Talk:Medical analysis of circumcision/Archive 6

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Contents

Review of the Literature on Circumcision

I'd like to direct those interested in this topic to a journal article I found which, I believe, present an objective review of the literature surrounding circumcision.--Jfurr1981 15:52, 11 November 2005 (UTC)

  • "Male Circumcision: A Review of the Evidence." The International Journal of Men's Health and Gender. Vol. 2, No. 1 pp. 21-30. March 2005.

Cleanup

I'm going to try to cleanup this article in the next few days. I won't make any major changes in the content of the article. This article does need to be re-written, if possible, to make it more valuable to our readers. If there are any specific suggestions, please feel free to send me a message on my talk page.

Cheers!--Jfurr1981 05:22, 10 November 2005 (UTC)

We want balanced articles not this

This article is so POV it is ridiculous. Why is there so much room devoted to Penile cancer, something that affects 1 in a million people, including 10 links to pictures? Yet the section on surgical mishaps, which is estimated to affect 1 in 100 circumcised babies, has just a few lines. Some babies even have gender realignment surgery, because too much of the penis was lost in a botched circumcision. Little is talked about this, and the problems these people face when they go through puberty.

If there was so much of a health benefit to circumcision, why is it that countries such as the USA and the UK, which have so many similarities, except for circumcision, don't have more differing rates of disease such as cervical cancer or HIV, yuet according to the article, they should.
Penile cancer affects about one in 600 hundred men, not one in 1,000,000. Please see the sources cited in the article. However, I agree that ten links to pictures is perhaps excessive.
Complication rates are 0.2% to 0.6%, which translates to one in 500 to one in 167. These are usually minor. Most common are minor bleeding and infection. This is discussed in the article. Please feel free to add details. More severe complications are vanishingly rare - doubtless one in a million or - more likely - rarer still. By your apparent "word count should be proportional to frequency" rule, they barely warrant mention.
Comparison between nations is a notably unreliable means of assessing such an effect. Although the UK and USA may be superficially similar, there are many differences between them. For example, British men are more likely to use condoms, which clearly has implications for both HIV and cervical cancer. Please see ecological fallacy and the section on ecological studies here. Jakew 20:18, 23 September 2005 (UTC)

A good way to determine whether or not the Wikipedia article is biased is to compare it with the official policy statements of professional medical organizations.

Every professional medical organization that has an official policy on circumcision says infant circumcision is not medically necessary. However the Wikipedia article does not include that relevant fact. -- DanBlackham 09:34, 24 September 2005 (UTC)

It's actually an opinion, not a fact. Regardless, the article does quote the AAP: "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision." Also the British Columbians: "Current understanding of the benefits, risks and potential harm of this procedure, however, no longer supports this practice for prophylactic health benefit. Routine infant male circumcision performed on a healthy infant is now considered a non-therapeutic and medically unnecessary intervention."
So please don't misrepresent the situation. Jakew 10:17, 24 September 2005 (UTC)

Jake, what is actually an opinion? -- DanBlackham 14:24, 25 September 2005 (UTC)

Philosophical Point of View

How about a section of this article dedicated to the philisophical matter at hand? That being, wether it is appropriate for parents to be able to decide to cut off part of their child, when the evidence as to wether this is beneficial is unclear at best? The medical analysis should not factoring in what "may" happen to someone at an extremely old age based upon neo-natal circumcision, but rather it should focus on what can happen from the span of birth to 18 years of age. At this age, or even younger, they are competent to decide wether they want part of their penis cut off or not. Therefore, if the risks of circumcision up until 18 years of age do not heavily outweigh the benefits of reamining intact, then there is no basis for one human being to be allowed to slice off part of another human being.

Ethical analysis of infant circumcision -- go write it.
I, personally, don't think there is any medical justification for routine infant circumcision. However I can understand that parents would decide to have their child circumcised if circumcision is widely practised (eg. for religious reasons) in the society it will grow up in, even if there is no medical need for it. It'd reduce psychological problems during puberty, which might be a good thing.
However I think hygiene is a non-issue because parents should educate their children on genital hygiene just like they tell them how to brush their teeth. That restrooms are lacking means of genital hygiene is a seperate issue.
As for the argument that circumcision is mutilation -- every surgical operation is mutilation. If you know a bit about law, you know that even getting a piercing is effectively voluntary mutilation -- the word voluntary is the important bit. In the case of children it's the parents' decision. Just like getting the child's ears pierced so it can wear ear rings (although that's oftenly based on a wish of the child and delayed until after infancy for medical reasons, it's just a culturally accepted form of body modification).
Comming from a European background I don't think of circumcision as "natural" and don't consider it normal, although I do see benefits in it. I think in the absence of medical neccessity it should be the parents' and the child's decision. Probably biased by my cultural background, I don't find "tightly" circumcised penises very aesthetic, although I do agree there are prettier things than a flaccid uncircumcised piece of meat or one that looks that way when it's fully errect; but that's MY opinion and I don't have the right to judge anyone else's just because it differs. --Ashmodai 07:44, 20 Jun 2005 (UTC)
I agree with Ashmodai. What, exactly, is there to say other than "in every society that has ever existed since the beginning of time, it has been unquestioned that parents can make medical decisions on behalf of their infant or minor children." Any argument against circumcision along these grounds must also address earrings, tattoos, and the like. It's a non-starter.
The thing you're missing is that from a legal point of view (in most countries), this decision is not "one human being [slicing off a body part] of another human being." From a legal standpoint, in terms of the decision being made, the parent is the child. You can argue that that's wrong, but that applies to a whole lot more than just circumcision.Nandesuka 11:21, 20 Jun 2005 (UTC)

In reply to Ashmodai: "However I can understand that parents would decide to have their child circumcised if circumcision is widely practised (eg. for religious reasons) in the society it will grow up in." This argument is invalid. Female genital mutilation is widely practiced in certain cultures, so by this justification, it is also correct. As would be, say, cutting off a child's ear, if that happened to be practiced in a particular culture. The idea that it would reduce psychological problems is extremely ironic, considering that it's merely irrational fear of their child being different that would lead the parent to make such a decision in the first place, regardless of whether it's medically justified-- which in itself is a psychological problem. Besides, what business is it of other people what your penis looks like? The idea that children routinely look at each other's penises and mock them based on wether they are circumcised or not-- and furthermore that this effect is so severe as to justify a surgery to prevent it- is ludicrous beyond words.

In the US children are apparently expected to shower together and since children are generally assholes about people being different, I think it's a pretty realistic assumption that it's one more thing they can mock about. Whatever advice the parents can give ("Just don't react and they'll get bored") doesn't help, because children are irrational and having someone to make fun of is considered fun until some point past puberty.
It has nothing to do with female circumcision. This is a common mistake, probably caused by the similar term. Female circumcision strongly affects the sensitivity of female genitalia and reduces the ability to lead a normal sex life. Cutting off an ear causes other problems (the ear drums are less protected, etc). Both practices have no practical benefits. Cutting off an arm or a leg would be even worse.
Male circumcision merely removes a part of the foreskin. Some people have very long or tight foreskins where such an operation becomes a medical neccessity, often it is not. I don't think the medical benefits are high enough to justify a routine, but there is no rational way this can be perceived as an entirely harmful operation. The cut heals off quickly and the glans adapts to the increased stimuli quickly. I haven't heard of many adults who reported a loss of sexual sensitivity in the glans, tho, and amazingly enough the wide number of people demonising circumcision are either uncircumcised or have been circumcised before becoming sexually active (either as an infant, eg. in a routine procedure, or as a child, eg. for religious reasons).
Also please refrain from using the term "mutilation", I already explained that every surgical operation is "mutilation" in the legislative sense. --Ashmodai 04:54, 21 Jun 2005 (UTC)

In reply to Nandesuka: "In every society that has ever existed since the beginning of time, it has been unquestioned that parents can make medical decisions on behalf of their infant or minor children." Are you also arguing that a parent should be allowed to remove all of a child's teeth to prevent them from ever getting cavities? Even though one could claim it's a "medical" decision, the key factor is wether such a "medical" decision is justified and in the best interest of the child. The evidence that circumsision is actually beneficial is extremely controversial. Your claim that the "parent 'is' the child" in the eyes of the law is without foundation-- as an adult can legally decide to have all their teeth pulled just for fun, but a parent cannot decide to have all their child's teeth pulled with the sole justification of preventing cavities. It's illegal in all civilized nations. In other words, parents cannot make a medical decision on behalf of their child that is not CLEARLY beneficial and/or necessary. Why is circumcision the SOLE exception to this rule? (And besides that, what is or is not currently legal in any particular place has no bearing on wether it *should* be legal.)

Did you know that anti-circumcision campaigns would be a lot more successful if they were more diplomatic? Eh. Anyway.
The factor is not whether it is strictly beneficial, but whether it causes no harm. Piercing the ears for earrings isn't beneficial in any sense, but it is not known to cause any rational harm. The problem with male circumcision, in this sense, is that there is no scientifically, rationally, proven harm in it. Instead of villifying it, maybe you should concentrate more on unbiased research. The medical harm is outweighed by the medical benefits, the sociological harm is non-existant in the countries where it is a routine procedure and the pracitcal harm has not been proven in unbiased research. You are seriously lacking arguments here. --Ashmodai 04:54, 21 Jun 2005 (UTC)

Ad Hominem qualifications

Is it acceptable to qualify researchers as "anti-circumcision activists"? Surely such qualifications are ad hominem and not relevant to their studies? —Ashley Y 00:02, 2005 Mar 14 (UTC)

