wonderful! -- Avi 20:15, 1 March 2007 (UTC)

I'm glad that you're happy, Michael.

Unfortunately, the link to CIRP's 'reprint' of Boczko's study contains not only the text but also a misleading - and arguably dishonest - commentary in a prominent location. Unless one has trained oneself to mentally erase and ignore CIRP's additions, it is easy to be manipulated by this. I felt it was necessary to alter the text in order to accurately represent the study itself, rather than what CIRP wanted the study to be. I am sorry that you mistakenly believed that I held you personally responsible for the misrepresentation.

WP:RS#Convenience links states "It is important to ensure that the copy being linked is a true copy of the original, without any comments, amendations, edits or changes." (Random aside: is there such a word as amendations?) Since this was clearly not the case, I did not include a link.

By the way, on the subject of spelling errors, I believe that Avraham spells his name with a 'v.' Jakew 22:31, 1 March 2007 (UTC)

That is the problem with CIRP. They do not hold to NPOV the way we do, and they take liberties with cherry-picking, highlighting text that they like, interspersing commentary with actual text. Perhaps we should ask for comment on WP Talk:ATT as to whether CIRP is even reliable? -- Avi 22:51, 1 March 2007 (UTC)

Firstly, congratulations to Avi for actually making a positive contribution to the text. Now, about the article referred to. It does contain the following comment:

"CIRP Note: This historic article conclusively disproves the false claims made by circumcision promoter Abraham Wolbarst in 1932 that circumcision prevents penile cancer. This article probably accurately reflects the state of medical knowledge at the time. The most important risk factors for penile cancer, which are the presence of human papilloma virus and use of tobacco, had not yet been discovered at the time this article was written. See Carcinoma in Situ of the Penis in a 76-Year-Old Circumcised Man for a more recent report on cancer in circumcised males."

I can appreciate that people might take issue with this comment. However, it is clearly marked as an editorial note. This note is in blue as may be seen here [18] so it is clearly marked as different from the rest of the text. Michael Glass 03:56, 2 March 2007 (UTC)

Michael, please would you take a look at the policy text (I've quoted it above for your convenience) and point out where exceptions are made for a) comments clearly marked as editorial notes, or b) comments in blue text?

Avi, my opinion is that we should assess acceptability on a per-page basis - some of CIRP's pages are a true copy of the original, whereas some are not. However, I'm interested to know the opinions of others, and your suggestion seems good. I'm quite open to removing many convenience links from the article, just leaving links to PubMed or the publishers. Jakew 10:13, 2 March 2007 (UTC)

Jake, I noticed the following at the beginning of that page:

This page is considered a guideline on Wikipedia. It is generally accepted among editors and is considered a standard that all users should follow. However, it is not set in stone and should be treated with common sense and the occasional exception.

I think the common sense rule and the occasional exception rule should provide enough flexibility to enable that policy to be applied sensibly. Let's take an example from your own website:[19] Should we take exception to it because the CIRCS logo appears and because some articles in the References are hotlinked and not others? The same applies to CIRP. Yes, the Laumann article has some text highlighted in yellow and an editorial comment in blue, and once again, some articles in the References are hotlinked and not others. [20] Should we take exception to some or all of that? If we turn to Medline, we only get the abstract, but we also get other links to follow.[21] In this situation I would be inclined to provide links to the lot of them! Michael Glass 13:11, 2 March 2007 (UTC)

Michael, I'd just like to remind you about civility, in your opening of your last comments, you seem to have forgotten. Secondly, if you look at the edit history of this article overthe last year or so, I think my contributions still outnumber yours ;) But that doesn't matter. It is good to see that you have the passion and drive to make wikipedia a better encyclopedia, but you MUST do it in accordance with our policies and guidelines. When you create the Michaelopdiea, you can do what you wish. -- Avi 14:51, 2 March 2007 (UTC)

I'm stunned that anyone could think that "should be treated with common sense and the occasional exception" might mean "should be completely ignored." Jakew 15:30, 2 March 2007 (UTC)

Avi, my last comment on this page began, "Jake, I noticed the following at the beginning of that page:" What is uncivil about that? Michael Glass 12:41, 3 March 2007 (UTC)

