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This article uses the WP:MEDMOS layout, as it has for at least the past year or more. It passed WP:GA and has been stable with that layout. There have been general suggestions that a different layout giving greater emphasis to non-medical aspects would improve the article. We had an WP:NPOVN discussion that brought up the WP:MEDMOS layout, but there was no specific suggestion for a new layout, and that NPOVN discussion didn't help resolve this. In giving the article its second round of full-protection, Drmiessuggested that we need to work out the issues and that maybe an RFC is in order. Follow-up comments from Alexbrn, Doc James, Yobol, FiachraByrne and myself show clear support for an RFC if those interested in proposing a new layout were to make a specific proposal and start one.
In previous discussions, Google Scholar and Harzing's Publish or Perish results--both of which describe overwhelmingly medical sourcing--had been used to support the WP:MEDMOS layout. In the past week, Fiachra has provided some new bibliometrics that might support a proposal for a new layout. They have been available here on this Talk page for several days, see the section #Weight. If the interest is still there, it is now time for those who would like to see a new layout to work up a specific change proposal based on the sourcing and grounded in policy and guideline so we can have an RFC about it. Zad68 15:24, 16 January 2014 (UTC)
Like I suggested before, following Encyclopedia Britanica's organization of topics isn't a bad idea. An overview is at the top, the historical religious and cultural reasons for circumcision are then explained, an explanation of the medical procedure follows, and finally the medical reasons for circumcision are listed last.(UTC)ScienceApe (talk) 18:36, 16 January 2014 (UTC)
@Zad, how detailed do you want the new version? Do you want us to rewrite the entire article like we want it? Do you want only headings? Is ScienceApe's example from Encyclopedia Britanica enough? I certainly think it would be a good start, and then we could work our way from there. Is it possible to create a wikipedia test-page for the new layout?Zanthius (talk) 20:52, 16 January 2014 (UTC)
I would like to see, in any proposal, proper consideration given to the impact on the satellite articles. For example: at the moment this (the "hub" circumcision article) has a medical focus. Would the plan be to spin some of this out to a new article (Circumcision (medical procedure) maybe) ? - and would some of the content of one of the current satellite article be merged in here? Or would this be merely a framework article summarizing a number of detailed articles? In other words, I would want to be assured that the proposal had taken account of the impact on the topic as a whole. Alexbrntalk|contribs|COI 21:29, 16 January 2014 (UTC)
I completely agree with this proposal. Zanthius (talk) 22:03, 16 January 2014 (UTC)
I would put together a list of level 1 and level 2 headings. For an RFC you don't want too little detail so that people trying to review the proposal can't figure out what it is you're proposing exactly, and you don't want too much detail so that it's too big and people just go TL;DR and don't comment on it. Zad68 03:04, 17 January 2014 (UTC)
The current layout is perfectly fine and I oppose changing it to another encyclopedia's style. Happy to look at arguements if people present any. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:38, 17 January 2014 (UTC)
The article does seem unwieldy and disjointed. I agree with ScienceApe that the practice in modernity is more closely related to cultural and religious practices than medical, but it is hard to see how to integrate a presentation of the two while maintaining the coherence in the presentation of either.
The proposal of a Circumcision (medical procedure) by Alexbrn might help reduce some of the more narrowly focused material related to medicine, but that probably doesn't solve the range of problems. I see that there already is a substantial "History" article.--Ubikwit 連絡 見学/迷惑 13:28, 17 January 2014 (UTC)
To be clear, I wasn't making a proposal, but giving an example of the kind of concrete detail I would like to see if a proposal were made. Alexbrntalk|contribs|COI 14:59, 17 January 2014 (UTC)
The issue with making a separate Circumcision (medical procedure) article is that it would not follow WP:PRECISION. According to our best-available sourcing from the WHO, worldwide, circumcisions are most often requested by Muslims and Americans for religious/cultural reasons. Even though they are often requested for non-medical reasons, these circumcisions are either done soon after birth or as outpatient medical procedures done by trained medical staff in medical settings. There isn't a difference between "Circumcision" and "Circumcision (medical procedure)", and doing that to the title would incorrectly suggest that a "Circumcision" is different from a "Circumcision medical procedure". Following the numbers from our sourcing, a much smaller fraction of the procedures are done by specialist religious practitioners such as Jewish mohels or African or Aboriginal tribal practitioners. For those less commonly-encountered activities we have the specialist articles Religious male circumcision, Brit milah, coverage at the articles of relevant groups like Xhosa people etc. And regardless of why it's done, the effects are the same: the changes in HIV infections rates, HPV, etc. end up the same. This was the point being made earlier about elective C-sections: regardless of why it's being elected, it's still a medical procedure with the complication rates, effects, wound healing time etc. documented in the best-available sourcing. We don't have Caesarean section (medical procedure) separate from Caesarean section. This is why this article is "Circumcision". Also this is an argument made on a perception of real-world prevalence, but per Wikipedia guidelines we need to follow the emphasis in the sourcing. Zad68 14:08, 17 January 2014 (UTC)
No, you're invoking the same equivocation fallacy that I mentioned earlier. You're equivocating what circumcision is, to how it is performed today. For thousands of years circumcisions were performed with a piece of flint, and before the idea of sterilization existed or even the concept of germs. Circumcision is the removal of the foreskin around the penis either partially or completely, how that is accomplished doesn't change what circumcision is. You're also equivocating the article, Religious male circumcision with a non-medical procedure. That article has nothing to do with an obscure non-medical procedure, it's simply expounding upon the religious reasons behind male circumcision. With that said, I don't think making Circumcision (medical procedure) is a good idea either, but not because of the fallacy you used, but because it's just a modern technique to accomplish circumcision that is widely practiced today and doesn't warrant an article on its own because there isn't much else to say about it other than explaining the procedure. ScienceApe (talk) 19:02, 17 January 2014 (UTC)
Ape, right now this article has four sections covering the medical aspects of circumcision, in about 16,670 characters of text. In your view, how much coverage should Wikipedia have covering the medical aspects of circumcision (approximate character count), and in what article should that coverage be? What Wikipedia content policy and sourcing are you basing that view on? Thanks... Zad68 19:17, 17 January 2014 (UTC)
That's not really what I want to tackle right now, although we can address it at a later time. Right now I'm mostly concerned with the organization of the sections and what order they should appear in. ScienceApe (talk) 19:19, 17 January 2014 (UTC)
Ape, well, whatever your proposal for either changing the amount of medical content Wikipeida carries, or reorganizing the article, you need to support your proposal with references to the reliable sourcing and Wikipeida content policy. Otherwise you'd be making article content change proposals based on your own opinions/views, and surely you'd agree that allowing article content development to be driven based on the opinions of individual editors isn't optimal, or in line with Wikipedia policy. Zad68 19:35, 17 January 2014 (UTC)
No I am not. We've been through this already, you know what my position is, you're feigning ignorance of my position and arguments to misdirect and obfuscate the issue. You have already admitted that the vast majority of circumcisions practiced in the world are due to religious and cultural reasons and this fact is already backed up by sources in the article. That's all that needs to be said, structure the article putting the importance on those aspects of circumcision, not on the medical reasons. ScienceApe (talk) 21:51, 17 January 2014 (UTC)
Hi Ape, I think I know your position. I spent some time researching it myself, and the research (which is already in this article) says that religion plays a large role in the Muslim population world wide. In the English speaking world there is a small minority of people who have religion as a primary reason. It appears that the history of circumcision in the US is driven from a combination of medical and preference, which seems less cultural than I had actually realized on reading the citations. Until the 1880s circumcision was not used in the US, became popular for health reasons and peaked in the 50s, and has been slowly declining since then. So the US history seems to be primarily medical. Today it seems that the primary driver for the preference for hygiene first, medical second, and "looks like father" third. circumcision preference So given your observation, we should put a lot more information about hygiene. It seems that there is good evidence of poor penile hygiene hygiene is needed and a guide to cleaning Smegma: penis hygiene. Would this help?Bob the goodwin (talk) 04:34, 18 January 2014 (UTC)
We already went through this, and I already explained the intertwined nature of religion and culture, so for you to continue to separate those issues is misrepresenting the point. None of those links demonstrate what you have concluded. circumcision preference even concludes, Despite new medical information and updated stances from various medical associations, newborn male circumcision rates continue to be heavily influenced by the circumcision status of the child's father.. That is a cultural phenomena, and the primary motivator for circumcision, it has zilch to do with medical reasons. Furthermore, wikipedia represents a worldwide view, not an American view. ScienceApe (talk) 17:11, 18 January 2014 (UTC)
One can speak of medical culture too ... but that's perhaps premature in this discussion. FiachraByrne (talk) 23:25, 18 January 2014 (UTC)
Your source indicates circumcision status of the father is the tertiary reason, behind 2 medical reasons. Seppi333 (Insert 2¢) 17:57, 18 January 2014 (UTC)
I agree that the layout of this article should stay as it is, or largely stay as it is at least. In what way would restructuring this article be in compliance with the WP:Neutral/WP:Due weight policy, including its Balancing aspects and Giving "equal validity" subsections? WP:Due weight begins by stating, "Neutrality requires that each article or other page in the mainspace fairly represents all significant viewpoints that have been published by reliable sources, in proportion to the prominence of each viewpoint in the published, reliable sources." And its Balancing aspects subsection begins by stating, "An article should not give undue weight to any aspects of the subject but should strive to treat each aspect with a weight appropriate to its significance to the subject."
To what degree the sources cover this topic, and relative to their respective fields, has already been presented in the #Weight section above. I advise anyone here considering the layout of this article to keep those source results in mind. It seems that certain editors here are ignoring those results. That they somehow see those results as part of a fallacy. Flyer22 (talk) 18:15, 18 January 2014 (UTC)
I'm agnostic on this until I see a concrete proposal but it goes without saying that any RFC that would entertain any hope of success should argue for change from within WP policy - and not simply by invoking the WP:IAR free-for-all. FiachraByrne (talk) 23:28, 18 January 2014 (UTC)
100% agree, except for where you state "it goes without saying." Apparently it needs saying. Zad68 02:30, 19 January 2014 (UTC)
You have just demonstrated that you do not understand WP:IAR. It's not a free-for-all, and no one ever proposed that. WP:IAR is invoked when the rules of Wikipedia are getting in the way of making a good encyclopedia. I made a case for how the rules are being gamed in order to push a bias, and I stand by that argument. ScienceApe (talk) 17:56, 20 January 2014 (UTC)
Ape the wording of your response is odd. My position is that Wikipedia policy regarding WP:NPOV states that we weight "in proportion to the prominence of each viewpoint in the published, reliable sources," and so that is what we should do. If the sources have significant coverage of the medical aspects, the article need to carry significant coverage, as is the case here. Wikipedia NPOV policy doesn't say that we weight based on how often certain reasons are provided for why something is done as compared to other reasons. It says we weight by the sources. Your statement starting "That's all that needs to be said..." simply isn't in line with policy, and based on your repeated citing of "ignore all the rules" you're aware of this. You are of course welcome to hold views about article development that go against WP:NPOV but you shouldn't be surprised when they're viewed as problematic. Zad68 02:22, 19 January 2014 (UTC)
I don't need to retread this which you constantly try to do even though I already refuted your position with arguments, I will simply link to my argument that I made for a case for IAR, Noticeboard#Circumcision, The assertion that the vast majority of scholarly sources regarding circumcision are medical has not been demonstrated, but even if it is true, this seems to be a case of Ignore all rules. Circumcision has been practiced for thousands of years, and the main impetus behind it are due to cultural and religious reasons. Throughout the history of mankind, various excuses have been used to justify circumcision. For example to discourage masturbation, or to maintain personal hygiene. The most recent rationalization are medical purposes. These medical purposes however mask the true rationale behind why circumcision is performed, and have very little to do with why the vast majority of why circumcisions are actually performed. No major medical association advocates routine neo-natal circumcision other than the recommendations of the WHO for certain HIV endemic areas in Africa. Medical rationale is often used as a mask to push a pro-circumcision bias. Putting the weight of the article on the medical purposes for circumcision is inconsistent with reality and serves as a vehicle to push a bias, and therefore is hurting the article. "If a rule prevents you from improving or maintaining Wikipedia, ignore it."
Your source - PMID23418252 - from your previous would seem to contradict that statement.
Probably also worth stating that non-medical reasons (i.e. "pro-circumcision bias") and medical reasons, as a motive to want/promote circumcision, do not constitute a dichotomy (i.e., a person may be motivated by both). Seppi333 (Insert 2¢) 17:43, 19 January 2014 (UTC)
That's not my source, so I don't know why you're saying it's mine. Further, that source does not in any way demonstrate the motive for the vast majority of circumcisions in the world. Even Zad admits that the sources already cited in the article state that the vast majority of circumcisions in the world are motivated by religious and cultural reasons. You are also equivocating, non-medical reasons with "pro-circumcision bias". That is fallacious and a strawman. Also no one ever said that there was a dichotomy, so that's another strawman. You should give up on this line of argumentation which even Zad would not try to argue, there is no way you'll ever demonstrate that circumcision is mostly motivated by medical reasons. It smacks in the face of reality. ScienceApe (talk) 17:51, 20 January 2014 (UTC)
I completely forgot to reply to your latter statement - my bad. You're correct, no one said there is a dichotomy; however, in saying there is not a dichotomy, I'm doing exactly the opposite of what you said I was doing when you stated:
You are also equivocating, non-medical reasons with "pro-circumcision bias".
The former statement implies the latter (follows directly from logically negating the definition given in dichotomy). IDK what you see as being an argumentation fallacy in these statements. Seppi333 (Insert 2¢) 05:13, 21 January 2014 (UTC)
That's a non-sequitur. ScienceApe (talk) 17:56, 21 January 2014 (UTC)
Extended formal logic discussion
The following discussion has been closed. Please do not modify it.
Lol. I've noticed every response you've made to valid arguments that refute you is "that's a logical fallacy" without justification. Granted, you do justify your argument in the subset of cases where you're actually correct about the fallacy, but you didn't (and can't) in the previous case. That's just a non-sequitur refutation (i.e., your "non-sequitur", "straw man", "reductio ad xyz" responses are non-sequitur). In particular, the preceding "non-sequitur" claim is non-sequitur for this reason. Seppi333 (Insert 2¢) 23:46, 21 January 2014 (UTC)
The reason I call this "your source" is the bolded/underlined text here:
We already went through this, and I already explained the intertwined nature of religion and culture, so for you to continue to separate those issues is misrepresenting the point. None of those links demonstrate what you have concluded. circumcision preference even concludes, Despite new medical information and updated stances from various medical associations, newborn male circumcision rates continue to be heavily influenced by the circumcision status of the child's father.. That is a cultural phenomena, and the primary motivator for circumcision, it has zilch to do with medical reasons. Furthermore, wikipedia represents a worldwide view, not an American view. — ScienceApe (talk) 17:11, 18 January 2014 (UTC)
In logical analysis, a statement using universal quantification is false if its logical negation is true (i.e., there exists an instance of an opposing case). Now, note the following: (1) the sample of parents in the associated cultural region from your source is representative (also:the parents indicated primarily medical reasons for circumcision); (2) valid statistical design results in valid statistical inference to the represented population; and (3) your statement (the following sentence) implies that nearly all parents do this primarily for cultural reasons.
the vast majority of circumcisions practiced in the world are due to religious and cultural reasons
The existence of a cultural region where your statement is not true (i.e., the % of population citing medical reasons is greater than cultural reasons) constitutes a logical contradiction with your statement (i.e., the statement needs to be qualified to particular regions in order to be true, since its validity is conditional upon geography).
Hopefully I explained that well enough. Seppi333 (Insert 2¢) 01:54, 21 January 2014 (UTC)
Stop. You are filibustering, and making an induction fallacy. The vast majority of circumcisions practiced in the world are due to religious and cultural reasons. This conclusion is not negated by an example to the contrary because I DID NOT SAY ALL CIRCUMCISIONS ARE DUE TO RELIGIONS AND CULTURAL REASONS. The the vast majority of circumcisions are still due to religious and cultural reasons. ScienceApe (talk) 03:29, 21 January 2014 (UTC)
Actually, I was using an analytic proof (this follows from the fact that I used a proof by contradiction), which is entirely deductive reasoning. Amusingly (IMO), analytic pf still uses deductive reasoning even when doing "mathematical induction" (read the lead for a citation). Seppi333 (Insert 2¢) 03:36, 21 January 2014 (UTC)
Forgot to refute your second point. =D My proof rested on the contradictory statements: (% medical incidence > % cultural incidence) and (% medical incidence ≪ % cultural incidence). I have no clue where you're getting the "all circumcision" idea from - that's not where universal quantification came in, but if you want me to write what your argument was in a quantified statement, I'll do so. Most people can't read logical script, so I omitted it. Seppi333 (Insert 2¢) 03:48, 21 January 2014 (UTC)
You do not understand what an induction fallacy is, nor do you understand logic and reason. I did not make a universal quantification, I made a generalization with the qualifier "vast majority". You are equivocating "vast majority of circumcision" to "all circumcision". An example to the contrary will invalidate the latter, it will not invalidate the former. Your argument is invalid. Stop the sophistry, you are obfuscating the issue. ScienceApe (talk) 17:42, 21 January 2014 (UTC)
Facepalm
Ok, ignoring the thinly veiled personal attack, I'll write out a rigorous proof for you over the next few minutes. You can point out the "induction fallacy" after I post it, and then I'll explain to you why you're wrong. Seppi333 (Insert 2¢) 22:14, 21 January 2014 (UTC)
Don't bother, you're soapboxing anyway. I already refuted your rebuttal. ScienceApe (talk) 22:23, 21 January 2014 (UTC)
Before you point out where an induction fallacy occurred, it might help to point out where induction was even used.Seppi333 (Insert 2¢) 23:46, 21 January 2014 (UTC)
Pf
I'm going to define these sets just to make the proof itself shorter.
C ≝ The % or frequency at which circumcision is sought for cultural reasons
M ≝ The % or frequency at which circumcision is sought for medical reasons
s ≝ Saskatchewan
R ≝ s ∈ R ∧ R constitutes a disjoint geopolitical (specifically, state/province) partition of the world (I.e., s ∩ (R\s) = ∅)
Proof that the relation C > M is conditional upon geographic regions:
(1) Assume your statement: C>M - this statement is vacuously true (i.e., defined on ∅) without quantification.
(2) C<M in s, s ∈ R (per PMID23418252)
Quantification for (1):
One of the following is true (this is obvious, but I'm stating it anyway), since the logical disjoint of these two is a tautology:
(3a) C>M is heterogeneous in the global population ≡ ∃ nonempty partition R* of the global population ∋ ∃x ∈ R* where C<M
(3b) C>M is homogeneous in the global population ≡ ∀ nonempty partitions R* of the global population, C>M ∀ x ∈ R* (i.e., logical negation of the 3a)
If (3a), there is no contradiction between your argument and (2) since R is a partition set (R*) where this holds. We also agree ∃x ∈ R* ∋ C<M ∧ ∃y ∈ R* ∋ C>M (in English, the relation C > M is conditional upon geographic regions). (follows from (1),(2), and (3a))
If (3b), then by assumption (1) we have (∀r∈R,C>M). Moreover,
(4) (∃r∈R ∋ C<M) ≡ (¬∀r∈R,C>M) (follows from negation of (2))
(5) Hence, (∃r∈R ∋ C<M ⊥ ∀r∈R,C>M). By contradiction, the assumption is false. ⟨ Seppi333 (Insert 2¢) 23:46, 21 January 2014 (UTC)
This is nonsense. In short, your premise is wrong. I didn't make a universal quantification. If the premise is wrong, then the conclusion is wrong. Garbage in, garbage out. ScienceApe (talk) 03:07, 22 January 2014 (UTC)
If you didn't mean that, then you've been agreeing with me all along - I covered that in case (3a). It's a nonconstructive proof - it's not necessary for me to say which you meant so long as it's valid in all possible (two, per the tautology) cases. In any event, for future reference, mathematical logic (aside: math is a much broader subject than most people think) is a much more rigorous, closed form system of logic than a typical "logical argument" - many argument fallacies aren't even applicable to analysis, e.g., inductive logic invalidates mathematical proofs, so all errors in inductive reasoning are irrelevant to this system. You may want to familiarize yourself with boolean logic (the aforementioned closed system which is also the elementary syntax/foundation in mathematical reasoning) if you're interested in learning a more rigorous logical system. You'll understand my proof more if you read/learn the system in that article. Seppi333 (Insert 2¢) 04:44, 22 January 2014 (UTC)
No, the error was entirely on your part. You equivocated my statement with a universal quantification when it was never that in the first place. You then tried to obfuscate your mistake by engaging in sophistry and long, tedious rationalizations that no one asked for, and even now you're trying to pin the error on me. Stop soapboxing, admit you made a mistake and move on. ScienceApe (talk) 19:30, 22 January 2014 (UTC)
Facepalm I have no idea why you're being so confrontational on this - you realize in my last reply, I didn't once outright state "you are wrong" even though, reading between the lines, it's obvious that I know you don't understand the mechanics of this form of logic, right? Whatever, I'll play your game. Just fyi, you're calling a proof by exhaustion over a set where the associated stataements constitute a tautology "[trying] to obfuscate your mistake by engaging in sophistry and long, tedious rationalizations that no one asked for" - that basic method of proof is covered in sophomore level intro-to-proof classes in virtually every US college (i.e., the ones with a math department). If that's too advanced for you to follow, perhaps you should stop arguing with me, since you can't "disprove" boolean logic with your diarrhea of words (Ad nauseam) arguments. If you can't use a logical connective to refute a statement, you can't prove anything in a closed logic system. In other words, now I'm flat out saying "you are wrong and you have no clue what you are talking about." Feel free to try again though. Seppi333 (Insert 2¢) 20:05, 22 January 2014 (UTC)
And you continue to pontificate. You made a mistake, and now you're trying to cover it up with this filibuster. Stop making excuses. ScienceApe (talk) 23:27, 22 January 2014 (UTC)
Lol, if you say so. Certain things in this thread are so self-evident now that it's unnecessary for me to state a conclusion. Consequently, this is my last reply, as I don't want to get any more of your verbal diarrhea on me.Seppi333 (Insert 2¢) 01:30, 23 January 2014 (UTC)
You wasted everyone's time on sophistry to cover up your mistake so I think verbal diarrhea is a good way to describe all of the nonsense you wrote. Thanks for the phrase, I'm gona steal it from you. ScienceApe (talk) 17:57, 23 January 2014 (UTC)
I'm basically an outsider here that got tangentially involved because I noticed a thread about a user that I'd seen engaging a controversial topic in a reasonable manner whom it appeared was being subjected to accusations for descriptively using a term that, upon further examination, does not merit being used even descriptively in this context.
But, what I have seen from a more generally editorial standpoint is that this article is rather unwieldy, and though I agree with the objections that have been raised to the creation of a "medical procedure" specific article, it would seem that there is too much technical medical data in the article beyond the "procedure", and that the more technical medical knowledge should be moved to an article more comprehensive than "medical procedure", such as "circumcision and modern medicine", for example, in order to streamline the medical content in the same manner that the "history" content has been streamlined through the creation of the "history" article.--Ubikwit 連絡 見学/迷惑 17:18, 21 January 2014 (UTC)
A nice human-interest article that gives the views of the individuals the authors interviewed. The information in it is largely already reflected in this article. The Judaism overview states that among Jews circumcision is considered very important and prevalence among Jews is over 90%, but the article can't say 100%. I checked to see if the CDC report linked to is any better than the CDC M&M report the article currently cites but both data sets stop at 2010. I'm a bit surprised the Guardian didn't mention "Brit shalom" by name. Zad68 02:22, 19 January 2014 (UTC)
Prevalence update
Does any awake editor think that the nice human interest Centre for Disease Control ( CDC) 1979 to 2010 graphs of declining popularity of male newborn circumcision in USA might merit a mention in our article http://www.cdc.gov/nchs/data/hestat/circumcision_2013/circumcision_2013.htm#table or perhaps there has been an undocumented surge in circumcision popularity within the last 3 years that I am unaware of ? — Preceding unsigned comment added by Tumadoireacht (talk • contribs)
Sure we can add a bit more detail to what the article currently carries. It currently states, "In the United States, hospital discharge surveys estimated rates at 48.3% around the year 1990,[62] 61% in 2000,[1] and around 56.6% in 2008." sourced to the WHO's GTDPSA and the CDC's M&M 2011. The article could state instead, "In the United States, hospital discharge surveys estimated rates at 64.7% in the year 1980, 59.0% in the year 1990, 62.4% in the year 2000, and 58.3% in the year 2010." sourced to the CDC's 2013 NCHS Health E-Stat. That would give a decade-over-decade overview. Sound good? Zad68 14:51, 20 January 2014 (UTC)
Would it be simpler to just mention that rates have dropped 10% in the 30 year period in that region as is done here http://healthland.time.com/2013/08/22/explaining-the-drop-in-circumcision-rates/ This article references regional variations within USA too which might be worth a mention and some stuff on the preventative power of circumcision in HIV high risk areas.--— ⦿⨦⨀TumadoireachtTalk/Stalk 18:33, 20 January 2014 (UTC)
Using relative percentages like "dropped 10%" can cause confusion when absolute percentages are also used. For example, if an article states the rate of something is 60% and then it fell 10%, does that mean that it ended up at 60 - 10 = 50%, or 60 - ( .1 * 60 ) = 54% ? Also, omitting the decade-by-decade data might suggest incorrectly that there was a steady decline--the CDC E-Stat document discusses how it wasn't. Luckily the content of the CDC document is public-domain and so may be quoted verbatim (with attribution) in the Wikipedia article. We can just lift their exact sentences: "Across the 32-year period from 1979 through 2010, the national rate of newborn circumcision declined 10% overall, from 64.5% to 58.3%." followed by "However, rates fluctuated during this period, generally declining during the 1980s, rising in the 1990s, and declining again in the early years of the 21st century." I'm willing go with this too, sound good? The rest of the CDC's E-Stat, starting with "These changes occurred during a period of changing guidance..." syncs up nicely with what the article already says.