It is quite normal to disclose a researcher's interests, because it helps the reader to form their own judgement. Indeed, most journals require these to be stated when an article is submitted (unfortunately, this is usually limited to financial interests; the requirement is rarely rigourous enough to demand statement of membership in activist groups, despite the fact that belief in a cause is often a more powerful motivator). Do you think that the journals are indulging in ad hominem attacks?
I suspect (though I don't know for sure) that this requirement arose as a result of the appalling behaviour of some researchers investigating the effects of tobacco. I'm sure you remember the 'studies' (that just happened to be funded by tobacco giants) that showed tobacco was harmless or even beneficial to health?
We can't say "these researchers are lying activist scum", for obvious reasons. But we can - and should - note their competing interests. Readers can form their own conclusions. And yes, that applies to tobacco research, too. - Jakew 11:51, 14 Mar 2005 (UTC)
It is quite appropriate for journals to require disclosure of financial and only financial interests. Indeed, the word "interest" usually refers to some way of gaining by a conclusion other than the pursuit of truth. This isn't the case for "activists" (unless paid), unless you're suggesting that anti-circumcision activists secretly believe that circumcision isn't so bad after all.
I am disturbed that someone might study circumcision, come to a particular medical conclusion, advocate based on ordinary medical ethics applied to that conclusion, and then be qualified as an "activist" on that basis. It's entirely ad hominem, it's inappropriate for medical journals, and it's inappropriate for Wikipedia if it wishes to approach a similar standard. —Ashley Y 04:35, 2005 Mar 15 (UTC)
You are right to be disturbed at that concept. I would certainly join you in opposing labelling an author as an activist on that basis. However, if an author is a known activist (take Tim Hammond, founder of NOHARMM, for an extreme example), and writes a paper, isn't it reasonable to note his activism?
Is there any evidence that his activism is not a consequence of his reading of the medical evidence? —Ashley Y 23:49, 2005 Mar 15 (UTC)
No evidence either way, to my knowledge, but since the bulk of the medical evidence indicates (usually minor) benefits from circumcision, it seems unlikely. - Jakew 12:23, 16 Mar 2005 (UTC)
No Jake, the bulk of the medical evidence indicates there is no net medical benefit from circumcision. That is not just my opinion, it is the opinion of every professional medical organization in the world that has an official policy on circumcision.
"Review of the literature in relation to risks and benefits shows there is no evidence of benefit outweighing harm for circumcision as a routine procedure." -- The Royal Australasian College of Physicians. Policy Statement On Circumcision. Sep 2002.
Usually doctors only perform surgery on children when the medical benefits of the surgery far outweigh the medical risks and harms. Non-therapeutic circumcision does not even come close to meeting that standard of care. Can you cite any other surgery that doctors will perform on children where the medical benefits of the surgery do not far outweigh the risks and harms or the surgery does not correct a birth defect? -- DanBlackham 07:12, 17 Mar 2005 (UTC)
Yet these same organisations, Dan, do not normally take a strong stance against circumcision. It is one thing to say that something is not necessary, but quite another to distort the evidence to create mythical harms. It is telling that policies of many (from the AAP's to the BMA's) med. orgs have been criticised from people on both 'sides' for being too wishy-washy. Is a more-or-less neutral statement enough to create an activist? It seems unlikely. Some anti-circers have gone so far as to call the AAP hypocritical or even liable for negligence - it seems hardly as though they are inspired by that same body! - Jakew 17:24, 18 Mar 2005 (UTC)
Jake it is your point of view that the harms caused by circumcision are mythical. Other reasonable people disagree with your point of view. They feel that cutting off a normal, healthy part of a child's body without a valid medical indication by definition causes harm. -- DanBlackham 08:22, 20 Mar 2005 (UTC)
On the contrary, there is a real (yet miniscule) risk of harms such as major complications. Unfortunately, the definition of "harm" to which you refer begs the question. Still, the matter being discussed is not what I think, nor what these people think, but is instead what the medical organisations think. Right? - Jakew 14:04, 20 Mar 2005 (UTC)
I think this is a good example of how cultural distorts the medical analysis of circumcision. Is there any other normal, healthy part of a child's body that doctors can cut off without a valid medical indication without it being considered harmful? -- DanBlackham 10:18, 23 Mar 2005 (UTC)
Furthermore, you argue that activists have absolutely no interest other than the pursuit of truth, unless they are paid. I find this quite remarkable. Many things other than money motivate people. A number of terrorists voluntarily lost their lives in a notorious incident that I'm sure I don't need to name. Were they paid? Unlikely (of couse we can hardly ask them) - they passionately believed that they were doing the right thing. Money is not the only motivator.
This is obviously irrelevant. The terrorists were not engaged in making scientific statements. —Ashley Y 23:49, 2005 Mar 15 (UTC)
The common ground is motivation, Ashley. - Jakew 12:23, 16 Mar 2005 (UTC)
Well, they were motivated by religion, I believe. So should we mention the religions of the researchers, where known, if those religions have a teaching on circumcision? I know of at least two major religions that advocate circumcision on religious grounds... —Ashley Y 06:48, 2005 Mar 18 (UTC)
Judaism requires Jews to be circumcised in order to satisfy God's covenant, but does not require Jews to falsify data to justify circumcising Jews or gentiles for any other reason (one would think that keeping the Big Guy happy would be enough, if one were a believer). There's some debate over whether this applies to Christians - some point to Paul's declaration that it is not a requirement, though others question his authority over the matter. Although the Koran doesn't strictly require circumcision, it does mandate cleanliness for prayer (which circumcision certainly facilitates), and there is the matter of emulating Mohammed (which I won't pretend to understand to the point of being able to explain). All three of these religions disapprove (at least officially) of dishonesty or deception.
In light of this, it would seem reasonable to mention the author's religion if he or she were writing about circumcision for religious reasons, but would seem rather irrelevant if writing about medical grounds. - Jakew 17:24, 18 Mar 2005 (UTC)
In terms of anti-circumcision activists, they passionately believe in stopping circumcision. There can be many underlying motivations for this - some believe it unethical, some have religious objections, some just 'like' foreskin, etc. - but the purpose is clear. Now suppose an activist is writing a paper. Isn't he going to want circumcision to look bad? Might he not be tempted to exaggerate any finding in that direction a teeny bit? Might he not be tempted to gloss over any findings to the contrary? - Jakew 12:29, 15 Mar 2005 (UTC)
If there is evidence of some motivation other than pursuit of truth, that should be mentioned. Since someone can be an activist merely on the basis of their reading of the scientific evidence, as I believe in fact most anti-circumcision activists are, qualifying them as "activists", even when true, serves only as POV disparagement. —Ashley Y 23:49, 2005 Mar 15 (UTC)
I think your belief is touching, Ashley, but mistaken. As I have explained previously, the bulk of the evidence can be said to be "in favour" of the procedure (though strictly speaking, science should be value-free, with only interpretation making a judgment). I can understand that having read a site like cirp.org, you might believe that, but remember that cirp generally only includes articles "opposing" circumcision. Have a look at the Index Medicus, or PubMed, and you'll see the bigger picture.
This is your own POV. That someone happens to disagree with you is not evidence of bias. —Ashley Y 06:40, 2005 Mar 18 (UTC)
Let's suspend our disbelief, for the sake of argument, that when examining the evidence, our "would-be activist" happens by chance upon evidence against. Now the first question is why was he reading about circumcision in the first place? He must have had an interest in the subject in order to read about it. What was Tim Hammond - a massage therapist if I recall correctly - reading medical studies about circumcision for? What possible reason could there be? What evidence could he have read that could possibly have motivated him to found NOHARMM? (Remember, this was in the days before CIRP had painstakingly found every paper that could conceivably be used to oppose circ)
You're incorrect, by the way, that reading evidence makes someone an activist. Nor is writing a paper necessarily an activist act. To use the term so freely would devalue it. Membership of an activist organisation, especially playing a prominent role (such as presenting at activist conferences) is evidence of activism. Good examples would be Van Howe's presentation at the "Strategies for Intactivists" conference, or Taylor's presentation at a NOCIRC symposia.
No Jake, the bulk of the evidence is not "in favour" of the procedure. No professional medical organization in the world agrees with your pro-circumcision point of view. For example: "Infant male circumcision was once considered a preventive health measure and was therefore adopted extensively in Western countries. Current understanding of the benefits, risks and potential harm of this procedure, however, no longer supports this practice for prophylactic health benefit. Routine infant male circumcision performed on a healthy infant is now considered a non-therapeutic and medically unnecessary intervention." -- College of Physicians and Surgeons of British Columbia. Infant Male Circumcision. Jun 2004. -- DanBlackham 07:12, 17 Mar 2005 (UTC)
Membership of an activist organisation is an extension of advocacy, and reasonable behaviour for someone who has come to a particular conclusion based on the evidence and on ordinary ethics applied to that conclusion. It is not evidence of bias. The "cause" that you object to is no more than this. We should follow the example of medical journals and remove such unprofessional and ad hominem qualifications.
However, if you do have evidence of bias, that should be mentioned. You mentioned religion as a possible motivation, does that mean we should label all the Jews and Muslims as such? Or does that only count if the religion teaches that circumcision is wrong? —Ashley Y 06:40, 2005 Mar 18 (UTC)
Labeling the authors of articles published in medical journals as "anti-circumcision activists" or "pro-circumcision activists" is ad hominem. In my opinion such labels are not appropriate for Wikipedia. -- DanBlackham 09:54, 15 Mar 2005 (UTC)
Thank you for your opinion. Do you feel that journals engage in ad hominems, too, when they print competing interests? - Jakew 12:29, 15 Mar 2005 (UTC)
I'm glad to see you're holding up journals as an example to follow. I wholeheartedly agree with this: we should follow them in mentioning specific interests and avoiding vague and frankly unprofessional disparagements such as "activist". —Ashley Y 23:49, 2005 Mar 15 (UTC)
The medical journals do not list "anti-circumcision activist" as a competing interest and neither should Wikipedia. That qualification was added to Wikipedia by supporters of medically unnecessary genital surgery on boys because the articles in question do not support their pro-circumcision point of view. -- DanBlackham 02:07, 16 Mar 2005 (UTC)
An excitingly wild accusation, Dan. Got any evidence? - Jakew 12:23, 16 Mar 2005 (UTC)
I edited my comment since I do not know the true motivation of the editors who added the qualifications to Wikipedia. The rest of the comment is supported by the evidence.
  • The medical journals do not list "anti-circumcision activist" as a competing interest.
  • That qualification was added to Wikipedia by Robert and Jake [1] [2]
  • Robert and Jake support non-therapeutic circumcision of minors, in other words they support medically unnecessary genital surgery on boys.
Because the medical journals do not list "anti-circumcision activist" as a competing interest neither should Wikipedia.-- DanBlackham 10:01, 23 Mar 2005 (UTC)

Circumcision is not a requirement for Christians

Jake wrote, "There's some debate over whether this applies to Christians - some point to Paul's declaration that it is not a requirement, though others question his authority over the matter."

There is probably more debate in the Jewish religious community over whether or not circumcision is a religious requirement than there is in the Christian religious community. For the vast majority of Christians the issue was settled at the First Council of Jerusalem described in the Book of Acts chapter 15 in the New Testament.

To characterize the declaration that circumcision is not a religious requirement for Christians as "Paul's declaration" misrepresents the history of the Christian church recorded in the Book of Acts.

The declaration that circumcision is not a religious requirement for Christians was the unanimous decision of the Council of apostles and elders described in the Book of Acts chapter 15. The apostles Peter and James introduced the decision to the Council and it was unanimously accepted by all the Christian leaders who were present.