Jake, I'm intrugued by your interpretation of "should be treated with common sense and the occasional exception" . In theory it appears to be easy to decide which convenience links are acceptable and which are not. In practice, the policy, like all policies, is open to interpretation. Interpret the policy really strictly and you could argue that virtually no webpage would reach the exacting standard that has been set. Interpret the policy more flexibly and a zealot might well argue that this means "should be completely ignored." I believe that there is a continuum in web pages, from those that almost all would agree are acceptable to those that almost all would agree are unacceptable. In this area, where people have strong points of view, their own ideology would colour their views on what was acceptable and what was not. Hence, the ideologically driven disputes about using CIRP, CIRCS and all the rest. In these disputes, the weapon of choice may be Wiki policy, as ideologues of various persuasions struggle to assert that they are on the Wiki high ground. Michael Glass 12:41, 3 March 2007 (UTC)

Michael, please review WP:AGF. There is little point in holding a discussion about the application of Wikipedia policy if you view it as a weapon in an ideologically-driven dispute. Please understand that all concerned want to produce a quality encyclopaedia article (although we may disagree in terms of what, precisely, is meant by that).

Now it is obvious that you are in favour of a looser interpretation than I am, and from my perspective the problem is that your interpretation seems so 'flexible' that, if followed, the policy might as well not exist. So perhaps you could help me understand where you're coming from by giving a few example pages that you would exclude per the convenience link criteria. Jakew 13:21, 3 March 2007 (UTC)

Jake, asserting that people's points of view are coloured by their beliefs is not an attack on your good faith. It is just an acknowledgement that we all have our points of view and our blind spots. Thus, when applying policies it is only natural that we will be influenced by our points of view. I am sorry that you appear to have taken what I wrote as a reflection on your integrity. That was certainly not my intention. What I said about people being affected by their ideology applies to everyone, me included. However, when people of different persuasions come together to work on something such as penile cancer, our very differences helped to ensure that the section ended up far more thorough and rounded than it otherwise would have been.

So where are there likely to be differences? Obviously in judgments of websites. You, for instance, take a far more tolerant view of Circlist than I do, while you are far less accepting of the Circumstitions website, I can remember one difference between us on the map that can be found here [22]. I linked the webpage; you removed that link and replaced it with a link to the actual map. I think at the time I described it as a nanny edit, because I thought that readers were quite able to decide what they wanted to take from the website and what to ignore. On the other hand, you have no tolerance for CIRP web pages which have any annotations (in blue) or yellow highlighted text. in this matter your standard seems to be far more exacting than, for instance, the British Medical Association:

Circumcision is one of those subjects that crops up repeatedly in online medical discussion forums. For useful online information on the subject visit the circumcision information resource on http://www.cirp.org/CIRP/. [23]

I believe that we are on common ground in preferring to use official websites in preference to using CIRP, CIRCS, Circumcision on line or whatever. However, sometimes useful material on official websites is only available on a pay-by-view basis and often good material is available on websites that are pro or anti-circumcision. In the Laumann study, for instance, there is a copy on your website and one on CIRP plus an abstract on Medline. The three of them have both advantages and disadvantages. CIRP provides links to some articles (plus the annotations that you object to) CIRCS provides links to other articles; Medline gives only an abstract, but it also provides useful links. From my point of view, I see nothing wrong in giving links to all three, but I can understand that you would take exception to the CIRP version because of the annotations. You have objected to useful information from Court Challenge on the grounds that this is an activist group; on the other hand, when a newspaper used Court Challenge material in one of its reports, you had no problem in using it from the newspaper! If we suppress all links and simply refer to journal articles, the average reader has no way of checking on what we write. No matter what we do or which way we turn there will be advantages and disadvantages in all courses of action. When it comes to links to good information, as far as I am concerned, the more links the better!