Regarding intra-USA regional differences, this article doesn't go into such detail for any other country covered in Prevalence, so per WP:DUEWEIGHT I do not think this article should go into such USA-specific detail, but it could be added to the specialized sub-article Prevalence of circumcision. Regarding HIV, the article already does make mention of its use for that, and the CDC NCHS Health E-Stat doesn't really cover that. Did you have a new source and a content change idea based on it in mind? Zad68 14:39, 21 January 2014 (UTC)
US Newborn Circumcision Rate (%) 1900-2010 [1][2][3] Here is a graphic I made, I don't know the standards for this sort of thing, so let me know? Bob the goodwin (talk) 06:51, 25 January 2014 (UTC) --------->
Hey Bob the format of the graph looks nice but the sourcing for the stats needs improvement. The WHO's GTDPSA I think only gave point-in-time stats, it will require some digging to find that for several countries. It might be available on the WHO's website here, feel like digging through the data there? Pinging Seppi333 as they might also be interested. Zad68 03:08, 27 January 2014 (UTC)
Hey Zad68 Thanks. When you say 'several countries' what did you have in mind? Selection can create its own bias. I also don't know what 'only gave point-in-time stats' means, sorry if I do not understand these standards yet. You also said that graphics can be overpowering. With well sources data, are you sure this is useful? I will work on your suggestion.Bob the goodwin (talk) 20:37, 30 January 2014 (UTC)
Statistics
Is it significant that the 10% decline in popularity of circumcision over the studied was lumpy based on the four different positions taken by american medical association or should THAT info go in the prevalence article too? Any 101 statistics class could answer the first query re stats and percentages raised by the previous editor--— ⦿⨦⨀TumadoireachtTalk/Stalk 23:58, 21 January 2014 (UTC)
I agree that more data from the source should be added. As for the "10% decline in popularity of circumcision," look at what the source states about the position changes; we should present that material as accurately as the source does. As for statistics, Wikipedia is for the layperson first and foremost; the general public. How are we expecting the average reader to factor in the statistics? Flyer22 (talk) 21:14, 22 January 2014 (UTC)
Agree with Flyer's points. As there's support for, at a bare minimum, updating the existing numerical statistics with the new values in the CDC E-Stat document I've gone ahead and applied that. Tumadoireacht, I'm sure it was just an oversight but the medical organization that the CDC E-Stat document refers to isn't the American Medical Association (the AMA) but rather the American Academy of Pediatrics (AAP). Anyway, sorry you're unhappy with both of the content change suggestions I've offered; I feel like I've tried to work with you to address your concerns, while addressing the points I've raised about clarity and not over-emphasizing U.S.-specific information. Is your only remaining concern that the relationship between the fluctuations in the data and the changing guidance from the AAP should be mentioned? I would be happy with that--as I mentioned before, what the CDC says regarding that syncs up nicely with what's in the article already, so I am not sure why you think this is an area where we'd disagree. Zad68 03:03, 23 January 2014 (UTC)
Pinging Seppi333 to this discussion, as Seppi is an experienced medical editor who also has some training in statistics... hoping you help us present this information clearly, any suggestions Seppi? Zad68 03:05, 23 January 2014 (UTC)
I think the best way to communicate frequency/descriptive statistics is graphically; personally, my eyes glaze over when I read prose that's heavy on descriptive statistics. A line chart, scatter plot, or a mix of those two is probably the best graph to use. Also, Zad68's edit was a good idea IMO, since nonstandard reporting intervals adds needless complexity.
Not sure if there was a particular issue to address besides that - I just skimmed this section. Seppi333 (Insert 2¢) 04:07, 23 January 2014 (UTC)
Thanks Seppi. I like the idea of a graph too but they take up a lot of visual space and emphasis. I'd like a worldwide prevalence graph instead of a US-specific one. A single graph charting rates of several countries would be good but I don't know of one that's available.
For the prose, suggestion #3: "In the United States, from 1979 through 2010, the national rate of newborn circumcision declined 10% overall, from 64.5% to 58.3%. Rates fluctuated up and down during this period, generally declining during the 1980s, rising in the 1990s, and declining again in the early years of the 21st century, as guidance from the AAP regarding the procedure varied." Sound good? Zad68 04:16, 23 January 2014 (UTC)
I could make a graph for it if I had the dataset. In any event, it may be best simply to say "the rate fluctuated between approximately (max value) to about (min value) over (the period)", since there's no data on what's happening annually within decades. Seppi333 (Insert 2¢) 04:24, 23 January 2014 (UTC)
tribal circumcisions amongst Maasai and elsewhere. also keratinization of the penis glans after foreskin cut off.Forced circumcisions from a human rights perspective-all require mention in the article
tribal circumcisions amongst Maasai and elsewhere. also keratinization of the penis glans after foreskin cut off
Her is the wikipedia article on the Maasai teen circumcision procedure :
"One rite of passage from boyhood to the status of junior warrior is a painful circumcision ceremony, which is performed without anaesthetic. This ritual is typically performed by the elders, who use a sharpened knife and makeshift cattle hide bandages for the procedure. The Maa word for circumcision is emorata.[44] The boy must endure the operation in silence. Expressions of pain bring dishonor, albeit temporarily. Any exclamations can cause a mistake in the delicate and tedious process, which can result in lifelong scarring, dysfunction, and pain. The healing process will take 3–4 months, during which urination is painful and nearly impossible at times, and boys must remain in black clothes for a period of 4–8 months.[45]
During this period, the newly circumcised young men will live in a "manyatta", a "village" built by their mothers. The manyatta has no encircling barricade for protection, emphasizing the warrior role of protecting the community. No inner kraal is built, since warriors neither own cattle nor undertake stock duties. Further rites of passage are required before achieving the status of senior warrior, culminating in the eunoto ceremony, the "coming of age".[46]"
Should this merit mention in the Circumcision article ? It is a very different exercise of MC that contrasts sharply with the homogenous mostly rosy picture of MC currently painted by our article.
Also- all circumcisions cause a keratinized penis tip -this means that the entire skin surface of the remaining portion of the head of the penis after the outer lip has been cut off, dries out permanently and the squamous epithelial cells of the head , perviously protected by the foreskin sheath, convert into a horny material for the remainder of the cut male's life ( horny-no pun intended). This important aspect of the custom of circumcision so far seems to have escaped mention in the article. Should we amend this ? Finally I would like to re-open discussion, from a human rights perspective, of the well documented current forced adult and teen circumcisions in Africa,Europe, and in Australia which have, so far, also failed to find mention in the article.--— ⦿⨦⨀Tumadoireacht Talk/Stalk 09:58, 26 January 2014 (UTC)
The article's current structure, which treats circumcision as a medical topic and essentially follows the outline described in WP:MEDMOS#Surgeries and procedures does not allow giving these aspects of the topic the weight they deserve. It has additionally been argued (or at least implied) in the past that all sources on circumcision, even those on non-medical aspects, must satisfy the requirements of WP:MEDRS. This would automatically rule out the strongest sources for anthropological information, permitting only medical sources which are typically out of their depth when they do happen to summarise some of the anthropological research.
To stifle unproductive conflicts along the lines of whether MEDMOS trumps NPOV or vice versa, I suggest starting with an RFC deciding between roughly the following options:
(A) The article circumcision is essentially a purely medical article. With only the usual caveats for medical articles, WP:MEDMOS and WP:MEDRS fully apply.
(B) Like (A), but the article needs to be renamed and a new article written under the current title which discusses all significant aspects of the topic (including medical, historical, religious, anthropological, legal, human rights) with appropriate relative weight.
(C) The article circumcision needs to be restructured, extended and in part shortened so that the medical approach is restricted to certain subsections that have appropriate, significant weight, but do not dominate the article. Anyone desiring an article on circumcision as a purely medical surgical procedure can write it elsewhere (to be summarised here in the medical section).
I also put out a call about a week and a half ago for those who are interested in a new structure for this article to put together an RFC, based on the bibliometrics FiachraByrne did. But Hans maybe you'll have better luck than I did. Option (A) unfortunately sounds like a mischaracterization of the current article layout. I would actually lean toward supporting something that looks like (C) if the bibliometrics bear it out, but would need to see a specific proposal, like a list of level-1 and level-2 headings as I suggested before with rough idea of the relative section sizes. I don't actually think the current article is actually too far off from that suggestion already. Currently, WP:MEDMOS is used but, as has been pointed out, there's a lot of non-medical material and non-WP:MEDRS sources are used... I'm not sure why the misunderstanding still exists that people are saying only medical sources may be used, even for things like History and Society and culture. Again, what needs to happen is for those who are interested in a new structure to propose one, something specific, and make a case based on the sourcing and Wikipedia guidelines and policy including WP:NPOV.
I'd also like to point out that the second of Tumadoireacht's proposals, "keratinization of the penis glans", is actually proposing to add new medical content, although no reliable source was provided and I don't actually see support for the proposal in the WP:MEDRS-compliant reliable sourcing. Zad68 00:41, 27 January 2014 (UTC)
Is that even necessary? The major opponent here stopping users from restructuring the article to how it should be, is you. The case has already been made to what the weight should be on, just change it. We shouldn't need any special approval to improve an article. ScienceApe (talk) 01:00, 27 January 2014 (UTC)
Unfortunately this response skips past two very important things I said. As we've discussed several times previously, your idea of "how it should be" so far has never been clearly defined, or demonstrated to be based in the sourcing and content policy. So, yes, if you want a major restructuring of one of the top-10 most contentious Wikipedia articles to be stable long-term, it'll require a clear change proposal discussed in an RFC, preferably one that runs for the full 30 days and is closed by an uninvolved admin. If you'd review our previous discussion on this you'll find I'm not the only one who supports this path. Zad68 02:52, 27 January 2014 (UTC)
Actually I did clearly define how the content should be organized several times, and if you like I'll say it again. An overview is at the top, the historical religious and cultural reasons for circumcision are then explained, an explanation of the medical procedure follows, and finally the medical reasons are listed last. Are you still confused on how this article should be organized? ScienceApe (talk) 04:02, 27 January 2014 (UTC)
Do you really think that one sentence is enough detail to convey your vision clearly? And you haven't addressed the relative weights at all. Come to think of it, when I asked you earlier specifically how much space you feel the article should devote to medical topics, you declined to answer at all. I am puzzled as to why you are so reluctant to be forthcoming. Zad68 04:43, 27 January 2014 (UTC)
It's a general sense of what the article should look like yes. As for your second point, I already told you why. Because you haven't even agreed to restructure the article yet which is the more pressing issue. Fix that problem first. ScienceApe (talk) 23:16, 30 January 2014 (UTC)
@Hans Adler: I don't remember ever seeing anyone say or imply that only MEDRS sources can be used in this article. Care to provide a recent diff or two? Such a suggestion would clearly be inappropriate, as we should use the strongest sources for the area of discussion (i.e. medical sources for complications from the procedure, legal sources for legal aspects, etc). I also think that the RfC you propose would not be neutral as proposed, and it would be a muddled RfC as it would suggest answers to questions that are probably better handled separately (such as Is there too much weight to medical content?; Should MEDMOS apply here?; Should there be a separate Circumcision medicine article forked out?, etc). Asking so many questions in a RfC would only muddy the waters and prevent a clear answer. I would suggest choosing one (i.e. discussion of MEDMOS or weight of medical content) first, so that we can come to a conclusion easier. Yobol (talk) 04:11, 27 January 2014 (UTC)
An RFC needs to state the proposed change clearly. General RFC questions like "Is there too much or too little emphasis on this or that?" are never productive because even if there's support for the RFC question, there is no clear direction that can result from that kind of vague question--if it's agreed there's not enough coverage or too much coverage of something, what needs to be done: add or delete one sentence, one paragraph, one section? Based on what sourcing? Without that it will be a waste of time. Zad68 04:49, 27 January 2014 (UTC)
Agreed, the RfC will need to be specific as to the question and the solution (i.e. with reference to sources). I don't want to waste time on a RfC that goes nowhere and leads to no conclusion. Yobol (talk) 04:54, 27 January 2014 (UTC)
Agreed. Flyer22 (talk) 05:50, 27 January 2014 (UTC)
I was quite specific above in asking about three omissions - the tribal process transcript above ,the keratinization, and the forced circumcisions -none of which are covered in our present article.
Uh... thanks for the pointer to the BJU and Urology, I guess. As always, it's back to whether there's sourcing and specific text. The "keratinization of the penis glans" suggestion is representative, no reliable sources were identified in the first place. You then made reference to two journals and provided a link to a list of three articles in those journals. Were these intended to be sources in support of the "keratinization" content you had just mentioned again? Have you made yourself familiar with Wikipedia's guidelines for identifying reliable sourcing in general, and for biomedical information in particular? For the latter, it's called Wikipedia:Identifying reliable sources (medicine) and the most common shortcut provided to it is "WP:MEDRS". Based on the date range you gave, you should also look at WP:MEDDATE. Being able to tell the difference between a primary source and a secondary source is also essential. If you're having any trouble with evaluating a particular source, please feel free to drop me a note on my User Talk and I'll try to help if you'd like. Zad68 03:23, 28 January 2014 (UTC)
Uh -Please feel free to discontinue running wikipedia guidelines 101 loop tape. Guidelines are just that. The many aspects of circumcision which i have mentioned several times and which we have failed to document -forced circumcisions/sale of cut off foreskins/tribal rites as sourced above/ and the universal keratinization of the penis tip post circumcision do not cease to exist as phenomena simply by denying them by unreasonably rigid adherence to guidelnes. --— ⦿⨦⨀TumadoireachtTalk/Stalk 23:14, 28 January 2014 (UTC)
I agree that the medical aspects of circumcision should be expanded. There is far more risk of BXO/cancer from not circumcising, than there is from scar tissue from doing the procedure. Having had skin in this game, I have done some research. Bob the goodwin (talk) 05:35, 31 January 2014 (UTC)
The Masaii forced circumcision might have value in the discussion, but my feeling was that this was more of a cultural right of passage, than a form of violence against the penis. They are not tying down boys, but nor are any boys refusing to do it. What is gruesome is the lack of pain killers, but again this is why I think it is cultural - like how we conscript into wars. Perhaps an additional sentence in the African Cultures section "The Maasai use unanesthetized circumcision as a rite of passage to manhood." [3]". I think the text about painful or impossible urination is unnecessary either in this section or the BXO medical section, as these symptoms are better reported in other articles.Bob the goodwin (talk) 05:35, 31 January 2014 (UTC)
I have looked around the Wikipedia site about forced circumcisions, and the stories of forced circumcisions seemed to be extremely rare, mostly criminal, and thus highlighting them is giving undue weight to an inflammatory argument. Bob the goodwin (talk) 05:35, 31 January 2014 (UTC)
Using primary sources to refute secondary ones
Per WP:MEDRS we do not use primary sources to refute secondary ones. Thus reverted [4]
This is a 1996 primary source and does not support the text provided Taylor, J. R.; Lockwood, A. P.; Taylor, A. J. (1996). "The Prepuce: Specialized Mucosa of the Penis and Its Loss to Circumcision". British Journal of Urology. 77: 291–295.
I believe it does support the text provided. Could you explain why you believe it doesn't. Kaldari (talk) 09:59, 29 January 2014 (UTC)
This is another primary source Bronselaer, Guy A. (2013). "Male circumcision decreases penile sensitivity as measured in a large cohort". BJU International. 111 (5): 820–827. doi:10.1111/j.1464-410X.2012.11761.x. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
Doc James (talk · contribs · email) (if I write on your page reply on mine) 09:49, 29 January 2014 (UTC)
Our article currently states that "Circumcision does not appear to decrease the sensitivity of the penis, harm sexual function or reduce sexual satisfaction." While this may be the majority opinion in the medical community, it is certainly not universal, and there are many significant and recent studies stating otherwise. The NPOV policy states that articles must "fairly represents all significant viewpoints that have been published by reliable sources". Perhaps my wording was not ideal, but the viewpoint that circumcision decreases sexual sensitivity is clearly significant (as it is discussed in numerous books and scholarly articles) and should at least be mentioned, per the NPOV policy. Does anyone have suggestions on appropriate wording for this? Kaldari (talk) 09:56, 29 January 2014 (UTC)
Why have you omitted the next sentence that reads "The Royal Dutch Medical Association's 2010 Viewpoint mentions that "complications in the area of sexuality" have been reported."? Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:03, 29 January 2014 (UTC)
"Complications in the area of sexuality" is about as vague as you can possibly get. Kaldari (talk) 10:06, 29 January 2014 (UTC)
We're not really talking "viewpoints" here, we're talking biomedical information. Alexbrntalk|contribs|COI 10:00, 29 January 2014 (UTC)
Even the review articles currently cited acknowledge that the matter is controversial, while our article does not. For example, the Task Force review article currently cited in the section states: "There is fair evidence from a cross-sectional study of Korean men of decreased masturbatory pleasure after adult circumcision." Is that good enough for WP:MEDRS? Kaldari (talk) 10:22, 29 January 2014 (UTC)
What wording are you proposing? Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:24, 29 January 2014 (UTC)
How about: "The majority of medical research concludes that circumcision does not appear to decrease the sensitivity of the penis, harm sexual function or reduce sexual satisfaction. However, some recent studies disagree with this conclusion." For the disagreeing sentence we could cite Kim 2007 (the study mentioned in the Task Force article) and Bronselaer 2013. Kaldari (talk) 10:32, 29 January 2014 (UTC)
Lets give others a chance to comment. We do not use primary sources to refute secondary ones. Thus we do not use Bronselaer 2013 as it is a primary source. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:38, 29 January 2014 (UTC)
Stating that there are studies that disagree is not the same as refuting. Refuting would be something like "It is unclear whether circumcision decreases the sensitivity of the penis." Regarding secondary sources, we can re-cite the Task Force review article, but I actually think citing the primary sources for the second sentence would be reasonable as we are specifically talking about "some studies", not the overall medical consensus. Regardless, I'll shut up now and let other folks weigh in. Kaldari (talk) 10:53, 29 January 2014 (UTC)
We do use primary sources. We use them to supplement and complement secondary backbone of article content.We also use them because they often contain useful information. The pattern of a small group of editors working in unison in this article to reject long established facts, knowledge about, and information, on so many aspects of circumcision, is both disturbing and risible.--— ⦿⨦⨀TumadoireachtTalk/Stalk 11:13, 29 January 2014 (UTC)
The guidance says: "Controversies or areas of uncertainty in medicine should be illustrated with reliable secondary sources describing the varying viewpoints". So I don't think we should use primaries to show any such controversies or areas of uncertainty here. The questions is: is there a good secondary source setting these controversies out? Alexbrntalk|contribs|COI 12:54, 29 January 2014 (UTC)
For general controversies, isn't the right place the Circumcision controversies article? I think the specific question at hand is: is there some good secondary RS which complicates the content in the current article around sensitivity of the penis? Alexbrntalk|contribs|COI 13:11, 29 January 2014 (UTC)
In just about every area of evidence-based medicine there are primary studies of varying quality and relevance that can be found to support or refute nearly every claim. I can point you to primary studies that show that HIV doesn't cause AIDS (it does) and I can point you to primary studies that show thiomersal causes autism (it doesn't). This is why it's critically important to use the best-quality authoritative secondary sources where available, and there are plenty available here. The existence of individual primary studies isn't by itself a controversy when there's a half-dozen high-quality secondary sources that review the primary studies, evaluate the evidence quality and relevance, and all come to essentially the same conclusion. The "controversy" will be expressed in the secondary sources' evaluation of the overall evidence base--if the highest-quality primary sources say X and a few lower-quality primary sources say Y, the secondary sources will say "generally X", and that's exactly what we have here. Pinto wrote a 2012 review article (PMID22857844, already used in the article) called "Circumcision Controversies" focused specifically on the controversies topic. Pinto's article doesn't mention any controversy at all regarding sexual effects. If the reliable secondary sources covering the subject don't pick it up as a controversy, there isn't a basis for depicting it as such in the article.
Also, we need to be careful with looking at an advocacy website like www.circinfo.net, I think looking to advocacy websites (on either side of the issue) is a bad idea for trying to locate reliable sources or getting an even-handed overview. Zad68 15:51, 29 January 2014 (UTC)
I agree we shouldn't look at circinfo as an even handed source but circinfo is the type of advocacy site that may well link to valid secondary sources which highlight the difference of opinion. I'm pretty confident having traced back most of the sources that there aren't in this case, reliable secondary sources showing a difference of opinion in the medical community on sensitivity. — Preceding unsigned comment added by SPACKlick (talk • contribs) 16:31, 29 January 2014 (UTC)
True, SPACKlick, that does seem to be the case, can agree that the sourcing does show that. Zad68 16:36, 29 January 2014 (UTC)
As I've already mentioned, one of the secondary sources already cited in the section says that there is recent high quality research showing adverse affect on sexual satisfaction (at least due to adult circumcision). Kaldari (talk) 17:40, 29 January 2014 (UTC)
You must be talking about the Korean study here? I am not seeing the Task Force report characterizing the Korean study as "high quality". That section of the Task Force report first discusses two large multi-center RCTs, and describes them as "good-quality". The Korean study is covered in the following part, which starts off with "Other studies in the area of function, sensation, and satisfaction have been less rigorous in design, and they fail to provide evidence that the circumcised penis has decreased sensitivity compared with the uncircumcised penis." So the Korean study is characterized as one of the ones that fails to produce worthwhile evidence. The Task Force characterizes the Korean study itself as providing "fair evidence". How are you getting that it's producing "high quality" evidence? Zad68 18:16, 29 January 2014 (UTC)
I do not believe that the Task Force paper was grouping the Korean study with the studies that "fail to provide evidence that the circumcised penis has decreased sensitivity compared with the uncircumcised penis." The Task Force paper seemed to be pointing out that there was at least one good paper showing adverse effects on sexual satisfaction (distinct from sensitivity). Kaldari (talk) 18:26, 29 January 2014 (UTC)
You're describing the Korean study again as "good" ("one good paper"), I'm not sure why you're still doing this? The Task Force doesn't call it "good", it calls it "fair". The Task Force describes the large multi-center RCTs as "good", the Korean study doesn't meet that standard. So I really think the Task Force was grouping it in with the discussion of non-worthwhile evidence. The Task Force's own conclusion regarding this topic indicates this: "The literature review does not support the belief that male circumcision adversely affects penile sexual function or sensitivity, or sexual satisfaction, regardless of how these factors are defined."--they don't have a special exception for masturbation. I'd like to get input from the experienced WP:MED editors involved in this conversation and familiar with this kind of report... Doc? Alex? Zad68 18:52, 29 January 2014 (UTC)
Yes, I'm describing the Korean study as good, as in good enough that it was not dismissed. Why are you describing it as "non-worthwhile"? The Task force doesn't describe it as "non-worthwhile". Let's focus on the substance of the sources and not get into pointless semantic debates. Kaldari (talk) 19:36, 29 January 2014 (UTC)
Sorry - the Korean study is a primary source (do I understand right?) If so, why is it even on the table here? Alexbrntalk|contribs|COI 19:43, 29 January 2014 (UTC)
I was actually talking about the Task Force review paper's assessment of the Korean study. The Task Force paper is a secondary source. Regardless, we seem to differ on our interpretation of the assessment, and I'm not really sure who is right. Guess I need to do some more research and see what other secondary source say. Kaldari (talk) 02:44, 30 January 2014 (UTC)
This incident is another example of the point I've been making about users gaming the rules to push a POV. Doc James and Zad are the major reverters to anyone who is making changes to the article under the pretense that this is supposed to be a medical article. By saying circumcision is a medical procedure, you're saying that it's necessarily a medical procedure when it's not. Circumcision is the removal of the foreskin from the penis, how that's accomplished is incidental. When they decided to make this a medical article, it had rules that allowed them to structure the article the way they wanted it to be, and refuse citations that they didn't want. When you choose how the article is structured, and what citations are allowed, you control the content, and thus can push a POV. ScienceApe (talk) 03:23, 31 January 2014 (UTC)
Hi ScienceApe. I looked through the dialog to see if I agreed that what we have is a case of POV disguised as rules. I think you are stating that your opponents are Wikilawyering to prevent the inclusion of medical studies which show that circumcisions reduce feelings in the penis. The argument on the other side is that there is a primary source that agrees, but that no secondary sources drew the conclusion of the primary sources, even when it referenced them. Am I summarizing properly? If so, then there is no secondary source which supports the claim. I understand your frustration, and I know you are dissatisfied, but still do not see your argument based on references. But will back you up if you have. Bob the goodwin (talk) 05:03, 31 January 2014 (UTC)
Doc James made the contention that primary sources can't be used to refute secondary sources because of WP:MEDRS, under the pretense that this article is organized under Wikipedia:MEDMOS because they assert that circumcision is a medical procedure. The problem is that circumcision is not necessarily a medical procedure, it's incidentally a medical procedure. So organizing it under those rules is inherently flawed. ScienceApe (talk) 17:29, 31 January 2014 (UTC)
Unfortunately this response is based on a few misunderstandings. First, the principle that secondary sources need to be respected isn't something peculiar to WP:MEDRS, this is part of core sourcing policy. WP:MEDRS is simply a description of how this core sourcing policy is applied to biomedical information. Second, it doesn't matter how an article is organized, WP:MEDMOS or not--WP:MEDRS is the sourcing guideline for biomedical statements no matter what the article is or how it's organized. Even if a convincing case is made to reorganize this article in some other way, that will not mean that WP:MEDRS will no longer apply to biomedical statements. Finally, that circumcision is a medical procedure, no matter what the reason it's ordered, is well-supported by the available sourcing. It's covered in most any pediatrics text you'll pick up, it's got an ICD code listed for it, it's being promoted by the World Health Organization as a tool to reduce the incidence of HIV in some populations, and as Doc James pointed out there's an entire surgical handbook devoted to it. Zad68 18:14, 31 January 2014 (UTC)
He cited the rules pertaining to WP:MEDRS so I challenged it on those merits. My core argument still stands however, everything seems to be coming back to the argument that circumcision is a medical procedure implying that it's necessarily a medical procedure. It's not, and pointing to X number of sources that say it's a medical procedure does not change that. For example, castration is described in plenty of sources as a medical procedure, because it can be. It can also be a method of torture, or punishment. Castration is the removal of the testes. That's what it necessarily is. It's incidentally a medical procedure, it's incidentally a method of torture or punishment, but not necessarily either. Likewise circumcision is the removal of the foreskin. It's incidentally a medical procedure, it's incidentally a method of torture or punishment, it's incidentally a religious ritual, but it's not necessarily any of these things. That's the problem you have created, you have decided to make the core article, circumcision a medical procedure when it's not necessarily that. That inevitably creates a slant article that does not give the proper weight to the proper subjects pertaining to circumcision. ScienceApe (talk) 20:29, 31 January 2014 (UTC)
This is a reasonable view to have (although I'm not sure 'incidental' is really what you mean here). I understand how one can view circumcision and castration as being on the same spectrum. However, as always, the argument needs to be brought back to the sources, and I've already stated my view about how that needs to be made. Zad68 21:08, 31 January 2014 (UTC)
'Incidental' is really what I mean here. No they don't. A source saying circumcision is a medical procedure doesn't make it necessarily a medical procedure, which is what this article has done to circumcision. ScienceApe (talk) 03:46, 5 February 2014 (UTC)
Forced MC.Also using primary sources to complement and supplement secondary and tertiary sources rather than refute them ?. Using secondary sources like newspapers for useful information currently missing from this unbalanced and lacking article.