Modern Christians who question the decision that circumcision is not a religious requirement for Christians are not only questioning Paul's authority, they are also questioning the authority of Peter and James and all the other apostles and elders who were present at the First Council of Jerusalem. -- DanBlackham 08:22, 20 Mar 2005 (UTC)

I'm neither an expert on Christianity nor Judaism, being agnostic-atheist myself. That said, I'm not aware of any serious debate in Judaism. Outside of a few fringe groups, I think that the consensus is pretty much clear.
As for Christianity, it is certainly the case that many Christians do regard circumcision as a religious obligation. I can't honestly see that it's possible to resolve such a thing, as the Bible is so self-contradictory that it seems there must be an element of doubt in any interpretation.
I don't pretend to know or care who is right or wrong. I just recognise that there is some dispute and don't judge either side. - Jakew 14:04, 20 Mar 2005 (UTC)
The Jewish community has begun to question the practice, using arguments based on the religion. For instance, according to Jewish law, it is forbidden to hurt living things. Even the necessary causing of pain is considered cruel in Judaism. Also the fact that circumcision involves the surgical alteration of a perfectly natural God's given part of the body, which stems from Jewish thought plays a role.
Nonsense; the Jewish community it not questioning the practice based on Jewish law, which is quite clear that it is mandatory. Jayjg (talk) 03:03, 26 August 2005 (UTC)
"The Jewish community has begun to question the practice" is an accurate statement. You may not agree with them, but members of the Jewish religious community have begun to question the practice of infant circumcision. For example:
DanBlackham 08:55, 26 August 2005 (UTC)
Ok, make the statement "Three members of the Jewish community have questioned the practice." Should be accurate (unless perhaps "member of Jewish community" is taken to be different in meaning from "a Jewish person", perhaps additionally implying religious and/or community involvement).
Implying that the community as a whole (or even more than a fringe minority) question it is a false generalisation, as I understand it. - Jakew 09:46, August 26, 2005 (UTC)
Sorry but it's not just "three members of the Jewish community." http://www.jewsagainstcircumcision.org/
I can't find any names on that site, so for all we know the founder (a Gillian Flato according to DNS records) could be the only member. Webpages exist to assert all kinds of silly things, and we have to rely upon credible sources. See WP:RS. - Jakew 12:20, August 26, 2005 (UTC)
I have no doubt there are dozens of Jews who question the practice, given that there are at least 13 million Jews worldwide. However, the significance of this tiny minority is questionable at best. Jayjg (talk) 15:48, 26 August 2005 (UTC)
As I recall from The Jewish Encyclopaedia, the Reform Jews do not consider circumcision mandatory. Perhaps we could compromise and mention this point? My gut feeling is that the individuals mentioned above are of less orthodox beliefs. Every time I try to elaborate on this I get stuck, partly because of a poor knowledge of the different sects, and partly due to vague but incomplete awareness of the complex interplay between religious beliefs and the concept of 'Jewish identity'. Could someone with a better understanding have a go? - Jakew 17:17, August 26, 2005 (UTC)
Already explained elsewhere in Wiki, and as I thought. Brit_milah#The_anti-circumcision_movement. - Jakew 17:26, August 26, 2005 (UTC)

No Jake, only a few fringe groups within Christianity believe that circumcision is a religious requirement. The vast majority of Christians accept the decision of the apostles and elders at the First Council of Jerusalem that circumcision is not a religious requirement for Christians. You are correct that much of the Bible is contradictory, however the Book of Acts chapter 15 is extremely straight forward and easy to understand. There is no room for different interpretations of that chapter. The text very plainly states that circumcision is not a religious requirement for Christians. -- DanBlackham 10:04, 23 Mar 2005 (UTC)

Is there any other surgery like circumcision?

Usually doctors only perform surgery on children when the medical benefits of the surgery far outweigh the medical risks and harms. Non-therapeutic circumcision does not come close to meeting that standard of care. Can anyone cite another surgery that doctors will perform on children where the medical benefits of the surgery do not far outweigh the risks and harms and the surgery does not correct a birth defect? -- DanBlackham 03:05, 19 Mar 2005 (UTC)

Fallacious caveats

Billjones, you added the following to the section on prostate cancer: "A caveat is that regions in which circumcision is practiced (such as the USA) do not have lower prostate cancer rates than regions that do not routinely circumcise. In fact, prostate cancer is about two times more common in the Caucasian US population than in Europe, and about eight times more common than in Japan."

In effect, you're conducting a different study here. Comparing rates of disease in different populations is called an ecological study, and is generally considered a very weak methodology.[3] How do you feel this inclusion benefits the article? - Jakew 17:42, 22 Mar 2005 (UTC)

I commend Jake Waskett for providing a link to the article which said that ecological studies are weak designs. This is indeed what it said. Nevertheless, such studies can provide information that is worth following up:

Ecological studies
Ecological studies are also weak designs. Here the units of study are populations rather than individuals. Foe example, when the coronary artery disease (CAD) prevalence rates were compared between different countries. it was found that CAD miss were highest in those countries where mean serum cholesterol values were the highest. CAD rates were very low in countries like Japan (low mean serum cholesterol) while it was very high in countries like Finland (high mean serum cholesterol). This ecological link paved the way for intensive investigation into the association between serum cholesterol and CAD. Another example is the ecological link between malaria incidence and prevalence of sickle cell disease: malaria is rare in areas where sickel cell disease was prevalent. The association between smoking and lung cancer was supported by the ecological link between smoking and gender (males had higher lung cancer rates). Ecological studies can be useful in generating hypothesis but no causal inference can be drawn from them; an apparent ecological link may not be a true link, it could be confounded by several other factors.

Michael Glass 30 June 2005 03:01 (UTC)

Thanks for this, Michael, but it isn't clear what you're trying to say here. An ecological study might present some interesting hypothesis, but one would normally follow up with a study of stronger design to test it more rigorously. Here we have the opposite scenario - we already have stronger designs showing a protective effect, and an ecological study is offered as a rebuttal. That's similar to offering "my grandmother told me that it's elves" as a rebuttal of the Special Theory of Relativity - a complete failure to weigh evidence properly. - Jakew 30 June 2005 12:50 (UTC)

In this case we have a series of studies that show a lower incidence of prostate cancer in circumcised men. There are also ecological studies showing differing rates of prostate cancer in different populations. So the picture is rather confused, and this suggests that there may be more than one cause of prostate cancer. Because of this, learned bodies are unwilling to say what causes prostate cancer at this time. I think that the article gives a reasonably fair picture of this at the moment, though I think it could be improved by putting the findings of the learned bodies first, and then showing the studies, both ecological and case-controlled.Michael Glass 1 July 2005 06:43 (UTC)

That there are multiple risk factors for prostate cancer (or indeed for any other disease) is a known and accepted fact. It is extremely common for ecological studies to show opposite results from accepted risk factors. This is particularly true when the countries concerned are chosen specifically in order to prove a point. Good examples are those countries often chosen to disprove the penile cancer connection, such as the inevitable USA (in spite of only having a 77% circ rate), scandinavian countries, and Japan. Amusingly, these exhibit no connection with smoking rates either.
-Jakew 1 July 2005 20:22 (UTC)

Foreskin may be sexually responsive

The following sentence is a good example of pro-circumcision POV pushing, "Anti-circumcision activists and others suggest that the foreskin may be sexually responsive."

Common sense suggests that the foreskin may be sexually responsive since it is a normal, functional part of the penis and has a high concentration of nerves. DanBlackham 08:14, 14 July 2005 (UTC)

As a matter of fact, anything with enough nerves can act as an errogenous area. Including tongue, lips, fingers, etc. If there is a concentration of nerves in the foreskin (which is likely, considering that it's part of the genitals), it can act as an errogenous area.
Whether it is "sexually responsive" may be doubted, but I find that term awfully absurd in the first place ("sexually responsive" doesn't really mean anything, other than that it somehow "responds" in a "sexual" way, which really doesn't sound any different from "errogenous"). Either way it's a sensitive part of the body and thus a sensitivity you loose in circumcision -- if it's not there, you can't have any sensitivity in it.
I hope nobody tries to dig up any esotherical counter-arguments again. I still wonder how anyone can be fanatic about what other people's genitalia look like. -- Ashmodai 10:08, 14 July 2005 (UTC)
Not all sensitivity is sexual. Sexual activity produces some kinds of stimulation, but not others. The type of nerve endings is important, since different types sense different stimuli. The prepuce could be packed with visual cones, but it would do nothing for sexual pleasure (though it would doubtless change the view...). Before anyone asks, that's just an example; I know that it doesn't. - Jakew 11:27, 14 July 2005 (UTC)

Recent changes

Michael, I've undone the bizarre rearrangement of the sexual effects section. I've also replaced your links to propaganda sites with a specific link to Maimonides. Feel free to add other original sources here, preferably medical ones, given the nature of the article. My purpose is not to censor information, but just to ensure that sources are credible.

I've also changed the blatant error concerning significance of Laumann's STD findings, and have removed the speculation about race and mother's education. Not only is this original research, it is also patent nonsense. The model used to calculate the odds ratios explicitly included many variables, stated in the explanatory text for the tables. - Jakew 11:27, 14 July 2005 (UTC)

I see that some folks feel very strongly about the "racial profiling" with respect to circumcision. I fail to see the relevance of this topic to "medical analysis of circumcision." Could the folks who are insistently dropping the sentence about Blacks and Hispanics in (notably User:Michael Glass) explain how this is relevant, and why it deserves mention in this article? Thanks. Nandesuka 02:27, 15 July 2005 (UTC)

I'd like to know that myself; it seems completely irrelevant to the topic. Jayjg (talk) 02:45, 15 July 2005 (UTC)
This is as easy as πr². Hispanics and blacks are second-class citizens. They are poorer and have terrible health-care. Blacks especially suffer from hypertension. Hypertension causes impotence. Blacks and hispanics are more likely to be intact. Unless one takes this into account, one might conclude that intactness causes impotence because more intact poor blacks without health-care and with hypertension are impotent than sexually genitally mutilated rich whites with normal bloodpressure and health-insurance. These are known as confounding variables. Correlation implies causation is a logical fallacy.