I think you can see that from my point of view, a link to your webpage is not a problem. However, suppressing links to other points of view is something that I find troubling. When it comes down to it, you appear to believe that there is a right way and a wrong way and it's all rather cut and dried. From my point of view, everyone, you and me included, have our insights and our blind spots, so a range of views is better than just one. It's a radically different way of looking at the world, and at Wikipedia, but it doesn't mean we can't work together productively, and it certainly doesn't mean that I doubt your integrity. Michael Glass 01:09, 4 March 2007 (UTC)

Michael, I note that you have not actually answered my question. I hope and trust that you will rectify this shortly. In the meantime, let me address a couple of points.

Firstly, I'd like to ask you to make a distinction between a personal point of view on the subject matter and a position on the application of Wikipedia policy. The two are distinct, for while you, I, and other editors have a point of view about circumcision, our privilege to edit Wikipedia is for the sole purpose of improving the encyclopaedia in accordance with consensus about how to do that (as expressed by policy).

Secondly, you note that I take a more tolerant view of Circlist than you do. I'm sure this is true, but since it does not meet the criteria of WP:RS, this is surely a moot point in light of the above. I do recall our discussion regarding the circumstitions map. That is a link that in retrospect I feel should not be in the article.

You say that my standard seems to be more exacting than Mark Pallen (whom you confuse with the British Medical Association). I can only say that I should sincerely hope so. As an encyclopaedia, we should have a higher standard for sources than an Internet review column.

Michael, you need to understand that we're not here to collect links. Although it is vitally important that we cite sources, a link is only there for convenience. The purpose they serve is to save the reader the trouble of having to use a search engine or an academic library to locate the source material. That isn't our primary purpose. Our purpose is to summarise the most reliable, published sources on the subject matter. Jakew 10:57, 4 March 2007 (UTC)

Jake, I believe that links are important because of the nature of Wikipedia. They enable readers and editors to follow up on things that have been written and so gain more information for themselves or to revise and improve the Wikipedia articles. In something like Wikipedia, where the article is only as good as the people who contributed to it, the links are vital to enable these two things to happen. It is important not only that Wikipedia is accurate but that it is seen to be accurate, and links to source material help to ensure that both of these objectives can be met. The name convenience link, I am afraid, underplays this function.

Take, for instance, my reference to the British Medical Association. I stand corrected. Mark Pallen was writing on behalf of the British Medical Journal. The link revealed the mistake I had made. However, you in turn, I would suggest, went too far in the other direction. It wasn't just a personal opinion. By being published on the BMJ website in the way that it was, it impliied some form of endorsement from the British Medical Journal of CIRP as a useful source of information at the time when it was written. Because I provided the link, interested readers can check this out for themselves on the spot [24].

I had no hesitation in rejecting sextoys.com as a source of reliable information. I have no hestiation in rejecting Circlist. When a document is published on an official website, this should be preferred over a copy on CIRC or CIRPS. Where an abstract of a paper is published on Medline, that should be used in preference to an abstract published elsewhere. However, if the entire paper is published, this should ordinarily be preferred. I regard Circumcision Online as an activist website. It Court Challenge is judged to be beyond the pale, then Circumcision Online should be too. However, when something of value is reproduced on either site that is not available elsewhere then I would be prepared to look at it. I think that this is consistent with the policy of applying the rule with commonsense. When copies of a document are available on more than one site, I think it might be in order to provide more than one link, if this could advantage (or make it convenient for) the reader or researcher.

I hope that this answers your question. There is, however, one thing that I would find quite unacceptable, and that is labelling anti-circumcision websites as activist while viewing pro-circumcision websites differently. A double standard should not be tolerated. Michael Glass 14:07, 4 March 2007 (UTC)

Michael, you seem to be confusing links with citations. Instead of a link, you could have written: Pallen M. Netlines. BMJ 1998;316:367 (31 January), and I could have found the text for myself. (Indeed, I could have found a better version.) A link is not necessarily needed, but what is vital is a precise description of how to find the material.

