Talk:Circumcision/Archive 31

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Please stop editwarring

This is getting tiresome. Please stop repeating the same edits over and over again. Just leave the page the way it is, and discuss it on the talk page until consensus is reached. I'm talking about this edit [1] and others like it. Also, always give an edit summary which explains what the edit is doing or what the reason for it is. The edit summary can refer to the talk page which can have a longer explanation. Don't just leave the edit summary blank. Do not make that same edit again unless consensus has been reached here about it. And please explain here on the talk page what that edit is all about. It's hard to tell by looking at the diff link. --Coppertwig 02:26, 8 August 2007 (UTC)

You cannot get consensus when a dominant group of people support or oppose content based solely on its apparent support or opposition of circumcision (respectively), with all Wikipedia policy gone out the window. Did Jakew obtain consensus when the letters he wrote to journals were deemed worthy of mention in the encyclopedia article he edits? Is there a consensus to avoid saying "circumcision is painful" or "circumcision is usually performed without anaethetic?" Was there a consensus when a mohel and a doctor were quoted as saying that it is more humane NOT to use anaesthetic? Of course there wasn't, but gosh darn, it's still in there because of you know who. Preposterous. I actually believed you were here to help change this screwed up article, Coppertwig, not to be yet another proponent of the broken status quo. Blackworm 02:19, 9 August 2007 (UTC)

Wikipedia is not a soapbox. We have policies and guidelines, regardless of how you, I, Coppertwig, Jake, Edwardsville, or anyone feels. Wikipedia cannot be used to push one idea over another. Regarding Jake (or anyone else's) letter, if it was deemed worthy enough to be published in a peer-reviewed journal, that is usually sufficient for passing wikipedia's reliability standards. Go ahead and get YOURSELF published,on-topic, in a peer-reveiwed journal. Blackworm, because the article is not being developed in a matter you deem appropriate may be unfortunate, but it is irrelevant. There have been issues raised with Edwardsville's edits which have not been accurately addressed. As for the Taddio statement, both Coppertwig and myself have tried to come up with accurate, reasonable, NPOV, and verifiable paraphrases of the article, which address both the existance of other factors as well as their apparent non-presence in the tests according to the examiners. Have you read the most recent version? -- Avi 03:26, 9 August 2007 (UTC)

Issues raised? Well, I suggest you start a discussion and raise your points. So far there have been none made.

Avi said: "Regarding Jake (or anyone else's) letter, if it was deemed worthy enough to be published in a peer-reviewed journal, that is usually sufficient for passing wikipedia's reliability standards." No, as the discussion [[2]] after I presented my case on the talk page for Wikipedia:Reliable Sources proved. Anyone can go read it, it's linked right there above-- the clear consensus was that it was not sufficient, contrary to the argument you, Jayjg, Nandesuka, and Jakew made. (Conversely, the phrase "Circumcision is a painful operation," quoted above in different flavors by four reliable sources, is forbidden from entering this article by you, Avi, as well as Jakew.) I can't even imagine how the interested parties over there would react knowing that an apparent activist writes letters to journals which then get referenced by the Wikipedia articles he is most interested in editing. It goes further than being against Wikipedia policy; it's completely unethical. Do you see lots of letters to journals, of any sort, not just those written by Wikipedia editors, being used to push anti-circumcision points in the article? I don't. If you do, I will be happy to help you remove them -- and all the others. Of course, you've already preemptively threatened me with a revert based on a violation of WP:POINT should I include anything you deem anti-circumcision that comes out of a letter from a peer-reviewed published journal. (That was completely unfounded, a blatant personal attack, and a blatant violation of WP:AGF. Yep.) Anything pro-circumcision, I suppose, would be fine? Can you really not see a problem with the editorial environment you have created here? Maybe you can't, but I'm hoping others can. Blackworm 08:42, 9 August 2007 (UTC)

Avi said: Go ahead and get YOURSELF published, on-topic, in a peer-reveiwed journal. Well gee, would an advertisement count too? I think I might be able to scrounge up a few thousand dollars. Seriously, being "published in a peer-reviewed journal" usually means you went through peer review. The flat denial of the previous sentence by the group of administrators + one editor above completely destroys your credibility, as far as I am concerned. Blackworm 08:49, 9 August 2007 (UTC)

Actually, It was not a clear consensus at all. For example, DGG who is both an admin as well as either an MS or PhD in library science, I forget, stated that while it should not be the sole source in an article, it is acceptable to show controversy (as opposed to, in my opinion, some wackjob advocacy website). The following edit by R.Baley suggests that such sources be marked as letters, but not unused, so you seem to be incorrect.

Further, if you are comparing a letter to the editor, in which I have an e-mail from the editorial staff that such letters are reviewed and even shown to the article authors before publishing, with a paid (or unpaid) advertisement, then you seem to have a deep fundamental misunderstanding of how peer reviewed journals work. For example, you cannot PAY to have your article or letter published, you know. Shall we now exclude ALL articles in ALL journals, newspapers, or magazines that have advertisments in them? According to your logic(?), it seems we should. Which in my opinion, strains the bounds of credulity. -- Avi 12:01, 9 August 2007 (UTC)

If you're trying to establish a scientific fact, then a peer-reviewed published scientific study presenting evidence about that fact is an excellent source. If you're trying to establish the fact that there is controversy about a point, then a published letter to the editor about it in a peer-reviewed journal seems to me to be an excellent source, possibly better than scientific studies which could be interpreted as science proceeding in a normal way without significant controversy even if they present contradictory evidence. Re paying to get published: actually, some peer-reviewed journals have something called "page charges". You still have to pass peer review, but you also have to pay. --Coppertwig 12:40, 9 August 2007 (UTC)

[OT] That's true, and the open access model of publication, which most commonly requires payment, is becoming increasingly used. Such payment does not, of course, bypass the peer-review process. There is an interesting article at the BMJ about their plans to move towards such a model. But this is, of course, off-topic. Jakew 12:49, 9 August 2007 (UTC)

Getting a letter in a journal does not require that the letter is considered scientifically respectable. It is not an appropriate citation to show scientific disagreement. If you want to show serious scientific disagreement, you must cite articles in peer reviewed scientific jourrnals. Nobody would accept a letter to the editor as an appropriate source for a college essay, let alone a scientific paper. Similarly, letters to the editor have no place in this article. 146.163.162.184 17:58, 9 August 2007 (UTC)

Interestingly, a lot of intelligent people disagree with you -- Avi 18:03, 9 August 2007 (UTC)

None of them are going to get a letter to the editor cited in a college paper without failing. None of them are going to publish an article in a peer-reviewed scientific journal if they cite a letter to the editor. Why should the standard here be lower than in a college paper? Just David 18:04, 9 August 2007 (UTC)

Not necessarily. A letter to the editor of a journal such as Lancet is significantly different than a letter to the editor of the Washington Post. Can you bring sources for your conjecture that a letter to the editor, when used to demonstrate conflict about a topic which is cited from a peer-reviewed article itself, would be an automatic failure? Somehow, I don't think so. -- Avi 18:09, 9 August 2007 (UTC)

Avi please show me a single example where a reputable scientific paper or book has cited a letter to the editor in support of its case. You have all of scientific literature to choose from. Just David 18:13, 9 August 2007 (UTC)

Au contraire, all that is being done here is demonstrating that controversy exists. If the peer-reviewed journal itself saw fit to publish the claim, that is sufficient. -- Avi 18:14, 9 August 2007 (UTC)

Are you familiar with the common Creationist tactic of getting a respectable to scientist to criticise their work, and then using the fact that they have been mentioned by a respectable scientist to argue that there is a serious debate in scientific circles over Creationism? Of course, the fact that they have been replied to proves absolutely nothing.

If you want to prove that there is a real scientific controversy, then you have to show that there are articles being published in reputable peer-reviewed scientific journals that argue both sides of the case. Again, no scientist would try to establish, in an article that they wanted published, that an issue is a serious bone of contention by pointing out that people have written letters to the editor saying that it is a serious bone of contention. For that, they need to cite published research: books and articles.

The fact that letters to the editor are being considered reasonable sources, but that the article doesn't even mention that the American Medical Association has stated that there are virtually no national medical bodies that recommend circumcision is just surreal.