—

— Ŭalabio‽ 04:06:02, 2005-07-15 (UTC)

The problem here is that this is a red herring. You see, Laumann did not perform univariate analysis - that is, consider only circumcision status. If he had, his study would have been subject to the problem described by Walabio. Instead, he performed multivariate analysis, including a number of different variables including ethnicity. The adjusted odds ratios were calculated using a type of multivariate analysis called logistic regression, and represent the effect of circumcision while simultaneously adjusting for other variables. You can verify this by looking at the footnotes to the tables. - Jakew 11:18, 15 July 2005 (UTC)
A variable is only confounding if it is not controlled for in a study. For example, taking everything you say as true for the purposes of argument, let's assume the existence of a hypothetical study that concludes that circumcision prevents schizophrenia (I am deliberately choosing a ridiculous example). It would be a valid criticism to say that this study was flawed because (again, hypothetically) all of the circumcized men in it were white, and jewish, and lived in Vermont, while all of the uncircumcized men in the study were black. However, it is a nonsequiteur to note that "blacks and hispanics are more likely to be intact," unless that fact has relevance to the population actually studied, rather than to the population at large. To be perfectly frank, I have seen so many bad faith discussions of race on Wikipedia that I think the burden is on those who would introduce it into a discussion to demonstrate that it is specifically relevant to the specific point being discussed. I don't think that burden has been met here yet.Nandesuka 10:37, 15 July 2005 (UTC)

Jake, the arrangement that you found bizarre was simply to reverse the order of two subsections of the article. I don't know why it's such a big deal for you, but let it be. I have no objection to the link to Maimondes, but the links to other sites did give some interesting information, even if you class them as 'propaganda sites'. The so-called speculation about race was simply reporting on the information that Laumann provided in his study and which you reproduced on your own website!

Now about the relevance of the information about differences between those who were circumcised and those who were not. As Laumann himself said: "..differences in the association between circumcision status and sexual practice across ethnic groups suggest that cultural, rather than physiological forces may be responsible." Now the differences that Laumann noted in his study included ethnicity and education level of the mother. I see no harm in mentioning the very factors that Laumann found and that could be responsible for the differences between the circumcised and uncircumcised men in his sample. Michael Glass 04:19, 15 July 2005 (UTC)

Michael, you're taking Laumann's remark out of context. That remark was only about sexual practices, and Laumann justified it by noting that associations differed across racial groups. If anything, that is an argument for removing the sexual practices from this article altogether, especially as neither race nor sexual habits are medical. As I've noted above, the statistical analysis has already adjusted for race in other findings. Looking at these comments alone, there is clearly significant scope for confusion arising from mention of race without mentioning that it is adjusted for. - Jakew 11:18, 15 July 2005 (UTC)

Jake, I take your point about race and ethnicity being allowed for in the statistical analysis, but this would have been easy to deal with by simply adding a note to that effect. On reading Laumann again I note the following passage:

While we do not wish to push speculation too far, differences in the association between circumcision status and sexual practice across ethnic groups suggest that cultural, rather than physiological forces may be responsible. In particular, the presented results may reflect attitudes regarding the cultural acceptability of the uncircumcised penis. Note that the association of circumcision with experience of sexual practices is weakest among ethnic minorities for whom circumcision is less prevalent. Among whites by contrast, uncircumcised men are relatively uncommon. A consequence of this may be that a certain stigma is attached to the uncircumcised penis by the white population. If the uncircumcised penis assumes a somewhat negative cultural association among whites, this may lead uncircumcised men to engage in a somewhat less elaborated set of sexual practices. [4]

If the foreskin has been demonised in the view of many Americans, this could explain why uncircumcised American men had less elaborate sexual practices and fewer venereal infections as a consequence! So what we are dealing with here is a mixture of physiological and cultural forces that shape the sexual behaviour of men in the United States culture in quite subtle and profound ways. Because of this interaction between physiological and cultural forces we really are not in a position to say that circumcision or non-circumcision does this or that, but only that these things were noted in one particular study in one particular culture. Michael Glass 12:17, 15 July 2005 (UTC)


Suppression of information in the guise of removing propaganda

Jake, once again you have suppressed a link to information on the flimsy excuse that you don't like the opinions expressed on the website. Yes, there are opinions expressed, but there is also a lot of information, too. Readers do not need your nanny edits.

Thank you, Jake, for shielding Wiki readers from the opinion of William Harvey, who discovered the circulation of the blood. This is what you have protected them from reading:

William Harvey, 17th Century
The circumcised are affected with less pleasure in coitus because the membrane is thickened and sensation blunted.
Quoted in David Gollaher, Circumcision: A history of the world's most controversial surgery, New York, Basic Books, 2000, p. 113
William Harvey (1578-1657) was the English scientist and physician who discovered the circulation of the blood.

Thank you, Jake, for shielding Wiki readers from the opinion of William Acton, the great Nineteenth Century physician. This is what you have protected them from reading:

William Acton, 1865
Many foreign writers maintain … that the chief source of sexual pleasure resides in the glans penis. That this organ has a considerable share in the sensations experienced is very true, but, from certain cases that have come under my notice, I cannot help thinking that it has less to do with them than is generally supposed. Some time ago I attended an officer on his return from India, who had lost the whole of his glans penis. The patient, completely recovered his health, the parts healed, and a considerable portion of the body of the penis was left. I found, to my surprise, that the sexual act was not only possible, but that the same amount of pleasure as formerly was still experienced. He assured me, indeed, that the sexual act differed in no respect (as far as he could detect) from what it had been before the mutilation.
William Acton, The functions and disorders of the reproductive organs in childhood, youth, adult age and advanced life, 3rd London edition, Philadelphia, Lindsay and Blakiston, 1865, pp. 114-15

Thank you, Jake, for shielding Wiki readers from the opinion of a Jewish doctor. This is what you have protected them from reading:

A Jewish surgeon, 1874
That the deprivation of the prepuce induces premature sexual excitement and onanism is quite opposed to experience and fact. On the contrary, the removal of the prepuce reduces in an extraordinary degree the sensitiveness of the glans penis; and, apart from biblical reasons, which have necessarily no place in your journal, I believe that the intention of the rite was to enhance and advance as far as possible the chastity of the race by blunting mechanically the sensibility of the organ of sexual appetite.
Letter, Lancet, 12 December 1874, p. 856
The surgeon was responding to a notice in the previous issue of the Lancet about a pamphlet against circumcision by a Jewish physician in Vienna, Dr Levit.

Am I asking that this material be put in the article? Of course not! All I did was to put a link to this web page so that readers can see the evidence that people used to believe that the foreskin was important. Sure, it's mixed with a lot of editorialising, but readers cope with that every day. Why do you want to prevent them from reading this website? [5]

Why don't you trust the Wiki readers? What do you fear? Michael Glass 15:22, 15 July 2005 (UTC)

I don't want to censor information, only propaganda. While I do not object to linking to such sites in certain contexts, linking to them bestows an implicit stamp of approval. It says, in effect, "we recommend this for further reading". A biased review is not a credible source for an encyclopaedia, unlike primary sources. In another context, it would be okay for us to state "some people believe that the Earth is flat", with a reference to the Flat Earth Society, but saying "there is some evidence that the Earth is flat" with a link to a page on flat-earth.org is an endorsement of sorts for that page. An encyclopaedia is itself the place for compilations of knowledge and thought. Let's write Historical views on circumcision and sexuality instead, include these quotes there, and link to that. Agreed? - Jakew 17:46, 15 July 2005 (UTC)
I don't want to censor information, only propaganda. What exactly does that mean? Most of the links you put in Wikipedia are propaganda, and I don't delete them. Wikipedia is not a "stamp of approval", we are simply supposed to present both sides. Your pro-circumcision slant, which no serious encyclopedia promotes, is already here saying Earth is flat. That being said, regardless of our differences, we're just going to have to tolerate each other's views. DanP 23:00, 15 July 2005 (UTC)

Jake, I appreciate your reply. However, the distinction between information and propaganda that you make is simply not so clear-cut. Everyone has biases. Everyone has opinions. Everyone has blind spots. If you look at two different encyclopedias you will find quite different views on circumcision, as you can see by comparing the articles in the Encyclopaedia Britannica and the Encyclopedia Americana. I take your point that the web page is highly opinionated. Nevertheless, it is full of so much information about changing attitudes towards circumcision that it is a valuable resource. It is also a valuable because all the quotations are sourced. Now, as you feel that it is suspect because of its strongly expressed opinions, perhaps you could suggest a way that the link could be provided, not to endorse the opinions expressed, but to document the fact that people used to feel differently about the foreskin. Remember what we are discussing: whether and how a link should be inserted. Michael Glass 01:37, 16 July 2005 (UTC)

I agree that it isn't always easy to tell propaganda from information. However, in the case of that site[6], it's fairly obvious that the intent is to make the reader feel negatively towards circumcision. Information intended to alter opinion is precisely the definition of propaganda.
many of the early beneficiaries/victims of the operation were not happy with the result;
I therefore wanted to tell something of their story and to arouse some sympathy for 
the indignities and cruelties inflicted
...
I hope that the historical perspective it provides will encourage people to take a 
sceptical view of reports that it can prevent AIDS, cervical cancer, urinary tract
infections etc, and show them to be not so far removed from nineteenth century
assertions that circumcision could prevent masturbation, syphilis, epilepsy, 
bed-wetting, hip-joint disease, hernia, pimples and other disorders too numerous 
to mention.
The trouble with such sources is not with the information that they present (at least in this case), but how they represent it and - importantly - what they leave out. On a personal note, if I were especially interested in historical aspects, I'd treat it like I treat any biased review - exploit the references, find others, and read and analyse myself. It's time consuming, but stops you from being tricked.
As stated, I suggest that we create a new article, and copy some of these quotes in. I don't object to adding the site as an 'External link', provided that a suitable note is added. We can link to that article from here. - Jakew 12:18, 16 July 2005 (UTC)

Jake, the idea of a new article on the history of circumcision is a good idea and I would be happy to work on such an article with you or any other interested person. However, this doesn't deal with the issue of providing links to useful and interesting information for this article. Firstly, we both agree that the History of Circumcision website is highly opinionated. You feel that this is a fault; I feel that this is no more a problem than it is with your own website, which, of course, is coloured by your views.

You mention two specific problems with the website:

  • the documents are presented in a way that you disapprove (anti-circumcision);
  • the documents may leave out equally important historical information.

I believe that I can deal with both of those objections with the substantive change shown in italics:

Traditionally, many believed that the foreskin was sexually sensitive [7][8], something that has been documented by those with strong opinions against circumcision [9] [10] [11]. More recently, some researchers have also suggested that the foreskin may be sexually responsive [12] [13] [14]. Opponents of circumcision have also cited these studies, which report on the sensitivity or innervation of the prepuce.

