Talk:Circumcision

Circumcision much less relevant to HIV in the US

Please see this text from the cited reference[[1]]:

Conclusion 7: Programmes should be targeted to maximize the public health benefit

The population level impact of male circumcision will be greatest in settings (countries or districts) where the prevalence of heterosexually transmitted HIV infection is high, the levels of male circumcision are low, and populations at risk of HIV are large. A population level impact of male circumcision on HIV transmission in such settings is not likely until a large proportion of men are circumcised, although benefit to the individual is expected in the short term. Modelling studies suggest that universal male circumcision in sub-Saharan Africa could prevent 5.7 million new cases of HIV infection and 3 million deaths over 20 years.

The greatest potential public health impact will be in settings where HIV is hyperendemic (HIV prevalence in the general population exceeds 15%), spread predominantly through heterosexual transmission, and where a substantial proportion of men (e.g. greater than 80%) are not circumcised.

Other settings where public health impact will be considerable include those with generalized HIV epidemics where prevalence in the general population is between 3% and 15%, HIV is spread predominantly through heterosexual transmission and where relatively few men are circumcised.

In settings with lower HIV prevalence in the general population, including where HIV infection is concentrated in specific populations at higher risk of HIV exposure, such as sex workers, injecting drug users or men who have sex with men, limited public health benefit would result from promoting male circumcision in the general population. However, there may be individual benefit for men at higher risk of heterosexually acquired HIV infection such as men in sero-discordant partnerships and clients presenting at clinics for the management of sexually transmitted infections. There is insufficient evidence to suggest that circumcision reduces HIV transmission among men who have sex with men.

The US (and all other English speaking and Western countries; added 12.6.09)) meets none (less than 1% prevalence, and spread primarily by homosexuals) of the above criteria for inclusion in the UN programe. Therefore, the last sentence in the introduction is misleading because this information is not relevant to most readers. But it's in the introduction! Why is this minor medical info in the introduction at all?.

At a min, we could "add public health benefits are minimal where prevalence is below 3%" to that last sentence. But again, as I think about it, the whole sentence should be deleted.Zinbarg (talk) 00:18, 2 December 2009 (UTC)

If this were USPedia, you might have a point, but since it isn't, you don't. Wikipedia is global in scope, and is about circumcision in general. The population of the US is 308 million, that of the globe is 6,800 million. To imply, as you do, that 95% of the world's population don't matter, is frankly offensive.

The second mistake you've made is to conflate two issues. The first, which is mentioned in the introduction, is whether circumcision reduces the risk of female-to-male transmission of HIV. A secondary issue is whether circumcision programmes should be introduced as a result, and if so, where. Jakew (talk) 09:51, 2 December 2009 (UTC)

You're smarter than that Jakew. The same statement (using the 3% threshold for "consideration" of circ as a health measure) can be said for nearly all the countries in the world. Rates in Muslim countries are all far far less than 3%. HIV/circ info is not relevant to the vast majority of the world's population.

The introduction has already treated medical issues fully in the pro/con, and in the medical assiciation sentences. Medical associations have considered HIV protection benefits when making their recommendations. Your forcing minor hiv prevention benefits into the introduction after the medical association position statement is biased pro circ, and POV unacceptable.

"Consideration" is a strong word, because for example in Africa spending on circ's would crowd out spending on vaccinations which return 100x the cost equivalent longevity benefit. Your "frankly offensive" is therefore grossly misplaced.Zinbarg (talk) 15:30, 2 December 2009 (UTC)

I've placed a POV tag on Circumcision until this issue is resolved.Zinbarg (talk) 15:54, 2 December 2009 (UTC)

Zinbarg, first if you mean "the US and other countries" then you need to say that. If you say "the US" then you can't blame me for assuming that you actually mean "the US".

Second, I'm not sure where you've found the word "consideration". The source you cited above uses the term "considerable". Is that what you mean?

Third, the source you've cited does not present 3% as a reversible "threshold". It states that "settings where public health impact will be considerable include those with generalized HIV epidemics where prevalence in the general population is between 3% and 15%..." (emph. added). Note the use of the word "include", which indicates that this is not an exhaustive list of criteria, and it is not therefore a reversible statement.

Fourth, even if ignore my previous point for the sake of argument and assume that public health impact is not "considerable" in a particular country, that does not mean that circumcision or information about it is irrelevant. It just means that the expected public health impact of circumcision programmes is less than considerable.

Fifth, most of the other medical association sentences, and certainly the 1999 AMA statement quoted in the lead predate the three randomised controlled trials that led the WHO and CDC to issue their statements. In order to give a more complete picture, therefore, it is necessary to cite these medical associations as well. Also, doing so helps to "explain why the subject is interesting or notable" and "summarize the most important points" (WP:LEAD). Jakew (talk) 15:59, 2 December 2009 (UTC)

The vast majority of readers of this wiki article are english speaking Americans. I see other languages have their own wikis, which implies a focus of this version on US readers. Regardless, it's only relevant to a few countries or a minority of global readers but you have it in the introduction as though its a VERY important part of the article. You make it much more important than other medical considerations and costs. That's POV bias.

Yes, consideration is from "considerable." If it's not considerable, it's left out of consideration (out of the range of high enough significance).

The sentence states that under 3% will have less than considerable impact on public health. "Include" means that other issues may not be considered here. For example, positive impact (of circs) requirements would "include" availability of hygenic procedure settings and methods. We already covered medical issues in the introduction in the two prior paragraphs.

We use the AMA only because we can quote them thus covering ~all other associations. Most individual association statements are recent enough to have considered hiv benefits found in studies (cited by WHO and CDC), most conducted between 2000 and 2005. For example, the AAP is 2005, CPS 2004, BMA 2006, and the AAFP reaffirmed in late 2007. Don't just look at the dates of the WHO and CDC statements (look to the underlying research).

Again, it is a benefit already covered in the introduction as a medical issue. Without bias. Placement after the AMA paragraph, and placement in the introduction puts undue weight on the information and is pro circ bias.Zinbarg (talk) 17:24, 2 December 2009 (UTC)

First, Zinbarg, there is little doubt that HIV/AIDS is an important aspect of circumcision, as can be seen from the attention given to the subject by reliable sources. A considerable fraction of papers about circumcision have focused HIV, and this fraction is increased further if you consider papers published in the past few years.

Second, you've misunderstood the sentence. As I explained, the word "include" indicates that prevalence of >3% is one of several factors leading to considerable public health impact. Consequently, as I stated, although a prevalence >3% may indicate considerable public health impact, that's not reversible: considerable public health impact does not require a prevalence >3%.

Third, the AMA discusses other associations at the time. However, the randomised controlled trials cited by the CDC and WHO were published in 2005 and 2006. Very few statements have been published since then; the AUA's statement is the only one that springs to mind. Jakew (talk) 17:55, 2 December 2009 (UTC)

"Attention given" is subjective. Recent attention doesn't mean it belongs in the lead. It's a known health benefit, but you present the information so that it subjugates the prior pro/con (includes medical) advocacy and the medical association paragraphs. You overweight the importance of HIV benefits relative to religious and cultural reasons, which are the primary reasons for almost all circumcisions.

We won't agree on "reversible." You know statistics; it's actually reversible. Instead look to the next paragraph in the WHO statement: "In settings with lower HIV prevalence in the general population, including where HIV infection is concentrated in specific populations at higher risk of HIV exposure, such as sex workers, injecting drug users or men who have sex with men, limited public health benefit would result from promoting male circumcision in the general population." In other words, VERY limited benefit for the vast majority of our readers, or of those who circumcise. But you force it into the lead, apart from the prior medical related paragraphs. VERY few circumcisions are done for medical reasons. This presentation in the lead is POV.

The HIV preventive benefits from circumcision were known well before 1999 (pre AMA statement) with the first meta in 2000. Looks like the WHO cited studies are 2000, 2007, 2005 and 2007. The CDC cited studies from 1999 to 2007 (2000, 2006, 2000, 2003, 2000, 1999, 2005, 2007, 2007, 2006). The RACP statement came out in 2009, the CPS in 2004, the AAP reaffirmed (not recommend) in 2005, and the BMA in 2006, so all would have considered HIV benefits. Note the CDC doesn't recommend circumcision in the US, and the WHO recommends conditionally.Zinbarg (talk) 00:50, 3 December 2009 (UTC)

Zinbarg, the present arrangement, consisting of the sentence about the WHO, etc., as well as the AMA sentence, has been the subject of long-standing consensus for a long time. It represents an attempt to represent the views of most medical associations via the 1999 AMA statement (admittedly outdated, but the best we have), and also documents another, more up-to-date statement from a globally influential medical organisation - the WHO. The two serve to balance each other: citing the AMA but not the WHO would give an outdated view skewed against circumcision, whereas citing the WHO but not the AMA would, perhaps, suggest stronger support for circumcision than is the case.

To an extent, the attention given to HIV is objectively verifiable. By checking Google Scholar, for example, we can confirm that there are 87,300 articles referring to circumcision, of which 14,800 (17%, roughly 1 in 5) discuss HIV. If we consider papers published in the last decade (since 1999), 14,400 and 9,100 (55%, roughly 1 in 2) respectively. The conclusion is difficult to escape: as a fraction of the text in the lead, the single sentence given to HIV is about the same as even the lowest of those percentages, let alone the more recent papers that represent more current scholarship on the subject. To remind you, Wikipedia articles are supposed to reflect the weight given to various aspects of the subject in reliable sources.

As I've stated several times now, the randomised controlled trials that led the CDC and WHO to publish their statements were published in 2005 and 2007 (Sorry, I erroneously said 2006 before; that was the date of the press release announcing the results of the latter two, the respective papers were not published until early 2007). It is true that papers have been published on the subject dating back to 1986, but due to the design of other studies, they were not considered sufficiently strong evidence (see, for example, the 2003 Cochrane Review and compare with the current Review. Also see this August 2006 press release from WHO stating that "WHO, UNFPA, UNICEF and the UNAIDS Secretariat emphasize that their current policy position has not changed and that they do not currently recommend the promotion of male circumcision for HIV prevention purposes. However, the UN recognizes the importance of anticipating and preparing for possible increased demand for circumcision if the current trials confirm the protective effect of the practice."). You might find Circumcision and HIV helpful.

