User talk:Williamwells
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NPOV and NOR
Hi William. Please will you familiarise yourself with our policies on maintaining a neutral point of view and avoiding original research. Thanks! Jakew 10:37, 15 November 2006 (UTC)
I am responding to your note both here and on my page..please just delete this after you read it. I am still getting the hang of the "internal mail" and clearly this doesnt really go here. Happily it can be deleted in seconds after you read it.
Did that (read the suggested sections) prior to edits submitted. Added based on conclusions currently used in pediatric practice and based on multiple neutral systematic reviews by such organizations as Cochrane.
I provided no original research "on purpose" - though I may have done so accidentally. Perhaps I could have re-referenced some statements but they have already been wonderfully provided elsewhere in the article and I did reference those that fit. If I left a major statement unsupported please point this out and I will fix the issue.
I added a relatively detailed explanation in plain english about conducting a risk to benefit analysis that follows the analysis in the paper referenced immediately above the explanation. This is not intended to be original research, rather a plain english description of a difficult subject that I have specific experience in teaching to medical students and residents (and I did not see explained anywhere else).
One cannot conclude that when a conclusion is arrived at through the analysis of undisputed evidence that one's opinion is somehow biased. If that were true, then I must non-neutral concerning the flatness of the planet.
Multiple well-established studies have determined "ranges" of risks of UTI and harm from circumcision. Choosing the best and worst case scenarios, there is no benefit to a population in the procedure and this article was not reflective of this analysis that has been adopted by virtually all governmental and specialty medical organizations on the planet. The original entry continued to refer to the "public health benefit" aspects of circumcision as in dispute. This is untrue.
Similarly, most people consider the planet round. Just because a few think it is flat does not provide a forum for "equal representation" of the flat earth society in a discussion of geology. At best they would be a footnote.
Given the predominance of evidence (not just opinion in this one subsection) is it no longer reasonable to describe a public health controversy. Perhaps in social or ethical considerations, but the public health aspects are rather mathematical - an answer can be calculated in this paragraph, and I have explained the concept in detail. I hope this ads to the complexity of the topic and helps someone reading this section to understand the concepts I outlined. I personally have no opinion when it comes to the social aspects of circumcision but just like I have an opinion about the answer to 2 x 2 = 4 being correct I will continue to explain how the risk to benefit analysis doesnt allow us to say circumcision is a recommended public health measure to prevent ANY condition, period. This simply is not a controversy in current public health/epidemiology literature. Some aspects of the subject do require further research but this does not in itself imply disagreement over the current data.
I hope that clarifies the edits. I use this site extensively in my teaching and research when I read the entry I felt it only fair that I contribute in this area since this one portion of the entry is clearly incorrect. There are more areas of reference to the public health benefit of circumcision, but I have already spend more time than I should have spend on this issue tonight.
As for my qualification to make revisions, I am not a particular authority on the subject but I am currently the faculty physician assigned to our hospital's newborn nursery/ mother baby unit and I must make treatment decisions based on these very principals on a daily basis. I have training in evidence based medicine (though I do not have an MPH) and frequently teach these concepts in my practice.
I wholeheartedly support the right of parents to make desicisions based on available evidence and without scaring them into a decision based on false science. Seems you are one of the few people who were able to make a truly informed decision and give informed consent for the procedure. —Preceding unsigned comment added by Williamwells (talk • contribs)
- William, please don't worry about making mistakes as you learn the 'internal mail' system, as you put it. If it's ok with you, I won't delete the above, but will reply to you here (this has the benefit that other people can see the whole conversation without having to flick between pages).
- I want you to understand that I am not suggesting that your edits are factually incorrect, nor that you are unqualified. On the contrary, with a few exceptions, I would fully support using similar material (properly published elsewhere) as sources for the article(s). My concern, however, is that they do not fully conform to the policies I mention.
- Please correct me if I'm wrong, but I believe that one of your statements above ("multiple neutral systematic reviews by such organizations as Cochrane") may indicate an incorrect understanding of NPOV policy. NPOV does not mean selecting a neutral point of view and then presenting that as fact. It means, to quote, "None of the views should be given undue weight or asserted as being the truth, and all significant published points of view are to be presented, not just the most popular one. It should also not be asserted that the most popular view or some sort of intermediate view among the different views is the correct one. Readers are left to form their own opinions."
- There is little doubt that circumcision is a controversial subject, and both the British and American medical associations acknowledge a wide range of opinion among their membership. A similar range of opinion can also be found in the literature (even among evidence-based analyses, which we should remember are not entirely mathematical and objective, but require the guidance and judgement of a human author). I have no doubt that every single author, every physician, considers his or her opinion to be fully based upon the available data, and would argue that they are unbiased. Fortunately we don't have to decide who is right: we only have to report upon the differing views. :-)
- Finally, may I express how pleased I am that Wikipedia is proving useful to you in your teaching.