This achieves the following:

  • The links are provided for the interested reader.
  • The links to strongly anti-circumcision sources are labelled as such.
  • The three links will enable the discerning reader to discover that the three lists are, in fact, largely identical.
  • The discerning reader is able to compare what Philo Judaeus and Moses Maimondes said about circumcision in two versions. The first links show their comments in a wider context whereas the shorter quotes in the anti-circumcision websites concentrate on the question of sexual pleasure. Is it fair to single out sexual pleasure like this, or should other issues be considered at the same time? Discerning readers are provided with the resources to check two of the quotations in a wider context and decide for themselves how appropriate this is.

I hope that you will see that this arrangement puts readers in a stronger position to find out more, if they want to. However, it does it in a way that alerts readers to the fact that several sites have strong opinions against circumcision, without using a label that implies that this is wrong. I hope that this answers the concerns of all, whether they have spoken for or against the links.

Best wishes, Michael Glass 13:57, 16 July 2005 (UTC)

Basically I think this is a workable solution, Michael. I'm not too happy with the current wording as presently stands, but I'm sure we can find something we're both happy with soon enough. I don't intend to remove the links as presently included. I think that we ought to create this page and, at some point in the future, replace the links with one to ours (which can certainly have an external links section). But for the time being - ok.
My website is for the most part just articles presented in full, and with no additions. As such, I don't think it is comparable. Exceptions would be the review pages and especially the index pages. These would be unsuitable for referencing here, except as a labelled external link. It is currently more pro- than anti-, but I hope that eventually it will be comprehensive.
My objection is not specifically that it is anti-circumcision. The objection is simply that it is biased. An additional objection is that it has not been peer-reviewed. - Jakew 16:35, 16 July 2005 (UTC)

Clarification of wording

Just a quick note to Jayig. Your edit made it clear that my previous wording may have been construed as implying that opponents of circumcision had documented evidence of foreskin sensitivity. This was not the intended meaning. What was documented was evidence of a belief that the foreskin was sexually sensitive. I hope that my latest revision makes that clear. Michael Glass 07:45, 17 July 2005 (UTC)


Epididymitis

I removed the following passage from the section on skin diseases:

In a study relating to Epididymitis Epididymitis in children: the circumcision factor? demonstrated with highly statistical significance that a relationship exists between epididymitis and the presence of a foreskin. It was found that an intact foreskin is an important etiological factor in boys with epididymitis.

There is a section on epididymitis in the article where the same article is commented on. However, because that comment covered the same ground in clear and simple English, and the link to the Pub Med article was there as well, I did not change that section. Michael Glass 02:58, 27 August 2005 (UTC)

Banned editors

Edits by banned editors (such as Robert Blair's insertion of a book name) should be reverted automatically. As well, References sections are for books that were used in writing the article; the added book was clearly not used in writing this article. Jayjg (talk) 22:41, 20 September 2005 (UTC)

Breastfeeding and circumcision

I rearranged this section, adding some new material which I think is important. I have also added a link to the relevant section of the Wiki article [Breastfeeding]. Michael Glass 22:55, 24 September 2005 (UTC)

I've made some changes, and have created a table to summarise relevant findings. It needs some work, but I think it's a good start. Jakew 10:23, 25 September 2005 (UTC)

Penile cancer

The following addition by AlbertCahalan belongs on the Talk page, not in the article.

  • It should be unsurprising that we can reduce cancer and other diseases of the penis by removing part of the penis. This method of disease prevention works for all body parts. Complete prevention from disease of a body part can be had by complete removal of that part.

-- DanBlackham 08:14, 26 September 2005 (UTC)

Agreed. Jayjg (talk) 14:45, 26 September 2005 (UTC)

Yep, that sounds reasonable. I do have a question about the article, in particular the Penile Cancer section. It states: "Penile cancer is a rare form of cancer with an annual incidence of 1 case in 100,000 men in developed countries." I have also read that this risk is as low as 1 in 1,000,000. However later in the section it states: "One 1980 study estimated that the lifetime risk of an uncircumcised man developing invasive penile cancer (IPC) is one in 600." This 1980 study seems flawed. If that rate was true it would show up like a sore thumb in comparisons between cancer rates of different similar countries, with different circumcision rate, but it doesn't. I propose that we remove the 1 in 600 reference, as it doesn't agree to any other study, i.e. it seems like flawed research, or the sample size was tiny, or the sample very squewed. --Dumbo1 01:33, 19 October 2005 (UTC)

Don't confuse lifetime risks with annual risks. Also be aware of the ecological fallacy. Jakew 12:47, 21 October 2005 (UTC)
Yes you are right, I was confusing lifetime risks with annual risks.--Dumbo1 16:06, 21 October 2005 (UTC)

Current studies on HIV/AIDs transmission in Sub Saharan Africa

The recent study into HIV/AIDS transmission and circumcision did not take into account the practise of Dry sex, which is relatively common in sub-Sarahan Africa. Dry sex increases the chances of foreskin ripping and tearing substantially, increasing the risk of STD infection. As such it is possible that the results of the recent study should not be extrapolated across the rest of the population, as during lubricated sex the foreskin does not rip as easily as in dry sex. It would be good to see a similar study in an area where dry sex is uncommon. It is possible that the results would be the same. It is also possible that results would be very different. It has been put forward that one fo the reasons that HIV/AIDS is more common in Sub-Saharan Africa is due to the high transmission rate caused by the practise of dry sex. Certainly the transmission rate per sexual encounter is higher in sub-Saharan Africa than elsewhere, although the reasons for this are as yet unknown. --Dumbo1 13:55, 19 October 2005 (UTC)

You might like to familiarise yourself with the policy on original research. Jakew 12:49, 21 October 2005 (UTC)
You might like to familiarise yourself with the Wikipedia article which I linked above and shall link again: Dry sex. This contains the following reference which you may like to familiarise yourself with: Beksinska ME, Rees HV, Kleinschmidt I, McIntyre J.The practice and prevalence of dry sex among men and women in South Africa: a risk factor for sexually transmitted infections? Sex Transm Infect. 1999 Jun;75(3):178-80. It is this that I have paraphrased above. It is not original research on my part. (Put STD and Dry Sex into Google and see what comes out!). The paper shows that there may be higher transmission of STDs for men practising dry sex, however the sample size was not large. Additionally the study looks at STDs as a whole as opposed to specifically HIV/AIDS. That study has not yet been done or published, however the results in the paper above should make us consider whether the South African research could be repeated in a population where dry sex is rare. I would have thought that you might have looked at the link that I included in this talk page, rather than just assume that I had made it up! The validity of the HIV/AIDS and circumcision research is very important. I don't have a vested interest in proving the research wrong. Do you have a vested interest in showing that circumcision can only be beneficial?. So much has been made of the recent HIV/AIDS and circumcision research, if there are any other factors that might have skewed the results, surely we should be interested in them. Hopefully we are all interested in reducing the risk of HIV/AIDS and other STDs, and hopefully we are all interested in finding out whether circumcision really does reduce the risk of HIV/AIDS transmission across the entire population. Of course what we should all be doing is practising safe sex, but then thats another discussion! --Dumbo1 15:42, 21 October 2005 (UTC)

Objectives

I'm uncertain here as I am a new contributor, but with this topic being under discussion for greater than 12 months, wouldn't it make more sense to remove the theories/hypotheses/estimates without proof and leave only the facts?

From scanning through the talk page history, it seems that more argument/discussion/thought has been afforded to those topics discussed within the article rather than to the overall weight/veracity of the article itself.

Is the community not here to maintain articles? How are we maintaining the article in this manner? Are we methodical in determing the article's POV? And is not the only way to guarantee a NPOV to relate fact and only fact? Hence should a dispute arise on the NPOV of an article, would that not be a dispute as to the veracity of the facts in the article? So, would the next step in solving the dispute be to remove any statements which are conjecture/supposition/exaggeration/assumption rather than fact?

Please clarify. Xyybyral 09:44, 8 November 2005 (UTC)

Here's one way to end a meaningless debate

Most civilized countries have some sort of democratic organ where medical professionals come to discuss issues. Where there is a consensus, a public statement will be made.

Create a list of the countries where democratic organs have issued statements regarding circumcision. Provide their findings -- the concluding ones! Then separate them into proper groups.

I'll start the list for you.


Australia: Royal Australasian College of Physicians' Health Policy Unit Findings: Review of the literature in relation to risks and benefits shows there is no evidence of benefit outweighing harm for circumcision as a routine procedure in the neonate

Canada: Canadian Paediatric Society Findings: The overall evidence of the benefits and harms of circumcision is so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns

Norway: Norwegian Council for Medical Ethics Findings: ritual circumcision of boys has no established medical benefit


The main argument for this approach:

Medical studies are often too complex for the general public to understand. Some studies, claiming to be objective, are in fact biased. Others do not state non-obvious facts, such as that the study was conducted in an area where a large majority are or are not circumcised.

Instead, allow the medical professionals themselves to interpret the studies their peers have conducted. In the case of the Norwegian Council, their statement was published in a journal all medical professionals in Norway read. The same will be the case for other countries.

Don't get hung up on individual studies. Tabloid media is ripe with presentations of individual studies, each showing a tendency towards one or the other. Wikipedia should have higher standards. Articles claiming to be scientific, like this one, should approach subjects in a scientific manner. Refer to the consensus of the medical community. People will then be able to make an informed decision, not based on the intentions of the author of the article, but based on the position of the professional medical communities of the world. Then start a new page where you can take this never-ending debate.

--Superdix 20:25, 22 November 2005 (UTC)

I see no reason why we shouldn't create a position statements on circumcision article, but Wikipedia should not be dumbed down. Presenting these conclusions alone tells the reader nothing whatsoever about the benefits and risks - it only tells you what various the opinions of these authorities: hardly scientific (indeed, a logical fallacy). Jakew 21:00, 22 November 2005 (UTC)


For the same reason you as a member of the general public may not write your own prescription for drugs, or perform surgery on your neighbour, this article should not contain endless references to studies. Medical professionals are granted a degree of power in the society based on their scientific knowledge and training. That very knowledge and training should be represented here as a reliable source of information.

When people come to Wikipedia for a Medical analysis of circumcision, the information they encounter should represent the broad medical community, and not a number of select studies by pro- and anti-circumcision advocates. The very fact that this page is disputed shows that there is something fundamentally wrong with its structure.

By all means, the page could try to cover all the potential benefits and risks of circumcision. As long as the conclusion reached is that of the consensus of the medical community.

I did not request for a 'dumbing down' of this article. I simply suggested we move the huge discussion to another page that doesn't claim to be a medical analysis.