So, if we consider the policies that you mention: the 2009 RACP update appears to have been withdrawn (at any rate it doesn't seem to be on their site any more), and in any case was a preliminary document lacking a detailed discussion of the evidence. The 2004 CPS statement and 2005 AAP reaffirmation predated the trials. Only the BMA post-dates the publication of one trial, and that document specifically avoids discussion of the medical harms or benefits, stating "The Association has no policy on these issues", so it can't meaningfully be included.

Since the sentence is about an effect of circumcision, rather than asserting a reason for it to be performed, I don't see the relevance of your comments about reasons. Jakew (talk) 11:02, 3 December 2009 (UTC)

Doing away with the indentation, you're correct in that HIV/circumcision is a hot topic recently in research. I guess I don't mind mention of the WHO and CDC statements in the lead, but that should be in the AMA (ie medical) paragraph and carefully written. It should be clear to the reader that the CDC does not recommend circumcision in the US, and the WHO effectively recommends only several countries in Africa (see[[2]]). Those conditions mean they don't recommend in English speaking countries, or in countries where almost all circumcisions currently take place.

I have very limited experience with "consensus." Please focus on verifiable fact without propaganda. Putting the HIV info in it's own paragraph in the lead is propaganda, made worse by its' placement at the end of the introduction, placement away and after the medical and pro/con paragraphs and, and by not noting the WHO conditions for relevant public benefit.

I understand the gold standard studies in 2005 and 2007. Regardless, the RACP, BMA, and AAP statements came after at least the 2005 study (confirmation). Lets not speculate on the RACP. The relevant BMA quote is: "The medical benefits previously claimed, however, have not been convincingly proven, and it is now widely accepted, including by the BMA, that this surgical procedure has medical and psychological risks. It is essential that doctors perform male circumcision only where this is demonstrably in the best interests of the child." The BMA has no opinion about religious circumcisions. The AAP came out in April 2005, but one of the gold standard studies came out in Feb 2005, so it would have been considered. If you believe the WHO, the primary basis for Assoc. decisions (cost/benefit) isn't changed where the incidence low and the disease in small (homosexual) demographic clusters. They all do not recommend routine "medical" neonatal circs.Zinbarg (talk) 16:04, 3 December 2009 (UTC)

It's difficult to imagine how the information you propose including could be expressed concisely, accurately, and with appropriate sourcing. However, I'm willing to consider a concrete proposal. What specific changes do you have in mind? Jakew (talk) 16:25, 3 December 2009 (UTC)

I agree with Zimberg in wondering why that statement is in the introduction. It isn't a primary or defining point about what circumcision is, it is controversial (the African studies researcher bias has been debated in their journals), and the effect and application is limited in a number of ways. This is a biased statement. At best, it goes down in the HIV section where its scope can be properly qualified. Because this topic has been in the news doesn't mean it deserves 'top billing' here. That would negate the factual, NPOV goals of WP. This isn't a news column or a blog, its an encyclopedia. My opinion is for deletion. Frank Koehler (talk) 16:23, 5 December 2009 (UTC)

I haven't been able to add the gist (removing mucosa reduces m/f intercourse infection) without undue emphasis. The only way I could think of making it relevant was to say it was a hot item in research recently. It's well covered in the HIV section. The lead is much more professional without the HIV paragraph/information.Zinbarg (talk) 19:30, 5 December 2009 (UTC)

(ec) I'm not convinced of Zinbarg's statement that the vast majority of readers of this article are English-speaking Americans, and suspect that's probably mistaken. Even if it were true, I would still oppose writing this article with a pro-US bias or favouring US readers; it should be NPOV, treating all countries of the world equally.

The weight placed on various subtopics should reflect the weight on those subtopics in reliable sources; this should determine the weight in the lead as well as in the body of the article. To get a feel for the weight of the circumcision-and-HIV subtopic, I looked at the first 10 Google Scholar hits in a search for "circumcision" for each of the following years. The number of hits mentioning "HIV" in the title (for the years I happened to check, if I counted right; I worked backwards from 2009, so found myself doing mostly odd years and filled in 2006 and 2008 afterwards) was:

year		1981	1991	2001	2003	2005	2006	2007	2008	2009
Google scholar hits mentioning HIV in title among first 10 hits		0	0	4	3	5	3	8	4	3

While the large amount of attention to HIV might be called "recent", since it seems to pretty well span at least the past 10 years, it's not just a brief spate of media attention, but a significant subtopic in the overall reliable sources. So the paragraph in the lead looks reasonable to me as a reflection of this amount of weight. If some of you feel that the paragraph leaves out some significant points of view about HIV, you can suggest different or additional wording to add to the paragraph, along with arguments that those points of view to be added are given a significant amount of weight in reliable sources. However, I think that the last part of the sentence ("minimal protection", etc.) already gives balance by presenting an alternative point of view, although from the same source.

Your Google hit table is novel, but all you've really done is show that HIV research began when AIDS was first discovered and named. In the grand timeline of circumcision going back millenia, the HIV aspect is just a blip, and it hasn't been proven that circumcision stops AIDS, which also makes the statement misleading. Frank Koehler (talk) 14:17, 6 December 2009 (UTC)

"Intervention" can mean something done to an individual, not necessarily a population-wide program. It's still a fact that these organizations have made these statements, regardless of what country one is in when one reads it or whether that information is relevant to decisions about programs in those countries. I think readers are smart enough to realize that reduction of risk of HIV transmission is relevant only in cases where there is an infected partner. ☺Coppertwig (talk) 20:09, 5 December 2009 (UTC)

I don't have the same confidence you do, Coppertwig. People still believe that smegma is carcinogenic, and that babies don't feel pain during circumcision. Let's not assume any more than we have to. Frank Koehler (talk) 14:17, 6 December 2009 (UTC)

Wait: I thought of a possible wording: appending at the end of the last sentence of the lead "... and also discuss how the health impact of circumcision programmes may vary with setting." (based on the same two references.)

I'm suggesting this to try to address the concerns raised by Zinbarg and Frank Koehler, but I myself don't think it's necessary. I note that the WHO/UNAIDS report also says "9.1 Countries should estimate the resources needed, develop costed national plans and allocate resources for male circumcision services without taking away resources from other essential health programmes." In other words, it seems to be recommending circumcision programmes in all countries. ☺Coppertwig (talk) 23:52, 5 December 2009 (UTC)

I think you are falling into the pitfall of trying to put everything in the introduction. There's an HIV section. Let it do its job. Circumcision is defined as the removal of the foreskin. It is not defined as a proposed AIDS prophylactic. If that were true, then circumcision would not have existed prior to 2001, according to the table above. Frank Koehler (talk) 14:17, 6 December 2009 (UTC)

Recommending only where there will be considerable public health benefit, as discussed above; Copper please read. That's true in no English speaking country. Our audience. It's not relevant to our audience because it's not a considerable health measure. There just isn't enough HIV in the English speaking countries. Medical associations considered the issue, and do not change their recommendations; as discussed above. Being in the news/research is not basis for introduction level relevance in a proper encyclopedia. This is not a blog.Zinbarg (talk) 00:12, 6 December 2009 (UTC)

Hi, Zinbarg. Thanks for your reply. Sorry: could you specify the particular sentence so I don't have to re-read this whole thread? Is it a different sentence from the one Jake explained uses 3% as a minimum but not as a maximum threshold? Perhaps they contradict themselves; the sentence I just quoted seems to recommend public health measures in all countries.

Our audience is not only English speaking countries, but people who read English regardless of whether they're native English speakers or not and regardless of whether they live in a country of predominantly English speakers. Even if the audience were only people in English speaking countries, we cannot assume these readers are uninterested in what happens in other parts of the world.

It's not only in news/research, but is also in secondary sources such as the cited documents, which is what makes it very relevant for this encyclopedia.

I'm not convinced that medical organizations didn't change their recommendations; I thought I remembered an updated set of recommendations from a medical organization that had subtly different nuances. Even if some medical organizations considered the information and didn't change their recommendations, that doesn't change the fact that the WHO and CDC made the statements quoted. If you can find a source that states that medical organizations didn't change their recommendations, possibly some wording could be added based on that.

If medical organizations didn't change their recommendations, that in no way erases the fact that there is extensive coverage of this subtopic in reliable sources. ☺Coppertwig (talk) 01:55, 6 December 2009 (UTC)

Pasted from the top of this discussion, from the UNAIDS citation: "In settings with lower HIV prevalence in the general population, including where HIV infection is concentrated in specific populations at higher risk of HIV exposure, such as sex workers, injecting drug users or men who have sex with men, limited public health benefit would result from promoting male circumcision in the general population."

Also from above from me: The US (and all other English speaking and Western countries; line added 12.6.09) meet none (less than 1% prevalence, and spread primarily by homosexuals) of the above criteria for inclusion in the UN programe. Therefore, the last sentence in the introduction is misleading because this information is not relevant to most readers. But it's in the introduction of this article!

Copper you seem to suggest, and Jakew's purpose is to sow doubt on the current recommendations of medical associations; 1999 AMA, versus 2007 and 2008 for the UNAIDS and CDC statements. That's propaganda and without factual basis. We discussed above the fact that the RACP 2009, CPS 2004, AAP 2005 (3 months after the 2005 gold standard study was published) and BMA 2006 statements all came after strong ie gold standard, HIV studies (even by 2004, when the CPS came out with their update, a strong effect was well known). Pasted from above and tweeked: "The HIV preventive benefits from circumcision were known well before 1999 (pre AMA statement) with the first meta in 2000. Looks like the WHO cited studies are 2000, 2007, 2005 and 2007. The CDC cited studies from 1999 to 2007 (2000, 2006, 2000, 2003, 2000, 1999, 2005, 2007, 2007, 2006). Note the CDC doesn't recommend circumcision, and the WHO recommends conditionally." Again, it's logical that Assoc policy wouldn't change, given the low incidence and demographics of HIV in those (English speaking) respective countries.

