Talk:Circumcision/Archive 37

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Title dispute

Is the title of this article still in dispute? If so, could someone please clearly state the problem, or point me to the discussion, so that it may be addressed? Otherwise, the tag should be removed. Thanks, AlphaEta 01:10, 14 April 2008 (UTC)

The title was never in dispute. The tag states "The neutrality of this article's title and/or subject matter is disputed." This would be an or subject matter case in point. Garycompugeek (talk) 01:23, 14 April 2008 (UTC)

Okay, I see. Is the subject matter dispute separate from the concern regarding the article's balance, or lack thereof? Thanks, AlphaEta 01:28, 14 April 2008 (UTC)

The neutrality of the article is in dispute and it is considered unbalanced. Garycompugeek (talk) 01:46, 14 April 2008 (UTC)

The title is actually disputed. As this article is about male circumcision, and not circumcision, it should be titled Male circumcision per WP:TITLE. This one required pages and pages of "discussion" to keep the status quo safe. Blackworm (talk) 03:50, 14 April 2008 (UTC)

I have removed both tags, since they were added inappropriately. If anyone wishes to restore them, please create a section on the talk page including a clear and detailed statement of the specific problems to be addressed. There is some useful guidance in Wikipedia:Dispute templates (both in the intro and in the section entitled "Banner templates"). Jakew (talk) 11:57, 14 April 2008 (UTC)

Jake you have inappropriately removed these tags and there is nothing wrong with the way they were added. Your refusal to work with editors who do not share your viewpoints is telling. You must learn to compromise and incorporate other viewpoints. Garycompugeek (talk) 15:06, 14 April 2008 (UTC)

"They should normally not be used without a clear description from the applying editor of the rationale, preferably presented in a numbered list form in a separate section which includes the template name. ... If one must be used, please make a thorough note listing deficiencies or items being disputed in bulleted or numbered paragraph format under a clear notice section heading." Wikipedia:Dispute templates Jakew (talk) 15:40, 14 April 2008 (UTC)

These tags were added at 21:06, April 11, 2008 and 21:36, April 11, 2008. They were removed at 12:48, April 14, 2008, and were then re-added at 15:41, April 14, 2008. Nearly four days have therefore elapsed since they were first added, and almost a day has elapsed since they were restored. Due to the above messages (including a quote from the appropriate page), in addition to the edit summary used when they were removed, it should be crystal clear that, for each tag, a "clear description from the applying editor of the rationale"/"thorough note listing deficiencies or items being disputed in bulleted or numbered paragraph format under a clear notice section heading" should be made on this talk page. This has not been done.

These descriptions are essential if we are to understand and deal with these issues. If the article is unbalanced, for example, we need a clear and detailed description of how it is unbalanced, in what sections it is unbalanced, and what the correct balance ought to be. Put simply, you need to explain the problem in sufficient detail that someone else can understand it, fix it, and know that it has been fixed. Comments made so far (eg., "the article appears to lean towards pro circumcision however it may simply be my natural aversion to genital mutilation clouding my judgment.") are simply inadequate, as they are far too vague and subjective.

Since the tags were added inappropriately, without these descriptions, they currently serve no function (indeed, they are actively misleading, since they point towards a talk page section that doesn't exist) and should really be removed. However, to give Garycompugeek time to prepare the rationales, I will wait for another day. Jakew (talk) 11:51, 15 April 2008 (UTC)

Come now Jake. You have lifted my very first comment on this page. I wished to state my position and not labor under false pretenses. You on the other hand claim neutrality yet show tremendous friction towards any con stance. I did not post these banners and walk away. I have been very active and will remain so. I shall try and summarize my doubts of unbalance. Note however I am far from the only editor who shares concern. I will start a new title for the banners listing my concerns and urge other editors to do the same. Garycompugeek (talk) 13:14, 15 April 2008 (UTC)

Ok, Gary, I will look forward to your explanations.

To be fair, I could have used a more recent example. For example, when AlphaEta asked you in this section whether the tags were independent of each other, or whether they covered the same issue, you replied "The neutrality of the article is in dispute and it is considered unbalanced", which is simply a restatement of the tag itself, rather than providing information that allows anyone to evaluate the underlying issues.