Just David 18:19, 9 August 2007 (UTC)

Creationism is not the topic of this article, nor are the tactics used by its proponents. As a side point, Hill, who is Denniston's partner in at least one paper, has argued in print with Waskett, who (Waskett) has been defended by Willcourt. (See http://www.bmj.com/cgi/eletters/321/7264/792#109475 ). Just another point in that letters to peer-reviewed journals are often extremely useful in furthering the understanding of the debate on a topic. -- Avi 18:36, 9 August 2007 (UTC)

Indeed. Another letter that springs to mind was a reply to an HIV meta-analysis by Van Howe. The letter, by Moses et al (and entitled 'Analysis of the scientific literature on male circumcision and risk for HIV infection'), pointed out several methodological flaws in Van Howe's paper, and has since been cited in (Google Scholar tells me) 15 other articles. Another letter, in reply to the same article, and again discussing shortcomings, was cited in 39 other articles, including a comprehensive 387-ref review of techniques in meta-analysis itself. So science marches on.... Jakew 19:13, 9 August 2007 (UTC)

David is right to make that point about creationism. The mere fact that a position is mentioned doesn't mean that there is significant controversy over that point.

If you want to establish that there is moral controversy over circumcision then you can cite all the websites on the topic. If you want to establish that there is medical controversy over circumcision then you have to cite scientific research papers and books. A letter to the editor demostrates nothing, since letters to the editor are not send off for peer-review as articles for publication are.

I am missing the point of your sentence about Hill, Denniston, Waskett and Willcourt. What is this demonstrating? You say that they have argued in print. What does this establish? That one letter cites another letter?

Can you show me where the Moses is cited as a letter to the editor? I found direct reference to the article by Moses and co. here w.hawaii.edu/hivandaids/Male%20Circumcision%20and%20HIV%20Prevention%20%20%20Current%20Knowledge%20and%20Future%20Research%20Directions.pdf but it didn't say that it was a letter to the editor.

Edwardsville 17:57, 10 August 2007 (UTC)

(This was originally in reply to Edwardsville, who asked: "Who selects articles for "Google Scholar" and how are they vetted? I am not familiar with their process. Are they subject to a review procedure, or is the process more like Wikipedia? As far as I can tell, it does not appear to be a peer-reviewed scientific journal of any kind, but I'm willing to learn better." In future, Edwardsville, please use <s>...</s> to strikethrough your old comments if you want to replace them. Jakew 18:25, 10 August 2007 (UTC))

Google Scholar is a database of articles published elsewhere, generally in academic journals that make their content available on the 'net either for free or by subscription. Unlike PubMed it provides the facility to search the full text of articles, including references. Unlike plain Google it excludes many (but not all) unreliable sources, such as lay websites, that are not useful for Wikipedia. In this instance I am using it to provide a convenient link to articles that cite the letters which I mention. Jakew 18:13, 10 August 2007 (UTC)

To verify that Moses et al was a letter, please go here and in the 'display' combobox, select 'Abstract'. You will then see 'Publication types: comment, letter'. Jakew 18:25, 10 August 2007 (UTC)

I don't know why you feel the need to reply to a question that I removed after I found the answer, but feel free.

Firstly, was it a letter to the editor, or was it a letter to someone else, later published in a journal article?

Secondly, and more importantly, it isn't a case like the one we are discussing. If three physicians with research credentials have the authority to have a letter they wrote together to be cited, that is a very different thing from citing a letter from an ordinary citizen. Can you show me a case where a letter like that has ever been cited?

I don't understand why you would want to cite it in the first place. What does it prove that you can't better prove by citing something more substantial?

Edwardsville 12:16, 12 August 2007 (UTC)

Looking at the edit history, I suspect that you deleted the question while I was busy replying to it. Unfortunately the Wiki seems poor at detecting such edit conflicts at present.

The letters cited above were published as 'letters to the editor' of a medical journal. I have demonstrated that letters to the editor can indeed highlight errors in published work, and I have also demonstrated that arguments above (that they are not cited in peer-reviewed articles) are incorrect. They also receive as a minimum the review of the editor, and it would be bizarre to exclude them. Jakew 13:06, 12 August 2007 (UTC)

It would not be bizarre to exclude them. The editor is not required to be a scientific expert on all topics. Only articles get submitted to proper peer review. If three medical researchers have sufficient authority when writing a letter together that they can be cited, that is one thing. That isn't what we are talking about here.

Why don't you just cite something more substantial?

Edwardsville

It would be bizarre to exclude them because letters to the editor are the proper place for criticism of published papers, and they have an important role. To quote Afifi: "Letter section of a scientific journal is an essential part of post- publication peer review. (1) Many readers seem to assume that articles published in peer reviewed journals are scientifically sound, despite much evidence to the contrary. Hence, misleading work should be identified even after publication. (2) Therefore, journals welcome and encourage the submission of letters to editors either a critical or research letters."[3] Jakew 14:28, 13 August 2007 (UTC)

"Reliable sources are authors or publications regarded as trustworthy or authoritative in relation to the subject at hand." What are the professional qualifications of the author of the letter in question that make him or her "trustworthy or authoritative in relation to the subject at hand"? -- DanBlackham 19:51, 13 August 2007 (UTC)

Please read carefully. Did you miss the words "or publications"? The policy goes on to say: "Academic and peer-reviewed publications are highly valued and usually the most reliable sources in areas where they are available, such as history, medicine and science." Jakew 19:57, 13 August 2007 (UTC)

Jakew, you are talking about a letter to the editor, not a peer-reviewed article. A letter to the editor, unless the source is themself authoritative, is not authoritative.

Why don't you just cite something more substantial?

Edwardsville 14:21, 14 August 2007 (UTC)

It may be your opinion that letters are not sufficient, but policy does not seem to agree with you. Jakew 14:35, 14 August 2007 (UTC)

Edwardsville, you're welcome to look for alternative citations yourself. --Coppertwig 16:19, 14 August 2007 (UTC)

Put me firmly in the not citing it camp. It has been shown that when three authorities in a field write a letter together, they might reasonably be cited. That isn't anything like what we are talking about here. Find something else to cite or just leave it out. I don't know of any case in acedemic literature where the sort of citation you are suggesting has been done, but you can show me if you can find one.

Just David 17:08, 14 August 2007 (UTC)

Sure, I'm welcome to do what I like, but that doesn't address my concern. My position is that the letter should not be cited. If someone wants to cite something substantial for the same purpose, they are welcome to find something, but citing the letter is not appropriate.

Edwardsville 13:05, 15 August 2007 (UTC)

One of the examples of much-cited letters Jakew gave had two authors, not three. What letter are you talking about, anyway? I mean, what letter is cited here that you think should not be? --Coppertwig 21:32, 15 August 2007 (UTC)

I was talking about the letter written by Jakew that is discussed above.

Just David 16:54, 16 August 2007 (UTC)

And how do you know that jake is not a respected academic in the field? Not only have his letters been published, they have been both responded to, and discussed by, various professionals in the field, INCLUDING author(s) of papers that can be found on CIRP . You may not personally like Jake because you have a particular issue on which you greatly disagree with him, but that is not a reason to disallow a valid piece of the literature from being brought in this discussion. -- Avi 17:09, 16 August 2007 (UTC)

If the author of the letter is a respected academic in the field, then please share his professional qualifications. What professional training has he received in the field of medicine? What degrees has he earned that qualify him as an authority in medical science? At which academic or medical research institution is he professionally employed? -- DanBlackham 05:54, 17 August 2007 (UTC)

As mentioned, what matters is that letters published in peer respected journals have entered the literature, and may be used to support the existance of controversy, as was the apparent consensus on WP:R when we asked months ago. -- Avi 06:05, 17 August 2007 (UTC)

But that isn't what matters at all. I don't know what the consensus was months ago, but I was not here months ago and it appears that a mistake was made months ago. It should not be cited. If he is a respected academic in the field, then I will withdraw my objection.

Just David 17:12, 17 August 2007 (UTC)

Avi means Talk:RS not WP:R. Don't take Avi's word for it, READ the discussion HERE:

[[4]]

Blueboar: "Its reliability for a citation of fact will depend on the reputation of the person who wrote it... it does not get an automatic approval by virtue of where it is published"

DCG: "For that matter, nothing about RS is really black and white."