- Jakew 12:30, 15 November 2006 (UTC)
I think we may disagree on that fact. How does one have an opinion about the solution to a quadratic equation (other than the sign of the answer)? Opinions are a social construct and are best placed in an appropriate heading designed to present them. Opinions aside, there ARE elements of circumcision that are controversial, and some that are simply factual. This type of controversy is based on the lack of available or properly designed data and can be sorted out with additional study. I will cite the example of the roundness of the earth again to illustrate.
Whereas we can present both sides of a debate at to whether or not a particular tribe agreed upon this fact as based on carbon dating of artifacts is certain. These can be opinions, and still based on data - but with data that cannot provide adequate resolution to provide an answer to one's particular question. If the dating was to the year 1000AD +/- 200 years, and the artifact depicted a round earth, you will have a difficult time supporting your argument that the theory was not developed until 1500ad. If this is still your "opinion" then it is uninformed.
We cannot, however, present "opinions" within elements of an entry about this as if they were facts without support. There are uninformed opinions, and the interpretations may change as new data is made available, but risks and benefits can and have been calculated for this procedure. To present opposite "opinions" when experimantal data exist is ignoring facts and this type of contruct then becomes part of the social or political aspects of circumcision. This deserves to be included in the subject treatment, but not as if the experimental supported the practice. To do so is being dishonest or ignoring facts to present opinion. There arent multiple sides to this kind of data - there is merely an interpretation of the data and so far as epidemiology is concerned nobody is arguing about how to calculate risk to benefit rations.
I will grant you for example that some people say that 100% of penile cancer is preventable (at the cost of 6 complications per case prevented) and that is in fact true. Epidemiology states that this is too little benefit to recommend circumcision with no other pre-existing risks. Perhaps someone wants to argue with these issues under the subject of "epidemiology" or "evidence based medicine" but dont present that under circumcision as this is misleading to those who do not understand these issues. I count on the collective knowledge of the large group to edit these entries and I have not been disappointed. I feel I should return the favor with an unambiguous stand on known, factual experimental data. The social issues I will observe from the sideline. As it is accepted fact that the planet is essentially round, the flat-earthers may be mentioned for completeness in the historical descriptions of the history of navigation, but deserve no space whatsoever in the section on cartography.
With circumcision, all ethical, social, religious matters aside, it is a computation to determine risk and benefit. These computations may change with further research, but with facts in hand we can show that if we calculate in favor of and against circumcision, we will circumcise 100 or 200 newborn males before we prevent a urinary tract infection in one of them. One of every 100 babies we circumcise will suffer some untoward complication from the procedure. No amount of "explaining" will ever make this data interpreted as a favorable risk to benefit ratio unless the meaning of "favorable" is changed within the science of epidemiology. Therefore circumcision, from a public health standpoint, is not indicated to "prevent" any disease in a normal patient and there exists no valid argument against that. Throw me any argument and I can mathematically show you evidence to refute all comers including cancer, HIV, cleanliness, any infection, etc.. I have nothing to stand on to show you if I will be reincarnated or admitted into heaven achieve nirvana, etc. if I do/dont circumcise my son/daughter.
My goal is to remove the ambiguous statements from only those sections where such statements remain that imply that a medical benefit is enjoyed by NORMAL newborn male infants as a result of circumcision. There simply is no controversy among informed scientists as to this fact. There may be those with opinions to the contrary but I again cite my description of the flat earth society.
If I say there is no controversy as to the planets resemblence to a pancke, only those unfamiliar with the scientific method will continue to protest. Only those who do not understand how to calculate risk, benefit, pretest probability, NNT/NNH will continue to claim that an argument exists here. Sometimes one must draw the line. Circumcision may have value to some individuals for personal/religious reasons but it is never a medically indicated therapy when performed on a normal newborn infant. It is no different from a tattoo or a piercing. Personal benefits but no medical improvements. It exerts no evolutionary pressure on the fitness of the species whatsoever. Opinion doesnt enter into it.
As for editing to conform to Wikipedia's standards, I need lots and lots of help as I am not a writer by trade. I will revamp things and try again to be certain to cite specific sources but again I will not be citing any proof of the 2D earth as there is none.
Williamwells 15:56, 15 November 2006 (UTC)
- William,
- Thank you for your reply.
- There seem to be two aspects where we seem to disagree (and again, the disagreement is largely on what should or should not be included in the article, not a fundamental disagreement).
- Firstly, as I've tried to explain to you already, NPOV policy requires presenting all main points of view, without presenting any as fact. That is not negotiable, and I'm afraid that you'll have to accept it eventually, like it or not.
- Secondly, you still seem to be insisting that evidence-based analyses are a mathematical certainty, like solutions to a quadratic equation. I think this is unrealistic.