I propose to add a new section to the article on the phenomenon (within adult male circumcision) of forced circumcisions. These occur in Africa, in Europe and in Australia. It would comprise a shortened version of the lead paragraph from the Wikipedia forced circumcision article using the same references. https://en.wikipedia.org/wiki/Forced_circumcision How does that sound ? The forced circumcision article fails to mention recent forced circumcisions as part of eastern european conflict and amongst Australian aborigines. Perhaps someone has a better reference for these than I do ?--— ⦿⨦⨀TumadoireachtTalk/Stalk 13:06, 30 January 2014 (UTC)
Given appropriate sourcing, this would make sense as paragraph subsection of Society and culture, with the {{Main}} template linking back to the main article per WP:SUMMARY. The sourcing and content at Forced circumcision is very uneven, and it doesn't have much in the way of secondary sources concerning the present day as you're proposing. If you're going to use it as a starting point you'll have to sift through and pick out what's of a high enough standard to use here, I'm interested to see the specific content and sourcing proposed. As you should be aware, significant chunks of new content can't be driven off of primary sources, such as reports of individual incidents. Zad68 14:05, 30 January 2014 (UTC)
Thank you for your opinions and suggestions Zad/Zach. Please do not edit my entries or their titles again. An editor of your vast experience should know that editing the contributions of another editor is a big no no.--— ⦿⨦⨀TumadoireachtTalk/Stalk 03:39, 31 January 2014 (UTC)
To the extent that the 'forced' circumcisions are cultural issues in Africa (for example the Maasai), an additional sentence or two in the African Societies section would be better.Bob the goodwin (talk) 05:55, 31 January 2014 (UTC)
I thought Zad's section title change improved the conversation substantially. The current section title is unfocused and does not help newcomers know how to participate. He also was very polite in how he suggested the improvement, and you still took umbrage. Can you explain why?Bob the goodwin (talk) 05:55, 31 January 2014 (UTC)
No umbrage taken. can you explain why you think umbrage involved? Have you read the forced circumcision article ? No umbrage generation intended in suggesting that you do so. Forced circumcision is confined neither to africa nor to cultural settings.--— ⦿⨦⨀TumadoireachtTalk/Stalk 16:46, 31 January 2014 (UTC)
"Please do not edit my entries or their titles again" <-- I took that as anger. "An editor of your vast experience " <-- I took that as sarcasm. Sorry if I misinterpreted your feelings. It is hard to judge intent through talk pages. I will assume good intent, and assume that I misunderstood you.Bob the goodwin (talk) 22:06, 31 January 2014 (UTC)
Per your comments, I looked for references for forced circumcision, including the reference you included in the talk page, and also Forced Circumcision. I should not be doing research for others, but was genuinely interested in understanding if there was a part of the debate I was missing. Every case that I found the sources either described rare crimes or some form of cultural tradition in Africa. I don't have a problem personally with these stories having a place in an article, but I think Zad would expect me to have a clean set of sentences with clear references, and expect me to word the sentences to say exactly what the references said. If you want to put together a set of references I would be happy to take a stab at it. I do not think there are going to be any quality references that view the Maasai as using 'forced circumcision' though, because the ceremony is so culturally entrenched.Bob the goodwin (talk) 22:06, 31 January 2014 (UTC)
Actually I thought my simplifying of the section title was perfectly in line with Wikipedia's guidelines regarding Talk page section headings. Have you reviewed the talk page guidelines yet? It points out "no one, including the original poster, 'owns' a talk page discussion or its heading" and that it's "generally acceptable to change headings when a better header is appropriate, e.g., one more descriptive of the content of the discussion or the issue discussed, less one-sided", etc. but, as it also suggests, I probably should have dropped you a note about it first. No matter, if the section title change upset you I won't bother pursuing it. Zad68 19:53, 31 January 2014 (UTC)
It is likely that we will continue to differ on what each judges "appropriate Zad/Zach. The title change did not"upset" me (as you chose to describe my request to you to not repeat such alterations in the future) . My original request for good references for the Australian and Eastern European forced cirtcumcisions remains unanswered. Several articles in the British "Times" newspaper this week about forced female circumcisions. Disappointing that they made no reference to forced male circumcisions.--— ⦿⨦⨀TumadoireachtTalk/Stalk 18:56, 7 February 2014 (UTC)
Something worth noting regarding World Health Organisation
I have often made the point that giving the WHO organisation's views a lot of weight is a mistake. For instance, calling the WHO's views a secondary or tertiary source and then using that fact to disregard an opposing view.
The most quoted/referred to source in this article is:
''Male circumcision: global trends and determinants of prevalence, safety and acceptability''
The thing I would like to be noted by all is this: Although we say this is the view of the WHO, if you look inside the report(The PDF, in acknowledgements section, after contents) , you will find this:
Now, anyone familiar with the circumcision debate will recognise those names. The lead authors of the report are the actual authors of the studies that show circumcision is beneficial.
So, I propose instead of writing "The WHO says...", we should say "Weiss et al. state...."
I think that a big global organisation like the WHO has a lot of respect and credence in the minds of readers. Which then gives more weight to any arguments that are endorsed by the WHO. This is unfair and misleading.
"This report is the result of collaborative work between the London School of Hygiene and Tropical Medicine, the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS)". To be strict, it is a report published by the WHO. Alexbrntalk|contribs|COI 07:59, 9 February 2014 (UTC)
If you read the next line on from the one you quoted, you will see who wrote the report. Sorry, don't understand what point you are trying to make. Tremello (talk) 08:14, 9 February 2014 (UTC)
That it comes from three reputable mainstream organizations, not just one. I agree in some cases these document issued by the WHO do require additional scrutiny, but with this level of institution involvement I don't believe we can perform an amateur peer-review to try and "smoke out" perceived bad authors. Alexbrntalk|contribs|COI 08:22, 9 February 2014 (UTC)
The WHO as a whole has made obvious substantial time and financial commitments in using circumcision to combat the spread of HIV in Africa. The idea that the source is the view of the individual authors but not well-accepted by the WHO as a whole isn't in line with the available evidence. Zad68 16:24, 9 February 2014 (UTC)
No, he's trying to tell you that there's an element of bias. When you conduct the study, and then write the recommendations, that raises a red flag. ScienceApe (talk) 07:10, 13 February 2014 (UTC)
My edit to adverse effects section
They may not be reviews by medical associations but I consider my sources secondary.
The Effects section contains primary sources to bolster its case. So I think reverting my edit is hypocritical. I dont think I am being out of order by mentioning the complications of circumcision - which nobody disputes. I actually chose my sources wisely. The Stanford medical school is hardly anti circ biased. Tremello (talk) 13:00, 9 February 2014 (UTC)
Tremello please pay attention to WP:MEDRS, the guideline for biomedical sourcing. Of the four sources you added, two didn't appear to be in line with the guideline--one wasn't MEDLINE indexed and the other was a primary study. We generally haven't been using websites maintained by individual hospitals for sourcing (I've even had my edits adding content based on the Mayo Clinic reverted), especially when we have better sourcing available, as is the case here. I kept what you added but removed the substandard sourcing, added a bit for context, and copyedited for flow.
Also I do not see where the Effects section is using primary sources, if it is would you please point them out? Zad68 16:20, 9 February 2014 (UTC)
I guess I am ok with the compromise. However I have a problem with your addition "These complications may be avoided with proper technique, and are most often treatable without requiring a hospital visit.[55]". I feel it is saying the same thing as the first sentence "Neonatal circumcision is generally safe when done by an experienced practitioner.[54] ". Tremello (talk) 19:00, 9 February 2014 (UTC)
The second sentence has additional material not stated in the first sentence, so it is not redundant, and I have restored it. Yobol (talk) 00:52, 17 February 2014 (UTC)
(e/c) Agree with Yobol, I was just at this moment restoring this same content and coming to the Talk page to make the same comment. Zad68 00:54, 17 February 2014 (UTC)
Adverse effects... castration anxiety?
The following sentence ends the section on adverse effects of circumcision:
"Additionally, the procedure may carry the risks of heightened pain response for newborns, castration anxiety for boys in the phallic stage, and dissatisfaction with the result.[26]"
Now, I didn't read through source 26, but this is what our Wikipedia page on castration anxiety has to say about the concept:
"Although Freud regarded castration anxiety as a universal human experience, few empirical studies have been conducted on the topic."
"In 19th century Europe it was not unheard of for parents to threaten their misbehaving sons with castration or otherwise threaten their genitals... [This] is a phenomenon Freud documents several times."
As an encyclopedia, Wikipedia has to be objective. If a circumcised child tends to be more sensitive to pain or more generally anxious or whatever, that's something measurable and definable, something worth including in the encyclopedia. If circumcised males tend to exhibit greater insecurity or literal fear of losing their genitalia, that is likewise something scientifically definable. If circumcised males tend to exhibit greater preoccupation with the state of their genitalia and/or greater dissatisfaction with said state, that likewise is scientifically definable.
Unfortunately, instead of sticking to these sorts of scientifically-definable worries, Wikipedia has chosen to suggest that circumcision might make phallic children become even more convinced that their parents are going to cut off their willies; which of course, may manifest not literally as castration anxiety, but instead as fear of death, feelings of powerlessness, or need for self-assertion (because Freud). If castration anxiety is really something the given study addresses, then oh well, so be it; but if so, Wikipedia should still define the finding scientifically, and cut the reference to Freudianism. This is to avoid encouraging people to pretend that Freud's methods were scientific, by including them in the same space as actual findings.
Also, it's a bit superfluous to put "dissatisfaction with the result" as an adverse effect of circumcision. It's roughly akin to calling dissatisfaction an adverse effect of repainting your house or rearranging your living room; potential for dissatisfaction is an understood risk of every change, of every kind, and its explicit naming here is a bit unnecessary (though not misleading, unlike the Freud one).
(Because this page is locked, I can't edit. Oh well. Better luck next time.) — Preceding unsigned comment added by 130.132.173.127 (talk) 03:21, 16 February 2014 (UTC)
I agree that the inclusion of "castration anxiety" in that list is probably unwarranted. Castration anxiety is not an objective medical condition; it's an outdated psychoanalytic theory. Kaldari (talk) 06:30, 16 February 2014 (UTC)
The mention of "castration anxiety" was added as it was mentioned in a secondary source, although it was not part of the conclusions of that source. After reading up on it I agree it is an outmoded concept. So, agree it's weak, and have removed it per this discussion. Zad68 01:09, 17 February 2014 (UTC)
Why no discussion of the relationship between circumcision and masturbation?
Most scholarly sources agree that the main reason circumcision became a common medical procedure in modern times is because it was considered an effective deterrent against masturbation. Our article almost completely glosses over this fact. Here are just a few examples from scholarly sources:
"Circumcision of males was perceived as an effective prophylactic against 'excessive lust' through diminution of penile sensitivity."
–Male and Female Circumcision: Medical, Legal, and Ethical Considerations in Pediatric Practice
"Implausible as it sounds, leading Jewish physicians maintained that circumcision served to immunize Jewish boys and men against the bad habit of masturbation."
–Circumcision: A History of the World's Most Controversial Surgery
"Male circumcision in the United States began in the mid-19th century to prevent masturbation."
–Encyclopedia of Women and Gender
At the very least, the section on modern history should have a few sentences discussing this. Kaldari (talk) 08:41, 29 January 2014 (UTC)
Hey Kaldari, actually this is already mentioned in the article, in the same section you said you'd expect to find it, using one of the sources you mentioned. See the History subsection Modern times, where the article has "Contemporary physicians picked up on Sayre's new treatment, which they believed could prevent or cure a wide-ranging array of medical problems and social ills, including masturbation (considered by the Victorians to be a serious problem), syphilis, epilepsy" etc. This is sourced to both Gollaher's book that you mentioned, plus a journal article by Alanis & Lucidi. Per the sources, although the discouragement of masturbation was one of many problems circumcision was later thought by the Victorians to help with, the original interest in it by Sayre and others was to address neurological issues based on their "reflex neurosis" theory of diease. (we really should have an article on reflex neurosis...). Zad68 15:51, 29 January 2014 (UTC)
I was just saying that the text fails to emphasize the importance of deterring masturbation, which should have additional weight per the preponderance of sources. Kaldari (talk) 18:17, 29 January 2014 (UTC)
I am not sure if you are being sincere, but we are told to assume the good intensions of other editors. Masturbation has no link to Circumcision, with the exception of a 100+ year old historical reference in the United states. It is relevant as an historical reference, and that reference exists in this article. I am not sure that the Circumcision article is the correct place for you to advocate for the importance of deterring masturbation (I am still struggling to believe that is what you are suggesting), as that would be considered Wikipedia:Coatrack. I think you would have difficulty taking this position in any article on Wikipedia, because I don't think your view is mainstream. Most medical articles over the last generation have taken the opposite position from yours, and think it is important not to deter masturbation. But I am sure there are cultures that have differing views. Bob the goodwin (talk) 05:47, 31 January 2014 (UTC)
@Bob the goodwin: Please re-read my original comment, as it seems you have misunderstood it. I did not say that circumcision deters masturbation. I said that circumcision became a common medical procedure in modern times is because it was considered an effective deterrent against masturbation. In addition to the sources listed above, I also recently found the following:
"The main health benefit of [circumcision] was the lessened tendency to masturbation, then regarded as a serious disease...
...by the early 1980s it was well established that widespread circumcision of young boys was introduced in English-speaking countries in the late nineteenth century, and that the main reason for the procedure was the desire to discourage masturbation in both childhood and adolescence...
...In summary, it can be seen that doctors in English-speaking countries introduced widespread circumcision of male infants in the late nineteenth century. At the time this innovation was justified largely in terms of discouraging masturbation, then regarded as a serious disease in its own right and as the cause of many more..."
–"The Masturbation Taboo and the Rise of Routine Male Circumcision: A Review of the Historiography", Journal of Social History (2003)
It also looks like the History of male circumcision article has a large section on circumcision's historical use to deter masturbation, an emphasis that is not reflected in the summary here. Kaldari (talk) 08:06, 16 February 2014 (UTC)
I've added some material to the modern history section in an effort to reflect the secondary sources listed above as well as the substantial section in the History of male circumcision article. Kaldari (talk) 23:18, 16 February 2014 (UTC)
Kaldari while I agree there's support in the sourcing for adding emphasis for the masturbation theory to the history section, I don't agree with breaking the existing chronological order. It makes the most sense for a history section to present the history in chronological order. I'd also prefer if Darby weren't used as a source--he's a particularly opinionated source, and it should really not be necessary to use him. I plan to make these adjustments when I next have a moment. Yes the added emphasis on the masturbation theory is warranted, just need to restore the chronological order and see if if it's really necessary to use Darby. Zad68 01:00, 17 February 2014 (UTC)
@Zad68: I should mention there are British medical texts as far back as 1858 (James Copland's A Dictionary of Practical Medicine) discussing the use of circumcision to deter masturbation. The idea did not originate with Lewis Sayre, although he did popularized it as a medical procedure. Personally, I think there is too much emphasis on Sayre, but I didn't want to gut the existing content. Kaldari (talk) 01:17, 17 February 2014 (UTC)
Bot archiver - too fast?
I am not happy with the speed that the bot archives the discussions. I feel it archives them too quick. It says that it archives discussions over 5 days old. I would like to change it to at least 10 days or 2 weeks. Anyone else agree? Tremello (talk) 15:47, 27 February 2014 (UTC)
I bumped it up to a week. This is an active Talk page with many watchers, if a thread hasn't been touched in 7 days, and there are several other, more recently active threads (that's part of the archive requirement), that'd be an indication that whatever the topic was of the untouched thread isn't seeing traction. Zad68 21:44, 28 February 2014 (UTC)
So it archives auto seven days after the last comment entered on a thread ?--— ⦿⨦⨀TumadoireachtTalk/Stalk 09:16, 3 March 2014 (UTC)
Heading
Have reverted [5] as it was more to the point / better before. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:26, 22 February 2014 (UTC)
Having a large section marked "effects" and a tiny section marked "adverse effects " below it, with smaller script where the "effects" section lists only the positive effects, is a good illustration of why this article still stinks. A joint title is elementarily logical. Why editors, who appear capable of good judgement on other articles, have a blind spot on this one is a mystery on a par with bermuda triangle or babylon.--— ⦿⨦⨀TumadoireachtTalk/Stalk 11:28, 28 February 2014 (UTC)
Agreed. The only logical headings are either "Positive" and "Negative", or a single heading of "Effects". The idea that the current format somehow makes things clearer is patently ridiculous. 86.181.120.165 (talk) 09:17, 6 March 2014 (UTC)
The Effects and Adverse effects section are both at the same heading level (level 2) and so the title fonts are the same size and have the same format. Naming the section Effects is more accurate than Positive effects or the like because not all the effects discussed in this section are positive, for example the section states that the procedure confers no male-to-female HIV transmission benefit, nor any benefit regarding the transmission of the type of HPV that causes genital warts. Having a separate Adverse effects section, with that name, is recommended by WP:MEDMOS. Having Adverse effects split out separately from Effects highlights and emphasizes the adverse effects more than if they appeared as paragraphs in the Effects section. Are you suggesting that we de-emphasize the adverse effects by moving them into the Effects section? I disagree with that suggestion. Zad68 06:04, 7 March 2014 (UTC)
How is providing no benefit eligible to be considered an effect?? It's that sort of "logic" that makes this article such a mess to read. Circumcision doesn't help you see in the dark or make hair grow on your chest either. Should that be considered a direct effect of the procedure? Why can there not be two sub-headings under 'Effects' labelled 'beneficial' and 'adverse'? 86.181.120.165 (talk) 11:07, 12 March 2014 (UTC)
...and can you please point to where WP:MEDMOS suggests the heading layout you describe? From what I can see that layout is reccommended for articles on drugs or test procedures. Surgery should have the headings "Indications" and "Contra-indications". In fact, according to WP:MEDMOS the entire "Effects" section should be removed and replaced with "Risks/Complications"86.181.120.165 (talk) 11:21, 12 March 2014 (UTC)
The average age of first foreskin retraction is 10.4 years.
Unhelpful sophistry. The implicit request was obviously to use the following reliable source:
"Thorvaldsen MA, Meyhoff H. Patologisk eller fysiologisk fimose? Ugeskr Læger 2005;167(17):1858-62."
This may or may not be usable, though the fact that it's published in Danish doesn't look good. Hans Adler 15:00, 22 March 2014 (UTC)
African cultures
Would it be possible to insert an interwiki link to Ulwaluko under the heading African cultures? Of all the ritual circumcisions, the initiation rites as practices by the amaXhosa are well known, in particular because of the health concerns that arise from the practice (many deaths and mutilations on a yearly basis). Buntu Nyawose (talk) 15:48, 28 March 2014 (UTC)
THat is a good idea. I have been trying unsuccessfully for some time to have such practices that include forced circumcisions and pariah status for the uncut in this article. In my experience one can deduce that there may be a cabal of editors who wish to portray this form of genital cutting and excision("circumcision") in the most positive light. They resist mentioning at all the forced circumcisions that presently take place in Australia, several parts of Africa and in Europe.--— ⦿⨦⨀TumadoireachtTalk/Stalk 07:28, 29 March 2014 (UTC)
Male and female genital modification/mutilation are similar.
Misleading response. Attitudes towards FGM/MGM require good sourcing to ordinary RS standards. MEDRS does not apply to those aspects of this article which are not primarily medical. That said, It doesn't look like RS to me, either, so probably not usable. Hans Adler 15:03, 22 March 2014 (UTC)
How could they possibly be similar? They both involve cutting the most sensitive tips of the sex organ off of the girl or boy and causing the remaining stumps to become leathery and desensitized- how can that be considered a similar outcome ? - oh and any information that is not a secondary source medical-pharma journal study has no legitimacy here anyway- unless of course it has something positive to say re the child genital chop. Besides Maggie O'Kane of the Guardian has not taken up the cudgels for cut boys . Yet.--— ⦿⨦⨀TumadoireachtTalk/Stalk 07:37, 29 March 2014 (UTC)
Balance, Emphasis, Article layout and USA centric stats
Here is the first paragraph of the USA Urological Association overview for the general public on Male Clinical Circumcision.
"The American Urological Association, Inc.® (AUA) believes that neonatal circumcision has potential medical benefits and advantages as well as disadvantages and risks. Neonatal circumcision is generally a safe procedure when performed by an experienced operator. There are immediate risks to circumcision such as bleeding, infection and penile injury, as well as complications recognized later that may include buried penis, meatal stenosis, skin bridges, chordee and poor cosmetic appearance. Some of these complications may require surgical correction. Nevertheless, when performed on healthy newborn infants as an elective procedure, the incidence of serious complications is extremely low. The minor complications are reported to be three percent."
I wonder whether we should give a similar prominence early in the article to the negative aspects as they do ? Also the paucity of links and references to forced circumcisions and to the forced circumcision wikipedia article from our main wikipedia article is disturbing. The W.H.O. give prominence to forced circumcisions in their main material.--— ⦿⨦⨀TumadoireachtTalk/Stalk 11:15, 22 February 2014 (UTC)
..