Hornplease: "I would personally think that anyone trying to insert a disputed opinion substantiated only by such a letter is pushing things a bit."

Piotrus: "Letters are not peer reviewed, aren't they? They can be cited, but certainly merit a clarification like 'Person X in a letter published in publication Y stated that...'"

R. Baley: "Any source that is a "letter to the editor" should be marked as such, that should be the default."

Your claim, shared by Jakew, Nandesuka, and Jayjg, that the letter IS a reliable source and warrants inclusion without mention of the fact it is a letter, based on its being reproduced in a journal that otherwise publishes peer-reviewed articles -- is DISPELLED. So mark it as a letter (denied by Avi, Jakew, etc), counterbalance it with really reliable sources like peer-reviewed articles and statements from the medical associations (denied), or remove it (denied). Blackworm 19:32, 18 August 2007 (UTC)

Interesting example of selective quoting, Blackworm. Your thoroughness in editing out the parts with which you disagreed is striking. Jakew 20:05, 18 August 2007 (UTC)

Interesting example of selective criticism, Jakew. Your predictability in attacking me for again pointing to the original discussion, rather than Avi for selectively summarizing pointsone point of view he agrees with and ignoring all others, is striking. Not. Blackworm 21:13, 18 August 2007 (UTC)

I must agree with Blackworm here. Your criticism does seem very selective here, Jakew. As for the letter, it should not be in the article at all. Also, having it in the article and not mentioning that it is a letter is clearly misleading. If you don't think it matters that it is a letter, why would you object to it being cited as a letter?

Edwardsville 13:47, 21 August 2007 (UTC)

Too long

Article is TOO long —The preceding unsigned comment was added by 24.19.158.216 (talk • contribs).

Please see discussion above. Jakew 11:28, 9 August 2007 (UTC)

... at Article too long? above, where there is ongoing discussion of a proposal to shorten the page and input from more editors is welcome. --Coppertwig 13:09, 9 August 2007 (UTC)

Circumcision lawsuit

User Nandesuka deleted the following content which had been added by user Areseepee. User Nandesuka's edit summary said "WP:NOR".

Most complications from circumcision go unreported because often after a major complication the family settles with the hospital or doctor and the public never knows. Only when the family spends money to hire a lawyer and sue does the reporting of major complications become public knowledge. See July 27th, 2007 article where Illinois boy has glans severed after a "routine" circumcision: http://www.jg-tc.com/articles/2007/07/19/news/doc469edde7e929a511952004.txt

I don't see how content supported by a newspaper article violates NOR. Please begin your edit summary with "revert" or "rv" when you revert. --Coppertwig 16:13, 10 August 2007 (UTC)

I don't see how content supported by a newspaper article violates WP:NOR either. However, that doesn't really describe the paragraph you quoted, which is essentially a little bundle of one editor's personal opinions, followed by a citation that has nothing to do with them. Nandesuka 12:29, 11 August 2007 (UTC)

I concur with Nandesuka and Avi. Situations such as this, in which OR is incorrectly attributed to a source, are particularly troublesome precisely because they appear at first glance to be sourced.

When reading the above, I'm asking some questions. If, as the wording implies, this is a proven fact, then it must have been demonstrated through scientific study. If a study has demonstrated (perhaps through a survey) that "most" complications go unreported, I want to know what methodology was used. I also want to know what percentage of complications go unreported - "most" is somewhat vague for an encyclopaedia (I'm also wondering why this information is omitted in favour of a sad, but anecdotal, account of a single incident). If, on the other hand, this an opinion stated in a reliable source, I want to know who stated it, for what purpose, and on what grounds. Proper attribution is important.

The fact that these questions were not answered by the text would prompt me to examine the source in hopes of finding answers. I'm glad that Nandesuka did so. Jakew 13:05, 11 August 2007 (UTC)

The original research is the claim "Most complications from circumcision go unreported because often after a major complication the family settles with the hospital or doctor and the public never knows. Only when the family spends money to hire a lawyer and sue does the reporting of major complications become public knowledge." None of that is in the article, which I reproduce here for completeness:

CHARLESTON — A woman filed a lawsuit Wednesday on her infant son’s behalf alleging a doctor at Sarah Bush Lincoln Health Center improperly performed a circumcision on the boy. The lawsuit claims physician Sherif Malek performed the circumcision at the hospital on Feb. 15, the day after the boy was born. Instead of removing only the foreskin, the entire head of the boy’s penis was removed, the lawsuit alleges. The suit also claims the boy later underwent corrective surgery and will require more operations in the future. The lawsuit asks for an unspecified amount of monetary damages against Malek and Sarah Bush Lincoln Health System, the organization that operates the hospital. Patty Peterson, SBLHC spokeswoman, said hospital representatives have been aware of the incident since it happened and continually have been in contact with the mother. Because of that, they were “disappointed” that the lawsuit was filed, Peterson said. She did not elaborate on the manner in which officials stayed in contact with the mother. Beyond that, Peterson said hospital officials would have no comment on the lawsuit. She said hospital representatives likely won’t want to say anything about the suit until court proceedings conclude. In the suit, the boy’s name is listed only as “John Doe” and his mother as “Jane Doe,” and it doesn’t indicate where they reside. Chicago attorney Jerry Latherow, who filed the suit on the woman’s behalf, included a motion asking that the boy’s and woman’s real names not be used. The motion says Illinois courts allow pseudonyms to be used in cases of a “highly sensitive and personal nature or where injury would be increased” if the real names were used. No hearings in the case have been scheduled yet.

— Charleston & Matoon Journal Gazette and Times-Courier, Thursday, July 19, 2007

Unfortunately, there are botched procedures that happen on a daily basis in the US ranging from unecessary surgery to improper amputations. Yes, this was a terrible incident, but I see nowhere that supports the claims that:

1. Most claims go unreported.
2. Assuming #1 true *(strike 1) the reason is due to the cost of litigation or existance of a settlemnt.

All that article can support is that there exists one instance of a horrible result that occured during a hospital-performed circumcision. Not only is that patently NOT the claim made in the article, the question arises is it even notable? Do we list any specific individual instance of birth defects caused by doctor malfeasence in the article on obstetrics? -- Avi 16:26, 10 August 2007 (UTC)

NOR seems a valid reason to delete the first two sentences only. Level of detail appropriate to this article may be a valid reason to delete the third sentence and the reference. --Coppertwig 17:14, 10 August 2007 (UTC)

Coppertwig, should we start listing the thousands of circumcisions that occur without incident daily too ? Of course not, I agree that is rediculous. However, I am uncertain as to the importance of the above news report to the encyclopædic article at current. -- Avi 17:41, 10 August 2007 (UTC)

That many go off without medical complications is not the issue - many drunk driving incidents occur without anyone being hit. The question is how frequently complications do occur. The article above can be used to support the case that they do occur and can have horrible results, which seems important, but not as important as how often they occur. I am not aware of research saying that they occur frequently, but others may know differently.

Edwardsville 18:12, 10 August 2007 (UTC)

My concern is that often circumcision is considered a "routine" or "simple" procedure. The sad fact is that terrible complications can and do happen-even today. Also, the Mogen Clamp is well known for severing the glans. The problem is that you have to look underneath the clamp to ensure the glans is not in the way of the blade. Even Stanford Medical School teaches the Mogen Clamp incorrectly. The way it is taught will result in severing the glans: http://newborns.stanford.edu/Circumcision.html

areseepee 10 August 2007

I can't find anything in the link you supplied that supports your claim that it is taught incorrectly. Jakew 10:14, 11 August 2007 (UTC)

Nandesuka: In answer to your claim that the citation has "nothing to do with" the material inserted with it: The third sentence is, in my opinion, an accurate summary of the article cited, and "WP:NOR" in the edit summary was not an adequate explanation of why that sentence was deleted. Furthermore, the first two sentences do have something to do with the citation. The citation provides partial evidence supporting those sentences. I acknowledge that further evidence would also be required. --Coppertwig 14:25, 11 August 2007 (UTC)

It is possible that, if one were willing to speculate wildly, one could see the citation as providing a basis for an argument that the first two sentences were true. However, since WP:NOR requires that "Articles should only contain verifiable content from reliable sources without further analysis" and "any facts, opinions, interpretations, definitions, and arguments published by Wikipedia must already have been published by a reliable publication in relation to the topic of the article", it does not constitute evidence for our purposes. The problem is not that further evidence would be required; the problem is that the argument is completely absent from the cited source. Jakew 14:39, 11 August 2007 (UTC)