Relevant to the article yes, but not in the lead because it's no more relevant (very minor in English speaking countries) than any other medical benefit. It's well covered in the body of the article, and in it's own article.

You said we should add something like "health impact of circumcision programmes may vary with setting." And I want the medical stuff in one paragraph without all those irrelevant dates and fluff. Not that I'm happy about it, but how about:

The Joint United Nations Programme on HIV/AIDS, and the Centers for Disease Control and Prevention state that evidence indicates male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, but also state that circumcision only provides minimal protection and that limited public health benefit would result from promoting male circumcision in the general population. The American Medical Association states: "Virtually all current all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice."Zinbarg (talk) 16:30, 6 December 2009 (UTC)

We got bogged down in "English speaking" stuff. The point is that there are very few countries in the world where there is enough HIV in the population having heterosexual relations to make circumcision a relevant health issue. It could have great impact in some African nations, but that's it. And some African nations are not our audience Copper. So why is HIV in the lead at all? An attempt at propaganda.Zinbarg (talk) 16:43, 6 December 2009 (UTC)

I see several obvious problems with your proposal, Zinbarg:

• It's erroneous. Neither the CDC nor the WHO state that "limited public health benefit would result from promoting male circumcision in the general population".
• Because the AMA sentence appears in the same paragraph, it appears as though the AMA are commenting on the same issue.
• No dates are provided. This actually makes the problem noted above worse, because it appears as though the AMA is a response to the WHO's statement. Jakew (talk) 16:59, 6 December 2009 (UTC)

It's a direct quote (fourth paragraph in Conclusion 7) from the WHO and directly implied by the CDC statement, and it pertains to our audience.

The AMA is in a seperate sentence with it's own citation. The AMA sentence does not read as a response to the WHO statement; it's an associations do not recommend statement. You just feel that way because it doesn't meet your purpose (sow doubt on the current recommendations). No dates are needed because they all are very current.Zinbarg (talk) 17:15, 6 December 2009 (UTC)

It may be a direct quote, but you've stripped away all of the context that acts as a qualifier. The WHO state that in certain settings, limited public health benefit would result, but by removing the context you've made it seem as though they're saying that limited public health benefit would result in any setting.

As noted, dates are needed, and the information should be presented in different paragraphs since the subject of the two sentences is different. Jakew (talk) 17:20, 6 December 2009 (UTC)

This version helps the two sentences be more seperate:

The Joint United Nations Programme on HIV/AIDS, and the Centers for Disease Control and Prevention reviews research finding male circumcision significantly reduces the risk of HIV, but also state that circumcision only provides minimal protection, and that limited public health benefit would result from promoting male circumcision in the general population. The American Medical Association in it’s circumcision policy statement concludes: "Virtually all current all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice."

• I left setting out, because the recommended setting is so very limited. It's certainly not our audience (english speaking, western, those who circumcise for religious purpose). How would you qualify the setting?
• Given the limited setting, how can you give it it's own paragraph in the lead?
• You're the one insisting on nearly irrelevant (to our audience, or to the transmission of HIV outside africa) information forced into the lead. The subject is the same, which is introduction to medical aspects of circumcision, so it can be in the same paragraph.Zinbarg (talk) 17:47, 6 December 2009 (UTC)

Medical paragraph in the lead continued

Lets jump here to save downloads

How about:

The WHO/Joint United Nations Programme on HIV/AIDS, and the Centers for Disease Control and Prevention conclude from recent research that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, but also state that circumcision only provides minimal protection and should not replace other interventions to prevent transmission of HIV. Limited public health benefit would result from promoting circumcision in settings with lower HIV prevalence. The American Medical Association, in it’s circumcision policy statement, concludes: "Virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice."Zinbarg (talk) 18:01, 6 December 2009 (UTC)

Several problems:

• "reviews research finding" is absurdly vague, and avoids saying what they conclude. They state that it significantly reduces the risk.
• The quote "In settings..." needs an introduction.
• There are grammatical errors in "American Medical Association in it’s circumcision policy statement concludes". Should be: "American Medical Association, in its circumcision policy statement, concludes".
• Why has WHO changed to UNAIDS?
• Dates are still missing. Jakew (talk) 18:53, 6 December 2009 (UTC)

Thanks for the gramatical fixes. Please changes you need above. You had it as three (WHO, UNAIDS, CDC); it's WHO/UNAIDS and CDC. Is the above OK? For me to accept dates for the WHO/UNAIDS and CDC publications we will have to put in a bunch of dates citing all the various medical association statements and their respective dates. Just saying AMA 1999 is misleading and deceptive. I guess I would prefer citing each of the associations linked to their statement and the dates. Is that OK?Zinbarg (talk) 21:31, 6 December 2009 (UTC)

I've reverted this change because it should have been clear that there is no consensus for the change at the present time. Specifically, dates are still missing, the information is still presented as one paragraph despite covering two different issues, and grammatical errors remain.

Regarding your question, I think it would be very difficult to cite individual medical association statements without either a) being too long, or b) constituting original synthesis. Jakew (talk) 10:17, 7 December 2009 (UTC)

Wait a second! There are English-speaking countries in Africa. For example, (according to the Wikipedia articles, at least), English is one of the official languages of South Africa, which has the largest HIV population in the world.

Sorry, Zinbarg, I oppose your edit. [3] Please get consensus on the talk page before making changes like that. As Jake explained, we can't state that " Limited public health benefit would result from promoting circumcision in settings with lower HIV prevalence", because we don't know that! Nobody can predict the future, and we can't even state that the WHO stated that because they didn't: they stated a longer sentence with some ifs ands and buts in it, which doesn't mean the same thing. As Jake explains, putting the AMA statement after the WHO statement (not in chronological order), removing the date and saying "concludes" each has the effect of implying that the AMA was commenting on or commenting after the WHO statement, which is misleading and unacceptable.

I suggested on your talk page moving the "1999" to inside square brackets immediately after the word "current", within the quote. I think that would address the problem you raised. Alternatively, I think it's OK to state one more year in the lead (or two, if the WHO and CDC statements were in different years), but I think it would be too cumbersome to put a lot of years everywhere: it would take up space and bore the reader. I don't understand your reason for wanting to add more medical association statements.

How about removing the date, but immediately after the AMA statement saying "Later, after results of randomized controlled trials were reported, ..." and continuing with the WHO and CDC statements. I'd prefer not to do it that way, as it could still be misleading to someone who reads only the first sentence of the paragraph, but it seems to me to be a way to remove the date, which I think you want to do. ☺Coppertwig (talk) 15:13, 7 December 2009 (UTC)

In fairness, it doesn't seem like it should be Jakew who decides to revert away the consolidated sentences. But also, thanks for putting in the POV tag.

It doesn't read as cleanly with all the dates, but it's not long. It's certainly not original synthesis; we have the AMA noticing a fact, and we can present a list of the the underlying assoc statements involved and their respective dates. It would make the lead more of an introduction.

Here's with dates, hopefully grammatically correct:

The WHO/UNAIDS;2007, and the CDC;2008 state that evidence indicates male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, but also state that circumcision only provides minimal protection and should not replace other interventions to prevent transmission of HIV. Limited public health benefit would result from promoting circumcision in settings with lower HIV prevalence. The AMA;1999, in it’s circumcision policy statement, concludes: "Virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice." Current policy statements include the RACP;2009, CPS;2004, BMA 2006, AAP;2005, AAFP;2007, and the AMA;1999.

And without dates, hopefully grammatically correct:

The WHO/UNAIDS, and the CDC state that evidence indicates male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, but also state that circumcision only provides minimal protection and should not replace other interventions to prevent transmission of HIV. Limited public health benefit would result from promoting circumcision in settings with lower HIV prevalence. The AMA, in it’s circumcision policy statement, concludes: "Virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice."Zinbarg (talk) 17:03, 7 December 2009 (UTC)

Good point on South Africa; 10% incidence is in the 3% to 15% range where interventions would be considered. I already agreed to the sentence about HIV in the lead. Mostly, I think readers will have seen the information in the media recently.

The sentence "Limited public health benefit would result from promoting circumcision in settings with lower HIV prevalence" is from this cited sentence in WHO/UNAIDS "Conclusion 7: Programmes should be targeted to maximize the public health benefit"..."In settings with lower HIV prevalence in the general population, including where HIV infection is concentrated in specific populations at higher risk of HIV exposure, such as sex workers, injecting drug users or men who have sex with men, limited public health benefit would result from promoting male circumcision in the general population." The paragraph goes on with "However, there may be individual benefit for men at higher risk of heterosexually acquired HIV infection such as men in sero-discordant partnerships and clients presenting at clinics for the management of sexually transmitted infections. There is insufficient evidence to suggest that circumcision reduces HIV transmission among men who have sex with men." The WHO/UNAIDS is recommending conditionally. The sentence in the lead currently reads like a blanket health issue and implicit recommendation. How would you like to qualify that sentence, but still keep it introduction short?