What text are you recommending were? Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:25, 22 February 2014 (UTC)
I am not yet proposing text , but pointing out a discrepancy between our emphasis and the emphasis of one of our most cited sources. Thus a discussion may ensue that will lead to consensus changes contributing to a better article. Did you get a chance to read the quoted text and ponder the point raised ? Hope "were" not short for werewolf. Be aware. WP needs wares.--— ⦿⨦⨀TumadoireachtTalk/Stalk 09:46, 23 February 2014 (UTC)
Maybe it'd be an occasion to include more negative aspects such as the fact that circumcision is inherently performed against the "patient's" will in most cases (neonatal). Certain sections from the "Circumcision controversies" article would help reaching a NPOV on the circumcision article. In fact, merging the circumcision, circumcision controversies, and female genital mutilation articles under a "Genital Mutilation" article would be a great improvement. Doriphor (talk) 05:18, 2 March 2014 (UTC)
Infants care is often dictated / consented for by their parents and this procedure is no different. No one has yet presented a reliable source that refers to circumcision as "genital mutilation" so neither shall we. Doc James (talk · contribs · email) (if I write on your page reply on mine) 09:49, 21 March 2014 (UTC)
On female genital mutilation it says: "Female genital mutilation (FGM), also known as female genital cutting and female circumcision, is defined by the World Health Organization (WHO) as "all procedures that involve partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons."" Now replace female by male, same exact thing. Doriphor (talk) 13:53, 23 March 2014 (UTC)
Sigh, again, we report on what others say, not what you think. Find reliable sources or health organizations (not advocacy groups) that call it mutilation and it would be added. That said, male circumcision is indeed used for medical reasons. EvergreenFir (talk) 20:57, 23 March 2014 (UTC)
You want to know what I think? I think there's no difference between the two, except that one of them is generally accepted, and Wikipedia articles aren't about generally accepted opinions, but about facts. Circumcision is mostly done for cultural and traditional reasons (Religion and/or continuation of 19th century anti-masturbation practices) and while there is evidence for STD prevention, I don't think it qualifies as a legitimate medical reason, especially in developed countries. Go tell parents of a newborn that excising a chunk of their baby just might prevent disease X or Y and watch their reaction... And that's why this article is beyond biased: because circumcision is the only procedure that gets a free pass!Doriphor (talk) 01:11, 2 April 2014 (UTC)
"I think Wikipedia should seriously consider marketing T-Shirts reading: I am an opponent of the Cabal: Wikipedia.com "<----first ever edit to Jimmy Wales's talk page back in 2001 LOLOLOL plus ça change ! EvergreenFir ( Fir means men in Gaelic !) -from an equality and from a feminist stance (which appear to be lenses of yours), genital cutting of any child should be examined with an especially critical eye. You may invoke stables of dead horses, but it will not make right the glaring omissions from this article. What is particularly disturbing with this article is the percentage of administrators who are amongst the small but superbly organized group who support its current selective content make-up--— ⦿⨦⨀TumadoireachtTalk/Stalk 11:34, 30 March 2014 (UTC)
Problem with balance of lead (concerning HIV stats)
1) In the lead we refer to the benefits of circumcision in reducing HIV and other STIs. Opponents of circumcision question whether the effect is that great in non-African settings or areas with low HIV prevalence. The reader isn't made aware of this. For balance, we cite the (low) complication rates (1.5% for newborns and 6% for older children) for western medicalised circumcision on newborns. Surely if we were being fair we should cite the higher complication rates for the African trials, which according to this (CDC) is 2-8%. And also mention the more severe complications of the African circumcisions.
2) Another point that is worrisome, and this is probably my main concern, is this line: "circumcision reduces the infection rate of HIV among heterosexual men by 38–66% over a period of 24 months." Is this not misleading? Surely it is only referring to these 3 particular studies in Africa. So does the line "circumcision reduces the infection rate of HIV among heterosexual men by 38–66% over a period of 24 months." apply to all populations? Genuine question. If not - I don't think we should be giving precise figures in the lead. Because surely it depends on various factors - such as HIV incidence, population demographics and culture.
I am happy to agree with Morris and use the Cochrane figure. So I think we should use the above quote instead. So instead of the misleading 38–66%, something like "circumcision resulted in a significant absolute risk reduction of 0.83% at 12 months and of 1.80% at 21 or 24 months". The benefit of this would be that it takes into account population dynamics.
Regarding "Opponents of circumcision question whether the effect is that great in non-African settings or areas with low HIV prevalence. The reader isn't made aware of this." It is not just opponents who question if circumcision has as great of an effect in other pops. it is everyone. We however make this very clear with "A 2009 Cochrane meta-analysis of studies done on sexually active men in Africa found that circumcision reduces the infection rate ofHIV among heterosexual men by 38–66% over a period of 24 months.[10] The WHO recommends considering circumcision as part of a comprehensive HIV program in areas with high endemic rates of HIV, such as sub-Saharan Africa" Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:51, 5 April 2014 (UTC)
That was my point, I don't think it is clear. The statement you quoted infers that this African trial can be applied to any population because it says "circumcision (implying not in Africa, but in general) reduces the infection rate of HIV among heterosexual men by 38–66% over a period of 24 months." Using the present tense "reduces" implies circumcision in general. If you want to be clear that this statistic is referring to the 3 randomised control trials, you would use "reduced" or "resulted in" as I have used in my suggestion above. Tremello (talk) 04:53, 6 April 2014 (UTC)
We specifically state "studies done on sexually active men in Africa". Thus I do not see any room for confusion. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:22, 6 April 2014 (UTC)
I know that. You seem to be missing my point. I know we say the studies were done in Africa but then we make out it applies to all populations. I disagree with you saying that adding the sentence "The WHO recommends considering circumcision as part of a comprehensive HIV program in areas with high endemic rates of HIV, such as sub-Saharan Africa" fixes the problem. It just implies that circumcision would be successful in preventing HIV anywhere and that they have merely chosen Africa to step up a circumcision programme. Tremello (talk) 07:44, 6 April 2014 (UTC)
How can "in areas with high endemic rates of HIV" be read as "anywhere"? Alexbrntalk|contribs|COI 08:39, 6 April 2014 (UTC)
You have missed my point. please re-read if you don't understand what I am saying.Tremello (talk) 18:58, 6 April 2014 (UTC)
@Tremello: Please also restate it for us concisely. What exactly is the issue? Your edit is technically correct, but likely difficult for anyone unfamiliar with the transmission rate or maths to understand. EvergreenFir (talk) 19:02, 6 April 2014 (UTC)
You know it is annoying when people can't be bothered to read your reasoning. I cannot make it any clearer. Read what I wrote for the rational for changing it to absolute risk. You are out of order for reverting my edit. Tremello (talk) 19:12, 6 April 2014 (UTC)
You must gain WP:CONSENSUS before making that change. Do not edit war over this. EvergreenFir (talk) 19:51, 6 April 2014 (UTC)
ok. explain yourself. What do you disagree with? Tremello (talk) 20:03, 6 April 2014 (UTC)
My objection is how the information is presented. You give absolute transmission risk reduction numbers, but without the base (uncircumcised) transmission rate, these numbers are meaningless and without context. Moreover, the paragraph uses the relative infection rate already, and we need to be consistent. I favor the relative rates (33%-66%) over the absolute rates because the average reader will be able to understand them better. Frankly the average reader is unlikely to be able to do the mental conversions from relative to absolute rates; people's math skills are sadly lacking. I do not object to the inclusion of absolute rates, but feel they are better suited for the more detailed analysis found in the body of the article. If we are to include them in the lead, they must be put in context by providing the base rate (e.g., "from an pre-circumcision rate of xx%-yy% to a post-circumcision rate of aa%-bb%"). EvergreenFir (talk) 20:50, 6 April 2014 (UTC)
Maybe I am being stupid. I need you to explain some things. You say "the paragraph uses the relative infection rate already" - don't know what you mean by this. In my edit I replaced the relative rate. There will be no maths or conversions needed to be done by the reader. You say "If we are to include them in the lead, they must be put in context by providing the base rate (e.g., "from an pre-circumcision rate of xx%-yy% to a post-circumcision rate of aa%-bb%"). What exactly do the xx, yy, aa, and bb percentages stand for?
Regarding the absolute risk rate being more meaningless and more out of context than the relative risk rate. Is that true? With the relative risk of 38-66% - you do not know the base HIV rate. You do realise it is not saying that it went from 38-66%? That it is saying it reduces HIV by BETWEEN 38-66% - that this is just a range. Because you do know there were 3 trials (sorry- don't know how familiar you are with circumcision research)? So did you read the 3 articles I provided by Goldacre, Welch, and Earpe? They advise we use the absolute risk. The benefits of using absolute risk reduction is that it does put the figures in context because it alerts the reader to the low numbers, both in the circumcision arm and the the control (non circumcising) arm, that actually got HIV. The figures were according to Hill: 64 (1.18%) of the 5411 in the group that were circumcised got HIV; 137 (2.49%) of the 5497 in the group that weren't circumcised got HIV. So the absolute risk reduction factors in how many people in the whole trial sample got HIV. It gives far more information than the relative risk rate. Tremello (talk) 22:28, 6 April 2014 (UTC)
I mean that the paragraph (the third paragraph in the article) does not use absolute rates when talking about HSV. As for xx, yy, etc., those are foobar. They are meant to be placeholders for real numbers (e.g., when we ask people to format dates in mm-dd-yyyy). I'm curious what others have to say on the issue of using absolute or relative rates in the lead. Again, I'm not opposed to including the absolute rates if the pre and post treatment rates are included. The benefit of relative rates is that it give the size of the effect of the treatment. EvergreenFir (talk) 23:24, 6 April 2014 (UTC)
Oh, you meant we use relative risk reduction when talking about HPV, not HIV. That was why I was confused. Well I think we are jumping ahead of ourselves. If we agree that absolute risk reduction is a better measure in general then obviously we would change the stats of other conditions to absolute risk reduction too.
Yes I know they are placeholders for numbers - I am not that stupid. I was asking what numbers they were placeholders for.
What do you mean by pre and post treatment rates?
You say "The benefit of relative rates is that it give the size of the effect of the treatment." I disagree. In fact it is the opposite. In terms of the trial population as a whole, the size of the effect of the treatment is the absolute risk reduction. It is a percentage decrease in the people who got HIV in the trial. Using Hills figures, it is a comparison between 1.18% and 2.49% . So 2.49% in the uncircumcised group got HIV, 1.18% in the circed group got HIV. So it would be 2.49 - 1.18 =1.31%.(for arguments sake ignore the fact that cochrane and Hills figures are slightly different - we use cochrane in the article). It is the only figure we should use. I think the relative risk reduction percentage of 38-66% is totally meaningless and misleading. As the 3 scholars I linked you to say, the effect is misleading because it doesn't inform the reader the chances of contracting the disease in the first place. That is why these scholars suggest using absolute risk reduction. Tremello (talk) 08:38, 7 April 2014 (UTC)
Pre and post treatment refers to before and after the experimental procedure took place (in this case, circumcision). "Treatment" is the term used in methodology literature. EvergreenFir (talk) 18:15, 7 April 2014 (UTC)
We should really contain both the ARR and the RRR. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:59, 7 April 2014 (UTC)
Regarding you changes, see my point above. I don't think we should use the 38-66% stat. I see no problem with my original proposal of "circumcision resulted in a significant absolute risk reduction of 0.83% at 12 months and of 1.80% at 21 or 24 months". I still have the same reservations with your change as we originally discussed - in that you are saying circumcision in general. You use the present tense "circumcision reduces". It was a randomised control trial - which is not the same as real life. So you cannot extrapolate it to "circumcision in general reduces HIV by a certain rate". I still prefer "circumcision resulted in a significant absolute risk reduction of 0.83% at 12 months and of 1.80% at 21 or 24 months". The reader can infer from that what he wants. Tremello (talk) 08:38, 7 April 2014 (UTC)
Where's the "1.8%" coming from? to a lay reader that makes it look like it has a negligible effect, and it differs from how Cochrane summarizes its findings. Alexbrntalk|contribs|COI 09:39, 7 April 2014 (UTC)
it is coming from the cochrane article. It is the absolute risk reduction. It is on page 18. Go to this link. You could say that circumcised men are 1.8% less likely to get HIV. It informs the reader that HIV is rare. Because of that fact it is debatable whether circumcision is worth it. Hence why it is only recommended in areas of high HIV prevelance. How cochrane summarises it's findings isn't really relevant as we have a duty to put everything into context when writing an article about circumcision in general, rather than an article on how circumcision reduces HIV. Tremello (talk) 14:20, 7 April 2014 (UTC)
It's very confusing, and strikes me as cherry-picking something out of the body which causes needless complication. What does it even mean, that the "infection rate" was reduced by 1.8%: rate of what? infections per exposure? For the lede this material as presented stands no chance of being understood by most general readers. Alexbrntalk|contribs|COI 14:28, 7 April 2014 (UTC)
(Add) For the general reader, the wording "Circumcision would prevent 17 HIV infections ... over two years per 1000 men" is much more suitable, I'd have thought. Alexbrntalk|contribs|COI 14:42, 7 April 2014 (UTC)
You seem to want to tell the reader circumcision reduces HIV by a certain percentage. But that is impossible because the conditions of the African trials are different from real life. So there is no exact figure. All we can do is report the result of the trials and that the WHO recommends it to prevent HIV in Africa. Your current edit is inaccurate for the reasons I gave above, but at least you have used the past tense "reduced". It isn't cherry picking. The 3 scholars I linked to above recommend using that figure and they and I have explained why the relative risk rate of 38-66% is misleading and doesn't tell the whole story. The 1.31% (from Hill) and the 1.8% (from cochrane) are referring to the same statistic - the absolute risk reduction. The 1.8% was calculated in the same way as the I calculated the 1.31% above. I don't know why they are different figures. You say that doc's edit where he writes "circumcision reduces the infection rate of HIV among heterosexual men by 1.8%, a 38–66% decrease over a period of 24 months." is confusing and you don't know what infection rate means. Infection rate means the percentage of people that have/get HIV. So the trial found that the infection rate of the whole population is 1.8% less if they are circumcised. The 38-66% is just a ratio of the circumcised group infection rate and the non-circumcised group infection rate so is less meaningful. Tremello (talk) 17:08, 7 April 2014 (UTC)
Wait, you made the calculations of the absolute risk reduction? They were not made by the authors? I see them in the sources you listed earlier. Was concerned you were doing WP:OR, but it was just the way you worded it. EvergreenFir (talk) 18:19, 7 April 2014 (UTC)
Agree with others that it's appropriate to add the ARR to the existing information about the RRR. Secondary sources covering this topic regularly provide the RRR, so we should too. No support for removing it entirely and replacing it with the ARR. Zad68
With my general reader hat on, can I ask what it means? Does it mean that overall 1.8% fewer people were infected among the people observed and this is equivalent to a 38-66% reduction in the number of infected people? Alexbrntalk|contribs|COI 05:48, 8 April 2014 (UTC)
From what I understand, that's close. But I'd change "38-66% reduction in the number of infected people" to "38-66% reduction in the rate of infected people". Similarly, change "overall 1.8% fewer people were infected" to "overall transmission rate decrease of 1.8%". We're talking about infection rates (through heterosexual sex). Correct me if I'm wrong. EvergreenFir (talk) 06:01, 8 April 2014 (UTC)
Yes Alex, that is what it is. Evergreen, I don't think that is an improvement on my edit. I don't think the word "transmission" should be used. I think the way Doc put it in my edit is good in terms of succinctness and the best you can do without overwording it and leading to confusion. Tremello (talk) 06:10, 8 April 2014 (UTC)
Okay thanks. In that case I don't see the point of mentioning the 1.8% - especially in the lede (though there may be a case for it being in the body). It's an incidental figure which will probably just cause confusion (which is why the Cochrane authors don't mention it in their summaries, I guess). Alexbrntalk|contribs|COI 05:45, 9 April 2014 (UTC)
Yes but the cochrane article was specifically about circumcision and HIV. This Wikipedia article is not. This is about circumcision in general. That is why it is appropriate to use the ARR. The 3 scholars I linked to recommend using the ARR and they outlined why the RRR makes headlines but is misleading. Tremello (talk) 05:56, 9 April 2014 (UTC)
Looking at this more closely, most of your links above are to blogs and activist sites. By "scholars" I assume you mean the two gentlemen affiliated with "Doctor against Circumcision" publishing an opinion piece in a non-WP:MEDRS journal. And we're using all this to re-frame Cochrane. Wow. Alexbrntalk|contribs|COI 06:07, 9 April 2014 (UTC)
No I wasn't talking about Boyle and Hill. I was talking about Goldacre, Welch, and Earpe, none of whom are activists. 2 of the links are not even related to circumcision, they are simply talking about the merits of using ARR. Whether Boyle and Hills work is peer reviewed or not is irrelevant because we aren't using their figures for absolute risk reduction, we are using cochrane's. Just because you find it hard to understand doesn't mean other people will. Tremello (talk) 06:20, 9 April 2014 (UTC)
Goldacre doesn't mention circumcision, and are you really suggesting we use a random blog and the Huffington Post as guides to presenting medical conclusions that trump the Cochrane authors decision? As to what a general reader will understand, I think we need to err on the side of caution. Personally I'd prefer to remove these figures entirely from the lede since rather than provide "hard evidence" they instead tend to prove an old saying about statistics (which I hardly need to repeat)! Alexbrntalk|contribs|COI 06:28, 9 April 2014 (UTC)
I actually said myself that 2 of the blogs aren't about circumcision. I get the feeling aren't even reading my responses sometimes. I was trying to convince you of the merits of the ARR statistic. You should recognise the context of the cochrane meta-analysis. They were specifically concerned abut HIV. It is addressed to scholars of HIV who understand epidemiology statistics, so they will know about the ARR. It isn't addressed to the general reader. So we aren't exactly trumping the cochrane decision. Their summaries are for different audiences. This general Wikipedia article is not about circumcision and HIV, it is about circumcision in general. So I think it is relevant information. Tremello (talk) 06:43, 9 April 2014 (UTC)
Sadly, in contrast to what Wikipedia policy indicates, Tremello is proposing that we adjust the article based on his own original research, "supported" by:
1) Material Tremello found at the anonymously self-published circumcision opposition website, circumsitions.com (on its front page: This site does not pretend to be "balanced".); the material Tremello cites by Ben Goldacre does not mention "circumcision" anywhere.
2) Material self-published by a blogger, and which also does not mention "circumcision" anywhere.
3) Material self-published by another blogger, who doesn't appear to have any medical training at all.
These suggestions are not supported. Comments like "I was trying to convince you of the merits of..." and admitting the sources cited weren't even written to address the topic at hand are simply attempts to argue for one's own original research. Zad68 04:43, 14 April 2014 (UTC)
Well, Cochrane also provides a "plain language" summary for lay readers: "Results from three large randomised controlled trials conducted in Africa have shown strong evidence that male circumcision prevents men in the general population from acquiring HIV from heterosexual sex". That, I suggest, gives a lead (hah!) Wikipedia could follow ... No numbers ... Alexbrntalk|contribs|COI 06:56, 9 April 2014 (UTC)
That would be undue weight because there is no evidence that circumcision is a good way to prevent HIV in general. Still don't see a problem with my edit. Zad's explanation for reverting is wrong because the aim of Wikipedia is to reflect the general consensus on whether circumcision to prevent HIV "in general" not just in Africa, is a good thing. The cochrane report's intention is different. It is talking to epidemiologists who work in the HIV field and know the Absolute risk ratios. The general consensus is that circumcision to prevent HIV is not that great in the majority of populations - the majority of which are low HIV populations where the main transmission method is gay sex. So using startling numbers like "a 38-66% decrease" is already undue weight - to make such a big thing about it. I feel my edit gets the balance just about right. Tremello (talk) 07:21, 9 April 2014 (UTC)
What is wrong with having both ARR and RRR? Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:53, 10 April 2014 (UTC)
Because RRR is a more easily understandable concept than ARR. This is presumably the reason why the authors chose this in the conclusion of the abstract rather than using ARR. Yobol (talk) 01:37, 11 April 2014 (UTC)
This is not the opinion of the majority of the medical community. Will start a RfC. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:45, 11 April 2014 (UTC)
European surveys on circumcision and sexual disfunction
Great, I'll edit then. But I am unsure how to add these references in. The "adverse effects" section has: "Circumcision does not appear to decrease the sensitivity of the penis, harm sexual function or reduce sexual satisfaction[ref1][ref2].". Should I change this to: "While some studies[ref1][ref2] argue that circumcision does not harm sexual function, surveys in Denmark [ref3] and Portugal [ref4] claim a higher proportion of sexual disfunctions among circumcised men" CarrKnight (talk) 14:25, 11 April 2014 (UTC)
"If they are reliable sources" ← but, they're not: a survey and a telephone poll reported in primary research. Alexbrntalk|contribs|COI 14:31, 11 April 2014 (UTC)
Do you mean the methodology of these studies was faulty, or do you mean that a secondary source would be preferable for Wikipedia? (or both?) Balaenoptera musculus (talk) 15:07, 11 April 2014 (UTC)
WP:MEDRS says we should ideally use secondary sources; but we certainly shouldn't use primary sources to "undercut" stronger ones which is the danger here. Alexbrntalk|contribs|COI 15:12, 11 April 2014 (UTC)
Okay, i am slightly confused now. So rather than citing the Danish peer-reviewed article it would be better to cite a survey citing it (like this?)? Isn't this an extreme round-about way of citing references? If somebody wanted to check the strength of the survey she would have to find it within the references of the reference. Wouldn't it be better to cite both the survey and the paper itself? CarrKnight (talk) 21:03, 11 April 2014 (UTC)
Is there any way of assessing damage to sensitivity or sexual function or pleasure for men or their sexual partners from circumcision OTHER than survey? Are there galvanic skin response studies comparing the sensitivity of the keratinized head and circular circumcision scar below it with the sensitivity of the uncut penis ? If the cuttimg off of the large area of skin from the penis head (skin which reportedly has the greatest close concentration of touch/pleasure receptors of any skin on a male body has been proven recently to cause no diminuition in pleasure then it goes against several thousand years of jewish acknowledgement, rationale, and knowledge of such a loss of pleasure.--— ⦿⨦⨀TumadoireachtTalk/Stalk 21:36, 11 April 2014 (UTC)
The article is currently using (among other sources) PMID20065281, which started by evaluating 73 primary studies. We can't use two weak primary studies to contradict strong sources like that. A strong up-to-date source on this topic that might be considered is PMID23937309. Alexbrntalk|contribs|COI 21:59, 11 April 2014 (UTC)
I also wonder if adding many surveys all from the same author really adds any valuable information CarrKnight (talk) 22:33, 11 April 2014 (UTC)
Also, sorry for the double post, can you define "weak" study? How do you compare a survey with 5000 interviewees to a meta-analysis literature review? It really seems like apple and oranges.
Unless it's exceptional in some way, any single study is weak (and one based on telephone interviews is even more prone to be so). But as you say, it's apples and oranges. Isn't this all quite clear from WP:MEDRS ? Alexbrntalk|contribs|COI 22:40, 11 April 2014 (UTC)
Just to see if I fully understand your point, would such edit do: "The AAP states that Circumcision does not appear to decrease the sensitivity of the penis, harm sexual function or reduce sexual satisfaction[various references]. In a commentary on Pediatrics[ref] a group of European doctors disagreed citing a Danish survey linking sexual disfunctions to circumcision[ref to paper]". The words may be wrong, but this way we cite both a secondary source and provide a handy link to primary source. Would that work? CarrKnight (talk) 22:46, 11 April 2014 (UTC)
I don't think the new sources introduced here (two primary studies and some commentary) and strong enough to warrant any change to the existing text. Alexbrntalk|contribs|COI 22:51, 11 April 2014 (UTC)
Is there a way to resolve this? It seems like a very personal definition of "strong" and "weak" is used to censor some published, peer-reviewed work. I readily admit I don't understand the power of literature meta-analysis which is probably what makes me a skeptic. CarrKnight (talk) 22:56, 11 April 2014 (UTC)
Actually, I am sorry about that. That was uncalled for. I just am uneasy about published information not being available on the wikipedia. CarrKnight (talk) 23:29, 11 April 2014 (UTC)
Unforutnately, the sources you propose to use do not meet WP:MEDRS, and so are not considered reliable for our purposes, especially to contradict existing high quality secondary sources. We only include information when the sources are reliable; in this case they are not for health claims, to contradict secondary sources. Yobol (talk) 13:07, 13 April 2014 (UTC)
Here are several quotations from WP:MEDRS that most cited, miscited, and least understood beleaugured piece of wikipedia guideline
"Reliable primary sources may occasionally be used with care as an adjunct to the secondary literature"
"edits that rely on primary sources should only describe the conclusions of the source, and should describe these findings clearly so the edit can be checked by editors with no specialist knowledge."
" When citing primary sources, particular care must be taken to adhere to Wikipedia's undue weight policy. Secondary sources should be used to determine due weight."
"when it comes to actually writing a Wikipedia article, it is misleading to give a full citation for a source after reading only its abstract; the abstract necessarily presents a stripped-down version of the conclusions and omits the background that can be crucial for understanding exactly what the source says.