Coppertwig, that was a terrible, terrible addition to the article. It was a soapbox original research that was masquerading as a cited third party opinion. It was deceptive. Removing it was the only sane thing to do. When a pig covered in mud and feces starts running around the kitchen, you don't just hose it off and try to make it cleaner: you get the pig out of the kitchen. Nandesuka 20:24, 11 August 2007 (UTC)

I agree, this newspaper article is irrelevant to the circumcision article. I don't agree with Nandesuka's violation of WP:AGF ("It was deceptive"), and her apparent comparison between a Wikipedia editor and a "pig covered in mud and feces," which is a clear violation of WP:NPA. The intimidating tone and open acknowledgement of Nandesuka's desire for the editor to be silenced ("get the pig out of the kitchen") is also completely uncalled for. A Wikipedia administrator should hold himself or herself to a higher standard. Blackworm 06:40, 12 August 2007 (UTC)

The newspaper article may not suit the level of detail desired in this article, however it is certainly not "irrelevant". It's about circumcision; it's specifically about injury during circumcision, and was placed in a section of the article about risks of the procedure.

It could be argued that Nandesuka did or did not violate WP:NPA or WP:AGF. The words "It was deceptive" and "pig out of the kitchen" could be understood as applying to the edited words, not the editor. However, anyone who understands human nature should see that an editor whose edits are described in that way is quite likely to take it personally. The remarks violate the WP:CIVIL policy and the WP:BITE guideline at least, in my opinion. Also, it was unnecessary to refer to someone's edit (which the user was likely proud of) as a "terrible, terrible addition". And the original edit summary, which says "WP:NOR" but does not give a link to that page nor explain that it is a page or a policy nor tell how to find it, also violates WP:BITE. Come on -- let's be welcoming to the newcomers, whether or not we're able to remember what it was like when we did our own first few edits. --Coppertwig 13:51, 12 August 2007 (UTC)

The pig in my analogy is the edit, not the editor. I fully believe that the editor loves their pig, but it still doesn't belong in the kitchen. Nandesuka 15:54, 12 August 2007 (UTC)

It certainly was not irrelevant.

Edwardsville 14:57, 12 August 2007 (UTC)

FDA Warning

I would like to see this added to the article. http://www.fda.gov/cdrh/safety/circumcision.html Also keep in mind that no circumcision device in the USA has been approved by the FDA.

areseepee 10 August 2007

This one might be a useful link as a footnote, perhaps at Medical analysis of circumcision, as this article is already too long, as discussed above. Thanks for finding an interesting citation that might be useful in improving these articles! --Coppertwig 14:27, 11 August 2007 (UTC)

I put it in at Medical analysis of circumcision. --Coppertwig 22:40, 11 August 2007 (UTC)

I believe that if areseepee can support his claim that no circ device is FDA approved, it should be somewhere in the main article. Nothing in the link he provides supports that claim. Blackworm 04:46, 12 August 2007 (UTC)

Avi, you posted regarding whether the FDA needs to approve devices. That never occured to me and I don't know the answer. Good catch. Now, you wrote "Nevermind, there may need to be reference to this letter" in your edit summary. Where is this need? Could you please discuss it here? Blackworm 06:27, 12 August 2007 (UTC)

I LOVE BEING UNCUT —Preceding unsigned comment added by 24.105.219.114 (talk) 12:35, August 29, 2007 (UTC)

If the claims that the FDA is reponsible for approving such devices and that they have approved no circumcision device can be supported, then they belong in the article. I do not think that the article should be shortened, since there will be no agreement as to what material is important and what isn't.

Edwardsville 12:43, 12 August 2007 (UTC)

This link looks to me like an FDA approval of a circumcision device: [5] --Coppertwig 13:59, 12 August 2007 (UTC)

It's interesting that FDA approval is needed to market circumcision devices, but areseepee is out of relevant claims in my opinion. Areseepee what do you think? Can we close this one? Blackworm 07:48, 13 August 2007 (UTC)

My comment that no circumcision device is approved by the FDA is not supported. I can't find any evidence for my statement. Perhaps someone else can prove/disprove whether they are FDA approved. But I still think it is a good idea to incorporate the FDA warning on these devices because it further acknowledges that the procedure can result in "laceration, hemorrhage, penile amputation, and urethral damage..."areseepee 10 August 2007 —The preceding signed but undated comment was added at 04:40, August 23, 2007 (UTC).

You're probably right. The problem is, there's a plan to shorten the whole page, including shortening the risks section to 300 words. (See Talk:Circumcision#Article too long?.) It won't be easy. However, for now, maybe it would be good to add something like "The FDA has received reports of injuries involving circumcision clamps, including laceration, hemorrhage, penile amputation, and urethral damage." with the source you give above as a footnote. What do other editors think about this? --Coppertwig 12:27, 23 August 2007 (UTC)

Several of those are already discussed in "Risks of circumcision", so it would seem rather repetitive. I suggest that, if it belongs anywhere, it should be in the "medical analysis of..." article. Jakew 17:52, 23 August 2007 (UTC)

Of the four, I think only hemorrhage is already mentioned in that section, and I don't think there's a mention of device-related injury there. --Coppertwig 18:15, 23 August 2007 (UTC)

General Comment From the AMA about Policy Statements

The section on the policy statments of medical organizations should include a section that states:

The American Medical Association states that "virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice."

Reason: It is important that virtually all current policy statements from specialty socieites and medical organzizations do not recommend routine neonatal circumcision and support the provision of accurate and unbiased information to parents to inform their choice. Someone reading the article might mistakenly suspect that the organizations listed there have been cherry-picked, so that only ones who do not recommend routine neonatal circumcision have been listed and quoted. The article as it stands gives specific examples of what societies say, but doesn't say anything about the big picture. The quote above should prevent any such misunderstanding - it gives a good general picture of the state of things.

Placing: The quote should appear before any discussion of what particular medical organizations say, to put them all in context. It shouldn't just appear in the US section, because its subject matter is much broader thanthat.

Edwardsville 15:08, 12 August 2007 (UTC)

I agree, and I suggest having a subsection with a name like "Overview" or "Consensus statements", to contain that quote and also to discuss statements which are supported by more than one medical assocation (which up until now we've had trouble finding a good home for). --Coppertwig 16:23, 12 August 2007 (UTC)

Although it might simplify the article to include this quote instead of the (similarly-worded) extracts from the individual statements (thus allowing the individual sections to discuss other points), there is a repetition and WP:SOAP problem with including both. Jakew 16:51, 12 August 2007 (UTC)

One solution might be to have only a general section in this article, with that quote and the statements supported by more than one association from different countries, and to have the individual country's policies on the Medical analysis of circumcision page. This would help with the overall plan to shorten the article, as well as giving the reader a way of quickly finding out what such assocations generally think, without having to read about each country one at a time. --Coppertwig 17:01, 12 August 2007 (UTC)

That might work. Incidentally, I also found another secondary source discussing these statements - the following (World Health Organization) quote:

The complication rates cited in some medical society statements also tend to be higher than observed for neonatal circumcision (for example 0.2%-2% in the Canadian statement, 1%-5% in the Australasian statement), and the Australasian and American statements have been criticized for being unduly negative towards circumcision and down-playing the benefits of circumcision on infections including UTIs, penile and cervical cancer, and HIV 144, 145.[6]

Jakew 17:12, 12 August 2007 (UTC)

That is not a WHO report, it is a WHO/UNAIDS report. It is in UNAIDS' interest to promote circumcision, since its mandate says nothing about neutrality toward circumcision, but everything about reducing AIDS. Their position is interesting, and is worthy of mention as their position. But the attribution should be clear: WHO/UNAIDS. Blackworm 03:04, 13 August 2007 (UTC)

Interesting! Could perhaps provide NPOV balancing for a general section such as I describe. What's the status of the document, though? It's marked "Draft document".