The way it is (dates wise), the reader is mislead thinking the AMA 1999 date is the most current Assoc statement to say do not recommend. The reader is mislead that the 1999 statement pre-dates significant HIV findings, and that those findings were possibly not considered when making their recommendation. Again, thanks for putting back the POV tag.Zinbarg (talk) 18:03, 7 December 2009 (UTC)

Coppertwig and Jakew, I was looking for a response to questions and points:

• The WHO/UNAIDS/CDC state that conditions for public benefit are limited, and their statements sentence must include something similar. The current text is misleading. Coppertwig is incorrect saying it's not a valid quote.
• Using all the dates looks and reads fine. Is there any problem with the dated version above?
• The only problem I see is it leaves the reader to look at the WHO/UNAIDS/CDC publications to see the underlying study dates. I wrote above, the HIV preventive benefits from circumcision were known well before 1999 (pre AMA statement) with the first meta in 2000. Looks like the WHO cited studies are 2000, 2007, 2005 and 2007. The CDC cited studies from 1999 to 2007 (2000, 2006, 2000, 2003, 2000, 1999, 2005, 2007, 2007, 2006). The RACP statement came out in 2009, the CPS in 2004, the AAP reaffirmed (not recommend) in 2005 (3 months after one of the gold standard studies), and the BMA in 2006, so all would have considered HIV benefits. But it's too subjective to just use Jakew's opinion about which studies/dates are valuable; see the list of studies and note that there's nothing special about 2005 and 2007; many studies/dates were (esp CDC) referenced.Zinbarg (talk) 18:46, 8 December 2009 (UTC)

I just read Coppertwig's last entry, and I had missed his statement that the AMA (1999) must go after the WHO/CDC (2007 2008) because of dates (chronological). The AMA sentence is about the current recommendation of medical associations worldwide. It's those statement dates that are relevant to the reader. One of those association recommentations has a later date than the WHO/CDC. Regardless, it's the underlying research dates (references) that are important. Please show me Wiki policy that publication date is more important that underlying research date. Actually, show me Wiki anything that says chronological over importance.Zinbarg (talk) 19:08, 8 December 2009 (UTC)

Actually, Zinbarg, I think that the version you present in your post dated 17:03, 7 December 2009 is still unacceptable. Problems include:

• The sentence "Current policy statements include the RACP;2009, CPS;2004, BMA 2006, AAP;2005, AAFP;2007, and the AMA;1999." is either pointless or nonsensical synthesis. If the intent is just to say that policy statements exist, what's the point? What does it tell the reader about circumcision? If, on the other hand, the intent is to tie these statements into the "current policy statements [that] do not recommend routine neonatal circumcision", it's synthesis, and nonsensical synthesis at that, since the AMA could not possibly have meant any statements published after their own.
• As Coppertwig points out, the "Limited public health benefit would result from promoting circumcision in settings with lower HIV prevalence." sentence is oversimplified and misses some of the finer points of the original. It's also rather confusing, because it jumps straight into where public health impact might be limited without first saying where it would be expected to be considerable.
• There is still a grammatical error in "in it’s circumcision" — this should be "its".
• Although relatively minor, "WHO/UNAIDS;2007" is not the correct way to introduce a term. Where it is the first use of an acronym in an article, we should present the full expansion, typically with the expanded version followed by the acronym in parentheses.
• As Coppertwig pointed out, the order is also wrong. Since the AMA and WHO/CDC sentences refer to different subjects, it would make more sense to present them in different paragraphs. However, if they're presented in the same paragraph then it makes much more sense to do so in chronological order.

I suggest that it might be more productive to consider adding a sentence to the WHO/CDC paragraph, something like "WHO expect the public health impact of circumcision programmes to vary according to the characteristics of the setting." Jakew (talk) 21:17, 8 December 2009 (UTC)

Your sentence suggestion is vague, but conclusions are specific. It needs to be short for the lead. Here's "Conclusion 7: Programmes should be targeted to maximize the public health benefit" again:

The population level impact of male circumcision will be greatest in settings (countries or districts) where the prevalence of heterosexually transmitted HIV infection is high, the levels of male circumcision are low, and populations at risk of HIV are large. A population level impact of male circumcision on HIV transmission in such settings is not likely until a large proportion of men are circumcised, although benefit to the individual is expected in the short term. Modelling studies suggest that universal male circumcision in sub-Saharan Africa could prevent 5.7 million new cases of HIV infection and 3 million deaths over 20 years.

The greatest potential public health impact will be in settings where HIV is hyperendemic (HIV prevalence in the general population exceeds 15%), spread predominantly through heterosexual transmission, and where a substantial proportion of men (e.g. greater than 80%) are not circumcised.

Other settings where public health impact will be considerable include those with generalized HIV epidemics where prevalence in the general population is between 3% and 15%, HIV is spread predominantly through heterosexual transmission and where relatively few men are circumcised.

In settings with lower HIV prevalence in the general population, including where HIV infection is concentrated in specific populations at higher risk of HIV exposure, such as sex workers, injecting drug users or men who have sex with men, limited public health benefit would result from promoting male circumcision in the general population. However, there may be individual benefit for men at higher risk of heterosexually acquired HIV infection such as men in sero-discordant partnerships and clients presenting at clinics for the management of sexually transmitted infections. There is insufficient evidence to suggest that circumcision reduces HIV transmission among men who have sex with men.

• I guess this works "WHO expect the public health impact of circumcision programmes to vary according to the characteristics of the setting where infection prevalence exceeds 3%."
• It's not original synthesis because the AMA pointed out the fact. What the AMA did needs updating. Remember, its an introduction, where you usually introduce stuff covered in the body. The intent is also to show not recommend for medical reasons is timely, pervasive, and qualified.
• Thanks, I have a hard time with grammatical problems spell check doesn't catch.
• I worried about the formal way to introduce. Note that the curser displays the full name anyway. Also, I think nearly everyone knows who the WHO is CDC, AMA ect. The point is to introduce. It's currently (the current lead) so detailed it's misleading (its two, not three, publications).
• If we could ever agree, a proper introduction is like an outline for the body. This paragraph might be the outline section for medical research and related associations statements. "Circumcision is usually performed as a religious duty or covenant, but preventative medical benefits are known including bla bla. The WHO bla bla high prevalance. The CDC bla bla certain populations. The AMA ect do not recommend routine non-therapeutic, provide information to parents.Zinbarg (talk) 02:14, 9 December 2009 (UTC)

Zinbarg, you don't have to quote the WHO's conclusions multiple times. I can manage to scroll up.

You're right that my proposed sentence is a little vague, but it seems to me that the alternative is trying to capture a large amount of detail, which would probably require a lot more words. Your suggestion doesn't work, because they expect the impact to vary according to the characteristics in all settings, not just those with prevalence >3%. The prevalence is one of several characteristics of the setting that cause the expected impact to vary.

The AMA summarised statements that had been published as of 1999. They did not summarise statements published after theirs — come on, they couldn't do so without a crystal ball! Consequently, it's original synthesis, as I said.

I suspect that most readers will probably be aware of the existence of the World Health Organisation, but they may not be familiar with the acronym "WHO". If you think the current sentence implies three publications, we could reword it to read "World Health Organization and Joint United Nations Programme on HIV/AIDS (WHO/UNAIDS; 2007)". Jakew (talk) 10:40, 9 December 2009 (UTC)

The key words are public health impact. Under 3% you will have "limited public health benefit would result from promoting male circumcision in the general population." They do not expect the impact to vary. The current sentence is very misleading.

Look to the definition of original synthesis again. The AMA noted a fact; it can, and should be be, updated.

OK, we just put in the full names of all the groups and associations.Zinbarg (talk) 22:18, 10 December 2009 (UTC)

Nothing in Wikipedia policy states that facts noted by secondary sources are candidates for being "updated" by Wikipedia editors. That is contrary to the letter and intent of WP:NOR, which implies that we should instead wait for the publication of new, updated reliable sources. Jakew (talk) 14:06, 11 December 2009 (UTC)

I've read that policy stuff. You are wrong. We can, and should provide the reader with the current Associations statements under the format provided by the AMA, ie those that do not recommend. They all don't. In fact the CDC and the UNAIDS don't (routine neonatal) recommend. That is the point of the paragraph that makes it worthy of being in the lead. The current two paragraphs are very misleading. Being misleading is certainly not Wiki policy.Zinbarg (talk) 02:19, 16 December 2009 (UTC)

Medical paragraph in the lead

The two paragraphs in the lead are misleading. We need a single paragraph in the lead that introduces medical facts. Here's cron (per coppertwig requirement), and neutral but factually qualified (WHO/UNAIDS), with the list of "do not recommend" per the AMA:

The American Medical Association (AMA;1999), in its circumcision policy statement, concludes: "Virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice." Medical associations that “do not recommend” routine neonatal circumcision include the Royal Australasian College of Physicians (RACP;2009), the Canadian Paediatric Society (CPS;2004)[[4]], the British Medical Association (BMA;2006), the American Academy of Pediatrics (AAP;2005)[[5]], the American Academy of Family Physicians (AAFP;2007) [[6]], and the American Medical Association (AMA;1999). The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (WHO/UNAIDS; 2007), and the Centers for Disease Control and Prevention (CDC; 2008) state that evidence indicates male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, but also state that circumcision only provides minimal protection and should not replace other interventions to prevent transmission of HIV. Limited public health benefit would result from promoting circumcision in settings where infection prevalence in a population is less than 3%.Zinbarg (talk) 17:17, 16 December 2009 (UTC)

We've already discussed this above. Original synthesis is forbidden by WP:NOR. Jakew (talk) 17:19, 16 December 2009 (UTC)

You misstated Wiki policy, that's all that was discussed above. It is certainly not "original" because the AMA noted the fact. There is no "synthesis" of the AMA statement. An encyclopedia needs to list medical associations (and agencies like the WHO) in the lead, using the format set by the AMA.Zinbarg (talk) 17:34, 16 December 2009 (UTC)

Did the AMA remark on any policy statements published after 1999? Yes or no?

If your answer is 'yes', please provide evidence.