As for your reference to 'appeal to authority'. While you may call the medical community an 'authority', it is very much a democracy of its own. Peer-review journals are the proof.

--Superdix 21:45, 22 November 2005 (UTC)

And in these journals - and in the community too - there is significant disagreement. WP:NPOV demands that we discuss the main relevant views and their supporting evidence. Jakew 22:07, 22 November 2005 (UTC)


You are wrong. By Jimbo Wales' own standards, this page should provide the information that current medicine discourages circumcision. Being titled Medical analysis, this page must adhere to medical standards. And by those medical standards, the following countries' medical communities have found that the medical benefits are lesser than the risks of circumcision: Australia/New Zealand, U.S.A., U.K., Norway, Finland. I have yet to see one that encourages circumcision.

--Superdix 22:57, 22 November 2005 (UTC)

Please see the section entitled 'costs and benefits'. Jakew 12:13, 23 November 2005 (UTC)

"Please discuss this on the talk page. Thanks."

Nandesuka asked me to bring this section to the talk page. Said and done.

As with all types of surgury there are risks connected with circumcision. How great the risk is difficult to find out since the death is reported as cused by the side effect, such as infection or bleeding. The cicumcision may cause liver failure, kidney failure, pneumonia, and blood poisoning.[15] Dr Douglas Gairdner reported 16-19 actual deaths a year in England and Wales from neonatal circumcisions in the 1940s. Br Med J 1949; 2:1433-1437. Dr Robert Baker estimated 229 deaths per year from circumcision in the United States.Sexual Medicine Today 1979;3(11):35-36. African tribal ritual circumcision produces reports of death or serious injury every year. BBC reprorts about the deaths of about 20 youths and another 100 injured from failed circumcisions in the past few weeks.[16]
The use of anastethics on infants is also a problem. If an anastethic is used there is a risk involved with that, if the infant is given too much it may cause death. In older days and in developing counties the surgery may be done without the use of anastethic and this may cause the child to go into a pain induced shock that also may be fatal.
Even if it doesn't cause death there may be complications. One famous example is David Reimer who got his penis amputated following a failed circumcision and was rasied as a girl.

I see several problems with this. Firstly, a minor one - you need to check it for spelling and grammar. If this were the only problem with it, I would have corrected it, however.

Next, there are unsourced claims. Who says that the risk is difficult to assess because of this reason? Who says that African tribal circumcisions produces these reports every year? The paragraph on anaesthetics is completely unsourced.

Next, the tone is alarmist and poorly balanced. It looks like propaganda. Baker's estimate, which is based on Gairdner's figures, is all very well, but overlooks the fact that Gairdner's figures included complications of general anaesthesia. American studies have found a much lower death rate. The most commonly cited death rate is 1/500,000, from Speert, H.: Circumcision of the newborn: An appraisal of its present status, Obstet Gynecol. 2: 164, 1953.

Next, it's redundant. The section details these risks further on. What is gained by mentioning them twice? Jakew 16:51, 26 November 2005 (UTC)

The risk is difficult to assess because there seems to be no statistics kept (and by the way that was also sourced). With BBC reporting 20 dead and 100 injured in just a few weeks it's no problem to see the truth in the claim "African tribal ritual circumcision produces reports of death or serious injury every year.". A quick googling should provide plenty of links. The problem with anaesthetics (especially on infants) is common knowledge, at least if you have some knowledge about medicine. [17] or "The physiologic immaturity of respiratory musculature and central respiratory control centers leads to an increased risk of apnea and respiratory complications following general anesthesia in the neonate."[18] and so on.

The tone is balanced and informative. However, you may feel otherwise because of your bias, but that's irrelevant. Also the section describes the risks and also informs (when data is available) about how big the risk is. The text clearly says that the death rate also includes complications (such as complications of general anaesthesia). As the alternative is to not perform the surgery it makes good sense to include that too. If you have other studies, feel free to include them too.

The flow of the text is much better than the chopped up, hard to read article. If I had the time I would like to rewrite the entire article for flow and readability. // Liftarn

The previous version was far more NPOV; repeating detail is POV. Jayjg (talk) 22:14, 29 November 2005 (UTC)

The repeating was unintentional. I guess the entire article needs to be looked over, but I'm afraid I don't have the time for that. // Liftarn

Minority views should get less attention. Why is the minority view getting the most attention?

In Western medicine babies are circumcised because the medical community thinks the benefits outweigh the costs. So why does the minority view get the most exposure?

The above comment is an example of ethnocentrism. If Western is defined as 'United States' it has a measure of truth, because the majority of boys are circumcised in that country. However, outside the United States, the majority of boys are not circumcised. Even in other English-speaking countries, including Canada, it is a minority practice. Other commentators see the cost-benefit ratio differently. [19], [20]. Michael Glass 01:01, 8 January 2006 (UTC)
Even if "Western" is taken to mean "United States" it is not wholly true. The majority of US boys are circumcised for unclear reasons - probably aesthetic. The entire "Costs and Benefits" section belies the idea that circumcision has substantial utility. LWizard @ 02:38, 8 January 2006 (UTC)
My apologies about Western medicine. I realize now that it is the United States where the procedure dominates. [21] I do know that foreign leaders are flown to the United States (Sadat for example if memory serves) because US medicine is so advanced. I still believe that cicumcision is best. .[22][23] And I am not even that big of a believer in allopathic medicine.

POV

Once again, the following changes have been made.

Insertion of:

Community-associated methicillin-resistant Staphylococcus aureus is viewed as an emerging risk.[24]

Note that the source cited is a statement from an anti-circumcision pressure group. Elsewhere in the article we cite peer-reviewed articles. If the scientific community views it as an emerging risk, it should be easy to find articles in peer-reviewed journals that say so. If, on the other hand, this is simply a scare tactic that lacks credibility, then we should not include it.

Next, this is inserted after the description of Schoen's cost-analysis:

Schoen and colleagues' outmoded data (1996) fails to recognize that most cases of phimosis are treated medically, not surgically in 2006. No more than 1 out of 100 boys will require a post-neonatal circumcision.[25]

"Outmoded data"? This is terribly POV.

"most cases of phimosis are treated medically, not surgically in 2006." According to whom? This is just nonsense.

"No more than 1 out of 100 boys will require a post-neonatal circumcision" According to a different source, that estimates 10 in 1,000. It doesn't state that this is an upper limit. Declaring one source to be 'right' (as this implicitly does) and another 'outmoded' again violates NPOV.

We shouldn't be criticising these studies anyway, due to WP:NOR. Instead, we should cite published criticism by others. Jakew 10:22, 11 March 2006 (UTC)

Jakew 10:22, 11 March 2006 (UTC)

Point by point:
1) Community-Associated Methicillin Resistant Staphylococcus aureus (CA-MRSA)[26] is a genuine issue and its existence is a counterindication against routine elective surgery, such as a circumcision. This is not a fringe POV.
2) If you don't like the word "outmoded", change it. What's important isn't the commentary, but the data itself. First of all, 1 in a 100 is the same thing as 10 in 1,000; do the math. I have no idea where you get the notion that the upper limit is going to deviate extensively from this estimate, but it's unsupported.
3) As far as I can tell, most cases of phimosis are, as the article now says, treated medically and not surgically. WebMD, for example, goes on and on [27] about non-surgical treaments, such as manual stretching or applying a medication. Even in the cases where surgery is needed, they can often perform preputioplasty instead of circumcision. According to one study [28], only 28% of males referred to for a possible circumcision actually needed one. These referrals would consist of only a subset of those who have trouble with their foreskins. That same study argues that about two thirds of "medically necessary" circumcisions performed in one particular place were unncessary. I think this qualifies as a published criticism, no?
So, given all this, what changes do you still suggest? Alienus 20:48, 11 March 2006 (UTC)
1. I do not dispute the existence of CA-MRSA. What I am asking for is a reliable source for the statement that it is viewed as an emerging risk. A mere claim in the website of an activist group is not sufficient.
2. Next, I'm always happy to change wording, if doing so results in an improvement. I also realise that 1/100 is equal to 10/1000.
2a. You have now changed the wording to: "This study, however, does not seem to account for the fact that most cases of phimosis are now treated medically [29]." This claim is not supported by the link given, which says nothing about which treatments are more commonly used.
3. The link you provide from WebMD states: "Circumcision, the surgical removal of the foreskin, often is used to treat phimosis." It says 'often', not 'less frequently'. It may well be that most cases are not treated medically, but as far as I'm aware, nobody has established what percentage.
3b. It's certainly true that several authors argue that more referrals occur for circumcision than are needed. It would certainly be appropriate to cite these authors' work in a Letter to the Editor in response to that paper. However, Wikipedia is not the place to do such in-depth analysis. WP:NOR forbids '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".' Jakew 21:15, 11 March 2006 (UTC)

1) You shouldn't be disputing the fact that CA-MRSA is an emerging risk, either. Antiobiotic reistant infections, on the whole, are an emerging risk, and CA-MRSA is no exception. A quick google turns up this, but there's no shortage of citations available.

2) The link does say that, even of those cases referred for surgery, the overwhelming majority did not need surgery. Add in the males who were never referred in the first place because non-surgical methods worked for them and you get an even larger majority. This is not unclear.

3) I'm not interested in publishing anything, just making reference to relevant articles.

At this point, I don't see any more changes to make. Alienus 21:34, 11 March 2006 (UTC)

1. I'm not disputing it as an emerging risk. However, I've searched PubMed for any mention of it as an emerging risk for circumcision specifically, and I have found nothing. The link you mention doesn't mention circumcision either.
2. It may well say that they didn't need it, but that was a single study at one surgical clinic. I don't doubt that at that particular clinic, medical rather than surgical treatment is common. However, that does not mean that non-surgical treatment is preferred anywhere else.
3. Fine. Don't publish anything, then. But please remember to follow Wikipedia's policies, which do not permit you to make novel syntheses of published data.

1) We have one link, from doctors, that points out the relevance of this type of infection, and another that confirms that it's an emerging threat. That seems sufficient.

2) Then bring up other studies. This one demonstrates that, no matter how popular surgery is at other places, it's not necessary.