By the way: I see your point about repetition. A certain amount of repetition is normal: the leadin is supposed to be a summary of the article as a whole, and I assume that paragraphs can have topic sentences which can sometimes be a summary of the paragraph. But I guess it might be too much to give a general statement about medical policies and then also list them. --Coppertwig 18:21, 12 August 2007 (UTC)

Yes, if we say "Organisations W, X, and Y say Z. Organisation W says Z. Organisation X says Z. Organisation Y says Z," it creates the impression that we're not so much supplying information as machine-gunning the reader with it. That can seem rather like a soapbox rant, and while there are plenty of websites doing just that, we have other standards. Jakew 23:13, 12 August 2007 (UTC)

This suggests that when we check over the "main article" pages to see whether they contain all the information from this page, they don't actually have to contain all the same quotes or references. It's more a matter of whether they contain all the same general ideas (plus they can contain additional detail not present here). --Coppertwig 13:02, 13 August 2007 (UTC)

The general claim should be listed, but there should also be listings for individual countries. For instance, someone from Australia should be able to look up Australia in the article and see that the medical organizations in their nation say that routine circumcision should not be performed.

Edwardsville 14:04, 13 August 2007 (UTC)

You're making a reasonable case for keeping the current state of the article, but a poor one for changing it. Jakew 14:16, 13 August 2007 (UTC)

Why should someone from Australia be able to look it up within the same article? There could be a link marked like For policies of specific national medical associations, see ... with a link to Medical analysis of circumcision where there is a proposal to copy (and another proposal here to move) that information. --Coppertwig 23:27, 13 August 2007 (UTC)

We seem to be losing sight of the original point about including the general statement. I want to defend the claim that people should be able to look up their nation and see what its policy is, but it might be better for that issue to have its own section. Are we going to include the general statement from the AAP?

Edwardsville 14:19, 14 August 2007 (UTC)

I'm sorry, I don't understand. A suggestion was made to allow the general statement to be included while addressing Jakew's point about repetition, by having the specific countries at a different article. It's not clear whether you support or oppose this particular suggestion. --Coppertwig 16:16, 14 August 2007 (UTC)

Personally, I would like the general statement included and I don't think that the specific countries should be listed in a different article. Both seem to be extremely important and so both seem to belong in this article. The general statement gives the general picture and then individual countries can have their policies briefly listed. If the section on general policies is too long, some of the stuff under US could be cut, leaving the recommendations and conclusions of the AMA and AAP. The article should definately let the reader know which countries do not recommend circumcision, which ones recommend that it should not be performed, and which (if any) recommend that it should be performed. What medical science has made of the research is even more important to present than giving the reader research details and asking them to work it out for themself.

Just David 17:04, 14 August 2007 (UTC)

I think that the general statement should be included and the statements of individual national organizations should also be listed. That wouldn't be repetition, since the general statement would give the big picture, while individual statements would give detail that the general statement does not. It is particularly important to list individual policies since the policies of national medical organizations in Canada, Australia and New Zealand don't just not recommend circumcision, they say that routine circumcision should not be performed.

If we are concerned about the length of the article, the policies of national medical organizations is not the place to cut detail - it is the most significant part of the article.

Edwardsville 13:03, 15 August 2007 (UTC)

What is going on with this? I have seen no change, yet the quote from the AMA seems to be extremely important.

Just David 17:11, 17 August 2007 (UTC)

Well, is there any objection anymore to adding the statement from the AMA? The only people talking about this anymore seem to be people who are in favor of adding it.

Edwardsville 13:43, 21 August 2007 (UTC)

Definition of phimosis

I feel uncomfortable about including a single definition of phimosis. Two articles (in one file) may be found here.

Let me quote in reverse chronological order. Richters asks:

• For example, what is ‘phimosis’? The definition used by Medline is broad: “The inability to retract the foreskin over the glans penis due to tightness of the prepuce”. Morris et al. complain that others use it to mean a much more specific pathological condition. However, in their reporting of study results they do not indicate which definitions are used in each study. In debates about circumcision, definitions of phimosis are chosen for tactical purposes."

This is in response to Morris et al, who argue:

• The foreskin should dislodge and retract over the glans by age 5. If not, the cause could be a narrow foreskin orifice. This is termed ‘phimosis’. It affects ~10% of uncircumcised men. The RACP Statement in saying the rate of phimosis is ‘at least 1%’ is referring to secondary cicatrisation of the foreskin due to balanitis xerotica obliterans (i.e. pathological phimosis in which the orifice is constricted from skin dryness, shrinkage and atrophy),55 as opposed to an anatomically narrow orifice, which is what is usually meant by phimosis.56, 57

I believe that the above demonstrates that there are at least two definitions of phimosis. If we include any definition, we should be careful to attribute it and note that others exist. Jakew 22:30, 12 August 2007 (UTC)

I had inserted "(nonretractility of the foreskin)" immediately after the word "phimosis" in the leadin. All of the definitions you mention above are forms of nonretractility of the foreskin, so I don't think that's inaccurate. I feel that the reader needs some clue about approximately what type of malady phimosis is, so they won't think it's a type of cancer or infectious disease or something. If a longer definition or set of definitions is required, it can go at the beginning of the section on phimosis. I suggest "inability to retract the foreskin, or a more specific condition", either immediately before or instead of the definition by Rickwood, which does not seem to correspond to the other definitions given. --Coppertwig 22:43, 12 August 2007 (UTC)

I agree that nonretractility of the foreskin is a common factor. However, the debate appears to be over whether the term should have a general or more specific meaning, so I think we need to be cautious.

I think your suggestion is reasonable, but slightly ambiguous. For greater clarity I propose "defined by some sources as an inability to retract the foreskin, while others use it to mean a specific cause of such a condition". I appreciate that this is a little clumsy, and if you can improve it please do so. Jakew 22:55, 12 August 2007 (UTC)

That sounds OK. I suggest deleting the Rickwood definition and inserting after the 1st sentence of the paragraph, "Phimosis is defined by some sources as an inability to retract the foreskin due to tightness of the prepuce, while others use it to mean a specific cause of such a condition". --Coppertwig 23:13, 12 August 2007 (UTC)

I strongly oppose that wording because a reader would easily infer, given the context, that the "specific cause of such a condition" is having a foreskin, i.e. not being circumcised. I propose "defined by some sources as an inability to retract the foreskin, while others use it to mean a form caused by a specific disease (balanitis xerotica obliterans)." Assuming it can all be sourced, of course. Blackworm 02:54, 13 August 2007 (UTC)

Actually, the age limit of 5 also seems relevant, since the circ article mostly discusses neonatal circumcision. Thus I propose, "defined by some sources as an inability to retract the foreskin, others by that occuring after age 5, and still others by a form of the first source's definition caused by a specific disease (balanitis xerotica obliterans)." This seems the most accurate, concise, and neutral POV definition possible with the source under discussion. Blackworm 02:58, 13 August 2007 (UTC)

That looks good to me [Coppertwig, not BW -BW]. What do you want to do about the lead section? Jakew 23:17, 12 August 2007 (UTC)

I suggest inserting in the leadin "(a condition which concerns retractility of the foreskin)". Perhaps you can think of a short phrase. "(retractility issues)" may be too informal. --Coppertwig 23:29, 12 August 2007 (UTC)

I can think of a possible phrase. How about (see [[#phimosis|section]] below)? :-) Jakew 18:48, 13 August 2007 (UTC)

The following quote from the article on phimosis is a very good, neutral explanation and should serve as an example for this article. "Phimosis is a medical condition in which the foreskin of the penis of a male cannot be fully retracted. ... The term is confusing because it is used to denote both a physiological stage of development (i.e. not a disease), and a pathological condition (i.e. a condition that causes problems for a person)." -- DanBlackham 20:09, 13 August 2007 (UTC)

That quote seems to have multiple issues. We should avoid stating that it is confusing (which would require sourcing), avoid endorsing a wider (or narrower) definition, and avoid characterising conditions as diseases or not (when there is apparent controversy). Let's just stick to the facts. Jakew 20:25, 13 August 2007 (UTC)

The introduction to the phimosis article does "just stick to the facts" and it presents those facts from a neutral point of view. That is why I suggested using it as a model for this article. -- DanBlackham 21:52, 13 August 2007 (UTC)

Dan, the first issue I raised is a WP:OR problem. The second and third are WP:NPOV problems. Instead of simply repeating your claim that it uses a neutral point of view, please address these issues. Jakew 21:55, 13 August 2007 (UTC)

(see [[#phimosis|section]] below) sounds OK, though I'd prefer a brief definition in the leadin (or even using a term such as "inability to retract" instead of "phimosis"). Another possible idea for a definition within that section: Phimosis means inability to retract the foreskin, though the term is applied by some only to certain age groups or causes of the condition; inability to retract the foreskin is normal in infancy. I think mentioning age somehow is important.