If your answer is 'no', then the synthesis of these articles is original to Wikipedia and hence disallowed by WP:NOR. The synthesis of statements dated 1999 or earlier, however, has been published previously (by the AMA) and hence is not original research. Jakew (talk) 17:41, 16 December 2009 (UTC)

You misstate Wiki policy. The synthesis of "do not recommend" is not original to Wiki, the AMA did it in their statement. We are encouraged (by Wiki) to list current "do not recommend" in the lead.Zinbarg (talk) 17:58, 16 December 2009 (UTC)

Incorrect, Zinbarg. Unless you can point to a specific sentence in a source that justifies the claim, that is WP:SYNTHesis and is not allowed, even if it is logically valid. Please list the specific sources and sentences that support the claims; otherwise, the change would not be allowed per WP:OR/WP:SYNTH. Thank you. -- Avi (talk) 18:50, 16 December 2009 (UTC)

The AMA identifies a fact, and makes a claim. We elaborate within that framework. That's not a problem in Wiki; it's encouraged.

Your writing is not clear. Please explain "point to a specific sentence in a source that justifies the claim."Zinbarg (talk) 20:22, 16 December 2009 (UTC)

I've consulted other editors, and an admin. They all say the above is OK. If you want, we could do away with the AMA "virtually all" sentence, and just say the following a,b,c,d,e,f do not recommend.Zinbarg (talk) 15:00, 17 December 2009 (UTC)

Without the AMA sentence

Medical associations that “do not recommend” routine neonatal circumcision include the Royal Australasian College of Physicians (RACP;2009), the Canadian Paediatric Society (CPS;2004)[[7]], the British Medical Association (BMA;2006), the American Academy of Pediatrics (AAP;2005)[[8]], the American Academy of Family Physicians (AAFP;2007) [[9]], and the American Medical Association (AMA;1999). The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (WHO/UNAIDS; 2007), and the Centers for Disease Control and Prevention (CDC; 2008) state that evidence indicates male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, but also state that circumcision only provides minimal protection and should not replace other interventions to prevent transmission of HIV. Limited public health benefit would result from promoting circumcision in settings where infection prevalence in a population is less than 3%.Zinbarg (talk) 16:55, 17 December 2009 (UTC)

As far as I can tell, this is exactly the same as your proposal above (dated 17:17, 16 December 2009), but with the exception that the properly sourced sentence (attributed to the AMA) has been removed, and the original research remains. Jakew (talk) 16:45, 17 December 2009 (UTC)

There no problem with the above paragraph re original research. It simply lists the do not recommend associations without qualification (virtually all). We often list in Wiki. Do you want me to plaster this discussion with examples taken from hundreds of articles as proof? This behavior is silly.Zinbarg (talk) 16:55, 17 December 2009 (UTC)

Yes, Zinbarg, there is a problem, as Avi and myself have already explained, and I see little point in repeating. It is original synthesis of multiple sources to advance a position. The position that is advanced is that many/most medical associations "do not recommend" circumcision (it is unclear, incidentally, why these words are presented as a quote). That is one summary, and I am not saying that it is invalid, but it is the result of a) selective choice of sources (there may well be organisations that do recommend circumcision), and b) selective summarisation of sources (many could be equally summarised by saying "do not recommend against infant circumcision", for example). When the synthesis has been performed by a third party (in this case the AMA, of sources then available), this isn't a problem, as the statement can be attributed. However, Wikipedia editors cannot perform this kind of synthesis. Jakew (talk) 17:33, 17 December 2009 (UTC)

Avi didn't explain anything, and you repeat. I've read original research. I put the do not recommend in quotes because those listed can be quoted, but it's not necessary. There is neither a "position advanced," nor "many/most," which would certainly be NOR. It's just a list. It's comprehensive (not selective). You are free (encouraged by Wiki) to list other ("do not recommend against," or "recommend" for example) associations. Again, I'll be glad to show you many examples of lists in Wiki.Zinbarg (talk) 17:56, 17 December 2009 (UTC)

No, Zinbarg, it is not comprehensive, but selective, as I said. It is easy to identify policy statements that are excluded (that of the AUA, for example). And I could not make a list of "do not recommend against" for exactly the same reason that one cannot list "do not recommend" - it's original synthesis. Jakew (talk) 18:35, 17 December 2009 (UTC)

It's funny, I just realized if you tried to say X,Y, and Z do not recommend against (note it's not in quotes) it would be NOR because they do not expressly state do not recommend against (it may be implied). The listed "do not recommend."Zinbarg (talk) 18:03, 17 December 2009 (UTC)

How about we list every association and their respective conclusions.Zinbarg (talk) 19:49, 17 December 2009 (UTC)

It's an introduction: there isn't space. We go into more detail in the policies section. We just need a short summary. Jakew (talk) 21:00, 17 December 2009 (UTC)

Not true. Almost all assoc are listed above, and that takes very little space. Adding a few more only takes up another three lines max.

The few that do not recommend that are not listed above are the Australian Association of Paediatric Surgeons, New Zealand Society of Paediatric Surgeons, Urological Society of Australasia, and the Paediatric Society of New Zealand. The only one left (not listed, I think) is The American Urological Association, which "believes that neonatal circumcision has potential medical benefits and advantages as well as disadvantages and risks," which sounds neutral (neither rec, nor do not, and should be listed thus).

Most of the article body is taken up with medical issues ie beneifts and risks, so that thrust should be introduced. Routine neonatal circumcision is usually a medical procedure, and these associations provide concensus judgements for medical benefits and risks. Taking a short paragraph to summarise assoc positions, and WHO/UNAIDS and CDC publications, is a good use of "summary" lead space and very encyclopedic. Compare that to what's in place right now, which is a grossly misleading presentation of a very limited, possibly dated, selection of medical information.Zinbarg (talk) 23:00, 17 December 2009 (UTC)

Listing every association and their respective conclusions takes a lot of space if done in an NPOV fashion without performing original research. It requires giving a balanced summary of their specific conclusions, and that takes at least a sentence or so. It may well be possible to write something shorter if one is able to perform original synthesis to advance a position, but we can't do that. Jakew (talk) 11:14, 18 December 2009 (UTC)

Not true. The positions are almost all so very similar it (general position) would be easily summarized, and those applicable assoc listed. I'm sure you and I could agree on the ones like the AUA. That format would take even less space. It would be clear that the issue is routine neonatal only.Zinbarg (talk) 23:22, 19 December 2009 (UTC)

POV tag

The reason for the tag continues; the last two sentences in the lead are grossly misleading. The first makes the concensus of Associations sound dated, and updating with current members is blocked for some reason by editors. The last sentence lacks necessary qualification (public benefit limited to regions where prevalence exceeds 3% among heterosexual men, basically only parts of Africa). This article is pro-circ propaganda; the sub articles are frequently worse.Zinbarg (talk) 23:29, 19 December 2009 (UTC)

Medical propaganda

I think it's propaganda to have medical advocacy in the pro/con paragraph, because almost all circumcisions are for religious purpose. Or, in US hospitals it's a cultural ritual (says the AMA). Medical advocacy is a tiny fringe group in the medical community, but it's given equal billing in the paragraph? It's propaganda, because it suggests equal strength of argument where there is actually very little. We should replace the "medical" (DR schoen) advocacy for religious purpose advocacy. The emphasis on medical interferes and detracts from the communication of the primary religious purpose of circumcision.Zinbarg (talk) 18:04, 6 December 2009 (UTC)

The paragraph isn't about the reasons why circumcision is performed (if it were, then it wouldn't make sense to include the arguments of opponents at all). It's about the controversy surrounding circumcision, and therefore includes the arguments of those arguing for or against the practice. Jakew (talk) 18:58, 6 December 2009 (UTC)

Exactly. Opponents fall away. You no longer sell medical "benefits," thus ignoring medical conclusions, which prompts a response from opponents. The valid arguments for are religious and cosmetic (be clean and look like Dad and everyone else) and the valid argument against is? Can't think of any. Again, primary advocacy by numbers (the majority of those who seeks circumcision) is religious. But that's completely missing, and needs to be added.Zinbarg (talk) 21:44, 6 December 2009 (UTC)

Zinbarg, I'm not sure I fully understand your argument. However, the balance of subtopics is determined by the writers and publishers of the reliable sources, not by opinions or logical arguments by us Wikipedians as to what ought to be considered important. If you want more prominence given to religion, please find reliable secondary sources and show that religion is a large enough subtopic in such sources to support giving it more weight in the article; also please suggest specific wording to be added. The weight on subtopics in the lead should be the same proportions as in the article, which in turn should be the same proportions as in reliable sources. ☺Coppertwig (talk) 22:00, 6 December 2009 (UTC)

So far I'm just going by the numbers. No medical association recommends routine. Almost all circumcisions are done for religious purpose. Most circumcisions not done for religious purpose are done for cosmetic reasons. A tiny percentage are done for medical reasons, so why are medical issues 2/3 of the article?Zinbarg (talk) 23:25, 6 December 2009 (UTC)

I suppose medical issues take up a lot of the article because there's been a lot written about medical issues in the reliable published sources the article is based on. I don't know what percentage of circumcisions are done for religious purposes, (you might provide a citation to support your statement), but it seems to me that when a circumcision is done for religious purposes, that medical issues may usually or often be part of the decision: that is, if circumcision is believed to be medically harmful, someone might decide not to circumcise even though their religion tends towards circumcising, and on the other hand, if circumcision is believed to be medically neutral or beneficial or to have benefits outweighing some harms, then someone might decide to go along with their religion's circumcision ritual. ☺Coppertwig (talk) 01:03, 7 December 2009 (UTC)

I used the WHO estimate of 68% Muslim in the lead, with a high birth rate. That gets me to most. Then you add the US, which is mostly cosmetic. But, you're right about medical benefits possibly being part of the decision. The article is long and spends lots of time on medical issues that are not (as most sections acknowledge) significant to longevity or medical costs. Reliable but not relevant. It becomes misleading spending so much space on it. But, I'll drop it, or be specific about changes I'd like to see.Zinbarg (talk) 03:47, 7 December 2009 (UTC)