Thus citing primary sources is NOT blanket forbidden as some might mislead editors into believing. "
" popular science and medicine books are useful sources, which may be primary, secondary, or tertiary" "Peer reviewed medical information resources such as WebMD, UpToDate, Mayo Clinic, and eMedicine are usually acceptable sources in themselves, and can be useful guides about the relevant medical literature and how much weight to give different sources".--— ⦿⨦⨀TumadoireachtTalk/Stalk 11:47, 14 April 2014 (UTC)
Oddly, you seemed to have missed the most relevant portion of WP:MEDRS to this situation: "Individual primary sources should not be cited or juxtaposed so as to "debunk" or contradict the conclusions of reliable secondary sources." Yobol (talk) 16:58, 15 April 2014 (UTC)
Oddly that is the only bit you seem to read.Do you appreciate the distinction between an adjunct and a debunking? Do you acknowledge that the editors who have stated that "Primary sources may not be used' are misinformed ? --— ⦿⨦⨀TumadoireachtTalk/Stalk 17:07, 17 April 2014 (UTC)
In this case that started this section, it would be using primary sources to debunk the secondary source. If you have a problem with MEDRS, take it up at WT:MEDRS, if you have a problem with a particular editor, take it up with them on their talk page. This is not the place to discuss MEDRS application in general, but to discuss specific applications of content in relation to this article. The suggestion that started this section specifically violates MEDRS, specifically the quote I just cited. Yobol (talk) 19:46, 17 April 2014 (UTC)
The relevant sentence in the guideline policy section which you have cited Zad/Zach is "primary sources favoring a minority opinion should not be aggregated or presented devoid of context in such a way as to undermine proportionate representation of expert opinion in a field" This guideline does not preclude mentioning these studies (which merely confirm thousands of years of knowledge about the diminishing effect on pleasure when you cut bits off genital tips) It DOES suggest that we not give excessive weight to minority opinion. What it does not say is "Keep any mention of it out of the article at all cost" Opposing presenting a balanced picture diminishes the article and diminishes the editors who engage in such opposition. You appear to be the leader of the small but persistent group of editors who work singly and together to misrepresent these policies in relation to this article and subject.--— ⦿⨦⨀TumadoireachtTalk/Stalk 06:52, 18 April 2014 (UTC)
At this point I'd really just like a suggestion about how to incorporate the papers (commentary and statistical survey) in the paragraph. I can understand the idea of not adding them just to "debunk" the previous statement, but surely there must be a way for them to coexist. 2602:304:CFA2:1B80:E2B9:A5FF:FE46:DB97 (talk) 01:00, 21 April 2014 (UTC)
If you'll understand secondary sources, you'll see that the results of the primary sources like Frisch 2011 and Dias 2013 are already incorporated and given the appropriate weight according to their quality, strength and relevance. The secondary sources review the primary sources such as these plus many others, and take them all into account in coming to their conclusions. So the evidence provided by primary sources such as these are already reflected. Zad68 04:00, 21 April 2014 (UTC)
Perhaps the editors who, for whatever reason, (and in Zad's case it is certainly not sloth) only permit selective quotes from secondary article summaries and abstracts should refresh their memories and heighten awareness that Wikipedia enjoins us not to rely on article summaries alone.--— ⦿⨦⨀TumadoireachtTalk/Stalk 07:09, 21 April 2014 (UTC)
Opening
What does it mean when it says the fore skin is opened??--31.55.123.188 (talk) 00:39, 21 April 2014 (UTC)
Hi there, it means the opening at the end of the foreskin is enlarged to allow an instrument to be passed through it to separate it from the glans. See the second paragraph of the Background section of the source cited here for more detail. Zad68 00:49, 21 April 2014 (UTC)
It means that the dominant editors here prefer selecting euphemisms when it comes to describing the mechanical part of cutting bits off the penis (and a matching obscure photo over a lead photo of the actual procedure). "Opening" means tearing the foreskin away from the penis head adhesions which nearly all infant boys have. In adult circumcisions, these adhesions have usually naturally diminished in preparation for the many functions of the foreskin in facilitating pleasurable sex for both partners. With the current editor make-up these functions of the foreskin are unlikely to get mentioned in the article any time soon.--— ⦿⨦⨀TumadoireachtTalk/Stalk 07:28, 21 April 2014 (UTC)
Summarizing the effects of circumcision on sexual function
Zad68 recently reverted one of my edits with the reason: "restore well-supported content, Crooks been discussed before, as a source & what it actually says doesn't overwhelm the many strong sources we have that are in close agreement"
I'm afraid it's not that simple, so allow me to explain. (I will continue to use "Crooks" for continuity of discussion, but for those reading this, the book in question is "Our Sexuality" by Crooks & Baur). I see that Crooks has been discussed here in the Circumcision talk archives. Zad68 summarized what reliable secondary sources have said about sexual function as follows:
AAP Tech Report 2012 - PMID 22926175 - "Male circumcision does not appear to adversely affect penile sexual function/sensitivity or sexual satisfaction."
Sadeghi-Nejad 2010 - PMID 20092446 - "most recent articles do not show evidence of adverse effects on sexual function"
Doyle 2010 - PMID 19913816 - "Adult male circumcision does not seem to have an adverse impact on sexual function."
Perera 2010 - PMID 20065281 - "The evidence suggests that adult circumcision does not affect sexual satisfaction and function."
Crooks 2013 - "questions about the relationship between circumcision and male sexual arousal remain to be answered" (It also goes on to say "Data concerning the effect of circumcision on erotic function are limited and inconclusive.")
Tian 2013 - PMID 23749001 - "These findings suggest that circumcision is unlikely to adversely affect male sexual functions."
Zad68 then said: "Based on this, I'm not sure Crooks 2013 changes what the article needs to say."
It's not just what Crooks is saying though. Other sources not mentioned on the above list have also analyzed the studies on sexual function, and came up with different conclusions. Here are the more recent ones:
RACP Circumcision statement 2010 - "The effects of circumcision on sexual sensation however are not clear, with reports of both enhanced and diminished sexual pleasure following the procedure in adults and little awareness of advantage or disadvantage in those circumcised in infancy."
So it's actually 3 sources cautiously stating that circumcision likely does not affect sexual function, 2 sources stating that adult circumcision likely does not affect sexual function, 2 sources saying the question is unclear (given the sometimes polarized results of various studies, this is technically the most accurate view), and 1 source stating that circumcision can have sexual complications. The wording before my edit, which is "Circumcision does not appear to have a negative impact on sexual function," only accurately summarizes 3 of the above 8 sources (AAP Tech Report 2012, Sadeghi-Nejad 2010, Tian 2013), since the others either refer only to adult circumcisions, or reached different conclusions entirely. A more neutral and succinct summarization of all sources is the one I suggested: "The impact of circumcision on sexual function is unclear."
I hope this clarifies why my changes are a more neutral and accurate summarization of what the sources say on the subject. Since WP:NPOV states that the views of all relevant reliable sources be represented, I will be re-adding my previous changes. --kyledueck (talk) 18:23, 18 April 2014 (UTC)
Kyledueck, one thing to keep in mind is that WP:Neutral states "representing fairly, proportionately, and, as far as possible, without bias, all of the significant views that have been published by reliable sources on a topic." It does not state "relevant" in that sentence, and this because, per the WP:Due weight (including subsections) aspect of WP:Neutral, not all relevant material should be included (reliable or not). Flyer22 (talk) 19:31, 18 April 2014 (UTC)
There are more strong secondary sources available that are unequivocal in their assessment of no negative effect, I can provide those later this weekend if necessary. The KNMG statement only mentions individual reports, which is the weakest form of evidence. Curiously Crooks only mentions a study from the 1990s, if I remember right, and ignores the large amount of good quality evidence from the large RCTs. The overwhelming consensus from the reliable sources is that there does not appear to be an effect. The weights of the views are not equal, we cannot pretend they are equivalent. Zad68 19:56, 18 April 2014 (UTC)
The idea that "Circumcision does not appear to have a negative impact on sexual function." as said in the above secondary sources that Zad cites (and in the wiki article) is obviously mainly due to the thinking that RCT trials are the gold standard and because the Ugandan and Kenyan RCTs showed no effect, there is no effect.
According to Morten Frisch:
"The questionnaires used to assess potential sexual problems in the two cited randomized controlled trials in Kenya and Uganda were not presented in detail in the original publications.4,5 Rather than blindly accepting such findings as any more trustworthy than other findings in the literature, it should be recalled that a strong study design, such as a randomized controlled trial, does not offset the need for high-quality questionnaires. Having obtained the questionnaires from the authors (RH Gray and RC Bailey, personal communication), I am not surprised that these studies provided little evidence of a link between circumcision and various sexual difficulties." LINK to article
Also, somewhat relevant is this letter in regard the Ugandan RCT method of circumcision:
"The most recent paper on male circumcision and its impact on sexual satisfaction [1] provided no details on the type of circumcision used in the volunteers. Correspondence with one of the authors, Dr. Stephen Watya, who is in charge of supervising and training medical personnel to do the operations, revealed that the sleeve technique was used, with the incision 0.5–1 cm from the frenulum. Further clarification with Dr. Watya confirmed that the entire frenular area, including the frenulum, was left completely intact in all of these volunteers...The current study is unique as all the volunteers had the same type of circumcision, and all were spared their most sensitive areas. " LINK to article.
The point they are making is that if the sensitive areas were left intact in the circumcised group then there will be less difference. (However I will admit that the Kenyan trial and South African Trial used the Forceps guided method (which does ablate the most sensitive areas) which kind of makes this argument less strong.)
Second letter criticising the Ugandan RCT:
" However, on closer scrutiny of the data I find the authors’ conclusions rather debatable." LINK
Also I know in the abstract of the AAP report it says "Male circumcision does not appear to adversely affect penile sexual function/sensitivity or sexual satisfaction" but in the technical report it does say: "There is fair evidence that men circumcised as adults demonstrate a higher threshold for light touch sensitivity with a static monofilament compared with uncircumcised men (meaning they are less sensitive); these findings failed to attain statistical significance for most locations on the penis, however, and it is unclear that sensitivity to static monofilament (as opposed to dynamic stimulus) has any relevance to sexual satisfaction.132 (Own opinion's of the members of the panel). There is fair evidence from a cross-sectional study of Korean men of decreased masturbatory pleasure after adult circumcision."
Once again you might say we should just go with what they say in the abstract but I feel this isn't appropriate.
Zad your criticism of the Dutch review may be a mistake since they may have made their own judgments on which sources they thought were important on reaching a view on the sexual effects. They may have looked at the RCT studies.
Another thing to note is that in the African trials the men were questioned only 24 months after circumcision. The keratinization process may mean that men circumcised as babies are less sensitive.
Tremello, please stop citing self-published anonymous activist sites and letters to the editor as if they were reliable sources per Wikipedia standards. How many times do you need to be told this before you'll start respecting Wikipedia sourcing policies? Zad68 02:48, 20 April 2014 (UTC)
Zad, I am not suggesting putting the activist sources in the article. So I am not breaking wiki policy. I am merely asking the question whether the way sexual effects are presented in the wiki article match the current consensus. I don't think the current consensus is that "Circumcision does not appear to have a negative impact on sexual function.[18]". Tremello (talk) 03:56, 23 April 2014 (UTC)
Your entire comment was arguing for a change to the article content based on anonymous activist websites and letters to the editor. Are you confirming now that those sources are not reliable sources, otherwise you would argue to use them in the article?How is your response anything other than game playing? Zad68 04:57, 23 April 2014 (UTC)
The AAP report is not an a activist site or a letter to the editor. We make no mention of greater difficulty in masturbation, nor of the fair evidence Sorrels study which they bring up.
Are we saying letters to the editors which point out flaws in a trial are completely unnoteworthy? Dr Frisch is an experienced sexual epidemiologist, who has carried out his own work.
With the secondary sources we use, their conclusions depend entirely on the RCT's. You dismiss the Dutch secondary source because they don't mention the RCTs. Maybe they believe that in this case RCTs are not the best type of evidence. Yes a properly done RCT would be the best but not everyone believes that to be the case with circumcision as it stands.
I don't think the way the current article summarises the sexual affects reflects real world consensus in the scientific community - at the very least there is a little bit of doubt.Tremello (talk) 10:01, 23 April 2014 (UTC)
Surgical procedure
"Male circumcision (from Latin circumcidere, meaning "to cut around")[1] is the surgical removal of the foreskin (prepuce) from the human penis."
By stating that circumcision is a surgical procedure, you are saying it's necessarily a surgical procedure when it's not. Circumcision is the removal of foreskin. Then you have subsets of that where circumcision is a religious ritual, where it's a form of torture, where it's a form of punishment, where it's a surgical procedure. If you were to claim that circumcision is necessarily a surgical procedure, you are implying that the subsets of circumcision, including circumcision as torture and punishment are also surgical procedures. Clearly this is not true. Remove surgical from the opening line, it's patently wrong as it stands. ScienceApe (talk) 01:40, 23 April 2014 (UTC)
It would help your case immensely if you could provide suitably high quality sources to dispute the current definition. (As an aside, even if it is surgically removed as a form of punishment, torture, religious reasons or for any other reason, it is still surgically removed, so I fail to see your point). Yobol (talk) 01:53, 23 April 2014 (UTC)
Also WP:COMMONNAME. Those are rather fringe versions of circumcision. EvergreenFir (talk) 02:05, 23 April 2014 (UTC)
No you're confused, your rebuttal is a non-sequitur. The removal of foreskin is the common definition of circumcision. Circumcision as torture is a subset of circumcision. Any subset of an umbrella term has to also meet the definition of the umbrella term. ScienceApe (talk) 17:22, 25 April 2014 (UTC)
The reference is the dictionary definition, 1, 2, 3. No, hacking the foreskin off with a rusty blade is not the removal of foreskin as a surgical procedure. ScienceApe (talk) 17:22, 25 April 2014 (UTC)
Are African and Australian tribal "bush" circumcisions also "surgical" Evergreen ? Are you maintaining that these are rare too ? Are you maintaining that all religious circumcisions are conducted in surgically aseptic conditions ? Would this include the NYC circumcisions where the cutter sucks blood with his mouth from the infant's penis and where children have died from infections thus contracted ? Do you have good sources for your assertion that these are fringe ?--— ⦿⨦⨀TumadoireachtTalk/Stalk 07:43, 23 April 2014 (UTC)
@Tumadoireacht: You don't understand the meaning of "surgical". Here's a start: Surgery. Also check your local web dictionary. You'd make a better argument with WP:GLOBALIZE. But you clearly have a severe POV issue and would caution you to keep it in check (as I do mine). EvergreenFir (talk) 21:01, 23 April 2014 (UTC)
Surgical has multiple meanings, but the context of the article implies that the word means the foreskin is removed as surgery. That is not what circumcision necessarily is. Circumcision necessarily is the removal of foreskin, how it's removed is incidental. It can be removed as a surgical procedure, or it can be hacked off with a rusty knife. It's the same thing as castration. Castration is the removal of the testicles, how it's removed is incidental. It can be a surgical procedure, or it can be done with a blunt or sharp instrument to induce torture. An umbrella term has to be inclusive not exclusive. ScienceApe (talk) 17:28, 25 April 2014 (UTC)
The pro circumcision lobby here seem to have lost the ability to respond to questions. The default response seems to be ignore the questions and make an ad hominem. It gets old.My POV is to aid the crafting of a balanced article.--— ⦿⨦⨀TumadoireachtTalk/Stalk 21:02, 25 April 2014 (UTC)
"Prevalence of circumcision" map
One of the colour codes in this map denotes "20 to 80 percent" circumcision rate. This is pretty a darn useless statistic display, in my opinion. 20 to 80 percent is a huge freaking gap. Very few people in Australia get the procedure done, but this map gives off the impression that Australia is just a tiny step down from the United States at a first glance. The Royal Australasian College of Physicians (RACP) estimates that in 2010 that 10 to 20 percent of newborn boys are being circumcised, an alarming bright red colour is highly WP:UNDUE, and borderline agenda pushing. --benlisquareT•C•E 05:08, 5 May 2014 (UTC)
Note: I am aware that this topic was brought up in 2008, but it still has not been addressed. This issue needs to be fixed, it's a significant balancing issue. --benlisquareT•C•E 05:13, 5 May 2014 (UTC)
I'm afraid you're confusing prevalence with incidence, review this for an explanation of the difference. The map and the section it's in are clearly labeled prevalence. Feel free to propose a map using different colors but be careful to use colors that work for the color blind per WP:ACCESS. Zad68 05:33, 6 May 2014 (UTC)
Alright, so the numbers are different. But still, 20 to 80 percent is a useless statistic bracket. It's huge, and makes no sense. At least divide the 100% into equal fifths or something. Can someone justify why we have a "20 to 80 percent" bracket for this map? Is there any reason why we shouldn't use a "20-40-60-80-100" system? Right now, a theoretical country with 21% prevalence has the same colour as a theoretical country with 79% prevalence. --benlisquareT•C•E 10:24, 6 May 2014 (UTC)
The source is the WHO, so the article is reflecting the data provided by the source. Do you have another, authoritative source that breaks up the data into the brackets you suggest? Zad68 19:53, 9 May 2014 (UTC)
Zad, do you have a valid reason why the graphic has to be from an authoritative source? As long as the data itself is from such a source the graphic could be generated separately. Aren't we comfortable with the idea that even an organisation as noble as the WHO could have some bias in their materials? jookieapc68 19:53, 9 May 2014 (UTC)
The following discussion has been closed. Please do not modify it.
== A DISGRACEFUL ARTICLE ==
If the pro-circumcision editors had the capacity to be shamed, which they don't, they would immediately remove all reference to the phony "HIV studies" which purport to be strong evidence of a benefit. This article peddles junk science to honest parents looking for accurate information. The pro-circumcision editors think they've outwitted the American people, but we have rejected their pseudo-science in favor of Human Rights and the accurate science out of Canada and Europe. Circumcision takes a dump in the long run -- good riddance to a worthless and destructive superstition. ~Brother K — Preceding unsigned comment added by 71.197.105.70 (talk) 16:23, 9 May 2014 (UTC)
Should we have both absolute RR and relative RR for the HIV benefit from circumcision?
There is not a consensus for changing the sentence as proposed. Number57 14:51, 26 May 2014 (UTC)
The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.
Should we have the text "circumcision reduced the infection rate of HIV among heterosexual men by 1.8% over 24 months, a reduction of between 38–66%" rather than " circumcision reduced their acquisition of HIV by 38–66% over a period of 24 months."?
Support
Support Absolute risk reduction is also useful in addition to relative risk reduction. Both these are supported by the Cochrane review in question and the ARR takes into account the overall risk in the population. Thus many people find ARR useful for interpreting prevention measures. We could also state 18 out of 1000 which is the same as 1.8%. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:53, 11 April 2014 (UTC)
Comment - Hi James here 18 out of 1000 is not conveying the full information. If you were explaining in terms of absolute numbers you have to say that if 1000 people received circumcision and 1000 did not, AND if in the group that did not get circumcision 100(10% baseline risk assumption) contracted AIDS, only 34 to 66 people in the circumcision group will contract HIV/AIDS. If you assume a different baseline risk you would get a different ARR. But you need to state both the relative and absolute risks. Manu Mathew (talk) 10:07, 24 April 2014 (UTC)
Support For my full reasoning see above discussion. My reasoning is similar to Doc James. Tremello (talk) 07:08, 11 April 2014 (UTC)
Support. Suggest we add wikilinks to absolute risk reduction and relative risk reduction so that the statement reads "circumcision reduced the absolute infection rate of HIV among heterosexual men by 1.8% over 24 months, a relative risk reduction of between 38–66%" so that readers without a knowledge of stats have a way to reconcile these two stats. --LT910001 (talk) 22:28, 11 April 2014 (UTC)
Comment I would be happy with that. Are those who oppose happy with this alternative? Tremello (talk) 11:22, 13 April 2014 (UTC)
I always thought it was generally bad writing to use terms where the reader has to follow multiple wikilinks due to WP:JARGON to understand a sentence, especially in the lead. Yobol (talk) 13:28, 13 April 2014 (UTC)
Support - Relative comparison is valid. I think the statement wording could be improved so that it doesn't sound like the act of getting circumcised creates the benefit. Suggest: "A 2009 Cochrane meta-analysis of studies done on in Africa found that over a period of 24 months, sexually active heterosexual men who had been circumcised acquired HIV at a rate 38–66% lower than comparable uncircumcised men." ~KvnG 02:14, 21 April 2014 (UTC)
Neutral
Neutral - I don't mind the proposed wording much as it includes both the RRR and ARR to put things in context. But I have minor concern about the inclusion of ARR in the lead for the same reasons as Alexbrn below. EvergreenFir (talk) 16:44, 13 April 2014 (UTC)
Oppose
Opppose (in the lede at any rate) - as is well-shown in the discussion below, this is not effective communication (i.e. it's bad medical writing for a lay audience). Alexbrntalk|contribs|COI 14:35, 11 April 2014 (UTC)
Oppose in the lead. As always, we should follow the emphasis of the source. While the 1.8% statistic is in the paper, it is not discussed in the "Discussion" section at all, so the only statistic the authors put any weight on is the 38-66%, so this should be what we place weight on as well. To say use of the statistic is "sensationalizing" when the authors of the paper only discuss that statistic in the Disucssion section is bizarre. As evidenced below, is also not clear to the average lay reader what this means; if we are to include it, we have to include a significant discussion/explanation, which is only reasonable in the body. Yobol (talk) 13:20, 13 April 2014 (UTC)
The decision to put that statistic in the lede is sensationalising things because it doesn't account for the rarity of HIV in most developed populations (never mind In the African trials), nor does it account for the rarity in acquiring HIV for a man having intercourse with an HIV infected woman (about 1 in 2000 per act in high income countries according to these transmission rates). So the question must be how much of a big deal do we make out of this statistic. My concern is that people will think that circumcision is definitely a worthwhile thing and that they are in danger of catching HIV if they aren't circumcised. If Europeans increased their circumcision rate, would their HIV rates go down by 38-66% exactly? I also fail to see how it is a bad thing to tell the reader what the statistic means. I would rather they learnt the difference between relative and absolute risk reduction than they be misled. As the 3 scholars I linked to have pointed out, the relative reduction statistic can be misleading. Also, the discussion section of the Cochrane report only briefly mentions the 38-66% statistic - there isn't much discussion at all regarding rates. Tremello (talk) 21:06, 13 April 2014 (UTC)
In cases of dispute, it is best to follow the sources. In this case, which, if any, statistics to emphasize should be guided by the source in question. The source singles out the 38-66% statistic in the abstract and discussion, and ignores the 1.8% statistic. To me, what we should emphasize and what we should not is clear based on this. Yobol (talk) 01:37, 14 April 2014 (UTC)
Yobol is exactly right, per WP:DUEWEIGHT we need to reflect the emphasis found in the best-available sources. How do the reliable sources handle it? I have pulled reliable secondary sources on the subject:
PMID23775468, a 2013 MEDLINE-indexed review, in the abstract: RRR: "showed a reduction in the rate of acquisition of HIV by up to 66 % over 24 months"; ARR: not covered.
PMID22797745, "Voluntary Medical Male Circumcision: An HIV Prevention Priority for PEPFAR"; section "The scientific evidence for voluntary medical male circumcision": RRR: provided for all data summarized; ARR: not covered.
PMID22926175, the AAP Technical Report: RRR: often used "reported protective effect of 40% to 60%", "average efficacy of 60%"; ARR: doesn't appear to be mentioned in the article body.
PMID22014096, "Male circumcision for HIV prevention: current evidence and implementation in sub-Saharan Africa": RRR: Review section, "efficacy of greater than 60%"; ARR: doesn't appear to be mentioned in the article body.
PMID19370585, Cochrane review, "Male circumcision for prevention of heterosexual acquisition of HIV in men": RRR: abstract, Authors' Conclusions, "There is strong evidence that medical male circumcision reduces the acquisition of HIV by heterosexual men by between 38% and 66% over 24 months"; IRR: not mentioned in abstract, but is embedded inside a detailed technical analysis in the body of the article, "At the end of the studies (21 or 24 months), the risk difference dropped further to -1.80% with 95% CI from -2.48% to -1.12% with minimal statistical heterogeneity (X² = 1.00, df = 2; p = 0.61; I² = 0%) (see Analysis 1.6). This can be interpreted as a significant absolute risk reduction of 0.83% at 12 months and of 1.80% at 21 or 24 months, following circumcision."
I support adding the ARR in the body, as per the emphasis found in the sources, and because in the body there is room to explain the statistics. Zad68 04:39, 14 April 2014 (UTC)
Oppose 1.8% makes no mathematical sense whatsoever. It gives the reader absolutely no information at all unless they understand what the 38-66% means, mathematically. Now, if you were to list the starting and ending percentage, that would make sense. Saying "reduced from 3% to 1.8%" makes logical sense. Absolute percentage reductions are meaningless without a starting and ending %. In fact, the relative reductions give redundant information. Only the absolute starting and ending percentage is needed. As a side comment, this article has certainly improved a lot over the last year and then some. Been keeping an eye on it. Rip-Saw (talk) 04:19, 14 April 2014 (UTC)
It means that if one is circ in Africa their risk of getting HIV decrease 1.8%. How is this "no information"? Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:02, 19 April 2014 (UTC)
It's no information because it gives no starting point. If your risk went from 99% to 97.2%, no one in the world could make the case for circumcision. That's not even a significant decrease. And if it went from 1.9% to 0.1%, well that would be absolutely massive, wouldn't it? Saying a risk decreased by an absolute amount is absolutely ridiculous, and only a fool would do so without context. Rip-Saw (talk) 01:51, 6 May 2014 (UTC)
If my chance of death when from 99 to 97.2% yes that is great. So is 1.9% to 0.1%. Different people wish the numbers in different ways. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:15, 6 May 2014 (UTC)
Comment I disagree with Yobol's and zad's logic. Your logic is we should follow what the abstract of the source says. But this cochrane an article about circumcison and HIV. Whereas this Wikipedia article is about circumcision alone/in general. So you have decide the weight to give it and how to put it in context.