I can go along with either suggestion, but the last does seem to dedicate a lot of words in the lead to a topic that's really tangential to the subject of this article.

In hope of guidance, I had a look at WP:LEAD. Unfortunately it wasn't particularly helpful. It says "Do not tease the reader by hinting at startling facts without describing them." But: "Avoid lengthy paragraphs and over-specific descriptions." Finally: "Work magic; do the impossible."

Ok, I made one of those WP:LEAD quotes up. ;-) Jakew 22:47, 13 August 2007 (UTC)

By "that section" I meant putting that longer definition in the "phimosis" section. --Coppertwig 23:20, 13 August 2007 (UTC)

DanBlackham, I think one of the problems Jakew was raising is that you gave a quote from "an article" but you didn't give a citation to the article. --Coppertwig 21:37, 15 August 2007 (UTC)

Coppertwig, I just noticed your comment. Sorry for the confusion. The quote is from the first paragraph of the Wikipedia article Phimosis. The controversy is not so much about the definition of phimosis as it is about if and when medical intervention is appropriate if a boy's foreskin is not retractable.

The first paragraph of the Wikipedia article has the following information:

1. Phimosis is a medical condition in which the foreskin of the penis of a male cannot be fully retracted.

2. A non-retractable foreskin in infants is a normal physiological stage of development that does not require medical intervention.

3. At some age a non-retractable foreskin is a medical condition that may require medical intervention.

I am sure we could find multiple reliable sources in the medical literature to support this basic information from the Wikipedia article on phimosis. In my opinion these three items should be the basis for the discussion of phimosis in this article. -- DanBlackham 22:36, 17 August 2007 (UTC)

Circumcision prevalent, not necessarily customary

"Circumcision is customary in Muslim countries, the United States,[7] the Philippines,[8] South Korea.[9] and Israel." The cited studies on the Philippines and South Korea were not easily available online, but it's possible they dealt with national customs. The cite given to include the United States seems dubious, since it discusses "prevalence" rather than custom. An examination of whether circumcision is "customary" is a social examination, not a straight observation of its prevalence. For example, would one say it is "customary" for cancer patients to die within the first twenty years? No, unless one could find a culture in which it is a custom. One could say it is prevalent, and cite source. I propose changing the word "customary" to "prevalent." And since it's plainly true that it is prevalent in Israel, I wouldn't even complain that the claim is unsourced. Blackworm 07:28, 13 August 2007 (UTC)

'Prevalent' is ok. We can actually replace these individual sources with a single source supporting the same claims: "countries with substantial prevalence of non-religious circumcision (Angola, Australia, Canada, Democratic Republic of Congo, Ethiopia, Ghana, Indonesia, Kenya, Madagascar, Nigeria, Philippines, the Republic of Korea, Uganda, United Kingdom, the United Republic of Tanzania, United States)."[7] Jakew 10:24, 13 August 2007 (UTC)

The leadin has been edited and now contains some unsourced claims about prevalence. I'm therefore replacing this text:

Circumcision is generally performed in Africans countries, in North America (United States and Canada), in Australia, on the Pacific Islands, throughout Asia (in countries such as the Philippines, Indonesia, Malaysia, and South Korea), in the Middle East, and in Israel.

with what Jakew suggests (edited slightly, e.g. "are"). One reason I quote this text here is so I or someone else can later check whether any valuable references here are missing from the prevalence page. One advantage of this edit is that it reduces the number of references on this page, which I believe will help the page load a little faster. --Coppertwig 16:58, 14 August 2007 (UTC)

Well, I made that change quickly to get rid of unsourced claims, but I don't think it actually looks all that good: too long a list of countries for the leadin, and doesn't mention countries with religious circumcision. I suggest something like: Circumcision is prevalent in parts of Africa, Central Asia, Indonesia, the Philippines, South Korea, the Middle East and the USA. (I used alphabetical order except that I put the Asian countries immediately after "Central Asia".) --Coppertwig 17:15, 14 August 2007 (UTC)

"parts of" is meant to apply only to Africa. Maybe mention Africa last to remove that ambiguity. --Coppertwig 17:21, 14 August 2007 (UTC)

I reverted back to an earlier version of the sentence but put "prevalent" instead of "customary". I realized that actually the quote Jakew provided is ambiguous or out-of-date: it has Canada in there under "substantial prevalence". So I don't think it's a good quote to put in, at all maybe or at least not without immediately putting other material to balance/interpret it. (I think the rate in Canada is well below 50%.) --Coppertwig 17:59, 14 August 2007 (UTC)

I still suggest replacing with:

Circumcision is prevalent in Central Asia, Indonesia, the Philippines, South Korea, the Middle East, the USA and parts of Africa.

--Coppertwig 18:04, 14 August 2007 (UTC)

Presumably, you are using 'prevalent' to mean neonatal circumcision is widespread today. Another equally valid meaning is 'the majority of males are circumcised'. Either way, fortunately we don't have to (and must not try to) evaluate whether sources are correct, because "The threshold for inclusion in Wikipedia is verifiability, not truth". Jakew 18:38, 14 August 2007 (UTC)

Is there a reason why Central Asia, Indonesia, and parts of Africa are no longer included as places where circumcision is prevalent? I'm not sure about the first two, but there should definitely be something about parts of Africa. Just wanted to inquire before changing anything in the intro. ~ Homologeo 18:22, 14 August 2007 (UTC)

The list of countries is arguably a little long for the lead, though perfectly reasonable for the 'prevalence' section. We need to work out how to summarise better. Jakew 18:38, 14 August 2007 (UTC)

If you think the list I suggested above is too long, how about Circumcision is prevalent in the Middle East, the USA and parts of Africa and Asia?.

There is a source giving a low circumcision rate for Canada (lower than 50%). Therefore, giving a quote in the lead that merely says it's "prevalent" in Canada would not be balanced or NPOV, or would be too open to misinterpretation. A 2003 article indicates that Canadian neonatal male circumcision rates are 10 to 30%. from Prevalence of circumcision. --Coppertwig 22:48, 14 August 2007 (UTC)

I think you must be reading the word 'prevalent' as 'with a prevalence of > 50%'. I'm not aware of such a meaning, but I may be mistaken. Perhaps substituting 'common', as you suggest below, or 'frequent', would address this perceived ambiguity? Alternatively, what would be the consequences of simply removing the sentence from the lead? Jakew 09:51, 15 August 2007 (UTC)

I reverted to an earlier version to take out Canada or any other countries I/we are not sure about. Sources can easily be found at the Prevalence of circumcision page to support the list of countries I suggest above. I might find them later, or someone else can. It's OK with me to put back in those countries, but not Canada or other questionable ones. (Any statement about it being "prevalent" in Canada would have to be explained/balanced with mention of the neonatal rate, which would probably take up too much space for the leadin.) --Coppertwig 22:52, 14 August 2007 (UTC)

I self-reverted, taking "prevalent" out again. I looked up "prevalent" on Wiktionary and one of the definitions is "superior, dominant". Oops. I think we'd better try to avoid that word, at least in the leadin. "Customary" isn't very good either. How about "common"? --Coppertwig 23:43, 14 August 2007 (UTC)

I see that the sentence about parts of the world has been removed completely from the leadin. I think it's important to have a sentence like that in the leadin, because it's important information about circumcision and is the type of information I think a reader expects to find in a place like the leadin; it sets the context for the information given in the rest of the article. Some alternative versions of the sentence include "Circumcision is widespread in ..."; "Circumcision is common in [list countries/continents] and in some places almost universal". I suggest that the earlier version of the sentence (with "customary") be put back in until consensus can be reached about the wording. I see no reason to leave the sentence out altogether. I think we may be able to quickly come to a consensus about the wording. (You don't have to wait for me to agree before editing, if you're putting in a version of the sentence not containing any details I've specifically objected to.)