New Circumcision Opposition Link

My name is Ted King, and I am the webmaster for the website of Attorneys for the Rights of the Child (ARC), http://arclaw.org/. I am writing in behalf of J. Steven Svoboda to ask that our website be added to your list of Circumcision Opposition links. J. Steven Svoboda is founder and Executive Director of ARC, a federally and state-certified non-profit corporation Steven founded in early 1997. ARC has become a leading voice in the movement to stop genital mutilation. As an attorney, Svoboda is involved in educating and litigating on behalf of genital integrity issues. He is a strong opponent of male circumcision. See his bio at http://en.wikipedia.org/wiki/J._Steven_Svoboda. The ARC website offers considerable documentation, articles, links, book reviews, news items, and descriptions of ARC activities and publications, including presentations at the UN and other world conferences, media appearances, letters to national publications and other resources of great value to others in this community. ARC has worked closely with Dan Bollinger, Marilyn Milos (NOCIRC) and other leaders in the movement. Thank you for your consideration. Arcing (talk) 22:54, 9 December 2009 (UTC)

In principle, I'm not opposed to linking to ARC. However, in order to maintain neutrality, we're trying to keep the numbers of links representing each point of view balanced. As such, we're not so much interested in adding new links, but rather in replacing existing links with more deserving ones. Per Wikipedia's external links policy, I am not convinced that arclaw.org has much merit, I'm afraid, but am happy to be persuaded. Looking at point 1, we might include organisations, but the subject of the article is circumcision, not organisations formed for or against it, so there isn't a compelling argument there. There might be a weak case under point 3, but that covers "neutral and accurate material", and an activist website is unlikely to be neutral. Jakew (talk) 10:01, 10 December 2009 (UTC)

Thanks, Jakew, for your prompt and helpful response. It seems to me that "trying to keep the numbers of links representing each point of view balanced" distorts neutrality by misrepresenting the degree of interest in a given position. In the interest of complete coverage every sincere point of view should be allowed that does not disrupt or abuse the process. Any who are left out remain at odds when the rest have come to a resolution. I understand the conundrum of trying to protect free speech by silencing its abusers, in this case by authorizing a censor (you) to decide if the ARC website violates your criteria. You may be as fair and impartial as you know how, but the position of censor always attracts successors with biased agendas. I submit that the essence of free speech is to maximize understanding by hearing all sincere contributions to an issue which also maximizes the potential for resolving conflicts. We are also confused about the "activist" prohibition; you are listing sites for and against so how could they not be activist sites, and anyway, why is that a bad thing?

Discussion of principle aside, we believe that the ARC site has as much merit as any of those listed, and provides extensive resources of value to BOTH sides of the issue. The maximizing understanding thing again. The process of resolving the issues will be greatly aided if each side can study the other's values and concerns. I believe you recognize this in providing external links for both sides. Given the extensive citations and sources provided it is not credible to question the offering of "neutral and accurate material." If we were deliberately distorting information we would quickly be called to account by the well informed target audience of this effort. In fact much of the content is in response to opposing points of view, which are fairly presented and given careful consideration in the kind of dialog that marks productive civil discourse. We avoid personal attacks or other attempts to sidetrack the path to understanding and resolution. We are not out to win at any cost, but to improve the quality of life for those being tortured. The ARC site offers a perspective from a legal and legislative point of view that no other source adequately provides. To reject it would be to deprive both sides. With respect, Arcing (talk) 22:01, 11 December 2009 (UTC)

The ARC site offers a different perspective on circumcision, namely legal, which is neutral by definition. This brings up my earlier suggestion that Circumcision Decision-Maker (CDM) be put in a new category, something like "Resources." Here's why. With circumcision being such a hot issue, there is never going to be agreement here that a certain website is neutral or has a NPOV. However, there are many sites that are Near-NPOV. I think a section for these middle-of-the-road resources would be useful, while keeping the pro and con lists as they are with identical number of links. Then, the Near-NPOV sites could be listed as needed. Since neither ARC and CDM are activist organizations, or are adamant about circumcision (pro or con), then they would be candidates for a new "Resources" section. Trapping the article into only two, polarized categories with a limited number of links does not do our readers a service. Frank Koehler (talk) 16:15, 23 December 2009 (UTC)

To be perfectly blunt, the effect of that would be to circumvent NPOV's requirement for balance by pretending that various sites did not have a POV. Jakew (talk) 17:21, 23 December 2009 (UTC)

I disagree. All websites and organizations have a POV (otherwise they wouldn't exist). We need to consider this like a gray-scale. Some at the far ends (pro and con) and some near the middle (neutral). Most of the Wikipedia articles have Resources pages with a wide range of POV, and very few have linkd divided into pro and con. I see no reason to not add a Resources section for websites that are in the middle of the gray-scale. We do our readers a diservice by insisting that all websites are either adamantly for or against circumcision, especially when that isn't true. Frank Koehler (talk) 15:49, 25 December 2009 (UTC)

A problem with your proposal, Frank, is that placing a site in a "resources" section as opposed to, say, the "opponents" section would imply that the site was not opposed to circumcision. If ever we find a site that is truly neutral, that might be justified, but for all the sites discussed so far, that would be misleading. And, of course, we'd still have to conform to NPOV by keeping the numbers of sites representing each point of view balanced, so it is difficult to see what would be the point. Jakew (talk) 17:17, 25 December 2009 (UTC)

Proposed change to 'sexual effects'

If nobody objects, I intend to remove the following paragraph from the 'sexual effects' paragraph. The reason is simple: in the full article we cover many different aspects of sexual function, including (but not limited to) ejaculatory function, sexual practice, sexual drive, and satisfaction. It doesn't make a lot of sense to summarise just one of these aspects, and in the absence of reliable secondary sources I think it is better if we avoid trying to summarise aspects ourselves.

• Reports detailing the effect of circumcision on erectile dysfunction have been mixed. Studies have shown that circumcision can result in a statistically significant increase, or decrease, in erectile dysfunction among circumcised men, while other studies have shown little to no effect.

I also propose to delete the following material from the end of the preceding paragraph. The reason is that we're already citing secondary sources, and there's no particular reason to cite primary sources as well (see WP:MEDRS#Respect secondary sources).

• Payne et al. reported that direct measurement of penile sensation during sexual arousal failed to support the hypothesised sensory differences associated with circumcision status.[119] In a 2007 study, Sorrells et al., using monofilament touch-test mapping, found that the foreskin contains the most sensitive parts of the penis, noting that these parts are lost to circumcision. They also found that "the glans of the circumcised penis is less sensitive to fine-touch than the glans of the uncircumcised penis."[120] In a 2008 study, Krieger et al. stated that "Adult male circumcision was not associated with sexual dysfunction. Circumcised men reported increased penile sensitivity and enhanced ease of reaching orgasm."[121]

Comments? Jakew (talk) 13:58, 11 December 2009 (UTC)

I reject the proposed changes. Doing so (Jakew proposes) would effectively remove these facts from the article:

• "In a 2007 study, Sorrells et al., using monofilament touch-test mapping, found that the foreskin contains the most sensitive parts of the penis, noting that these parts are lost to circumcision. They also found that "the glans of the circumcised penis is less sensitive to fine-touch than the glans of the uncircumcised penis." Note that this sentence or information is missing from Foreskin Sensitivity in full article. Instead, you have a bunch of jumbled writing that's junk.Zinbarg (talk) 02:11, 16 December 2009 (UTC)

Of course deleting material would remove certain statements - that's almost an inevitable result of deletion. It isn't a good reason for objecting.

Contrary to your claim that this information is absent from the full article, information about Sorrells et al. can be found in the third paragraph [[sexual effects of circumcision#Foreskin sensitivity|here] and the fourth paragraph here. Jakew (talk) 09:24, 16 December 2009 (UTC)

The conclusion of the Sorrells study, and other relevant information in the main body is deleted by Jakew's proposal. I obviously read the third and forth paragraphs, which is why I wrote "a bunch of jumbled writing that's junk."

The paragraph in the main body is concensus, amd the Sorrells sentence is fully accurate to the source and informative. It's the only detailed and objective study of sensitivity, and very recent. You propose deleting a critical (main body worthy) study.

I object to leaving the reader dependent on the sub, which is less subject to balanced review by editors. Most editors would find the sub pro-circ propaganda.

It's a religious rite. I've been told to avoid misleading the reader. The behavior exhibited in this article will backfire badly, especially with Wiki loosing editors and clamping down on abuses.

Other editors, I think it's dangerous to sell circumcision with medical benefits propaganda. For example, it makes no sense to have an equal number of pro and anti circ links at the end of the body; the pro-circ camp is a relatively tiny fringe in the medical community. That's even in the US.Zinbarg (talk) 16:15, 16 December 2009 (UTC)

Actually, Zinbarg, I'm not just proposing to delete Sorrells (which is actually one of several sensitivity studies) from this article. I'm also proposing to delete nine other primary sources as well, three (including Sorrells) could be said to support the "circumcision is sexually harmful" position, three support the "circumcision is sexually beneficial" position, and four find no difference either way.

In a sense, the reader is and always will be dependent on the detailed article, because it is not possible to include every study in this article, so the information presented here has to be incomplete. So your argument is less than persuasive. If you believe that the detailed article is, as you say, "pro-circ propaganda", then I suggest you raise the issues in the appropriate place. Jakew (talk) 17:07, 16 December 2009 (UTC)

I read your proposal. Sorrells is the only recent objective (not a subjective patient survey) sensitivity study. The current text is OK, as you say, it touches all the "positions." Details can be found in the sub. You can not delete any of the current text. You remove critical information. If recent experience in the body is indicative, progress in the sub will be blocked anyway. The sexual effects sub is so bad it should be simply deleted.Zinbarg (talk) 17:29, 16 December 2009 (UTC)

I'm sorry, Zinbarg, you're incorrect. Bleustein 2003, Bleustein 2005, and Payne (2007) were all conducted in the last decade, and are equally objective as Sorrells.