3) Noted. Alienus 22:05, 11 March 2006 (UTC)

1. No, we have one link, from an anti-circumcision activist group that are not exactly known for their scrupulous honesty, and certainly do not count as a reliable source. We have another link that doesn't even mention circumcision. We need a proper link, otherwise the claim must go.
2. The only relevant study would be of patients in that particular health management organisation. The rates of referrals for unneeded circumcisions can only possibly apply there, since this depends entirely upon doctors making those referrals. Also, it doesn't matter whether the surgery is necessary or not, what matters is whether it happens, since this is what affects cost. Whether it should happen is an entirely different matter. Finally, unless this criticism of this particular study can be found in the literature, it is original research and must be removed.
3. Thank you. Jakew 22:32, 11 March 2006 (UTC)

As Jake has noted, we need reliable sources for claims, particularly controversial ones, and the links provided simply do not meet that requirement. Jayjg (talk) 18:19, 13 March 2006 (UTC)

Help me out here...
1) We have no shortage of reliable sources showing that CA-MRSA is an emerging risk. We also have sources that confirm that this risk applies to pretty much any surgery, including circumcision. Neither of these statements is the least bit controversial. The only controversy is that the connection between the two has been pointed out by a medical advocacy group. By analogy, it's as if one link explained that rain makes people wet and another says it's going to rain tomorrow, but it's forbidden for us to say that anyone who goes out tomorrow is at risk of getting wet.
2) That doesn't follow. If a particular form of surgery is expensive but usually unnecessary, then the obvious way to cut the cost is to avoid the unncessary surgery. It doesn't make sense to perform a cheaper (but still unnecesary) version of that surgery earlier on. It's not original research to actually understand the relevance reliable sources. Likewise, it's not original research to quote two studies that cover related topics and let the reader draw any conclusions they like.
3) Given all this, what exactly would satisfy your demand for reliable sources in the above cases? Alienus 19:22, 13 March 2006 (UTC)

Ah, here's the issue in a nutshell. CA-MRSA may indeed be an emerging risk for "pretty much any surgery". In that case, why link it specifically to circumcision? Do you plan to insert the exact same text about CA-MRSA in every single article we have about every single surgery that is done? Clearly not, as there are thousands of such articles; you might as well have a CA-MRSA template that you added as boilerplate to every surgery article. The only thing linking CA-MRSA specifically to circumcision is an article from an unreliable source. And your claim that the topics are "related", in the absence of reliable sources linking them, relies purely on original research. Jayjg (talk) 19:59, 13 March 2006 (UTC)

Actually, I wouldn't object to the addition of text about the risk of CA-MRSA to any article for elective surgery, but it's not my job to modify all articles. After all, if I see "the" typoed as "teh" in this article, should I not fix it unless I'm willing to fix it in all articles? This is not a strong argument.
The risk of CA-MRSA is certainly something to consider before going under the knife for a procedure that you may well be able to do without. Or, in this case, before you have someone perform such surgery on your son. As part of informed consent, anyone considering surgery should be made aware of the issue.
That circumcision puts the patient at some risk for CA-MRSA is not at all controversial, so it doesn't need any citations at all. Any surgical procedure has this risk, including circumcision, and I can support that with citations easily.
Likewise, you can argue that the advocacy site is too biased to be a reputable source for medical information, but you can't deny that it's a reputable source for supporting the claim that such advocates have raised the issue of CA-MRSA in their arguments against circumcision. This suffices to show that the juxtapositioning of circumcision and CA-MRSA is not OR.
In any case, the emerging risk of CA-MRSA is not a slam-dunk argument for those who oppose circumcision. It's a risk that even they would admit is entirely acceptable in cases where surgical intervention is medically necessary. However, it does qualify as one more reason to hesitate before elective surgery, particularly when you're making the decision for someone else.
Once again, I ask precisely what is required to restore mention of the CA-MRSA risk to this article. Alienus 23:00, 13 March 2006 (UTC)
Alienus, boilerplate information that can be added to dozens of articles should not be added to dozens of articles. That's simple common sense. Rather, it should be added once to a relevant article. If you have reliable sources which specifically link CA-MRSA to Circumcision in a unique way, then the information belongs here. That's it. Jayjg (talk) 22:17, 14 March 2006 (UTC)
In answer to your question, what is required is an article in a reliable source linking circumcision to CA-MRSA. Jakew 11:05, 14 March 2006 (UTC)

Done. [30] Alienus 20:14, 14 March 2006 (UTC)

Sorry, that article doesn't mention circumcision, except in passing, where it says: "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." (emph added)
Another source you cite reported: "Authors of these reports speculated that the circumcision site may be particularly susceptible to bacterial growth. In our study, however, none of the MRSA infections were at the circumcision site, although many were in the genital region." (emph added) [31]
You also added a link to the anti-circumcision site CIRP. This is no more credible than the original link. It may interest you to know that CIRP's 'librarian' is George Hill, a retired airline pilot who just happens to be the Executive Secretary of Doctors Opposing Circumcision and most often writes on their behalf.
So, we have: 2 links to anti-circumcision sites (which are not reliable sources), 2 links to pages that don't mention circumcision, and 2 links to sites mentioning circumcision but rejecting it as a cause. This is insufficient. Jakew 20:53, 14 March 2006 (UTC)
Jayjg, what other surgeries will doctors perform on infants with a ratio of medical benefits to medical risks and harms similar to elective, non-therapeutic circumcision? I am not aware of any. -- DanBlackham 05:27, 14 March 2006 (UTC)
Dan, as an anti-circumcision activist, your POV on this predictable, but not relevant to the discussion. Please note that Wikipedia is not a soapbox, and the purpose of Talk: pages is not to proselytize anti-circumcision. Jayjg (talk) 22:13, 14 March 2006 (UTC)
Jayjg, you asked "why link it specifically to circumcision?" and you implied that this article is like "thousands" of other articles about surgery. Unless there are other articles about medically unnecessary surgery commonly performed on children, this article is unique. That is why I ask you what other surgeries are similar to elective, non-therapeutic circumcision of children in terms of the ratio of medical benefits to medical risks and harms.
Please remember that referring to me as "an anti-circumcision activist" is not good Wikiquette especially in light of your own pro-circumcision POV. -- DanBlackham 10:04, 15 March 2006 (UTC)
Dan, it may suit your agenda to divide the world up into "medically unnecessary surgeries commonly performed on children" and "all other surgeries", but in the non-activist world surgery is surgery. Perhaps you should target rhinoplasty for a while. As for me, I have no "pro-circumcision POV", as I do not advocate or recommend it for everyone (or indeed anyone), but rather consider it to be purely a personal choice. Resisting insertion of POV into Wikipedia articles by anti-circumcision advocates is not the same as having a "pro-circumcision POV". Jayjg (talk) 16:27, 15 March 2006 (UTC)

Jay, I don't understand your interpretation of the requirements for citation of reliable sources. Consider this text from WP:RS:

Do they have an agenda or conflict of interest, strong views, or other bias which may color their report? Remember that conflicts of interest are not always explicitly exposed and bias is not always self-evident. However, that a source has strong views is not necessarily a reason not to use it, although editors should avoid using political groups with widely acknowledged extremist views, like Stormfront.org or the British Socialist Workers Party. Groups like these may be used as primary sources only i.e. as sources about themselves, and even then with caution and sparingly. Extremist groups should not be used as secondary sources.

As an activist group, DOC clearly has an agenda. But, as the rules say, this isn't sufficient reason not to use it. In fact, even if DOC were an extremist group, which they're obviously not, we could still use them as a source about themselves. In other words, it's perfectly fine to say that some doctors who oppose routine circumcision raise the issue of the emerging threat of CA-MRSA because they see it as relevant. We can then quote DOC as a reliable source about its own views, without claiming that DOC is right or wrong. Or are you going to suggest that their web site is lying about their views? Alienus 23:51, 14 March 2006 (UTC)

Feel free to use the DOC links in an article about the DOC; in articles about medicine, it's best to use links to reliable medical sources. Jayjg (talk) 04:07, 15 March 2006 (UTC)
I'm curious. By what standard is the Socialist Workers Party extremist but not DOC? Jakew 13:48, 15 March 2006 (UTC)

Michael, I'm making a partial revert of your changes, for the following reasons.

"However, methicillin-resistant Staphylococcus aureus.is spreading [32]"

This does not mention circumcision, and hence should not be included.

"and has infected newly-circumcised boys [33]."

This gives the reader the mistaken impression that circumcision was the cause. However, as the article notes, infection occurred at different sites.

"This has led to changes in infection control in one hospital [34]"

Ambiguous. It was MRSA that caused changes, not circumcision. The article mentions circumcision only twice, noting that it did not support the idea that circumcision was causative.

"and widespread concern about the implications for procedures on vulnerable newborns, especially premature babies [35]."

Does not mention circumcision. Hence it is inappropriate.

So of the only two articles that are appropriate sources for an article on circumcision, neither support the idea that it is relevant. At best, I could edit the article to say something like "Studies do not support the notion that circumcision plays a role in MRSA", but that is utterly pointless since there are an infinite number of things that are not related to circumcision, and there is nothing in reliable sources stating the opposite. Hence it is best removed. Jakew 15:22, 17 March 2006 (UTC)

Jake, you have argued your case like a defence lawyer. Of course, you are right that there isn't a smoking gun, but some have speculated that there may be a connection between circumcision and infection with MRSA. [36]. I quote:
Of particular interest was the fact that all 22 infected neonates were male and all but two were circumcised. Previous studies have reported that male neonates are more likely to become colonized78 and infected77,79 with S. aureus than are female neonates. In one study, the male-female infection rate was 3:179, in another it was 6:1.77 High male-female ratios have also been reported in outbreaks of neonatal scalded skin syndrome.80-82 Authors of these reports speculated that the circumcision site may be particularly susceptible to bacterial growth. 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.
Now we have established several things: MRSA is a growing concern, and some have speculated that there could be a connection between MRSA infection and circumcision, though the evidence is not clear. Also Doctors Opposing Circumcision has also expressed conceern. We can also say that a hospital been able to control an outbreak of MRSA by stringent hygiene [37]. Finally, we could say that MRSA has caused widespread concern about the welfare of vulnerable newborns, especially premature babies. [38].
I think this information is relevant to an article on circumcision. The question is how to put it into the article, or at least link it, in a way that is accurate and fair. I don't think that this is a big ask, and when we do this it will enhance the article. Michael Glass 07:50, 18 March 2006 (UTC)
Michael Glass 07:50, 18 March 2006 (UTC)

Michael, if you read the paragraph you quoted carefully, you'll see that it is S. aureus, not the specific strain MRSA, that previous authors have speculated about. I have searched PubMed for circumcision and MRSA (with variations), and the only study that I have found is this one, which rejects the notion. Until something can be found in reliable sources linking MRSA to circumcision, there is no reason to include it in this article.