As for "show tremendous friction towards any con stance", I believe that your efforts have thus far attempted to move the article away from WP:NPOV, for reasons that I've explained in detail elsewhere on this talk page, and for that reason I've largely opposed them. I'm not suggesting that you're acting in bad faith; far from it, in fact. I'm sure you're trying to fix some problem or other which you consider to be "unbalanced", but until I can understand what you're trying to do, all I can do is to evaluate the effect of your fixes as edits in their own right and, where necessary, fix those. Jakew (talk) 13:39, 15 April 2008 (UTC)

I appreciate that response Jake. Pardon the analogy but you simply cannot see the forest for the trees. I do not mean that in a belittling way but if you saw the problems you would have already have tried to solve them. Whether by design or not your edits generally represent the pro side or slanted in that direction. You may have noticed other pro editors who have been backing you up for this reason. There is nothing wrong with any of that as long as both sides are fairly represented. I am working on the banner summation and will post it when complete. Garycompugeek (talk) 17:20, 15 April 2008 (UTC)

Balance Tag

Note to editors: These are my reasons please feel free to add your on own concerns.

1. I would to flesh out the medical and sexual effect/aspects respectively. I have many peer reviewed sources that seem to be missing.
2. The US policies should include a summary from the CDC
3. Only the United Kingdom is represented for Europe a few more notable med associations from other European countries should be included ie France, Spain, Germany…am not particular about inclusion just better representation of European stance
4. China being the most populous country in the world should probably be represented. Garycompugeek (talk) 20:05, 16 April 2008 (UTC)

Thanks for posting this explanation, Gary. Some questions in response:

1. What peer-reviewed sources do you have in mind?
2. Half agree, half disagree. I have considered adding the CDC, along with the WHO, to the 'policies' section but decided against doing so for two reasons. Firstly, they are already represented elsewhere in the article, and secondly we have to be conscious of the article length (it is supposed to be written in summary style, after all).
3. To my knowledge, no English-language versions of circumcision policies are available for medical association policies representing these countries. If you've been able to find them, I'd be grateful if you can let me know where. After all, if we can't find them, we can't cite them!
4. Again, if you're aware of where Chinese medical association policies may be found, I'd be grateful if you'd share that information.

These seem to be general comments about additions that you'd like to make or see made. They don't seem to warrant the "unbalanced" tag. Do you agree that it can be removed? Jakew (talk) 20:20, 16 April 2008 (UTC)

No. I am content with the intro and allowed the neutrality tag to be removed. The medical and sexual sections are unbalenced. I will post them soon time permitting. Garycompugeek (talk) 21:32, 16 April 2008 (UTC)

Ok. Can you please post your explanation as soon as possible (say, within the next 24 hours)? The tag has been present for five days now, and you still haven't justified its presence. Jakew (talk) 21:38, 16 April 2008 (UTC)

Circumcision reduces penis length - Some of the penis length and circumference because its double-layered wrapping of loose and usually overhanging foreskin is now missing, making the circumcised penis truncated and thinner than it would have been if left intact. An Australian survey in 1995 showed circumcised men to have erect penises an average of 8mm shorter than intact men. [1. R. D. Talarico and J. E. Jasaitis, "Concealed Penis: A Complication of Neonatal Circumcision," Journal of Urology 110 (1973): 732-733. 2. Richters J, Gerofi J, Donovan B. Why do condoms break or slip off in use? An exploratory study. Int J STD AIDS. 1995; 6(1):11-8. ]

"circumcision is an iatrogenic cause in the etiology of a concealed penis" - Concealed Penis:Rare Complication of Circumcision A. Adil Esen, Güven Aslan, Hatem Kazmolu, Deniz Arslan, lhan Çelebi - Department of Urology, Dokuz Eylül University School of Medicine, Izmir, Turkey Garycompugeek (talk) 22:17, 17 April 2008 (UTC)

I have looked up "Why do condoms break or slip off in use? An exploratory study" in the Department of Public Health, University of Sydney, Australia. While circumcision is one reason given I was looking for data on penis length. I have reviewed both sources directly and see no justification of that point in those sources however we should probably include the concealed penis complication. Jake I see what you mean about left and right side websites posting their own conclusions. I shall continue researching the other sources. Garycompugeek (talk) 22:41, 17 April 2008 (UTC)

Gary, thanks for checking out the Richters et al. article. As you probably know, the International Journal of STD & AIDS' website hasn't posted articles pre-dating January 1996, so you saved me a trip to the library! Kindest regards, AlphaEta 01:26, 18 April 2008 (UTC)

The Frenar Ridged Band, the primary erogenous zone of the male body. Loss of this delicate belt of densely innervated, sexually responsive tissue reduces the fullness and intensity of sexual response. [Taylor, J. R. et al., "The Prepuce: Specialized Mucosa of the Penis and Its Loss to Circumcision," British Journal of Urology 77 (1996): 291-295.]