Unfortunately ripsaw, they do not give the starting and ending percentage. I think they did some statistical stuff weighting some studies more than others to get the 1.8% - which I don't umderstand.
I have some problems with the 38-66%. What if a lot of those who got HIV also had genital ulcers for example? What if the protection percentage varies upon type of circumcision. My question to those who are in favour is - is this a definite percentage?
Also is this relevant from WP:MEDRS: "However, when it comes to actually writing a Wikipedia article, it is misleading to give a full citation for a source after reading only its abstract; the abstract necessarily presents a stripped-down version of the conclusions and omits the background that can be crucial for understanding exactly what the source says." Tremello (talk) 18:09, 14 April 2014 (UTC)
Our logic is that we do what the Wikipedia content policy says. The Wikipedia content policy says that we summarize the scientific consensus of the best-available sources, giving weight proportionate to the weight given by the sources. If you want to see what the most important points are, look to the abstract or conclusions, as it is precisely the purpose of an abstract or conclusion section to summarize the most important points. In my comment above I provide the relevant WP:MEDRS-compliant reliable secondary sources and show they weight the RRR heavily, and the ARR very little.
Re I have some problems with the 38-66%. What if a lot of those who got HIV also had genital ulcers...Tremello, your personal issue with the subject of this article should be irrelevant. Your argument has been nothing more than your own original research based on anonymous self-published activism sites. If you disagree, you're welcome to go try to change Wikipedia content policy to say that it's OK for Wikipedia articles to reflect the original research put forth by single-purpose accounts. Zad68 19:16, 14 April 2014 (UTC)
Oppose - Per Alexbrn's logic. Information might be helpful for more educated readers, but probably just confusing for the common Joe. NickCT (talk) 20:15, 14 April 2014 (UTC)
Oppose - I have been following this for a little while now and tend to agree with the above commentators. Best to keep it simple in the lead and follow the emphasis from the sources. Have no issues with the 1.8% being explained in the body though. AIRcorn(talk) 23:14, 14 April 2014 (UTC)
Comment: Oppose and Oppose Firstly, the lede in this article is ludicrous. If it were on a less hysterically contentious subject I would climb in and split it into a five-line real lede plus one or more introductory overview sections, but I suspect I would be wasting my time. The numeric topic under discussion certainly does not belong in the lede anyway and most certainly not in that form. It does of course belong in the article, in an appropriate context, but also appropriately discussed, not quoted out of context without analysis of its significance. Until that is corrected it does not in fact belong in the article at all, being in effect incoherent, of use neither to naive nor advanced readers. To plead WP policy in defence is the purest legalistic window dressing; to summarize the most important points is useless out of context, if not positively misleading. JonRichfield (talk) 06:31, 19 April 2014 (UTC)
Agree with you that the lede is an unreadable mess. Neither of the warring factions can be bothered to write for readers. That is the reason why I no longer mingle in this ant hill, see also my comment here.82.113.99.92 (talk) 20:46, 19 April 2014 (UTC)
Oppose per above, in particular Rip-Saw and JonRichfield. The amount of medical detail in the bloated lede is given totally undue weight, and is directly confusing to the reader by throwing it like that in their face instead of being introduced in the appropriate sections (Circumcision#Effects and Circumcision#Adverse_effects). Material from the lede should be trimmed and moved to these sections, so that it is more in line with wp:lede. walkvictor falktalk 16:29, 4 May 2014 (UTC)
Discussion
Is the RFC for text in the body, the lede, or both? Alexbrntalk|contribs|COI 05:26, 11 April 2014 (UTC)
Both, I presume. Can't have it in lede without it being in body also. My view is that to include just the 38-66% in the lede would be undue weight and sensationalising things. See my reasoning above. I am not sure I prefer the non- statistics proposal you offered above as I identified problems with it.Tremello (talk) 07:03, 11 April 2014 (UTC)
Okay as someone is asking for outside input, presumably from those unfamiliar with the article and perhaps topic, could someone explain the meaning of the above statement "circumcision reduced the infection rate of HIV among heterosexual men by 1.8% over 24 months, a reduction of between 38–66%" How can it reduce it by 1.8% and 38-66%? AIRcorn(talk) 10:34, 11 April 2014 (UTC)
Exactly, for the general reader it is just confusing. (But see discussion in section above for elucidation). Alexbrntalk|contribs|COI 10:38, 11 April 2014 (UTC)
Question Where is the 1.8% figure coming from? I don't see it in the abstract of the source.
Comment As someone also unfamiliar with the topic, I agree with AIRcorn in finding the sentence showing both figures difficult to understand (in its current form). It's not clear to a lay reader what each percentage is a percentage of. : 94.193.139.22 (talk) 10:55, 11 April 2014 (UTC)
Comment Re WP:UNDUE: The source makes a very strong statement ("strong evidence that male circumcision prevents men in the general population from acquiring HIV from heterosexual sex"). If the source is reliable (and it does look reliable to me) then quoting the 38-66% alone, while it is a strong statement, would be justified by the source IMO.
To explain: So let's us say for arguments sake, the HIV rate for the non circumcised group after 24 months was 3% and for the circumcised group it was 1.5%. That would be a 1.5% reduction in the rate of HIV, but comparing the 2 groups it would be a 50% reduction because 1.5 is 50% of 3. So which percentage should we use? The absolute reduction (1.5%), the relative reduction (50%) or both? See Goldacre, Welch, and Earpe for the merits and reasoning behind the absolute reduction statistic. Tremello (talk) 13:51, 11 April 2014 (UTC)
Got it. If we do go with the two figures then IMO what each one stands for does need further explanation, or at the very least a wikilink to an explanation elsewhere on wikipedia. So is the 1.8% from the body (but not the abstract) of the source? I'm seeing " At the end of the studies (21 or 24 months), the risk difference dropped further to -1.80% with 95% CI from -2.48% to -1.12% with minimal statistical heterogeneity ... This can be interpreted as a significant absolute risk reduction of 0.83% at 12 months and of 1.80% at 21 or 24 months, following circumcision." - is that where the 1.8% is coming from? Why are we not using the 1-year figures? Balaenoptera musculus (talk) 14:20, 11 April 2014 (UTC)
Yes the figure is located in the Effects of intervention > primary outcome> sensitivity analysis of the full article not the abstract. Generally it is seen as more reliable if the reduction holds true over a longer period. Yes maybe the use of percentage points with inline link could improve things. Tremello (talk) 14:34, 11 April 2014 (UTC)
? Is the issue here really one of presentation (i.e. which of the two ways to present the figures is clearest and most informative) or is it one of how much weight we should allot to the African studies (and the Cochrane meta-study), given the scientific debate that seems to be going on (example) about the validity of the studies (e.g. alleged selection bias, inadequate blinding etc)?
If the reliability of these studies is debatable, then should we not move them out of the lede entirely and deal with them in the body of the article, where the arguments for and against could be spelled out in more detail? Balaenoptera musculus (talk) 15:02, 11 April 2014 (UTC)
It is best practice to use both RR and AR for the benefits and harms of treatment. I find AR to be much better. 1.8% means that if you are circ in Africa your chance of getting HIV decrease 1.8%. The RR is less informative. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:59, 19 April 2014 (UTC)
It means no such thing.Doc James(User Jmh649) is at best misguided or ill informed in making the following statement
"1.8% means that if you are circ in Africa your chance of getting HIV decrease 1.8%"
In fact, if you were circumcised in Africa- if you survived the often crude and often forced process of Tribal Circumcision you may have all sorts of complications,scarring, or malfunction from having the top of yer willy lopped off.
What it DOES mean is that for a small cohort of subjects( all of whose foreskins were cut off in clinical settings) in a questionable study in a part of one country on the continent of Africa (a study which was halted on ethical grounds) that there may be some support for the idea that being cut eliminates or reduces one route of entry for HIV into the male body through th moist envelope of the inner of the still attached foreskin which unfolds during intercourse.
The moist envelope of the foreskin normally protects the penis head and helps retains its sensitivity preventing the hardening and coonsequent desensitization of the penis head which is a result of every circumcision worldwide.
There exists a counter argument to the one extolling the protective virtues of the chop.
That is that the mucous membrane of the intact foreskin is a vital part of the immune system. Perhaps circumcision will, (like many gung-ho knife based procedures in medicine -like cutting out tonsils and appendix too readily) fall out of fashion when this aspect receives more attention .--— ⦿⨦⨀TumadoireachtTalk/Stalk 21:45, 22 April 2014 (UTC)
@Tumadoireacht: mind saying that not in all caps and in a more understandable way? EvergreenFir (talk) 02:04, 23 April 2014 (UTC)
The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.
Pro circumcision bias
This article still has a pro circumcision bias. Given the prevalence of circumcision of the penises of the contributors to Wikipedia and the US origins of this organisation I wonder if this is unavoidable. I hope not.
The pro circ argument around possible std prevention is absolutely shameful, and it's a dangerous idea to circulate. By that I mean, there should be no material that encourages sexually capable men of all ages to practise sex without a condom because of any slight perceived protection by having a calloused glans on their penis. It's also dangerous to circulate this idea with parents who think it's their right to circumcise their son.
What ever happened to the section in this article around the negative side effects of routine penile modification?
Perhaps some more competent editor could put the identity of the editor who made the above comment at the end of it. Or the editor concerned could do it .--— ⦿⨦⨀TumadoireachtTalk/Stalk 11:41, 3 June 2014 (UTC)
Should we have both absolute RR and relative RR for the HIV benefit from circumcision?
There is not a consensus for changing the sentence as proposed. Number57 14:51, 26 May 2014 (UTC)
The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.
Should we have the text "circumcision reduced the infection rate of HIV among heterosexual men by 1.8% over 24 months, a reduction of between 38–66%" rather than " circumcision reduced their acquisition of HIV by 38–66% over a period of 24 months."?
Support
Support Absolute risk reduction is also useful in addition to relative risk reduction. Both these are supported by the Cochrane review in question and the ARR takes into account the overall risk in the population. Thus many people find ARR useful for interpreting prevention measures. We could also state 18 out of 1000 which is the same as 1.8%. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:53, 11 April 2014 (UTC)
Comment - Hi James here 18 out of 1000 is not conveying the full information. If you were explaining in terms of absolute numbers you have to say that if 1000 people received circumcision and 1000 did not, AND if in the group that did not get circumcision 100(10% baseline risk assumption) contracted AIDS, only 34 to 66 people in the circumcision group will contract HIV/AIDS. If you assume a different baseline risk you would get a different ARR. But you need to state both the relative and absolute risks. Manu Mathew (talk) 10:07, 24 April 2014 (UTC)
Support For my full reasoning see above discussion. My reasoning is similar to Doc James. Tremello (talk) 07:08, 11 April 2014 (UTC)
Support. Suggest we add wikilinks to absolute risk reduction and relative risk reduction so that the statement reads "circumcision reduced the absolute infection rate of HIV among heterosexual men by 1.8% over 24 months, a relative risk reduction of between 38–66%" so that readers without a knowledge of stats have a way to reconcile these two stats. --LT910001 (talk) 22:28, 11 April 2014 (UTC)
Comment I would be happy with that. Are those who oppose happy with this alternative? Tremello (talk) 11:22, 13 April 2014 (UTC)
I always thought it was generally bad writing to use terms where the reader has to follow multiple wikilinks due to WP:JARGON to understand a sentence, especially in the lead. Yobol (talk) 13:28, 13 April 2014 (UTC)
Support - Relative comparison is valid. I think the statement wording could be improved so that it doesn't sound like the act of getting circumcised creates the benefit. Suggest: "A 2009 Cochrane meta-analysis of studies done on in Africa found that over a period of 24 months, sexually active heterosexual men who had been circumcised acquired HIV at a rate 38–66% lower than comparable uncircumcised men." ~KvnG 02:14, 21 April 2014 (UTC)
Neutral
Neutral - I don't mind the proposed wording much as it includes both the RRR and ARR to put things in context. But I have minor concern about the inclusion of ARR in the lead for the same reasons as Alexbrn below. EvergreenFir (talk) 16:44, 13 April 2014 (UTC)
Oppose
Opppose (in the lede at any rate) - as is well-shown in the discussion below, this is not effective communication (i.e. it's bad medical writing for a lay audience). Alexbrntalk|contribs|COI 14:35, 11 April 2014 (UTC)
Oppose in the lead. As always, we should follow the emphasis of the source. While the 1.8% statistic is in the paper, it is not discussed in the "Discussion" section at all, so the only statistic the authors put any weight on is the 38-66%, so this should be what we place weight on as well. To say use of the statistic is "sensationalizing" when the authors of the paper only discuss that statistic in the Disucssion section is bizarre. As evidenced below, is also not clear to the average lay reader what this means; if we are to include it, we have to include a significant discussion/explanation, which is only reasonable in the body. Yobol (talk) 13:20, 13 April 2014 (UTC)
The decision to put that statistic in the lede is sensationalising things because it doesn't account for the rarity of HIV in most developed populations (never mind In the African trials), nor does it account for the rarity in acquiring HIV for a man having intercourse with an HIV infected woman (about 1 in 2000 per act in high income countries according to these transmission rates). So the question must be how much of a big deal do we make out of this statistic. My concern is that people will think that circumcision is definitely a worthwhile thing and that they are in danger of catching HIV if they aren't circumcised. If Europeans increased their circumcision rate, would their HIV rates go down by 38-66% exactly? I also fail to see how it is a bad thing to tell the reader what the statistic means. I would rather they learnt the difference between relative and absolute risk reduction than they be misled. As the 3 scholars I linked to have pointed out, the relative reduction statistic can be misleading. Also, the discussion section of the Cochrane report only briefly mentions the 38-66% statistic - there isn't much discussion at all regarding rates. Tremello (talk) 21:06, 13 April 2014 (UTC)
In cases of dispute, it is best to follow the sources. In this case, which, if any, statistics to emphasize should be guided by the source in question. The source singles out the 38-66% statistic in the abstract and discussion, and ignores the 1.8% statistic. To me, what we should emphasize and what we should not is clear based on this. Yobol (talk) 01:37, 14 April 2014 (UTC)
Yobol is exactly right, per WP:DUEWEIGHT we need to reflect the emphasis found in the best-available sources. How do the reliable sources handle it? I have pulled reliable secondary sources on the subject:
PMID23775468, a 2013 MEDLINE-indexed review, in the abstract: RRR: "showed a reduction in the rate of acquisition of HIV by up to 66 % over 24 months"; ARR: not covered.
PMID22797745, "Voluntary Medical Male Circumcision: An HIV Prevention Priority for PEPFAR"; section "The scientific evidence for voluntary medical male circumcision": RRR: provided for all data summarized; ARR: not covered.
PMID22926175, the AAP Technical Report: RRR: often used "reported protective effect of 40% to 60%", "average efficacy of 60%"; ARR: doesn't appear to be mentioned in the article body.
PMID22014096, "Male circumcision for HIV prevention: current evidence and implementation in sub-Saharan Africa": RRR: Review section, "efficacy of greater than 60%"; ARR: doesn't appear to be mentioned in the article body.
PMID19370585, Cochrane review, "Male circumcision for prevention of heterosexual acquisition of HIV in men": RRR: abstract, Authors' Conclusions, "There is strong evidence that medical male circumcision reduces the acquisition of HIV by heterosexual men by between 38% and 66% over 24 months"; IRR: not mentioned in abstract, but is embedded inside a detailed technical analysis in the body of the article, "At the end of the studies (21 or 24 months), the risk difference dropped further to -1.80% with 95% CI from -2.48% to -1.12% with minimal statistical heterogeneity (X² = 1.00, df = 2; p = 0.61; I² = 0%) (see Analysis 1.6). This can be interpreted as a significant absolute risk reduction of 0.83% at 12 months and of 1.80% at 21 or 24 months, following circumcision."
I support adding the ARR in the body, as per the emphasis found in the sources, and because in the body there is room to explain the statistics. Zad68 04:39, 14 April 2014 (UTC)
Oppose 1.8% makes no mathematical sense whatsoever. It gives the reader absolutely no information at all unless they understand what the 38-66% means, mathematically. Now, if you were to list the starting and ending percentage, that would make sense. Saying "reduced from 3% to 1.8%" makes logical sense. Absolute percentage reductions are meaningless without a starting and ending %. In fact, the relative reductions give redundant information. Only the absolute starting and ending percentage is needed. As a side comment, this article has certainly improved a lot over the last year and then some. Been keeping an eye on it. Rip-Saw (talk) 04:19, 14 April 2014 (UTC)
It means that if one is circ in Africa their risk of getting HIV decrease 1.8%. How is this "no information"? Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:02, 19 April 2014 (UTC)
It's no information because it gives no starting point. If your risk went from 99% to 97.2%, no one in the world could make the case for circumcision. That's not even a significant decrease. And if it went from 1.9% to 0.1%, well that would be absolutely massive, wouldn't it? Saying a risk decreased by an absolute amount is absolutely ridiculous, and only a fool would do so without context. Rip-Saw (talk) 01:51, 6 May 2014 (UTC)
If my chance of death when from 99 to 97.2% yes that is great. So is 1.9% to 0.1%. Different people wish the numbers in different ways. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:15, 6 May 2014 (UTC)
Comment I disagree with Yobol's and zad's logic. Your logic is we should follow what the abstract of the source says. But this cochrane an article about circumcison and HIV. Whereas this Wikipedia article is about circumcision alone/in general. So you have decide the weight to give it and how to put it in context.
Unfortunately ripsaw, they do not give the starting and ending percentage. I think they did some statistical stuff weighting some studies more than others to get the 1.8% - which I don't umderstand.
I have some problems with the 38-66%. What if a lot of those who got HIV also had genital ulcers for example? What if the protection percentage varies upon type of circumcision. My question to those who are in favour is - is this a definite percentage?
Also is this relevant from WP:MEDRS: "However, when it comes to actually writing a Wikipedia article, it is misleading to give a full citation for a source after reading only its abstract; the abstract necessarily presents a stripped-down version of the conclusions and omits the background that can be crucial for understanding exactly what the source says." Tremello (talk) 18:09, 14 April 2014 (UTC)
Our logic is that we do what the Wikipedia content policy says. The Wikipedia content policy says that we summarize the scientific consensus of the best-available sources, giving weight proportionate to the weight given by the sources. If you want to see what the most important points are, look to the abstract or conclusions, as it is precisely the purpose of an abstract or conclusion section to summarize the most important points. In my comment above I provide the relevant WP:MEDRS-compliant reliable secondary sources and show they weight the RRR heavily, and the ARR very little.
Re I have some problems with the 38-66%. What if a lot of those who got HIV also had genital ulcers...Tremello, your personal issue with the subject of this article should be irrelevant. Your argument has been nothing more than your own original research based on anonymous self-published activism sites. If you disagree, you're welcome to go try to change Wikipedia content policy to say that it's OK for Wikipedia articles to reflect the original research put forth by single-purpose accounts. Zad68 19:16, 14 April 2014 (UTC)
Oppose - Per Alexbrn's logic. Information might be helpful for more educated readers, but probably just confusing for the common Joe. NickCT (talk) 20:15, 14 April 2014 (UTC)
Oppose - I have been following this for a little while now and tend to agree with the above commentators. Best to keep it simple in the lead and follow the emphasis from the sources. Have no issues with the 1.8% being explained in the body though. AIRcorn(talk) 23:14, 14 April 2014 (UTC)
Comment: Oppose and Oppose Firstly, the lede in this article is ludicrous. If it were on a less hysterically contentious subject I would climb in and split it into a five-line real lede plus one or more introductory overview sections, but I suspect I would be wasting my time. The numeric topic under discussion certainly does not belong in the lede anyway and most certainly not in that form. It does of course belong in the article, in an appropriate context, but also appropriately discussed, not quoted out of context without analysis of its significance. Until that is corrected it does not in fact belong in the article at all, being in effect incoherent, of use neither to naive nor advanced readers. To plead WP policy in defence is the purest legalistic window dressing; to summarize the most important points is useless out of context, if not positively misleading. JonRichfield (talk) 06:31, 19 April 2014 (UTC)
Agree with you that the lede is an unreadable mess. Neither of the warring factions can be bothered to write for readers. That is the reason why I no longer mingle in this ant hill, see also my comment here.82.113.99.92 (talk) 20:46, 19 April 2014 (UTC)
Oppose per above, in particular Rip-Saw and JonRichfield. The amount of medical detail in the bloated lede is given totally undue weight, and is directly confusing to the reader by throwing it like that in their face instead of being introduced in the appropriate sections (Circumcision#Effects and Circumcision#Adverse_effects). Material from the lede should be trimmed and moved to these sections, so that it is more in line with wp:lede. walkvictor falktalk 16:29, 4 May 2014 (UTC)
Discussion
Is the RFC for text in the body, the lede, or both? Alexbrntalk|contribs|COI 05:26, 11 April 2014 (UTC)
Both, I presume. Can't have it in lede without it being in body also. My view is that to include just the 38-66% in the lede would be undue weight and sensationalising things. See my reasoning above. I am not sure I prefer the non- statistics proposal you offered above as I identified problems with it.Tremello (talk) 07:03, 11 April 2014 (UTC)
Okay as someone is asking for outside input, presumably from those unfamiliar with the article and perhaps topic, could someone explain the meaning of the above statement "circumcision reduced the infection rate of HIV among heterosexual men by 1.8% over 24 months, a reduction of between 38–66%" How can it reduce it by 1.8% and 38-66%? AIRcorn(talk) 10:34, 11 April 2014 (UTC)
Exactly, for the general reader it is just confusing. (But see discussion in section above for elucidation). Alexbrntalk|contribs|COI 10:38, 11 April 2014 (UTC)
Question Where is the 1.8% figure coming from? I don't see it in the abstract of the source.
Comment As someone also unfamiliar with the topic, I agree with AIRcorn in finding the sentence showing both figures difficult to understand (in its current form). It's not clear to a lay reader what each percentage is a percentage of. : 94.193.139.22 (talk) 10:55, 11 April 2014 (UTC)
Comment Re WP:UNDUE: The source makes a very strong statement ("strong evidence that male circumcision prevents men in the general population from acquiring HIV from heterosexual sex"). If the source is reliable (and it does look reliable to me) then quoting the 38-66% alone, while it is a strong statement, would be justified by the source IMO.
To explain: So let's us say for arguments sake, the HIV rate for the non circumcised group after 24 months was 3% and for the circumcised group it was 1.5%. That would be a 1.5% reduction in the rate of HIV, but comparing the 2 groups it would be a 50% reduction because 1.5 is 50% of 3. So which percentage should we use? The absolute reduction (1.5%), the relative reduction (50%) or both? See Goldacre, Welch, and Earpe for the merits and reasoning behind the absolute reduction statistic. Tremello (talk) 13:51, 11 April 2014 (UTC)
Got it. If we do go with the two figures then IMO what each one stands for does need further explanation, or at the very least a wikilink to an explanation elsewhere on wikipedia. So is the 1.8% from the body (but not the abstract) of the source? I'm seeing " At the end of the studies (21 or 24 months), the risk difference dropped further to -1.80% with 95% CI from -2.48% to -1.12% with minimal statistical heterogeneity ... This can be interpreted as a significant absolute risk reduction of 0.83% at 12 months and of 1.80% at 21 or 24 months, following circumcision." - is that where the 1.8% is coming from? Why are we not using the 1-year figures? Balaenoptera musculus (talk) 14:20, 11 April 2014 (UTC)
Yes the figure is located in the Effects of intervention > primary outcome> sensitivity analysis of the full article not the abstract. Generally it is seen as more reliable if the reduction holds true over a longer period. Yes maybe the use of percentage points with inline link could improve things. Tremello (talk) 14:34, 11 April 2014 (UTC)
? Is the issue here really one of presentation (i.e. which of the two ways to present the figures is clearest and most informative) or is it one of how much weight we should allot to the African studies (and the Cochrane meta-study), given the scientific debate that seems to be going on (example) about the validity of the studies (e.g. alleged selection bias, inadequate blinding etc)?
If the reliability of these studies is debatable, then should we not move them out of the lede entirely and deal with them in the body of the article, where the arguments for and against could be spelled out in more detail? Balaenoptera musculus (talk) 15:02, 11 April 2014 (UTC)
It is best practice to use both RR and AR for the benefits and harms of treatment. I find AR to be much better. 1.8% means that if you are circ in Africa your chance of getting HIV decrease 1.8%. The RR is less informative. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:59, 19 April 2014 (UTC)
It means no such thing.Doc James(User Jmh649) is at best misguided or ill informed in making the following statement
"1.8% means that if you are circ in Africa your chance of getting HIV decrease 1.8%"
In fact, if you were circumcised in Africa- if you survived the often crude and often forced process of Tribal Circumcision you may have all sorts of complications,scarring, or malfunction from having the top of yer willy lopped off.