As I noted above, the current text is problematic for several reasons. First, the choice of subject matter seems very arbitrary — as I noted above we dedicate a paragraph to studies of erectile dysfunction, but we don't even mention many of the other aspects covered at length in the full article. Second, a few primary sources are selected (again, on a seemingly arbitrary basis) for inclusion; what we ought to do when confronted with limited space is to rely on secondary sources.

If you believe that the full article should be deleted, the correct procedure is to nominate it for deletion via Wikipedia's articles for deletion process. Jakew (talk) 17:38, 16 December 2009 (UTC)

I'm sorry, I thought we were talking about erogenous zones because we're in the sexual effects section.

Payne "assessed on the penile shaft, the glans penis, and the volar surface of the forearm," not the foreskin.

Bleustein "tested on the dorsal midline glans of the penis," not the foreskin.

The corona of the glans (not the glans), and the ventral mucosal tissue of the penis are considered erogenous.

Only Sorrells tested the foreskin, specifically the mucosal tissue.Zinbarg (talk) 17:53, 16 December 2009 (UTC)

I think that claiming that the glans is not erogenous is a novel argument, to say the least.

Incidentally, if you trouble yourself to read the sources I cited, you'll find that Bleustein 2005 also tested the foreskin. Jakew (talk)

Show me a text or study that finds the glans to be erogenous. No, Bleu 2005 did not test the foreskin (see, it's retracted to reach the glans). See the conclusion: "circumcision status does not significantly alter the quantitative somatosensory testing results at the glans penis."[[10]].Zinbarg (talk) 18:29, 16 December 2009 (UTC)

I don't think any studies have actually proved that the glans or indeed any other part of the penis is erogenous. However, it is generally regarded as erogenous. For example, Winkelmann dedicates a section of his paper "The erogenous zones: their nerve supply and significance" to the glans.

To quote from Bleustein 2005, page 774, section "Material and methods", 4th para: "In uncircumcised men, an additional measurement was taken at the dorsal midline "foreskin,"..." As I stated above, you would have realised this if you read the source. It is extremely tedious to have to correct you multiple times. Jakew (talk) 18:47, 16 December 2009 (UTC)

I stand corrected re glans and winkelmann. He speculates.

I read the PubMed for bleu 2005, not having access to the whole. I wonder, just what did they compare to (they had no measurement for circ'd guys)? Note, it wasn't part of their conclusions, so it wasn't worthy. My point stands (Sorrells is necessary in the body of the article).Zinbarg (talk) 20:15, 16 December 2009 (UTC)

It remains unclear to me what, precisely, your point stands on. It doesn't seem to have much of a basis, as far as I can tell. Jakew (talk) 20:36, 16 December 2009 (UTC)

Looking at the table in the sexual effects main. There needs to be a column stating the percentage of patients that responded to the questionares. In most cases, the very low participation rate makes the conclusions low quality (low statistical relelvance).Zinbarg (talk) 18:24, 16 December 2009 (UTC)

So identify what needs to be changed and discuss at the appropriate place. Jakew (talk) 18:47, 16 December 2009 (UTC)

Again, Wiki would be best with that whole sub deleted. I just pointed out a serious flaw. It's your section Jakew (looks like you wrote most); why wasnn't it done correctly, or isn't it being corrected now?Zinbarg (talk) 20:15, 16 December 2009 (UTC)

This is not the correct place to discuss the content of another article. Jakew (talk) 20:36, 16 December 2009 (UTC)

Your proposal would relegate the reader to that sub to find critical information burried in jumbled writing and misleading tables, so it is quite relevant here. My point has been stated above. Here again, leave the current text unchanged because the paragraph in the main body is concensus; lots of discussion with many editors made it thus. The Sorrells sentences are fully accurate to the source and informative. It's the only detailed and objective (foreskin) study of sensitivity, and very recent. You propose deleting a critical (main body worthy) study. I object to leaving the reader dependent on the sub, which is less subject to balanced review by editors. Most editors would find the sub pro-circ propaganda.Zinbarg (talk) 21:27, 16 December 2009 (UTC)

I find repetition rather tedious, so if you don't mind I won't respond in detail. Jakew (talk) 21:36, 16 December 2009 (UTC)

Jake says "what we ought to do when confronted with limited space is to rely on secondary sources." I'm not sure what you mean. The Sorrells sentence in question, as I calculate it, uses less than 1/3 percent of the article. Also, I'm concerned that Jake's reasons for deleting this primary source aren't really concrete - they change throughout this discussion. There may also be a conflict of interest here, because Jake has published at least one article contesting Sorrells. It's passing strange that he wants to delete this one part - sounds like original research by deletion to me. Wandooi (talk) 23:24, 22 December 2009 (UTC)

I mildly support keeping the text as it is. It attempts to summarize the subarticle and does a reasonable job. I attempted just now to write a summary of the ejaculatory function section, but found it practically impossible since almost all, but not quite all, the studies listed fail to find any statistically significant result. At least we summarize what we can. ☺Coppertwig (talk) 00:29, 23 December 2009 (UTC)

I can't help but note that you seem to have just presented a not-unreasonable summary of that section, Coppertwig. This seems to indicate, at least to me, that it could be done. What troubles me, as I have said above, is the selectivity of the section: of all the primary sources cited in the full article, why cite these particular ten sources? And why cite only one aspect of the results of seven of those? It doesn't make much sense. Re sexual sensitivity, we cite in this section Payne, Sorrells, and Krieger, but we don't cite Masood, Fink, Cortés-González, Masters and Johnson, Bleustein, Waskett and Morris, or Young. Why? It doesn't make much sense; it seems to be arbitrary. Re erectile function, we summarise seven of eleven sources, the reasons for this particular selection being unfathomable. And re the other aspects, we maintain a stern silence, which is again incomprehensible. So what I wonder is, is the intent to say that, of the 40+ studies cited in the full article, only these are important? If so, can we justify that? Jakew (talk) 10:41, 23 December 2009 (UTC)

Those were agreed upon for the topic. They were considered worthy. If you want to bring a specific study up for discussion and possible inclusion, please lets see. Then we'll juggle things around so it's made "equal."

The sexual effects (main? article) is grossly biased, so we need to be careful to be at least "equal" balance in the topic.Zinbarg (talk) 19:32, 27 December 2009 (UTC)

Would you be kind enough to link to the discussion(s) in which they were discussed? Thanks in advance. Jakew (talk) 20:57, 27 December 2009 (UTC)

I was going by the very careful wording, assuming. It is typically forced equal. It is concensus, or it wouldn't be there. Regardless, I don't know how to link to prior discussion. I reiterate the critical importance of Sorrell's. It's the only objective study, and one of few studies of specifically the foreskin. It clearly belongs in the topic.Zinbarg (talk) 21:34, 27 December 2009 (UTC)

Your argument doesn't seem very compelling, Zinbarg. To paraphrase: "The selection of papers was agreed upon and these papers were considered worthy of inclusion, therefore we should not reconsider their presence in the article. I can offer no evidence whatsoever for this agreement and admit that I have only an assumption that discussion ever took place." I've already corrected your claim that Sorrells is the only objective study; it seems a waste of time to do so twice. Jakew (talk) 10:42, 28 December 2009 (UTC)

I'm sure I could find the discussions. You have clear editor objections to your proposed change. Why are you beating a dead horse? I said don't relagate to the "main" article, because it's so lousy. The article text is OK, and serves as a good intro to the lousy main. You didn't correct anything, save find an questionable objective measurement burried in the text of a study with no findings or comp. benchmark. Another dead horse waste of time.Zinbarg (talk) 18:38, 29 December 2009 (UTC)

I've identified several problems with the section, and those problems need to be addressed. I'm quite happy to discuss alternative solutions, but simply ignoring the problems seems irresponsible. Jakew (talk) 13:19, 30 December 2009 (UTC)

Male genital mutilation

Male circumcision has been referred to as male genital mutilation as well for years. Propose adding "male genital mutilation" and "male genital cutting" as other names for "male circumcision".Jayhammers (talk) 08:32, 23 December 2009 (UTC)

We've discussed this previously. The problem is that these terms are used too infrequently in reliable sources. For example, there are only approx 400 Google Scholar results for "male genital mutilation", and 4 of the 10 on the first page are actually matches for "fe- male genital mutilation" (suggesting that the true figure is somewhat lower). The situation with "male genital cutting" is even more extreme: only 62 results, and 6 of the first 10 match "fe- male genital cutting". In contrast, there are 87,600 matches for "circumcision". Consequently your proposal would give undue weight to what is actually obscure terminology. Jakew (talk) 10:20, 23 December 2009 (UTC)

Restoring previous opponents' lead statement

Edit summary for this edit:

The argument that "best performed during the neonatal period" is a "factual error"(see edit summary used to revert here) doesn't hold when the article discusses the sourced, cited arguments of one side. See WP:V.

On the other reversion [11], the "agreed on points from the anti side" is not a valid reason for reversion as it does not address the reason given in the edit summary for the edits. The version I restored was also agreed upon, and it has several major advantages:

• It does not mention "female genital cutting," a phrase not used in the cited source at all. Further, that opponents "think it's the same as female genital mutilation" is a pro-circumcision argument, due to the simplification of this comparison; i.e., the general (incorrect) belief that all forms of female circumcision are more invasive than male circumcision. That the opponents believe it is "effectively comparable" to FGC is a wholly arbitrary assessment made by a Wikipedia editor, not a neutral reflection of the source.

• It does mention "human rights," which I'll note is a main point of the opposition, mentioned in the title of the cited source: Circumcision: A Medical or a Human Rights Issue?

• It mentions the opponents' argument that circumcision is "extremely painful," as this is the first point mentioned in the abstract of the source, after the "natural integrity of the male newborn's body." That is was softened from "excruciatingly painful" to "extreme pain" was a concession made. That discussion took place here.