The Frenulum The highly erogenous V-shaped web-like tethering structure on the underside of the glans; frequently amputated along with the foreskin, or severed, either of which destroys its function and potential for pleasure. [1. Cold, C, Taylor, J, "The Prepuce," BJU International 83, Suppl. 1, (1999): 34-44. 2. Kaplan, G.W., "Complications of Circumcision," Urologic Clinics of North America 10, 1983.]

The Foreskin's 'Gliding Action' - the hallmark mechanical feature of the normal natural, intact penis. This non-abrasive gliding of the penis in and out of itself within the vagina facilitates smooth , comfortable, pleasurable intercourse for both partners. Without this gliding action, the corona of the circumcised penis can function as a oneway valve, scraping vaginal lubricants out into the drying air and making artificial lubricants essential for pleasurable intercourse. [P. M. Fleiss, MD, MPH, "The Case Against Circumcision," Mothering: The Magazine of Natural Family Living (Winter 1997): 36-45.]

Emotional Bonding Circumcision performed during infancy disrupts the bonding process between child and mother. There are indications that the innate sense of trust in intimate human contact is inhibited or lost. It can also have significant adverse effects on neurological development. Additionally, an infant's self-confidence and hardiness is diminished by forcing the newborn victim into a defensive psychological state of "learned helplessness" or "acquired passivity" to cope with the excruciating pain which he can neither fight nor flee. The trauma of this early pain lowers a circumcised boy's pain threshold below that of intact boys and girls. [1. R. Goldman, Circumcision: The Hidden Trauma (Boston: Vanguard Publications, 1997), 139-175. 2. A. Taddio et al., "Effect of Neonatal Circumcision on Pain Responses during Vaccination in Boys," Lancet 345 (1995): 291-292.]

Circumcision Removes the Most Sensitive Parts of the Penis - Sorrells, M. et al., “Fine-Touch Pressure Thresholds in the Adult Penis,” BJU International 99 (2007): 864-869.

This peer reviewed and published information needs to be incorporated into the article. Garycompugeek (talk) 22:51, 16 April 2008 (UTC)

For goodness sake, Gary, this is a blatant copyright infringement of this anti-circumcision website. Not only does it utterly fail WP:NPOV, but it is plagiarism. Jakew (talk) 22:59, 16 April 2008 (UTC)

As if I had copied them onto the article Jake. The examples were copied from the above website, in the UK, I'm sure you are familure with it. This does not invalidate the science or the sources. It also does not matter if an "anti circucision" website host the sources. I'm not proposing we quote the website just the studies. I repeat these studies need mention in the article. Garycompugeek (talk) 00:33, 17 April 2008 (UTC)

A little advice for all of us: I would suggest that all information added to this article be derived from a direct reading of the peer-reviewed studies. It would be a mistake to base new information on the editorial synopeses of pro- or anti-circumcision sites. This is the only way we can guarantee that information isn't misrepresented. Kindest regards, AlphaEta 01:21, 17 April 2008 (UTC)

Why can we not quote the sources directly? Garycompugeek (talk) 01:48, 17 April 2008 (UTC)

I don't have a problem with direct quotes from peer-reviewed sources. Is that what you meant? Maybe I misunderstood the question. AlphaEta 02:17, 17 April 2008 (UTC)

We can (and do) cite peer-reviewed sources directly. For example, we already cite Taddio (1997) in this article (ref 54). And we cite Sorrells (2007) and Taylor (1996) in sexual effects of circumcision. And we cite Kaplan in medical analysis of circumcision. All of which is perfectly appropriate. (Others are less appropriate, for example neither Fleiss' magazine article nor Goldman's book are peer-reviewed articles.)