The interpretation of "prevalent" as "greater than 50%" is a natural result of its definition as given at Wiktionary. While others may interpret it differently, I'm guessing many others will interpret it as I tend to. In the New Shorter OED (1993), it gives two definitions which are marked "Now rare" and which include things like "having the advantage", and then a third definition which is "Generally occurring or existing; in general use; usual." Given even only that third definition, I think it would be misleading[open to misinterpretation] to describe circumcision in a country with a less than 50% rate (either adult or neonatal) as "prevalent" without also giving additional information to clarify the meaning, set the context and/or provide a balancing POV. I also thought of the word "frequent" but unfortunately it sounds odd to describe a once-in-a-lifetime event with that word. The word "usual" suffers from the same problem as "customary". --Coppertwig 13:25, 15 August 2007 (UTC)

After thinking it over: because the OED marked certain definitions as rare, I think it's OK to use the word "prevalent", although, as I said, not for countries with rates under 50% unless further clarification is given. --Coppertwig 18:13, 15 August 2007 (UTC)

The sentence was not removed from the leadin after all: it was moved to earlier in the paragraph. However, the way it is now doesn't address Blackworm's comment at the beginning of the section: do we know that the reasons are religious or cultural in those places? I thought in the USA, for example, it might be medical. So it seems like an unsourced claim. --Coppertwig 21:02, 15 August 2007 (UTC)

Some references that might be useful

These references were deleted from the article but might be useful in other articles or to be put back in later. From the phimosis section, " Rickwood defined the term 'phimosis' as "scarring of the tip of the prepuce". "And repeating here what I removed from the leadin:

Circumcision is generally performed in Africans countries, in North America (United States and Canada), in Australia, on the Pacific Islands, throughout Asia (in countries such as the Philippines, Indonesia, Malaysia, and South Korea), in the Middle East, and in Israel.

--Coppertwig 21:57, 15 August 2007 (UTC)

Suggestion: Currently, the Masters and Johnson(M&J) factoid is footnoted to the American Academy of Pediatrics statement, which mentions M&J in the same words as here and lists M&J as a reference. I suggest putting instead a footnote to the actual M&J reference, as is done at the sexual effects of circumcision page.

By the way, (re footnotes): my experience on another Wikimedia project suggests that what slows down the page loading/rendering is the total number of <ref> superscripts, i.e. the total number of little superscripts in the text that go to footnotes. (Superscripts done using <sup> don't slow things down like this, I believe.) In other words, a short named reference like <ref name="AAFP"/> may slow things down just as much as a complete reference; or to put it another way, a reference that's linked to many times in the text (with an alphabet beside it in the list of references) slows down the page rendering a lot more than a reference with a single link to it; or so my experience at Simple English Wiktionary suggests.

By the way, (re shortening this page) in case anyone isn't paying attention to the top half of this talk page, activity directed towards shortening the page according to WP:SUMMARY is continuing. See Talk:Circumcision#Article too long?. --Coppertwig 22:49, 18 August 2007 (UTC)

Duplicate reference? References 68 and 70 (BMAGuide2 and BMAGuide) seem to refer to the same publication (although one gives specific quotes). --Coppertwig 17:19, 19 August 2007 (UTC)

That's exactly the point. One is giving specific quotations, which was the compromise instead of quoting long tracts in-line in the article. #70 refers to statements in the BMA that are not directly related to those quotes; rather, it refers to the article as a whole. Thus the duplication. -- Avi 17:24, 19 August 2007 (UTC)

I thought that might be the case. It's the same for a couple of other position statements, too, I suppose. However, the Birley reference seems to be an unnecessary duplication. --Coppertwig 19:59, 19 August 2007 (UTC)

I removed duplicate references to articles by Glass, J.M. and by Williams and Kapila. For the Birley duplicate, the access date and PMD numbers differ, so maybe I'll leave that to a more experienced user to clean up if required. (The access dates also differed for Williams and Kapila, but I went ahead and removed one of them anyway.) --Coppertwig 20:40, 19 August 2007 (UTC)

Changes to leadin

Re this edit: [8] I would prefer not to list Canada as a place where circumcision is "common" since apparently the current neonatal circumcision rate is much less that 50%. There are some spelling and grammar problems and there may be other problems such as whether certain organizations would consider themselves "advocates of circumcision" and whether the list of organizations is too long and cluttered for the leadin; a phrase like "many leading international organizations" might flow more smoothly. --Coppertwig 14:13, 20 August 2007 (UTC)

I believe that the Canada issue is best solved with proper attribution, rather than arguing that the source is incorrect. Nevertheless, I don't think that it needs to be in the introduction: this problem may be best avoided rather than solved.

As for the other issues you raise, I'm inclined to agree. That part of the article was, I think, written before the WHO endorsed circumcision. At that time, it was perhaps more sensible to characterise the debate as between these extremes. However, times change, and it seems dubious to characterise WHO, etc, as "advocates of circumcision". I would suggest instead something nice and explicit like "others, including the World Health Organisation,[source] regard it as...". Jakew 14:41, 20 August 2007 (UTC)

I think the situation with Canada is too complex to be discussed in the leadin, so it's best just to not mention Canada in the leadin. The leadin could use some reorganization; at the moment, stuff about WHO and stuff about how common it is around the world is split before and after the history paragraph; it should be collected together. I'm not saying that any source is incorrect, but sources may say something like "circumcision is prevalent" and perhaps mean circumcised males are commonly found, or perhaps mean the act of neonatal circumcision is now common or usual. Other sources can be referred to for clarification or balance. --Coppertwig 17:28, 20 August 2007 (UTC)

Here's a suggested version of the leadin:

Circumcision is a surgical procedure that removes some or all of the foreskin (prepuce) from the penis. The word "circumcision" comes from Latin circum (meaning "around") and caedere (meaning "to cut").

Circumcision predates recorded human history, with depictions in stone-age cave drawings and Ancient Egyptian tombs. Theories include that circumcision is a form of ritual sacrifice or offering, a health precaution, a sign of submission to a deity, a rite of passage to adulthood, a mark of defeat or slavery, or an attempt to alter esthetics or sexuality. Male circumcision is a religious commandment in Judaism, expected in Islam, and customary in some Oriental Orthodox and other Christian churches in Africa.

Since March 2007 the World Health Organization, UNAIDS and some other major organizations recognize male circumcision as an efficacious intervention for HIV prevention, while cautioning that male circumcision only provides partial protection and should not replace other interventions to prevent heterosexual transmission of HIV. Genital integrity supporters, on the other hand, condemn infant circumcision as a human rights abuse and a genital mutilation like female genital cutting. Circumcision may also be used to treat inflammation of the glans and penile cancer. Using circumcision to treat phimosis (see section below) is debated in medical literature.

According to WHO, 30% of men worldwide have had the procedure, mostly in countries where it is common for religious or cultural reasons. Circumcision is common in the Middle East, the USA and parts of Africa and Asia.

In the version above, I haven't changed the first paragraph or the "circumcision predates" paragraph, though I moved the paragraph that had been between them. I rearranged other stuff and deleted some stuff that seems to already be covered. I think that, (compared to the second-last version,) all I've left out was this: while advocates of circumcision regard it as a worthwhile public health measure[10], particularly in the control of HIV. Along with that sentence I've left out 4 references, only 1 of which (reference 10, Schoen) is not referenced elsewhere in the article. (It should probably be worked into the body of the article somehow.)

Australia is in a similar situation to Canada: apparently the current neonatal rate much lower than 50%, so it would take a bit more space to explain the situation fully and probably shouldn't be mentioned in the leadin.

I haven't checked whether we have reliable sources for the "and some other major organizations" bit. --Coppertwig 19:02, 20 August 2007 (UTC)

The introductory paragraph right now is extremely biased. It mentioned organizations that recommend circumcision but does not mention organizations that do not recommend circumcision or who recommend against circumcision.

This is particularly significant since the AMA states

"Virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice." [9]

Either there should be no mention of organizations taking either side at this point in the article or both sides should be mentioned here.

Edwardsville 13:38, 21 August 2007 (UTC)

After I wrote the above, I realized that there's stuff missing from the leadin. The leadin should summarize the article. I suggest a brief mention of pain, risks/side effects and perhaps sexual effects (if it's possible to summarize sexual effects briefly). So I suggest taking the above draft, taking the "genital integrity" sentence out of the paragraph it's in and forming a new paragraph, to go after that one, becoming the new second-last paragraph:

Genital integrity supporters condemn infant circumcision as a human rights abuse and a genital mutilation like female genital cutting. Circumcision involves risks including infection, injury and in rare cases death. Several medical associations state that effective pain management should be used if circumcision is performed. The effects of circumcision on sexuality are debated.