I'm not too sure what you mean by 'circumcision online.' Do you mean CIRCUMCISION ONLINE NEWS? Geocities pages are generally regarded as unreliable sources anyway. Jakew 14:45, 4 March 2007 (UTC)

• Yes, I was referring to Circumcision Online News.
• Quite right. Even on a talk page a writer can't be too precise or too accurate. It's interesting that Michael Pallen's advice appears to have been put on more than one place on the BMJ's website. Michael Glass 20:35, 4 March 2007 (UTC)

Michael, it's a mistake to think of the BMJ putting things on their website. Instead, view their website as a different view of the content published in one of the BMJ journals. Every article published by the BMJ has several links by which it may be found. The nature of these depend in part upon the date of publication. For example, another article in my bookmarks is Szabo & Short (2000). I'm aware of the existence of at least the following three links to that article, and I'm quite prepared to believe that there are other ways of finding it as well: [25] [26] [27] All pages are generated from the same database using a technology called Common Gateway Interface, but as this is getting way off-topic for this page, I won't go into detail. The point is that, given a full citation, I can find the specified article. Jakew 21:16, 4 March 2007 (UTC)

Uncut

if i am not uncut man,can i have problem and my penic is down not up when strong —Preceding unsigned comment added by 84.255.135.34 (talk • contribs)

Try WP:RD. Jakew 14:26, 4 March 2007 (UTC)

Illustrations

We have four photographs of penises. I can't see that the fifth is necessary. Michael Glass 22:10, 4 March 2007 (UTC)

Annals of Epidemiology Article

I have just added the following to the article:

However, unhygenic circumcision procedures have been associated with the transmission of HIV in Kenya, Lesotho and Tanzania.^[1] this study reported, "Circumcised male and female virgins were substantially more likely to be HIV infected than uncircumcised virgins Among adolescents, regardless of sexual experience, circumcision was just as strongly associated with prevalent HIV infection. However, uncircumcised adults were more likely to be HIV positive than circumcised adults. Self-reported sexual experience was independently related to HIV infection in adolescent Kenyan females, but was unrelated to HIV infection in adolescent Kenyan, Lesothoan, and Tanzanian males." The study concluded, "HIV transmission may occur through circumcision-related blood exposures in eastern and southern Africa." ^[2]

One of the problems in Africa has been the spreading of HIV from unhygienic medical practices, as shown in this study. There is also the problem of traditional circumcision practices which result in death and mutilation. As a result, there are reports like this:

Nine killed in Eastern Cape botched circumcisions

December 17, 2004, 15:00

Nine Eastern Cape initiates have died since the beginning of the circumcision season. The latest victims are in the Port Elizabeth, Stutterheim, Mount Fletcher and Bizana areas.

Sizwe Kupelo, the provincial health spokesperson, says three of the initiates died of botched circumcision, while one was allegedly killed by his minders. Kupelo says two traditional surgeons have been arrested so far for allegedly performing illegal circumcisions.

Meanwhile, 16 initiates have been admitted to the Mthatha General Hospital and another 15 at Cecilia Makhiwane Hospital in Mdantsane near East London. [28]

I think it is important to draw attention to this aspect of the problem, because the very measure promoted as a way of reducing the chances of getting HIV could be the means of spreading the virus if the circumcisions are performed in unhygienic conditions. Michael Glass 22:52, 4 March 2007 (UTC)

Your reasoning is a little too soapbox-y for my liking, Michael, but it is a good addition to the article. However, the lead section is intended to summarise the rest of the article, so I have moved this interesting and important detail to the 'HIV' section. Jakew 23:28, 4 March 2007 (UTC)

Jake, I note you don't question my facts or my reasoning, but you have still found something to use to label and belittle the problem that I drew attention to How uncool to jump up and down about such things as

• children of both sexes being infected with HIV from unhygienic circumcisions
• boys being maimed and mutilated by traditional circumcisions
• boys dying as a result of traditional circumcisions.

I believe that it is perfectly in order to let other editors know - on the TALK page - that these are significant problems.Michael Glass 10:25, 5 March 2007 (UTC)

AIDS section

The AIDS section, especially with the addition of material on the transmission of HIV from unhygienic circumcisions, was a bit of a dog's breakfast. To remedy this, I have put the information in chronological order, checked the references and made some changes to bring the text closer to the references cited. The hypothesis about HIV target cells in the foreskin now has its own subheading. I hope that these changes make the passage clearer, easier to follow and more accurate. Michael Glass 02:47, 6 March 2007 (UTC)