- Since you seem to want to talk about it, let's take UTIs as an example. The outcome of any analysis depends upon at least the following:
- The relative risk of UTI in uncircumcised males
- The absolute prevalence of UTI in uncircumcised males (or the means to calculate this)
- The absolute risk of complications in the circumcision procedure
- The former is perhaps the easiest to agree upon: generally one would use a meta-analysis of published work in the field. But even here there's a human element, because the inclusion criteria for such an analysis would be defined by a human, and the searches done by a human, and these choices can influence the outcome. Singh-Grewal et al (Arch Dis Child 2005 Aug;90(8):853-8) reported an OR of 0.13, which is more or less the figure you state.
- The second is slightly trickier. You can get a range of figures, depending in part upon the age range of the persons studied. Jakobsson et al (Pediatrics. 1999 Aug;104(2 Pt 1):222-6) give a cumulative risk of 2.2% by 2 years of age. Singh-Grewal, citing three studies, take a range of "1% to 2%", and then base their calculations on a rate of 1%. Correct me if I'm wrong, but to my knowledge nobody has established this rate with the thorough, methodical, approach used in a typical meta-analysis. The base data for these critical calculations seems to be merely an estimate.
- The third is much trickier, for there is such a wide range of data, perhaps reflecting different definitions of what, exactly, is a complication. Schoen (Arch Dis Child. 2005 Aug;90(8):772-3), criticising Singh-Grewal's work, pointed out that their choice of a 2% complication rate was 3 to 10 times higher than that (0.2-0.6%) cited by the AAP. Again, I'm not aware of any methodical approach to this question, but a guess seems a poor basis for an unarguable mathematical truth.
- As I think I've shown, NNT and NNH calculations are only as good as the raw data, and that is often selected by humans, which introduces a certain amount of subjectivity. Jakew 17:45, 15 November 2006 (UTC)
(deleted post from permanently banned user)
Bill,
Thanks for your in-depth reply, and for your kind offer to obtain articles.
As you rightly suggest, the work needed is on the form, rather than the content of your proposed additions. It can be difficult to adhere to NPOV policy at times, especially when the truth of one argument seems obvious. As a rule of thumb, I find that replacing "the sky is blue because..." with "Smith argues that the sky is blue because..." solves the problem very nicely.
I would like to address some of your points in a moment, but I wonder if we may have slightly different objectives here. My objective is to show you that there are points of view other than your own that may have some validity. I don't, however, intend to convince you that they are correct (I'll gladly try elsewhere, but this is not the place). I greatly admire the goals of evidence-based practice, but there is still a lot of room for human error and (perhaps) bias to manifest itself. Consequently I don't believe that we can yet divide results into "provably true" and "provably false".
The American Medical Association indicate otherwise: "Debate on the wisdom of routine circumcision centers on the possible benefits offered by circumcision, and whether they medically justify the risks associated with the procedure." Likewise, the British Medical Association state: "There is a spectrum of views within the BMA’s membership about whether non-therapeutic male circumcision is a beneficial, neutral or harmful procedure or whether it is superfluous, and whether it should ever be done on a child who is not capable of deciding for himself."
I have no reason to disbelieve these associations (especially when the literature confirms their claims). There is a spectrum of views, and policy requires us to represent them fairly, even if we think that they're wrong.
Now, to return to our discussion, I note that you're now limiting discussion of UTIs to those that cause renal scarring. While that is not unreasonable, surely we should restrict the complications to those of similar magnitude?
Furthermore, is it really meaningful to compare a single benefit (eg., reduced risk of UTI) to all complications? With most decisions, we tend to weigh all the "pros" against all the "cons". I see no reason why this should be an exception. Indeed, as I'm sure we're both aware, there are decision-making tools available. My view is that these tend to suffer from the same problems that we've discussed previously: while they appear rigorous and mathematical on the surface, they are still subject to much subjectivity.
I would also suggest that any analysis is likely to be specific to a given country. For example, in parts of sub-Saharan Africa, where the HIV rates are ~30-40%, the reduced risk is likely to have more impact on the results than, say, in the USA. We must remember that Wikipedia is a global resource.
I hope that the above makes sense. If not, my excuse is that I've not had enough sleep. :-) Jakew 18:10, 16 November 2006 (UTC)
Your contributions
Dear Mr Wells,
I was interested to read your comments on circumcision. I thought they were quite reasonable. Unfortunately, a few users are adept at using policies such as 'neutral point of view' and 'no original research' as weapons in their culture war on behalf of their favourite cause. However, I can assure you that these people are just as liable as others to depart from the policies that they try to enforce on others. So their language, in turn, can be revised to ensure that the elusive 'neutral point of view' will be more closely adhered to. Michael Glass 02:07, 22 November 2006 (UTC)