I think footnotes are not needed, since these things are discussed in more detail and with footnotes in the relevant sections of the article. --Coppertwig 17:18, 21 August 2007 (UTC)

If the article were not so controversial, I'd agree with leaving out footnotes. However, since any material is likely to be challenged I think we'd better include them. Jakew 10:45, 22 August 2007 (UTC)

Bleeding

This page says "Bleeding is mostly minor; applying pressure will stop it." The footnoted source says, "In the majority of cases, bleeding is minor and hemostasis can be achieved by pressure application." It seems to me that the source is saying that in the majority of cases hemostasis can be achieved by pressure application, while this page seems to be saying that applying pressure will stop it, implying in all cases. To make the text here reflect the source more accurately, I suggest changing it to "Most bleeding is minor and can be stopped by applying pressure." This is also better grammar; joining two sentences with a semicolon isn't the best grammar, however frequently I'm tempted to do so myself :-). --Coppertwig 12:03, 23 August 2007 (UTC)

Absolutely; it should be changed; it may also be worth stating '[Author] states that ...'; avoiding potential liability problems; let's avoid bad grammar too. Jakew 12:07, 23 August 2007 (UTC)

Hmm. "A report by the Council on Scientific Affairs of the American Medical Association" sounds rather wordy. (Can we say AMA everywhere except the first time the association's name appears on the page? Wikipedia:Naming conventions (abbreviations)#Acronym usage in article body). How about something shorter such as "A medical report says that ..."? (After all, the footnote is there to specify what report is meant.) --Coppertwig 12:20, 23 August 2007 (UTC)

I combined it with the previous sentence, which seems to depend on the same footnote, to make "According to the AMA, blood loss and infection are the most common complications, and most bleeding is minor and can be stopped by applying pressure." —Preceding unsigned comment added by Coppertwig (talk • contribs) 23:38, August 24, 2007 (UTC) (OK, I had forgotten to sign my message --Coppertwig 15:41, 25 August 2007 (UTC))

Fergusson et al

This page says "Fergusson et al found phimosis in 16% of non-circumcised boys." I think this is an error. In a table in the cited study it gives a rate of 3.7%, with the number 16 in parentheses. 16 is the total number of affected boys out of their sample of more than 500 boys. So, it should be corrected to 3.7% not 16%. --Coppertwig 21:56, 23 August 2007 (UTC)

Sweden or United States?

Re this part:

In 2001, Sweden allowed only persons certified by the National Board of Health to circumcise infants, requiring a medical doctor or an anesthesia nurse to accompany the circumciser and for anaesthetic to be applied beforehand. Jews and Muslims in Sweden objected to the law, and in 2001, the World Jewish Congress stated that it was “the first legal restriction on Jewish religious practice in Europe since the Nazi era.” However, in 2006, the United States State Department reported that most Jewish mohels had been certified under the law and 3000 Muslim and 40-50 Jewish boys were circumcised each year. The National Board of Health and Welfare reviewed the law in 2005 and recommended that it be maintained.

I find it ambiguous. Is it in Sweden or the U.S. that 3000 Muslim and 40-50 Jewish boys are circumcised? (Sweden, I presume.) Is the National Board of Health and Welfare a Swedish or a U.S. institution? (Swedish, I presume.) I looked at the source document and it seems ambiguous there, too. Any way to fix it up? How about inserting a phrase like "in its report on Sweden"? --Coppertwig 23:33, 24 August 2007 (UTC)

Emotional Consequences

In the interests of presenting both equally applicable sides of the consequences of circumcision and lack thereof, I propse that we add to Emotional Consequences: "It should also be noted that organisations exist to support those men who desire to be circumcised, aiming to mitigate the psychological issues which may prevent them from going to have it done." Or words to similar effect.Dcarm 03:56, 25 August 2007 (UTC)

That is merely an ad for a pro-circumcision activism website, not a reference to a reliable source. It does not warrant inclusion. ("Psychological issues" *preventing* them circumcising themselves? Is this a joke? Are adult males anywhere desperate to cut off some of their penile skin for no apparent medical indication, but are *prevented* from doing so by some malfunction of the brain? I think your brain is malfunctioning, personally.) Blackworm 08:28, 25 August 2007 (UTC)

It may well be true, but the standard for Wikipedia is verifiability, not truth. To support the inclusion of such a statement, we need a reliable source that explicitly makes such a claim. In this instance, what is being presented is not a source, but an example that the author interprets as substantiating the claim, and that is incompatible with WP:NOR.

I'm removing the reference to NORM for exactly the same reasons. Jakew 10:41, 25 August 2007 (UTC)

Thanks Jakew, I'm content with this outcome. I guess I figured that in both cases, since groups claiming these things exist, their existence was sufficient verification of the claim. Thanks for clearing me up on that. Dcarm 00:39, 26 August 2007 (UTC) contribs) 13:43, August 25, 2007 (UTC)

Sources mentioning "support group[s]" in the context of "circumcised" or "circumcision", from a Google Scholar search and a Google Books search. (I haven't looked at every search result.) I was looking for any sort of support group related to (male) circumcision. [10] [11] [12] [13] this one, according to Google Scholar contains the quote "...as well as more general health issues (eg, substance abuse, circumcision), life events...".

The book "Sexual Mutilations: A Human Tragedy By George C. Denniston, Marilyn Fayre Milos" [14] mentions "NORM UK (the National Organization of Restoring Men), a support group for circumcised men in England".

The book "From Abraham to America: A History of Jewish Circumcision By Eric Kline Silverman" [15] mentions "The Alternative Bris Support Group, organized by Helen Bryce in northern California".

This book: "Technologies of Truth: Cultural Citizenship and the Popular Media By Toby Miller" [16] says that in 1996, "twenty men sent a letter to the British Medical Journal, signing themselves "Norm UK" and announcing a support group for the circumcised..." .

Based on some of these, Jakew, would you please put the bit about NORM back into the article? Maybe other things can be added too. --Coppertwig 16:16, 25 August 2007 (UTC)

We already cite Milos and Macris elsewhere in the article, so that's probably the best choice of citation. I won't personally add it in because I regard support groups as of dubious relevance, but I have no objection if someone else does so.

Incidentally, to help balance that section we might quote Moses and Bailey's review: "Long term psychological, emotional, and sexual adverse effects from male circumcision have been claimed by some, but we were able to find only anecdotal accounts[74], and scientific evidence is lacking. A longitudinal study which began in 1946 in Britain and followed more than 5000 individuals from birth to age 27 found no difference between uncircumcised and circumcised males in relation to a number of developmental and behavioural indices[75]."[17] Jakew 17:22, 25 August 2007 (UTC)

I object to the way in which the above was actually implemented. 'Moses et al. state that scientific evidence for psychological and emotional harm is "lacking"' implies that this source should be treated with skepticism. Is it reasonable to have the full quote in the article as mentioned here in Talk? Perhaps even 'Moses et al. state that "scientific evidence is lacking" for psychological and emotional harm' or similar. One word in quotation marks implies that it is "dodgy". Dcarm 00:39, 26 August 2007 (UTC)

Sorry, that wasn't my intention. Fixed. Jakew 09:25, 26 August 2007 (UTC)

When editing this page

... remember that a plan to shorten this page is currently in process. To make sure information you add is not lost, you may want to also add it to the appropriate subpage. See Talk:Circumcision#Article too long? above. --Coppertwig 18:12, 26 August 2007 (UTC)

Citing Acts of the Apostles directly

This sentence "The first Church Council in Jerusalem declared that circumcision was not necessary" cites the Acts of the Apostles directly. It's not clear to me that the cited web page supports that statement. Maybe someone could find a secondary source? (Or point out to me where on the web page it says that?) It clearly mentions discussion about circumcision, but I don't see anything about such a declaration by the council. --Coppertwig 01:41, 29 August 2007 (UTC)

Pictures of skin bridges

This website Pictures of skin bridges at circumstitions.com seems informative and relevant. Maybe it could go under "External links"? --Coppertwig 14:16, 29 August 2007 (UTC)