What it DOES mean is that for a small cohort of subjects( all of whose foreskins were cut off in clinical settings) in a questionable study in a part of one country on the continent of Africa (a study which was halted on ethical grounds) that there may be some support for the idea that being cut eliminates or reduces one route of entry for HIV into the male body through th moist envelope of the inner of the still attached foreskin which unfolds during intercourse.
The moist envelope of the foreskin normally protects the penis head and helps retains its sensitivity preventing the hardening and coonsequent desensitization of the penis head which is a result of every circumcision worldwide.
There exists a counter argument to the one extolling the protective virtues of the chop.
That is that the mucous membrane of the intact foreskin is a vital part of the immune system. Perhaps circumcision will, (like many gung-ho knife based procedures in medicine -like cutting out tonsils and appendix too readily) fall out of fashion when this aspect receives more attention .--— ⦿⨦⨀TumadoireachtTalk/Stalk 21:45, 22 April 2014 (UTC)
@Tumadoireacht: mind saying that not in all caps and in a more understandable way? EvergreenFir (talk) 02:04, 23 April 2014 (UTC)
The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.
Pro circumcision bias
This article still has a pro circumcision bias. Given the prevalence of circumcision of the penises of the contributors to Wikipedia and the US origins of this organisation I wonder if this is unavoidable. I hope not.
The pro circ argument around possible std prevention is absolutely shameful, and it's a dangerous idea to circulate. By that I mean, there should be no material that encourages sexually capable men of all ages to practise sex without a condom because of any slight perceived protection by having a calloused glans on their penis. It's also dangerous to circulate this idea with parents who think it's their right to circumcise their son.
What ever happened to the section in this article around the negative side effects of routine penile modification?
Perhaps some more competent editor could put the identity of the editor who made the above comment at the end of it. Or the editor concerned could do it .--— ⦿⨦⨀TumadoireachtTalk/Stalk 11:41, 3 June 2014 (UTC)
Primary sources
For medical content such as this we do not use primary sources but instead use secondary sources. This has been made clear in the edit summaries such as this one [6]Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:45, 11 June 2014 (UTC)
Sexual impact
The article states in the third paragraph "Circumcision does not appear to have a negative impact on sexual function.", citing a study done by Pediatricians, who I believe have a questionable at best knowledge of adult human sexuality. I have a study which presents clear evidence to the contrary that circumcision leads to a loss of pressure sensitivity, but since I am a new editor I would like to bring the topic up for discussion before I go ahead with the edit. Here is the whitepaper: http://www.ncbi.nlm.nih.gov/pubmed/17378847Santacide (talk) 01:40, 7 June 2014 (UTC)
Hi Santacide, you didn't propose a specific edit but the general idea of using a primary study to contradict the conclusions of multiple secondary sources is contraindicated by WP:MEDREV. If you're interested in editing Wikipedia biomedical content, please start by reading WP:MEDRS carefully.
As a side note: First, you are discussing sexual impact, but the study you've provided in your proposal to update the Wikipedia article's content in this area did not investigate sexual impact and makes no statement about sexual impact in its conclusions. Second, you state that you believe pediatricians "have a questionable at best knowledge of adult human sexuality" but the lead author of the study you provided is a pediatrician--Why would you propose to change content because it was done by a kind of investigator you question and then offer to replace it with a study done by the same kind of investigator? Zad68 14:05, 9 June 2014 (UTC)
I support Santacide; posting that circumcision does not effect sexual pleasure is a lie to the people of the public and is not considered as good faith. — Preceding unsigned comment added by Enlightened one088 (talk • contribs) 03:43, 11 June 2014 (UTC)
I agree that currently the way we summarise the sexual effects does not accurately reflect the secondary sources or current scientific consensus.
Tremello (talk) 07:53, 11 June 2014 (UTC)
Do you have some new secondary sources to discuss? Doc James (talk · contribs · email) (if I write on your page reply on mine) 08:25, 11 June 2014 (UTC)
Thank you all very much for helping me with trying to improve this article, even though I am new here. I will try to look up relevant secondary sources to support this thesis in my spare time, and for the record we currently only have one secondary source stating that circumcision has no negative sexual repercussions, if I recall correctly. Once again, I appreciate your honest and helpful feedback! Thank you! Santacide (talk) 00:35, 12 June 2014 (UTC)
You're welcome. But, a few important things: First, you state that you want to support your "thesis". So you are coming to the article with a preconceived view (your "thesis") and will now scout around to look for sources to support your belief--this is backwards. Per Wikipedia content policy we review the available sources and summarize them with due weight: the sources need to lead you to the content, not the other way around.. That, plus the advocacy website you first used to attempt to support the content, explain why you might be here; please see WP:NOTADVOCACY. Second, your statement "we currently only have one secondary source stating that circumcision has no negative sexual repercussions"--No, please look again. Zad68 04:10, 12 June 2014 (UTC)
By "my thesis" I was simply referring to, as Tremello stated, the current scientific consensus, which I believe is that circumcision, since it removes erogenous tissue, decreases erogenous sensation... And the NIH is not an advocacy website... Secondly, by one secondary source I was referring to source 18 which, on second glance, does contain several citations therein, so my apologies. However, none of these citations are links or URLs, so how is a reader supposed to look them up and verify them? Thank you! Santacide47eb06a9@opayq.com (talk) 06:04, 12 June 2014 (UTC)
By the way this [7] is a primary source as thus we do not really allow its use. We want secondary sources that provide a general overview of primary sources. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:25, 12 June 2014 (UTC)
I have found a recent secondary source [8] which I will add. It is freely available. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:26, 12 June 2014 (UTC)
Reposting archived discussions without actually unarchiving those discussions
Tremello, stop your WP:Disruptive behavior of reposting archived discussions without actually unarchiving those discussions. You don't know what I mean, you stated here. Well, then why don't you try reading the WP:Talk page guidelines I pointed to, including this attempted revert of your duplicates I just made, specifically Wikipedia:Talk page guidelines#When to condense pages? These discussions that you are posting, which include my commentary, are already archived. So you are creating duplicates that just so happen to have new commentary. That is not what you should be doing. You should start a new section while pointing to the past discussions, which is exactly what I am about to do for your material. Flyer22 (talk) 05:49, 14 June 2014 (UTC)
I don't think that is an improvement. I want the whole discussion on the current page. It isn't disruptive at all, so stop over-reacting.Tremello (talk) 06:03, 14 June 2014 (UTC)
Other than your obvious inexperience with Wikipedia editing, I don't understand how you don't see it as WP:Disruptive, when you are duplicating archived content and making it so that if one wants to point to that discussion, it turns out that there's a duplicate that might have extra content in it. The archives aren't for you to play with and pull out simply because you want those discussions to stay on the talk page. The WP:TALK guideline I pointed you to is very clear about that. Flyer22 (talk) 06:21, 14 June 2014 (UTC)
Let's leave aside your condescending and inaccurate remark. No it won't have extra content in it. You just refer to the latest discussion - the one that you republished from the archives. All the new content will be in that discussion. So you only need to point to that discussion. Tremello (talk) 07:03, 14 June 2014 (UTC)
Leave it aside; your duplication is still disruptive, for the reasons I stated above. I didn't state that the original would have "extra content in it"; I was clearly referring to the inappropriate duplicate. And not everyone would be aware of which version to point to, when an editor states, for example, "Hey, we discussed that [under the so and so name two years ago]." In that case, an editor would simply look for the discussion and would likely happen upon the original, obviously not consider that there is a duplicate, and therefore read the "wrong version." There is no WP:TALK page acceptance of duplicating in the way that you did, and that's for the reasons I've given. There is, however, WP:TALK page discouragement of reposting material in the way that you did. But you did not even technically unarchive, which makes the matter worse. The original was still in the archive. You can debate that your approach was correct as much as you want; it was not. And I have the WP:TALK page guideline supporting me on that. Flyer22 (talk) 07:50, 14 June 2014 (UTC)
Summarizing the sexual effects and lead adequacy on summarizing the sexual effects?
If you actually read my reply, what I was actually saying doc James is that the aap report is not fairly reflected in this wiki article. Plus there is also the Dutch view too. So all in all, as it stands "'Circumcision does not appear to have a negative impact on sexual function" in the lede is biased. Tremello (talk) 19:50, 12 June 2014 (UTC)
IMO we accurately reflect the conclusions of the APP report. Which text from that report do you believe contradicts our text? Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:08, 17 June 2014 (UTC)
Penilo-Cavernosus Reflex
Hi everyone, I want to add a piece of information to the "Circumcision" page under the "Adverse Effects". I was blocked temporarily a few days ago because I wasn't really aware of how Wikipedia worked and the rules associated with it. So today I am going to discuss what I want to post and the type of sources I have along with my proposal.
I want to talk about how the penilo-cavernosus reflex is responsible for sexual, bowel, and urine function. The foreskin which is removed, contains a high density of fine-touch mechanoreceptors while the glans do not. Since the foreskin is removed in circumcision, the penilo-cavernosus reflex is less elicitable in circumcised men and men with retracted foreskins as opposed to men who are intact.
Please let me know what you think, thank you.
BobbyEnlightened one088 (talk) 04:29, 14 June 2014 (UTC)
They won't let you add it because it is a primary source. I kind of agree. We have to think about undue weight. But you are slightly concerned, as I am, that the negative sexual effects of circumcision contained in secondary sources are not being outlined Tremello (talk) 05:32, 14 June 2014 (UTC)
Hey, thanks for replying, but that is a secondary source. It is a peer reviewed journal by BJUI International... Enlightened one088 (talk) 07:06, 14 June 2014 (UTC)
This is important information that should be included in this article. Many of those who patrol this article and maintain it in its current poor and unbalanced state do not understand that primary sources ARE permitted per the medical article guidelines and general guidelines.
It is simply a question of not either giving them disproportionate mention("undue weight") or using them to contradict overview/review type secondary sources. If the article you came across is a secondary source I cannot see any problem, or a reason to block you for attempting to edit. Sometimes the courtesy extended to new editors generally appears to be lacking for new editors who attempt to add balance to this particular article. Here is the encyclopedia britannica entry on circumcision.
http://www.britannica.com/EBchecked/topic/118439/circumcision
The contrast in objectivity and clear overview is startling. The entry in the catholic encyclopedia below too is interesting for many aspects including information on some cultures forcing circumcision on others and the suspension of circumcision entirely amongst jews during the forty years in the desert with Moses.
http://www.newadvent.org/cathen/03777a.htm
Here are several other online encyclopedias on the subject:
http://www.encyclopedia.com/topic/circumcision.aspxhttp://www.newworldencyclopedia.org/entry/Circumcision
Here is the Jewish Encyclopedia on the subject in wonderful detail on history, origins and motivation for genital cutting and trimming.
http://www.jewishencyclopedia.com/articles/4391-circumcision
Noteworthy IS the following statement.
"The subject can not be adequately treated without a reference to the analogous operation of clitoridectomy performed on girls of nubile age"
and the section on the dangers of the custom called "mezizah" (where the cutter sucks the just cut infant's bloody penis tip with his mouth) is horrifying in particular the transmitting of syphilis to a large number of Jewish infant boys in Cracow in Poland by this practice. This is in addition to the similar herpes transmissions to children in New York resulting in some deaths, by the same practice.
So far, we have not managed to make reference to either of these in our article.
I wonder whether we can use these other encyclopedias to good effect on this article and give a good spring clean to it? Perhaps, at present we cannot see the woods for the trees.
--— ⦿⨦⨀TumadoireachtTalk/Stalk 07:13, 16 June 2014 (UTC)
Hey Tumadoireacht, thank you for replying, that was a lot of information to consider. I kind of agree with you about the unbalanced information in the circumcision page here. Also, the source I provided was indeed a secondary one. The original, primary source was reviewed by the BJUI International Journal (what I provided). This journal specifically covers most, if not all, aspects of urology. Enlightened one088 (talk) 18:59, 16 June 2014 (UTC)
Have you read WP:MEDRS yet? Your original edit cited an anti-circumcision advocacy group, and isn't the kind of source considered reliable. Please do read WP:MEDRS to learn how to identify high quality secondary sources like the ones used in the article. Zad68 19:56, 16 June 2014 (UTC)
Hi Zad, I have read WP:MEDRS, thank you. I have read it numerous times since I found out about it; that is why I changed my source and made sure I have input a reliable, secondary, peer reviewed, preferably a medical journal, as my source. Also, my original edit happened to be http://www.doctorsopposingcircumcision.org/pdf/2012-02_Podnar.pdf If you actually click on it and read it, which I have a feeling you still have yet to do; Then you will know that technically, this is still considered a reliable source. If you look closely, "Doctorsopposingcircumcion" is only an organization, but the information they provided, is 100% reliable since it is still by the BJUI International Journal, and is indeed a secondary, peer reviewed source. Enlightened one088 (talk) 20:26, 16 June 2014 (UTC)
Hi Alexbrn, please read WP:MEDRS, you do not seem to know what secondary sources are. BJUI International Journals are considered very reliable, secondary sources. This is what I am presenting, if you take a closer look. Thank you Enlightened one088 (talk) 20:49, 16 June 2014 (UTC)
That is a primary source. Pubmed tells us so. If you click on publication type here [9] it does not say review article. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:11, 17 June 2014 (UTC)
@Enlightened one088 – I have read WP:MEDRS, with comprehension. The paper you cite is a primary source: the authors are documenting a study they themselves conducted. It is a poor source for our purposes, and not usable here. Alexbrntalk|contribs|COI 07:01, 17 June 2014 (UTC)
The foregoing comments are in error in saying that this study cannot be referred to within the article . It DOES, however, appear to be a primary source. And it also DOES appear to confirm what many other studies, common knowledge and jewish religious tradition, and other traditions, have long known to be true - that cutting off a large chunk of one of the most sensitive parts of one's body DOES leave scars, completely dried("keratinized") skin on the entire penis head dome and some ways down the shaft, and consequent decreased sensitivity. I think a sentence along the lines of "One study has found -with statistics ...." would be the correct "weight" to give this important information. Are there any studies on whether loss of the foreskin decreases penis length or girth ?. I do remember reading somewhere that the "sliding sleeve effect" which is lost or diminished when the foreskin is cut off, decreases pleasure (and may increase chafing) for both sexual partners? Does anyone else remember the reference ?--— ⦿⨦⨀TumadoireachtTalk/Stalk 08:43, 17 June 2014 (UTC)
No, it is (as I wrote) not usable here: such a use would be using a primary source to counter the good secondary sources we use, which goes right against WP:MEDRS. Alexbrntalk|contribs|COI 08:46, 17 June 2014 (UTC)
Your saying so repeatedly does not make your misinterpretation any more correct Alexbrn. Here is a relevant sentence from MEDRS which you may care to refresh your memory with :
"The rare edits that rely on primary sources should have minimal WP:WEIGHT, should only describe the conclusions of the source, and should describe these findings clearly so the edit can be checked by editors with no specialist knowledge. "
The MEDRS says that primary sources should not be used to debunk or contradict secondary sources. They do not mention "countering" at all at all. Using a primary source to supplement secondary sources can be most useful and informative. My suggestion about using TERTIARY sources such as other encyclopedias remains unaddressed.--— ⦿⨦⨀TumadoireachtTalk/Stalk 14:16, 18 June 2014 (UTC)
Contradiction is synonymous with countering. We don't in any case use primary sources, other than in exceptional circumstances (not met for your proposal). Alexbrntalk|contribs|COI 15:22, 18 June 2014 (UTC)::
I hope that the small group of editors who patrol this article can come in time to see the difference between contradicting and supplementing, and the difference between giving disproportionate weight and excluding pertinent information altogether. The blanket practice of the latter has led to the peculiarly skewed article we presently have.--— ⦿⨦⨀TumadoireachtTalk/Stalk 20:10, 18 June 2014 (UTC)
If you wish to publish a systematic review and meta analysis regarding this issue in the Lancet / BMJ / NEJM we would be happy to than reflect those conclusions. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:35, 18 June 2014 (UTC)
Who is the we that you refer to ? If you wish to suspend the bizarre control exercised on this article which excludes any mention at all of forced circumcisions, disease and deaths caused by diseases transmitted during circumcisions and the deleterious effects on penis sensitivity post-circumcision we would be happy to help you into the light.--— ⦿⨦⨀TumadoireachtTalk/Stalk 08:08, 19 June 2014 (UTC)
This article is biased and POV
The article is clearly biased for circumcision. There are many logical and medical flaws in the arguments, but the article seems not to care or follow. From more than 1000 studies on circumcision it cherry-picks the most optimistic on circumcision. Maybe the english language is heavily influenced by the US, where circumcision is still defended by major institutions. All pediatric institutions in Germany or Northern Europe are today highly critical of non-medical circumcision. Therefore the whole picture seems all too rosy, when it comes to "less than one percent" complications (which is a high factor for medical standard procedures) and it does not come to the main issue at stake: That for no good reason 50 % of sensitive penile skin are amputed.
If I would have the time I would insert the comparison between HIV, HSV and penile cancer-rates in Denmark and the US. Circumcision rates in Denmark are about 1-3 % against the US with 40 %. Nonetheless, Denmarks STD-rate is far lower than in the US. Easy math. In cross-country-comparisons, anyone can see, that all the calculations about benefits from mass-circumcision are mumbo-jumbo, positivist constructions on a feeble base. What matters is culture, nutrition and healthcare.
"The most dramatic evidence of the protective effect of circumcision comes from a new study of couples in Uganda who had discordant HIV status; in this study the woman was HIV positive and her male partner was not.6 No new infections occurred among any of the 50 circumcised men over 30 months, whereas 40 of 137 uncircumcised men became infected during this time. Both groups had been given free access to HIV testing, intensive instruction about preventing infection, and free condoms (which were continuously available), but 89% of the men never used condoms, and condom use did not seem to influence the rate of transmission of HIV."[1]
A study on such a base is ridiculous. It proves the following: That condom use does not influence the rate of transmission of HIV. This is the "most dramatic evidence" for circumcision vs. HIV today.
In reality, it is not only medically logical but also empirically proven, that mass-circumcision increased HIV-rates. Through scars and bleedings mainly. Any circumcised man will know, that you cannot pull the remaining skin as used in masturbation and sexual acts with uncircumcised men and this is where fissures come in, and fissures are an entrance for the HIVirus.
The major issue is: On a very weak if not falsified base mass-circumcision promises the eradication of HIV. This is the biggest medical mass-experiment in modern times, funded by nations in which circumcision rates decline.
The main study on HSV in Uganda is seriously flawed by ethical standards, as it randomly sends people to circumcision: "of these subjects, 1684 had been randomly assigned to undergo immediate circumcision (intervention group) and 1709 to undergo circumcision in 24 months (control group). The retention rates at 24 months were 81.9% (1370 of 1673 subjects) in the intervention group and 82.0% (1395 of 1701) subjects in the control group." [2]
No such study would be possible in Europe for ethical reasons. Only racist bias allows for mass-experiments in such an invasive manner. Retention rates show, how many individuals rejected circumcision: about 18 % left the study, because it seemed inappropriate to them to get circumcised.
Then: The study does not talk about sexual abstinence during circumcision. Abstinence is likely to last 3 months but also exceeds 2 years, as the penile skin changes in that time, causing uneasyness and avoidance of sexual acts.
In any case, the data-mining attitude (surveys) just show one more attempt to overcome the objections of common sense and reason.
1. If babies don't feel pain, would one vote for infant-FGM once a blinded and randomized study proves, that there is a 50-60% rate to avoid HIV-contraction? FGM-Countries like egypt, Sudan and Gambia have a lower HIV-rate than South-Africa or Botswana with low or no FGM.
2. If it doesn't matter to loose 40-60 scm of penile skin, would the same studies call for the removal of the palm-skin, given the same evidence? The foreskin is even more sensitive than the Palm.
3. If it doesn't matter for one's sexlife that 40-60 scm of penile skin are gone, what conclusions come out of this? That psychological compensation is a strong factor, or that it doesn't matter for sex if 50 scm of skin are gone? Why then use skin at all, if skin doesn't matter?
4. The gender bias: The foreskin is not that much different from female labias or clitoris. In fact, the clitoris is never fully excised in FGM-2, as it stretches 11 cm into the female body. Any study vowing for male circumcision with the argument of benefits has to prove, why the same findings in FGM would make any difference for practice. Breast-amputation effectively precents breast-cancer. Women with small or no breasts don't show less lust in sexual acts. Study finished. Islamist scholars argue for FGM with the argument of HIV and "cleanliness". This should make us suspicious at last.
The entire positivist language of the so-called "medical" studies harvesting percentages are in fact only sociological mass-experiments without any advanced medical theory. Such a theory would include psychology, psychosomatics, sex-science, culture, anatomy and in the end philosophy. The attempts to settle the arguments with sheer numbers and data-mumbo-jumbo fails to grasp the main argument, which is philosophical (moral philosophy), psychological, anatomical and cultural. And it does not meet the contradicting surveys which prove exactly the opposite, for example a study with high-risk group proved no difference or even slight benefits of uncircumcised gay men in the UK: [3]
Also see, how easy it is to get the "60% reduction":
One study, led by Auvert, offered medical circumcision to men in a region of South Africa and compared them with a non-circumcised group. After 21 months, there were 20 cases of HIV in the circumcised group and 49 among the uncircumcised men, equating to a 60% reduction in HIV risk.
[4]
Totally agree. Also, the human foreskin is highly innervated and vascularized sensitive erogenous tissue. It plays an important role in normal human sexual response and is necessary for normal copulatory behavior. An understanding of this role is now emerging in the scientific literature. Removal of the foreskin (circumcision) interferes with normal sexual function.
...titling this page "circumcision" and the page for the female equivalent "female genital mutilation"? This page needs to be titled "male genital mutilation". That's some sexist crap right there. I'm requesting a discussion be opened on the topic.Brakoholic (talk) 13:30, 6 July 2014 (UTC)
Please see this page's FAQ. Zad68 14:48, 6 July 2014 (UTC)
secondary source ? meta view/overview/ review of field ?
Fleiss PM. An analysis of bias regarding circumcision in American medical literature. In: Denniston GC, Hodges FM, Milos MF (eds.) Male and Female Circumcision: Medical, Legal, and Ethical Considerations in Pediatric Practice. New York: Kluwer Academic/Plenum Publishers, 1999: pp. 379-402.--— ⦿⨦⨀TumadoireachtTalk/Stalk 22:06, 11 July 2014 (UTC)
These are the self-published proceedings from a conference of an activist group that calls itself "NO CIRC". Zad68 23:10, 13 July 2014 (UTC)
Semi-protected edit request on 21 July 2014
This edit request to Circumcision has been answered. Set the |answered= or |ans= parameter to no to reactivate your request.
The opening paragraph for the page on Circumcision contains the statement "Circumcision does not appear to have a negative impact on sexual function.". This is not true, and it should be noted that fully removing the foreskin removes approx 20,000 or so nerves, and there are countless cases of this effecting sexual function. I'd like to have this corrected.
IAmAWhale (talk) 09:05, 21 July 2014 (UTC)
Not done. Doc James (talk · contribs · email) (if I write on your page reply on mine) 09:09, 21 July 2014 (UTC)
2014 practice guideline
In JAMA [10] which discusses circumcision.Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:35, 21 July 2014 (UTC)
Compare the "weight" and emphasis in a more rounded picture of circumcision given in this poor but legible translation of the intro in the french wikipedia
Here is the French wikipedia article opening paragraph on circumcision(circonsion) - it gives a wider and more comprehensive picture, though is still saddled with that bizarre opening photo of the turbanned men sitting on a carpet 100 years ago.
Here we get context, and prevalence, popularity, and rationale from the beginning as any article ought to do. How and why do you think the English language version has been prevented from achieving such a basic standard of description?
Circumcision (latin: circumcisio "cut around") refers, in its most common form, the partial or total removal of the foreskin, leaving the glans penis exposed. According to the World Health Organization, in 2009, 661 million men over 15 years would be circumcised, approximately 30% of the male population mondiale1. Ritual circumcision has been practiced for cultural and religious reasons since ancient times. In Judaism, the brit milah ritual is called. Although not being mentioned in the Qur'an, circumcision is practiced throughout the Muslim world,it is most often considered a sunna. It is also practiced by members of some Eastern Orthodox churches.
Some people practice circumcision without religious reasons but by tradition, social cohesion, identity or masculinité. In the Anglo-Saxon industrialized world, circumcision was promoted to harm as a means to prevent masturbation, a hygiene, and to reduce the risk of infection. The statement attributing circumcision health benefits has since been tempered by medical research, as well as the correlation between circumcision and masturbation. The practice of circumcision increased in the English-speaking world in the early twentieth century to become a routine operation on newborns, but following lively debate is steadily declining since the late twentieth century ........
Do we need to radically rethink the emphasis or "weight" of the english language intro -or indeed of the entire article ?--— ⦿⨦⨀TumadoireachtTalk/Stalk 12:36, 27 July 2014 (UTC)
Modern Times (Hutchington)
"In 1855, motivated in part by an interest in promoting circumcision to reduce masturbation, English physician Jonathan Hutchinson published his findings that Jews had a lower prevalence of certain venerial diseases.[73] While pursuing a successful career as a general practitioner, Hutchinson went on to advocate circumcision for health reasons for the next fifty years,[73] and eventually earned a knighthood for his overall contributions to medicine.[74]"
Delete "While pursuing a successfull career as a general practitioner" and "and eventually earned a knighthood for his overall contributions to medicine." It is highly suggestive and does not help the understanding.