Frankly, it's irrelevant that DOC have expressed concern, since they are not a reliable source. It is interesting to note, however, that George Hill issued three press releases on behalf of DOC within the past year or so, each expressing 'concern', and each within days of new HIV findings being reported in the news. Jakew 11:35, 18 March 2006 (UTC)

Thanks for your comment, Jake. You are right that the paragraph did discuss golden staph (s. aureus), and evidence about the danger of this form of infection.should be linked to the article. MRSA is a methycillin resistant strain of s. aureus. The spread of this form of golden staph is a growing concern, and I think it should be mentioned, if only to say that no links with circumcision have yet been reported.
You have said that DOC is not reliable. Is this just because they don't agree with you, or do you have any hard evidence of a lack of reliability? In particular, do you have any evidence that their statement on MRSA [39]contains any inaccuracies? Michael Glass 12:29, 18 March 2006 (UTC)
DOC do not meet the criteria in WP:RS, Michael. It's as simple as that. As soon as anything proposing or (better) supporting a link with circumcision appears in a peer-reviewed journal, I have no objection to its inclusion, but Wikipedia is not a propaganda vehicle, and should not cite what is in effect a press release from an activist group.
As for your suggestion that the article should say that no links have yet been reported, that's simply bizarre. There are an infinite number of links that have not yet been reported, from alien kidnapping to impromptu opera performances. We don't report on these, do we? Jakew 13:08, 18 March 2006 (UTC)

Funny, I was just reading WP:RS and came upon a section that says: "However, that a source has strong views is not necessarily a reason not to use it..."

Maybe you could be more clear about what in specific prevents DOC from being reliable. I just don't see anything there that seems to apply. Please help me out. Alienus 13:10, 18 March 2006 (UTC)

You omitted the rest of that sentence, which says: "although editors should avoid using political groups with widely acknowledged extremist views, like Stormfront.org or the Socialist Workers Party. Groups like these may be used as primary sources only i.e. as sources about themselves, and even then with caution and sparingly, or about their viewpoints." It also began: "Do they have an agenda or conflict of interest, strong views, or other bias which may color their report?"
Other relevant aspects include:
"Have they reported other facts reliably, including on different subjects? Cross-check with what you already know."
"Certain "red flags" should prompt editors to examine closely and skeptically the sources for a given claim. ... Surprising or important facts which are not widely known. ... Claims which are not supported, or which are contradicted, by the prevailing view in the scientific community. ... Claims which strongly support one or another party in an ongoing dispute."
"Cite peer-reviewed scientific journals and check community consensus ... Scientific journals are the best place to find primary source articles about scientific experiments, including medical studies. The best scientific journals are peer-reviewed, which means that independent experts in the field are asked to (usually anonymously) review articles before they are published. This usually results in corrections and improvement, sometimes substantial. Many articles are excluded from peer-reviewed journals because they report questionable (or perhaps merely unimportant, in the opinion of the editors) results."
"Publications with teams of fact-checkers, reporters, editors, lawyers, and managers — like the New York Times or The Times of London — are likely to be reliable, and are regarded as reputable sources for the purposes of Wikipedia. ... At the other end of the reliability scale lie personal websites, weblogs (blogs), bulletin boards, and Usenet posts, which are not acceptable as sources. Rare exceptions may be when a well-known professional person or acknowledged expert in a relevant field has set up a personal website using his or her real name. Even then, we should proceed with caution, because the information has been self-published, which means it has not been subject to any independent form of fact-checking."
I think it should be fairly clear, now. Jakew 13:40, 18 March 2006 (UTC)


Not really. I'll break it down for you, since you mostly quoted from the WP:RS page without explaining how it relates to the issue at hand.

1) I don't see how DOC qualifies as a political group with widely acknowledged extremist views. Do you?

2) Note that, even for truly extremist groups, like Stormfront.org, it's still acceptable to quote them on the one subject where they are still largely reliable: their own views. You'll note that, rather than stating factually that CA-MRSA is a significant risk in circumcision, the text in question merely states that this is the view of DOC.

Precisely because DOC is an advocacy group, its beliefs on this matter are relevant and should be reported, albeit neutrally. We achieve this neutrality by also mentioning the lack of support from medical studies. Given all this, do you see anything POV about this text?

3) If you have any examples of DOC misreporting other facts, please share.

4) Are you claiming DOC raises any of the "red flags" mentioned? If so, please specify.

5) The section on peer-reviewed scientific studies supports the inclusion of the text, since we reference such studies.

6) Are you suggesting that an advocacy group is as amateur as a blog?

In short, I don't see any problem here. You'll have to explain. Alienus 13:49, 18 March 2006 (UTC)

Ok, 1) They hold a political agenda. To quote Chessler: "With the formation of DOC (Doctors Opposing Circumcision), a campaign to ban routine infant circumcision is underway.384" [40] Groups including DOC are described as extremists in the Washington Post (see republished article here).
2) While it is accerpable to quote extremist groups on their own views, sparingly, the article is about evidence, not the opinions of activists. Were it an article on DOC, it would be appropriate to include their views, but this is a scientific topic requiring credible, peer-reviewed scientific evidence.
3) No problem. For example, here is a DOC press release relating to an HIV study. It refers to a WSJ article, which may be found here. The study was later published here. There are several faults. Firstly, the author tries to imply bias, suggesting that Robert Bailey sponsored the study. In fact, as you can see from the links, the lead researcher was Bertran Auvert, and the study was sponsored by ANRS. Secondly, he claims that UNAIDS have cautioned against circumcision. If you read the UNAIDS/WHO joint statement, you'll see that they do nothing of the kind. The author claims that the WHO "fear a false security from having been circumcised, and reduced sensitivity in the penis, may cause an increase in risky, sexual behavior and a decline in condom use leading to increased transmission of the virus." In fact, if you read their statement, you'll see that they say nothing about penile sensitivity whatsoever - this is a misrepresentation.
4) Yes, DOC raises every one of those red flags. The alleged MRSA link is a surprising or important 'fact' that is not widely known. The claim, among other claims made by DOC, is not supported by the prevailing view. Note that the vast majority of their references predate the evidence-based policy statements from medical organisations that they criticise for being 'outmoded'. The claim also explicitly supports the anti-circumcision side of the circumcision dispute.
5) DOC's statement does not meet this criteria, and the only peer-reviewed study offered so far does not support the link.
6) No, I'm stating that a) there is no reason to believe that DOC has teams of fact-checkers (indeed, the vast majority of their publications are from a single retired airline pilot). b) it is a self-published report from a small group of activists with a website. It may not be strictly a personal website, but on a scale of 0 to 10 where 0 is a blog and 10 is, say, the British Medical Journal, it doesn't rate highly. Jakew 14:26, 18 March 2006 (UTC)

1) Yes, they're an advocacy group, so they necessarily hold a political agenda. I don't see how that disqualifies them. Balacing their political view is the fact that some of the members are doctors, and are therefore professionally qualified to speak about such matters as CA-MRSA.

2) Reading that article made me wish it was on Wikipedia, so I could correct some of the worst excesses of POV. The author doesn't single out DOC but instead referrs to all anti-circumcision as extremists, which is just plain nuts. In any case, one reporter's opinion not suffice to show that DOC is widely regarded as extremist. At best, it shows that the reporter is an extremist.

3) As an advocacy group, we can expect that they'd have their own interpretation of the motives of those who oppose them. This is the realm where bias exists and should be noted. However, a simple statement that CA-MRSA applies to circumcision is medically obvious and uncontroversial. After all, CA-MRSA applies to any surgery.

Now, a separate issue is whether the risk of CA-MRSA after circumcision is at all significant, or even measurable. The one study we have is ambiguous, as it does not CA-MRSA infections in the genital region, but not on the head of the penis. Note how the text we're discussing mentions this study and links to it.

4)Again, as an advocacy group, we should expect them to mention the facts that support their view but not necessarily the ones that undermine it. This makes them biased in terms of coverage, but doesn't undermine the validity of what they do say. A good indication of this is the fact that DOC's statement is reported in medical publications (not as a peer-reviewed study, which it doesn't claim to be, but as a news item worth printing). In fact, the first link that comes up when I google "CA-MRSA circumcision" is for BMJ.com, "The general medical journal website". It's also noted on such circumcision-neutral sites as mrsaresources.com, tahilla.typepad.com/mrsawatch, news.bigg.net, and www.emediawire.com.

5) Once again, stating that DOC is right would require a clinical study. Instead, we're reporting what DOC said and then offering a study that is inconclusive.

6) Good thing we're not claiming it's a medical study. The statement is, however, consistent with a medically reasonable opinion, which is all it claims to be.

Frankly, you are holding it to inappropriately high standards. It's a brief, relevant and neutral statement. Alienus 22:14, 18 March 2006 (UTC)

1) Since they are a) a political group, and b) (according to at least one observer, though I'm sure I can find others) are extremist, they are unreliable according to WP:RS. It is true that at least two of their number are doctors, though that is no guarantee that they are reliable on such matters, but the statement is unsigned. Even if it were clearly written by somebody medically qualified, that would be no more reason to disregard the other problems than if the leader of the Socialist Workers Party had a doctorate in political science.
2) See 1.
3) The fact that they have incorrectly identified the sponsor of a study, and have also misrepresented the views of UNAIDS, is evidence that they are unreliable as sources. I also notice, incidentally, that the text we're discussing conveniently omits the conclusion of the study we're discussing.
4) Could you give the link to the BMJ.com page? When I google for this I find nothing. For MRSAresources.com I can find only blog entries, tahilla.typepad.com/mrsawatch/ appears to be another blog, and emediawire is a PR service that DOC used to issue a press release.
5) We should not report what DOC says because they are not a reliable source.
6) And so once again, it fails to meet the criteria.
Finally, any neutral statement would mention the fact that the study was not able to confirm the hypothesis. It is by no means neutral.
I'm sorry that you find these standards inappropriate. I wish you luck in lobbying to relax them. In the meantime, policy is policy. Jakew 22:39, 18 March 2006 (UTC)

The problem here is that we disagree on the interpretation of policy. Now that you're speaking entirely in conclusions, there is no point continuing to act as if you have an open mind. I'm going to take the next step.

References

The article includes two books in the 'references' section, yet the article itself does not refer to them in the text. This is not helpful to readers, is unprofessional, and is likely to cause confusion.

I therefore propose to do one of the following:

  1. Delete this section.
  2. Rename it to something more appropriate ('further reading' springs to mind).

Comments? Jakew 10:50, 13 March 2006 (UTC)

Good idea. If it's not really used as a reference, then it should be descibed as "Futher reading" or something similar. Jayjg (talk) 18:26, 13 March 2006 (UTC)