I reverted this change because it seemed soapboxy; specifically, by presenting the data "in chronological order" we spent paragraphs and paragraphs describing research that has since been superceded, before getting to the more recent research. This puts us in the odd position of introducing a topic by talking about conclusions that are the exact opposite of best current research, and that's poor style. I express no opinion on the changes you made to the text, but it was too difficult to tease those differences out, so I simply reverted. Nandesuka 02:51, 6 March 2007 (UTC)

As you are aware, I noted your concerns but reverted your changes. Putting things in chronological order helps to make sense of them. Now that the passage has been worked over by other editors I think it is significantly better. There was, of course, no soapboxing about the changes I introduced. Michael Glass 12:47, 6 March 2007 (UTC)

Paragraph spacing

Michael, would you please stop adding multiple blank lines between paragraphs.

Per WP:LAYOUT#Headers and paragraphs: "Between paragraphs and between sections, there should be only a single blank line. Multiple blank lines unnecessarily lengthen the article and can make it more difficult to read."

I have already fixed this once. Will you please revert your change to that version? Jakew 13:01, 6 March 2007 (UTC)

Sorry. I wasn't aware that this was a policy. Michael Glass 22:47, 6 March 2007 (UTC)

Ok. Sorry I snapped at you. Jakew 10:01, 7 March 2007 (UTC)

Phantom reference

At present the article contains the following sentence:

In Mexico mainly, but also in other countries of Latin America, circumsicion is a sign of social status, therefore it prevails among people with economic prosperity.

The reference for this reads as follows:

Torales, Javier; Pedro Vargasllosa, Carlos Pelicer, and Regina Torne (2006). "Circumcision practice patterns in Mexico: community based survey: social status" (PDF). Sexually Transmitted Infections 79 (1): 65–67. DOI:10.1136/sti.79.1.65. PMID 12576619. Retrieved on 12 December 2006.

I checked both references. The first one is non-existent <http://www.stdjournal.com/pt/re/std/searchresults.htm;jsessionid=FzvQ1gTh1mR1GF1b1yWZJR3CZnR4jsCf5xK3Pwxr5mTv3tmp311Z!315358234!-949856145!8091!-1?&index=1&results=1&searchid=2>. The second reference is to circumcision practices in Korea. Finally, although the note claims that the passage was retrieved on 12 December 2006, this sentence wasn't in the article on 21 january 2007. <http://en.wikipedia.org/w/index.php?title=Circumcision&diff=102235810&oldid=102203398>. When I Googled the reference, all I came up with was the Wikipedia article. This sentence and its references bears all the marks of fraud. It has to go. Michael Glass 11:35, 11 March 2007 (UTC)

I vaguely recall having seen such an article, but you're right: the links appear to be about South Korea. I've temporarily removed them - they can be restored if/when the proper article is found. Jakew 11:47, 11 March 2007 (UTC)

Jake, one link was indeed about South Korea but the other one appeared to be a furphy. I could find no credible evidence for the assertion in that sentence. Thanks for deleting it. You beat me to it! Best wishes, Michael Glass 01:59, 12 March 2007 (UTC)

Afraid I don't know what a furphy is, but one link (http://sti.bmjjournals.com/cgi/repnt/79/1/65.pdf) was a typo as far as I can tell (compare with the corrected South Korea URL: http://sti.bmjjournals.com/cgi/reprint/79/1/65.pdf -- two characters are missing). Either way, the links were wrong. I'll try to remember where I've seen the Mexico data. Jakew 09:36, 12 March 2007 (UTC)

A furphy is a rumour, a false story, according to the Macquarie Dictionary. It's used in Australia but others may not be familiar with the word. I suspect someone tried to pull the wool over our eyes by giving their sentence a false reference to give it some ersatz credibility. When I Googled "Circumcision + class + Mexico" up came Circlist, so that could explain why you had some recollection of reading it somewhere. Michael Glass 12:43, 12 March 2007 (UTC)

Thanks for the explanation, Michael. Furphy... one learns something new every day. Jakew 13:03, 12 March 2007 (UTC)

Furphy, I'll have to remeber that one. Thanks. -- Avi 14:09, 12 March 2007 (UTC)