Blackworm (talk) 18:21, 24 December 2009 (UTC)

Blackworm, please see the concluding paragraph in national orginazitions are formed (in the article):

"Representatives from nine nations attended the Second ISC in San Francisco in the Spring of 1991. Dr. Benjamin Spock, one of America's best-known pediatricians, was honored with and accepted the first Human Rights Award of the ISC for reversing his position on this issue: "My own preference, if I had the good fortune to have another son, would be to leave his little penis alone" (28). The practice of genital mutilation of females in Africa was addressed by Dr. Asha Mohamud, an African pediatrician. Today, 100 million females, including young girls and infants, suffer the effects of this debilitating surgery. And now, with increased African immigration, American health care providers are faced with clinically caring for infibulated women (29) and requests to infibulate their daughters. The ISC is an international forum, networking with Women's International Network News (WIN News) and the Inter-African Committee to abolish the myths of genital mutilation of both males and females in defense of body ownership rights of all the world's children. The greatest tool of the ISC and related international groups is truth because of the many myths which still prevail."

And please see In Conclusion:

"To overcome the American double standard of the acceptance of circumcision for men but not for women, consider this: If it could be unequivocally proven that women had a decreased incidence of UTIs, sexually transmitted diseases, AIDS, vulvitis, vulvar cancer, and/or increased sexual staying power as a result of performing neonatal labiectomy, would the American medical and nurse-midwifery communities approve routine, unanesthetized neonatal labial amputation as a prophylactic measure? Of course not! If we wouldn't do this to our newborn females, we must take a hard look at why we condone and perform "prophylactic" foreskin amputations upon our newborn males. Women have struggled to achieve rights to body ownership for themselves. It is imperative that mutual respect for these inalienable human rights be extended, not only to the women in Africa with whom we can identify, but also to men, male children, and male newborns.

Consider further: The foreskin is normal, healthy, functioning tissue. Circumcision has inherent risks, including hemorrhage, infection, mutilation, and death. Circumcision is painful, even when an anesthetic is used. Circumcision causes both physical and psychological scars. Most importantly, every human being has an inherent, inalienable right to his own body.

Lawsuits have been filed to challenge circumcision as a violation of the basic right of every person to his or her own body. Circumcision violates many constitutional rights of infants and children, including the right to religious freedom, which is denied when an infant or child's body is marked. Health care professionals do, in fact, have a legal basis for claiming conscientious objector status with regard to participation in newborn male circumcision (66).

While this human rights issue is being addressed within the American legal system, it becomes urgent for the American College of Nurse-Midwives (ACNM) to consider the legal and the ethical implications of performing newborn circumcision. The ACNM is faced with ethical dilemmas unique to midwifery 1) that of genitally intact women, CNMs, performing permanent surgical alteration o the intact sex organs of nonconsenting newborn boys, and 2) that of CNMs, who as a group philosophically claim to be "guardians of the normal," not protecting normal male genitalia while protecting the integrity of normal female genitalia.

These ethical dilemmas warrant an ACNM review of its advocacy role on behalf of newborns. Regarding the ACNM advocacy role, the Journal of Nurse-Midwifery's Associate Editor, Jeanne Raisler, CNM, MPH, wrote "...from time to time, national policy issues arise that challenge our deepest sense of what is important and necessary for maternal-child health. We need a mechanism to discuss and debate these topics" (67). In the case of circumcision, a task force committee would provide that mechanism. And, until ACNM policy is established, a moratorium on the performance of routine newborn circumcision would protect CNMs as well as newborns.

As the ACNM ponders its advocacy role, CNMs will find guidance in the words of human rights activists, Fran P. Hosken:

Human rights are indivisible, they apply to every society and culture, and every continent. We cannot differentiate between black and white, rich and poor, or between male and female, if the concept of human rights is to mean anything at all (68)."

FGM is OK per the source. As good as rights. But the key word missing from the topic is mutilation, which is certainly central to the anti circ article. That's what they consider a violation of rights. How about saying "genital mutilation" instead of FGM?

Schoen is writing personal opinion when he talks of timing. He needs to have cited research for us to put that in the lead of the topic. Plus, it's NOT TRUE! There are conclusive research studies that find neonatal is not the best time. For example[[12]]. That pharse must go because it's not factual. Which means we remove one of the anti points. Which do you want to remove? I suggest pain, because that can be easily mitigated.Zinbarg (talk) 19:07, 27 December 2009 (UTC)

Jakew, the common term is female genital mutilation, and that's what the anti circ's wording. I don't know how to change the FGC topic's title to FGM, but that should be done. Note the (FGC topic) intro sentence emphasis on FGM, the common term.Zinbarg (talk) 21:18, 27 December 2009 (UTC)

How about:

There is controversy regarding circumcision. Advocates of circumcision argue, for example, that it provides important health advantages which outweigh the risks, has no substantial effects on sexual function, has a low complication rate when carried out by an experienced physician. Opponents of circumcision argue, for example, that it adversely affects normal sexual pleasure and performance, is justified by medical myths, and is effectively comparable to female genital mutilation.

Blackworm, you should be satisfied with that, because rights issues are one of those effectively comparable.Zinbarg (talk) 21:25, 27 December 2009 (UTC)

There have been several attempts to rename female genital cutting, Zinbarg. See, for example, here or here. None f these attempts have gained consensus, as there are NPOV problems with "female circumcision" or "female genital mutilation". If consensus to rename is ever achieved, we can do that, but in the meantime we should link to the correct title. Jakew (talk) 21:29, 27 December 2009 (UTC)

A biased (pro circ) reading of NPOV, but not worth fighting.Zinbarg (talk) 21:37, 27 December 2009 (UTC)

Why is Zinbarg here responding to Jakew, but Jakew's comments aren't here, and why is Zinbarg not responding to the points I made in my reversion of his changes, changes that weaken the presentation of the anti-circumcision arguments, reduce the number of arguments, and invite an initial knee-jerk disagreement with anti-circumcision arguments? Why is Jakew seemingly supporting this action of Zinbarg, weakening it even further? Please stop weakening the presentation of the anti-circumcision side in this article through original research Zinbarg and Jakew. It does not conform to WP:NPOV. Saying things like opponents "effectively compare" male circumcision to FGC are meaningless original research, and seem to be phrased specifically to turn the reader's point of view one way. Fix it. Put it back the way it was and everyone agreed on for months, or present a real argument as to why it should be changed. But don't stray from the source by putting your own spin on it then try to convince editors your version is better. Blackworm (talk) 11:00, 30 December 2009 (UTC)

First, I responded to your presentation with quotes from critical sections of the citation, which show that you're objections are inaccurate. Our purpose in fixing the paragraph in the lead was to make it factual; Schoen's recommended neonatal hospital circ right after birth is not factual. Right after birth is a relatively poor time to circ, compared to 8 days, or 5 months, or 5 years. For some, certainly not encyclopedic reason, we have to have the same number of points.

If you object to anything, object to the idea that there MUST be an equal number of points to both sides. Or, if you want it more accurate to the source, maintain my sentence "Opponents of circumcision argue, for example, that it adversely affects normal sexual pleasure and performance, is justified by medical myths, and is genital mutilation, comparable to female genital cutting."

I think ~human rights is vague relative to FGC.

Finally, I respond to Jakew's comment about FGC versus FGM, where he notes it's basically impossible to change anyway.Zinbarg (talk) 18:22, 30 December 2009 (UTC)

No, you didn't respond adequately to my arguments. You're still not. You are responding with non-sequiturs, original research, and misunderstandings of Wikipedia policy (again, see WP:V about stating the arguments of others without regard to whether they're factual -- that they hold that opinion is factual). Go ahead, ignore the source and make up things about "sexual performance" and "FGM" if you absolutely want the reader to reject the arguments and therefore the anti-circumcision position. But hopefully someone will eventually notice the enforced violations of Wikipedia policy that you and Jakew are committing. Blackworm (talk) 20:33, 30 December 2009 (UTC)

Origins

I first read this in the Economist (see their Search), but here's a broadly usable link [[13]]. Here's an origin that makes sense from an DNA imperative perspective; there must be a divine reason circ persists. I'd like to change Origins:

• It has been variously proposed that circumcision began as a religious sacrifice, as a rite of passage marking a boy's entrance into adulthood, as a form of sympathetic magic to ensure virility, as a means of suppressing sexual pleasure or to increase a man's attractiveness to women, as a means of reducing adultery, or as an aid to hygiene where regular bathing was impractical, among other possibilities. Immerman et al. suggest that circumcision causes lowered sexual arousal of pubescent males, and hypothesize that this was a competitive advantage to tribes practicing circumcision, leading to its spread regardless of whether the people understood this.It is possible that circumcision arose independently in different cultures for different reasons.Zinbarg (talk) 19:06, 29 December 2009 (UTC)

A respected place of academia like Cornell University wouldn't publish a story on "male genital mutilation" saying that "one-third of men have endured the painful procedure." It must be a fake, or a hacker has hacked into their computers. Jakew says no one calls it that, and we can't ever call it that here. Jakew knows everything, just ask his supporters. Blackworm (talk) 11:04, 30 December 2009 (UTC)

I'll guess you're kidding. I've seen you as extremely pro circ, so don't pick on Jakew. At least he's honest. Not saying your not. Please, easily find the published study[[14]]. Here's the Economist article[[15]]. The Wilson study points are "sperm-competition theory," and reducing "mischievous matings" and "adultery," not mutilation. There is a strong health reason for circumcision, and it's genetically based. I think that's divine intervention. Regardless, it's a recent, relevant, and detailed reference.

Jakew avoids the word mutilation, and I doubt it would remain for long anyway, so we're not using that word. Above he and I talk of FGC versus FGM as though FGM is NPOV; hogwash because FGM is THE commonly used term. I hadn't even heard of FGC until Wiki circ. Can we have two POV tags?Zinbarg (talk) 17:53, 30 December 2009 (UTC)