Hutchingtons findings are questioned by the fact, that jewish women and jewish men were equally underreperesented in Syphilis-statistics and that he ignored a main factor: anti-Semitic prohibition of cross-culture prostitution, i.e. of christian prostitutes with jews. In: Van Howe, that is blocked here from citing.
I also wonder, why John Harvey Kelloggs is not mentioned in this section, as he was one of the first supporters of circumcision (1888). "Kellogg worked on the rehabilitation of masturbators, often employing extreme measures, even mutilation, on both sexes. He was an advocate of circumcising young boys to curb masturbation and applying phenol to a young woman's clitoris." John Harvey Kelloggs#Masturbation Prevention— Preceding unsigned comment added by Preconscious (talk • contribs) 09:38, 28 July 2014 (UTC)
"appear"
"Circumcision does not appear to have a negative impact on sexual function."
Considering the obvious and common-sense anatomical fact, that the foreskin HAS a sexual function, as it is highly innervated, produces lubrics and protects the glans and provides elasticity of the penis inside the female organ, this is an incorrect sentence. Also considering that sexual function includes psychosexual functioning, there is both logical (trauma and resulting impotence at least in grown up men) and empirical evidence disproving the sentence.
Change into:
"The impact of circumcision on sexual function remains disputed."
A meta-analysis of studies on negative impacts:
[11]Preconscious (talk) 11:50, 25 July 2014 (UTC)
Agree that it is a very blunt statement in the lead at present. I would support changing the sentence to "The impact of circumcision on sexual function remains disputed." --TBM10 (talk) 13:11, 25 July 2014 (UTC)
Although editors often bring their own very strong personal feelings about article topics to Wikipedia, per Wikipedia content policy we do not base article content on them, see WP:NOR among others. The current article content is extremely well-supported with up-to-date sourcing. See WP:MEDRS for the Wikipedia's guidelines for biomedical content. Zad68 13:44, 25 July 2014 (UTC)
The fact remains, however, that the current statement does remain disputed. --TBM10 (talk) 16:40, 25 July 2014 (UTC)
I don't like the addition of "disputed" wording as it is vague (who is disputing? what are they disputing?, etc). Per WP:LEAD, that sentence needs to be a summary of the text; I count 6 sources that say there is no relationship, and one to one small medical association reporting case reports (which are not a high quality of medical evidence). The wording as it stands appears appropriate given the WP:WEIGHT of reliable sources. Yobol (talk) 17:00, 25 July 2014 (UTC)
"Disputed" is putting it mildly! Circumcision (or cutting off bits from the head of the penis to call a spade a spade) is not a medical phenomenon but a cultural and anthropological one. There ARE well documented acknowledgements in Jewish and other traditions of both the pleasure reducing intention and result of cutting off most of the pleasure receptors on the tip of a sexual organ. Therefore constantly gurning and referencing the lack of secondary medical sources on the subject is both counterproductive and misleading. The historical, psychoanalytic, psychological and psychiatric literature on both victims and perpetrators of circumcision needs to be included for this article to maintain the currently wrongly awarded "good article" status. The sale of foreskins harvested from circumcision and sold at about 200 dollars USA each at current rates (and the most interesting cosmetic and medical and med research purposes they are put to) needs to be mentioned, as does forced circumcision in several cultures worldwide and the deaths and disease fron some forms of circumcision where the perpetrator takes the baby's penis in his sometimes hepatitic mouth during the procedure. I hope that the editors who are so soi-disant stringent on the medical front can apply the same objectivity to correcting these lacks. The recent and decent tightening up of the law in Britain for those who attempt to cut bits off baby girls' genitals is also beginning to focus on the the parallel practice of cutting bits off baby boys. The worldwide decline in popularity in circumcision also weirdly goes unmentioned in this very poor article. Has no editor with the resources to do so got the courage to buck the trend here, damn the torpedoes, and add these glaringly missing bits to the article ? --— ⦿⨦⨀TumadoireachtTalk/Stalk 20:36, 25 July 2014 (UTC)
Certainly Tumadoireacht you are not suggesting to add content that is unsourced, poorly-sourced, or violates WP:WEIGHT, or to violate Wikipedia behavior policies regarding such things as edit-warring or tendentious editing, right? Your use of a Wikipedia article Talk page to air your personal opinion is once again noted. Zad68 21:27, 25 July 2014 (UTC)
Zad - your propensity to duck the issues raised by contributions on this page and instead accuse those whose intent is to improve the article of "airing' personal opinions is odd. Let us instead try to find ways of improving the article without resorting to such unwwiki like aspersions. I raised 16 points in my last contribution. You chose to ignore them all and instead describe the suggestions for improvement as "personal opinion". As you well know the "weight argument refers to how much mention is given to aspects of a subject and NOT to whether they get mentioned at all at all. i ahve stopped editing this article some time ago as I have observed that any edit that does not conform to a particular view of circumcision quickly gets reverted by any one of a small and concerted team of editors. Surely you do not intend to continue to stand over such a partial and selective article which is so in contrast to other encyclopedias and other wiki encyclopedias in its omissions ?--— ⦿⨦⨀TumadoireachtTalk/Stalk 17:40, 26 July 2014 (UTC)
The use of article Talk pages to air personal opinions is disallowed per WP:TPG; it's not "odd" to point that out and it's perfectly in line with Wikipedia behavior. Are you saying you do not intend to ever abide by WP:TPG? Your understanding of "weight" is not in line with WP:WEIGHT, please refer to that policy document for more information.
And, Tumadoireacht, the edit summary you provided for your comment (diff) that you addressed to me was, "pewsonal makes me newvuss". What exactly did you intend to communicate to me with that? I'd be happy to pursue your concerns further but I want to make sure I understand all the information you intended to communicate before I do. Zad68 02:30, 27 July 2014 (UTC)
Of course personal opinions are not the thing. But the "oddness" as i clearly stated above was rather in the transparent tactic of repeatedly ignoring cogent critique of the article and instead attempting to characterize such critique as "personal opinion" This, from an admin, has the potential to inhibit many would-be contributors. Hence personal/nervous. The "surely it is not your intention" line of chat is camp and inappropriate. By the way the use of "your use of a talk page .... again...has been noted" is not a good way to address a fellow editor - noted by whom? (the passive verb is particularly silly) noted where ? and for what purpose? I hope no other editor is intimidated by seeing such peculiar statements trotted out. Please revise your reading of the WP policy on weight given to particular aspects of a subject. I have given you the relevant sections from that policy in the past. Attempting to shut out facts from the article DOES constitute an ongoing imposition of personal opinion which is at odds with core WP values. Please reconsider your position,statements, reversions, and actions.--— ⦿⨦⨀TumadoireachtTalk/Stalk 12:06, 27 July 2014 (UTC)
But you didn't write "personal/nervous" you wrote "pewsonal makes me newvuss". And your reply here indicates that when you were writing "me" you were not indicating yourself, but rather putting those words in my mouth, while mocking me? Zad68 02:48, 28 July 2014 (UTC)
Question is, if it appears or if there are studies that don't prove it. (I linked a meta-analysis of studies that do and there are dozends if not hundreds of others that imply an impact, do you want to cite them all?)
It appears, that if you cut away a part of the genital organ it results in a decrease of sexual function. This is, what should "appear" to any common sense. If you can disprove this obvious assumption through any statistical methods and what psychological theories are involved to explain a compensation of the loss of foreskin, is another subject. which you could include as "Discussion on sexual function". BWT, I don't feel invited to invest any time in searching for links, if former contributions WITH sources are deleted at will. Preconscious (talk) 14:59, 26 July 2014 (UTC)
Hi Preconscious, first you need to review WP:MEDRS, English Wikipedia's standards for biomedical content. As Yobol mentioned the article currently carries a half-dozen high-quality secondary sources such as MEDLINE-indexed systematic reviews and review articles. Per WP:MEDREV individual primary sources aren't used to counter the conclusions of high-quality secondary sources, and in this case there are a lot of them, all saying the same thing. Honestly, even just one of the secondary sources in use would be enough to support the simple assertive statement the article carries. There are many similar kinds of statements along the lines of "Intervention X has effect Y" throughout many other articles on English Wikipedia that are cited to just one good-quality secondary source; six is really overkill, but the number of references has grown over time because our readers demand it. Zad68 02:30, 27 July 2014 (UTC)
Zad: "The current article content is extremely well-supported with up-to-date sourcing." - Not in this case. "appear" is not exactly well-supported, you ignore common sense at best. In terms of general outlines, this article is a rather poor exegesis of a very limited scale of studies with almost no logical argument or overarching sense of the difficulty and diversity of the issues at stake. I have read better and this is, why I'm intervening. I bet there is a Wikipedia-policy on common sense used as argument. Preconscious (talk) 15:06, 26 July 2014 (UTC)
Preconscious, the trouble with "It is obvious that..." and "It is common sense..." is that, most often, those phrases are exactly equivalent to "In my opinion"--this is a form of original research which is disallowed, see WP:OR. To answer your question I bet there is a Wikipedia-policy on common sense used as argument: there is, in a way: see WP:BURDEN. In a nutshell, if you feel something is "common sense", you can add it to an article without a source, or with a poor-quality source, but per WP:BURDEN if that content is challenged it is up to you to support it with reliable sourcing and demonstrate compliance with other policies, and if you can't, the challenged content cannot stand--this is policy. Zad68 02:30, 27 July 2014 (UTC)
I would suggest to consider reading and implementing the links from the well-organized, less sophistic and more informative German wikipedia article on "Zirkumzision", where the issue of sexual pleasure and function is disputed more scientifically (most of the links are in english) I would offer to translate the German section on Sexual Function if implemention (and further discussion) is granted:
Zirkumzision - Auswirkungen auf die SexualitätPreconscious (talk) 15:20, 26 July 2014 (UTC)
Preconscious, actually the sourcing standards of English Wikipedia are much more stringent than German Wikipedia, so most all of the sourcing used there could not be used here. Here is something interesting: English Wikipedia's sourcing and article content standards have gotten to be sufficiently well-respected that the English Wikipedia's Medicine Wiki-project is actually publishing our best-quality article content as review articles in peer-reviewed medical journals. Also, English Wikipedia's articles (including this one, actually) are being translated and exported to other-language Wikipedias. If you are interested in medical articles and have a native command of German, you might consider joining the Medical Tranlsation team to help translate and export English Wikipedia's articles, let me know if interested. Zad68 02:30, 27 July 2014 (UTC)
Zad, 1. Sexual function is not biomedical content. It is primary psychological and philosophical. One can see, what happens, if biomedicine or empiricist sociology feels competent to judge sexual satisfaction from questionaires.
2. This is why this article contains large parts of cultural science.
3. "that the English Wikipedia's Medicine Wiki-project is actually publishing our best-quality article content as review articles in peer-reviewed medical journals." - this article is not "wikipedia's medicine Wiki-Project" it has to stand alone for its reputation and quality.
4. "Also, English Wikipedia's articles (including this one, actually) are being translated and exported to other-language Wikipedias." - Also other scientific articles are translated and exported to english wikipedia. Check bias.
5. Again, anyone else than Zad who has both, control and competence of this article and thinks, the sentence on sexual function does not represent the pluralistic research, (the argument is, that it "appears" not to be existent, which is disproved by the sources, if they are acceptable can be discussed one by one). I offer to translate some arguments from different scientific studies proving the logical presuppositions, that something happens if you remove a part of a sexual organ.
6. I also offer a translation from German into English of parts of Hegel, if that helps you, Zad. Or from Marx or Kant or Virchow or other primary sources, that seem to inhibit primary philosophical standards in the discussion of the content and structure of this article. Preconscious (talk) 18:08, 27 July 2014 (UTC)
Zad, In fact, what the current sentence actually does, Zad, is the following: to disprove individual factual evidence with statistics.
This is not scientific, it is dishonest sophistry. It is FACT, that circumcision causes in a (disputable) range of persons dysfunctions up to penile loss and in rare circumstances death. As the article includes cultural circumcision, this is even increased through ritual circumcision with a high incidence of penile loss, necrosis and death. Other factual evidence consists about loss of sensitivity and pleasure. It does not matter in the first range, if in a statistical survey this can be measured or not. The fact exists, that it happens (see complication rate). And the sentence suggests against all evidence, that complications don't happen, that there is no single case of sexual dysfunctioning through circumcision. In effigie, the sentence discriminates against persons who suffered such impairment (up to penile loss) and declares their complication as non-existent. That you need this sentence so much testifies heavy subconscious doubts that seek for denial. Preconscious (talk) 18:47, 27 July 2014 (UTC)
I cannot speak for Zad's subconscious or its needs and should not in any case, but up to that Preconscious you have made some well thought out points. Would you like to propose a better wording than the current one ? --— ⦿⨦⨀TumadoireachtTalk/Stalk 00:42, 28 July 2014 (UTC)
Preconscious, please do not personalize this discussion and focus only on the article content. Don't make comments about editors.
You may feel Sexual function is not biomedical content but the sourcing disagrees with you. What we do here is summarize the best-available sources, we do not advance our own arguments, and we do not synthesize our own conclusions from primary sources, so translating primary sources to support an argument you are making would not be a good use of time. The word "appears" is exactly what several of the sources cited in the article use, please review the sourcing provided and you'll see they support the current content. Complication rates and the rare catastrophic outcomes are already covered in the article, in both the lead and the body, not sure how you missed that, please review carefully. Zad68 02:40, 28 July 2014 (UTC)
Zad, There is a sentence in this article that is effectively FALSE. If it is cited in scientific studies, it stays false. Science is not religion, which is, why it is open to corrections. I don't know, who is in charge here and how, but my argument has been made from several angles and if you ignore all of them, I can only document this and see if I can find assistance on a higher level. This "personalization"-argument is rather funny sophistry, as you seem to be in charge of editing - which is why any argument discussed is governed by a person at the moment. Preconscious (talk) 07:49, 28 July 2014 (UTC)
Preconscious, your statement There is a sentence in this article that is effectively FALSE. If it is cited in scientific studies, it stays false. is at the heart of the content issues you're having here. You appear to be saying that you don't care what the sourcing says; you know the truth. Fundamentally, we disregard what individual editors might believe is "The Truth" (again see WP:NOR) and instead we summarize the conclusions of the best-available sources. (Although if you can get your views published in a high-quality source, we can cite that source.) Please read this essay, WP:Verifiability, not truth. Zad68 13:36, 28 July 2014 (UTC)
No, you know the truth, which is why you are blocking it. I'm not making a statement about the sources you cite, I'm making a statement about the sources you don't cite and about how you cite the source which makes the quotation FALSE as contradicting any factual evidence of any single complication. Why do you need this sentence as it is? Alternatively quote the study, where it "verifies" that there is not a single complication caused by circumcision. Which is what your sentence says.
If it helps, please read this essay, as obviously this is not about medicine, but about science: https://en.wikipedia.org/wiki/Science_of_Logic.
Preconscious (talk) 16:03, 28 July 2014 (UTC)
Once again I request that you please stop personalizing this content issue. Your statements Alternatively quote the study, where it "verifies" that there is not a single complication caused by circumcision. Which is what your sentence says. indicate you're not reading or understanding what the article or sources say. Zad68 21:52, 28 July 2014 (UTC)
What a time-sink, one could have avoided if one would have just let me edit this sentence. I again suggest, that you reformulate: "The following studies were unable to find statistic significance for (insert what they could not measure, e.g. effects on sexual function)". — Preceding unsigned comment added by Preconscious (talk • contribs) 08:27, 29 July 2014 (UTC)
"strong evidence"
In the HIV-section you write "strong evidence". As the link to the Circumcision and HIV is there, one would think, that the Cochrane study linked there would be important for the unexplained judgement of "strong":
"A 2003 systematic review from the Cochrane Collaboration was more cautious. This review of 35 observational studies concluded that while there was an association between circumcision and HIV prevention, the evidence was insufficient to support changes to public health policy.[28] A 2005 review of 37 observational studies expressed reservations about solidity of the conclusion that could be drawn because of possible confounding factors." — Preceding unsigned comment added by Preconscious (talk • contribs) 10:11, 28 July 2014 (UTC)
Cochrane itself uses the word "strong". Do you not agree the current article content summarizes the source accurately? I'm not getting the impression that you're reading the sources here. Cochrane is perhaps the most-preferred kind of source. Zad68 13:36, 28 July 2014 (UTC)
If you cite "strong", cite correctly. If you don't cite, don't cite. If you need help with citing, I will gladly inform you about the rules of objective citing. I cited a cochrane study above. So either you accept Cochrane is good, then implement the Cochrane study cited above which states no reliable evidence. Or you stick to your study of preference.
And no, cochrane is "perhaps" not the most-preferred kind of source, especially not when a high level of personal involvement in sexual issues is at stake. In 1935 you would have yielded a Cochrane-evidence for racist theses. Meta-analyses as such are not preferrable once it comes to understanding. They are in selection biases as easy as manipulated as a conventional survey, especially if manipulated as will for lobbying.
They might be useful for general estimates about costs and insurances and general attitudes. Which is, why cochrane is insurance and public-health-politics. But it remains statistics. And relying on it includes the attitude, that the majority is right. Which is especially unscientific. And especially in medical science, that has especially not been the most outstanding model for science in the past 3000 years (despite some outstanding progresses). Which is noted by critical physicians who tend to found pharma-independent journals and distrust any pimped study on the market that is trying to blur fact and fiction with statistics. Awareness about the temporality of "science" in medicine is taught in better universities, medics know about trends from yesterday today counting as unscientific. The poor methodology and the evident methodological flaws of the MAJORITY of studies in Medline-sources on circumcision has been critisized by Van Howe, as they are all funded without meeting basic standards of avoiding obvious biases. And none of them seeks to mention or explain the cross-country comparison-"paradox". Preconscious (talk) 15:23, 28 July 2014 (UTC)
I see a lot of hand waving above, but Cochrane reviews are considered the highest quality evidence. We generally do not point to out-dated reviews when newer ones supplant them, so your suggestion that we need to use out-dated information is not reasonable, and will not gain traction. If other article use out-dated information, it is a reason to improve the other article by removing it there, not make this article worse by adding it here. Yobol (talk) 16:53, 28 July 2014 (UTC)
I agree to the argument, that there is a more current cochrane study that might speak of strong evidence. Please cite then correctly from the study. Otherwise its prone to suspicion of POV, as the rest of the article tends to rather euphemistic language. In any case: would it not further your argument, to mention this development of opinion making process and list the three cochrane studies in dispute? Preconscious (talk) 21:08, 28 July 2014 (UTC)
What are the exact PMIDs of the Cochrane articles you are looking at? The Cochrane Review from 2009 says "There is strong evidence that medical male circumcision reduces the acquisition of HIV by heterosexual men". The Cochrane Summary from 2013 says "Results from three large randomised controlled trials conducted in Africa have shown strong evidence that male circumcision prevents men in the general population from acquiring HIV from heterosexual sex." They both use the results of the three large RCTs that were conducted through 2008. Are you actually suggesting we use one from 2003 to weaken the conclusions from the ones from 2009 and 2013?? Zad68 21:36, 28 July 2014 (UTC)
No, I suggested to cite the passage. And not adopt the finding precautiously without quotation marks. As the study you cite right know relies totally on the three trials, and as all these three trials have neglected lead bias and all of them were stopped early and none of them provides long-term insights and none of them explains the transmission process biologicalls, there should be reason to stay cautious and only cite it. At the moment the article adopts the findings unsceptically. Which is a rather superstitious bueraucratic procedure, that has nothing to do with checking and understanding medical knowledge in process. The more, as the entire text of the study is not available to the common user and only abstracts are online.Preconscious (talk) 07:47, 29 July 2014 (UTC)
As explained below, when writing content well-supported by high-quality sources, we write plain assertive statements, see our style guideline WP:MEDMOS. There is no requirement that we cite only sources that provide the full text for free, see WP:SOURCEACCESS. Zad68 13:37, 29 July 2014 (UTC)
Removed
"The first medical doctor to advocate for the adoption of circumcision, was the eminent English physician, Jonathan Hutchinson.[1] A study he published in 1855 appeared to demonstrate that circumcised men were significantly less vulnerable to such disease.[2] Hutchinson became a notable leader in the campaign for medical circumcision for the next fifty years, publishing A plea for circumcison in the British Medical Journal (1890), where he contended that the foreskin "...constitutes a harbour for filth, and is a constant source of irritation. It conduces to masturbation, and adds to the difficulties of sexual continence. It increases the risk of syphilis in early life, and of cancer in the aged."[3]"
^Hutchinson J (1855). "On the influence of circumcision in preventing syphilis". Medical Times and Gazette. NS. II: 542–3.
^"A plea for circumcison", Archives of Surgery, Vol. II, 1890, p. 15; reprinted in British Medical Journal, 27 September 1890, p. 769.
The first sentence is not supported by ref as it does not say he was first. We do not use primary sources from the 1890s typically. Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:52, 21 July 2014 (UTC)
It is supported. "As early as 1855, English physician Jonathan Hutchinson advocated circumcision...Hutchinson’s theories formed the basis for an ongoing discussion in western medical literature about the preventive potential of male circumcision." I'd say that was pretty clear. The source from the 1890s is for the passage quoted in the text!Noodleki (talk) 17:05, 21 July 2014 (UTC)
Instead of using SIECCAN's pamphlet, we'd be better off mentioning Hutchinson and citing Darby 2003 directly, that sounds OK to me. I strongly disagree with citing Hutchinson's own publications from 1855 and 1890 and using them as primary sources, the article needs to continue to use up-to-date secondary sources that interpret the historical primary sources for us and put them in context. Zad68 17:18, 21 July 2014 (UTC)
His 1855 publication (venereal disease comparative rates) is mentioned by all secondary sources. The quotation from 1890 is a good summation of his view. Darby seems to have put up his work on [12] where he has this quotation.Noodleki (talk) 18:00, 21 July 2014 (UTC)
But that's just the thing--Gollaher is the most complete and detailed history source (240+ pages) we're using and does not mention Hutchinson 1855--I certainly can't find it if he does. The one quote they do have from Hutchinson is from a 1900 source. Of the Victorian-era adoptors of the procedure, Gollaher talks about Sayre a lot more than Hutchinson. That's really the issue with primary sources, you can't tell by looking at them alone whether your use of them is with due weight. If the article is going to quote anybody it should be Sayre rather than Hutchinson. So, yes, a mention of Hutchinson could be added, and if we really must have a quote (and honestly because of how difficult it is to manage due-weight issues with quotes from individuals, I'd prefer not to) Sayre should be quoted. Zad68 19:45, 21 July 2014 (UTC)
Glick has a great big section on him, as does Darby. There's also the issue of precedence, (15 or so years).Noodleki (talk) 20:49, 21 July 2014 (UTC)
...as do they both have significant discussion of Sayre--I already said I agree a mention of Hutchinson should be added, and probably should be about the same weight as Sayre.. Zad68 21:29, 21 July 2014 (UTC)
There was equal weighting before. So, restore, with sources to Glick and Darby?Noodleki (talk) 09:52, 22 July 2014 (UTC)
Well we can't put back in exactly what was there before due to some of the issues Doc James pointed out, although they're easily fixable. We're pretty close on this: we both agree that Hutchinson could use a mention, it can be done without the use of Victorian-era primary sources, and should be with about the same weight as Sayre. Our disagreement is over whether we should paraphrase the secondary sources, or have a direct quote from Hutchinson. I think the advice at WP:QUOTE is correct where it talks about the pitfalls of using direct quotes, and a quote isn't necessary in this case where we have an accessibly-written secondary source. So how about:
In 1855, motivated in part by an interest in promoting circumcision to reduce masturbation, English physician Jonathan Hutchinson published his findings that Jews had a lower prevalence of certain venerial diseases.(Darby 2003, p. 262) Hutchinson went on to advocate circumcision for health reasons for the next fifty years, eventually earning a knighthood.(Darby 2003, p. 262-) In America, one of the first modern physicians to advocate the procedure was Lewis Sayre, a founder of the American Medical Association. In 1870, Sayre began using circumcision as a purported cure ...(etc. as currently there)
Done Applied to article... per WP:WEIGHT I had to do a bit of tweaking to not make it sound like Hutchinson got a knighthood solely for his work in this area--I read for example this biography on him which does not even mention his association with circumcision. But, a good addition, thanks. Zad68 20:12, 22 July 2014 (UTC)
what has his knighthood to do with the content?Preconscious (talk) 22:21, 29 July 2014 (UTC)
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Is the issue here really one of presentation (i.e. which of the two ways to present the figures is clearest and most informative) or is it one of how much weight we should allot to the African studies (and the Cochrane meta-study), given the scientific debate that seems to be going on (example) about the validity of the studies (e.g. alleged selection bias, inadequate blinding etc)?
Done Applied to article... per WP:WEIGHT I had to do a bit of tweaking to not make it sound like Hutchinson got a knighthood solely for his work in this area--I read for example this biography on him which does not even mention his association with circumcision. But, a good addition, thanks. 