But in each and every case we cite the article directly, and the claim we attribute to the article is based upon a careful reading of the source itself. And because we have policies such as WP:NPOV and WP:V, we must treat the material neutrally, we can't extrapolate beyond the sources, and we can't, to be blunt, invent claims out of thin air which we then attribute to sources. Jakew (talk) 10:58, 17 April 2008 (UTC)

So this Dr. Ronald Goldman who has wrote the book "The Hidden Trauma" and runs the Circumcision Resource Centert in Boston, a non profit organizaion, is not quoteable? Garycompugeek (talk) 19:07, 17 April 2008 (UTC)

See ref 49. Jakew (talk) 19:14, 17 April 2008 (UTC)

Thank you Jake. I thought I remember seeing him somewhere in the article. Ok so we do quote him but you object to quoting him from the Circumcision Resource Center because it is not peer reviewed magazine or university publication. Note that it is permissible to quote from there however if all of our sources are peer reviewed I can understand wanting to keep it that way. I am content with Goldman's ref although I may attempt to change some order or phrasing. I will attempt to locate the other above sources in likewise peer reviewed articles. I'm sure they were published somewhere. Garycompugeek (talk) 20:21, 17 April 2008 (UTC)

Tags are not weapons. No compelling rationale for the tag has been advanced, beyond an ideological opposition to circumcision itself. Please do not deface articles with spurious tags; instead work with editors to improve articles. Jayjg ^(talk) 02:08, 18 April 2008 (UTC)

I disagree. This article has multiple open disputes, especially regarding neutrality. Please do not accuse editors of bad faith without evidence beyond your personal conclusion of their ideological opposition to circumcision. Some editors here are working together in an atmosphere of civility and respect. Blackworm (talk) 03:33, 18 April 2008 (UTC)

The Tags have the same purpose they have always had. I have used them to illustrate unbalance and neutrality disputes while working with other editors here in discussion. Regardless of my personal stance I have only interest in truth and facts and have readily admitted any misconceptions I have encountered. Progress has been made in my opinion and I shall continue my endeavors. Garycompugeek (talk) 14:34, 18 April 2008 (UTC)

Choice of source in lead

As noted in the above section, the CDC and WHO make very similar statements about lack of data regarding whether circumcision is protective against HIV for either partner during anal sex with men or women. Because of this, it seems best to cite WHO for this and the preceding statement: there seems little reason to cite both, and in fact doing so adds several hundred bytes to the article length while containing the same information.

Arguments expressed in favour of using the WHO source for both include (taken from edit summaries):

• "WHO source makes the same claim as the CDC." -- AlphaEta [1]
• "no point citing two sources here when one supports both statements. happily, this also reduces the article length slightly" -- Jakew [2]

The argument expressed in favour of using separate sources was (again, taken from edit summaries):

• "I prefer a different source than WHO" -- Garycompugeek [3]
• "Reverted to AlphaEta intro edit" (technically not an argument, but included here for the sake of completeness) -- Garycompugeek [4]

Besides the personal preferences of one editor, are there any actual arguments in favour of using separate sources? Jakew (talk) 17:29, 14 April 2008 (UTC)

AlphaEta has specificly stated no side per "minor cleanup of duplicated material -NOT making an editorial decision on which reference should stand". Are you going to straw poll for every edit that doesn't support your POV? Garycompugeek (talk) 18:22, 14 April 2008 (UTC)

In general, discussion is preferable to polling, Garycompugeek. Consequently the above is an attempt to review and summarise arguments that have been made in favour of one or the other source, and to request elaboration and/or further input. Since I understood AlphaEta's edit summary (please correct me if I'm wrong, AlphaEta) to mean that (s)he did not intend the edit to be taken as an editorial decision, I did not include it. Jakew (talk) 18:50, 14 April 2008 (UTC)

As per Jake and AlphaEta, I do not see any reason to remove the WHO other than Gary's preference. While it would be wonderful to be able to accommodate each and every one of us and our preference in wikipedia, that is an impossibility, and without a valid and compelling reason to change the current consensus, it should remain as it is. -- Avi (talk) 19:18, 14 April 2008 (UTC)

Wonderful but not practical. Which is why we do things through consensus. Be Bold and make changes then come to discussion to talk about edit conflicts and differece of opinion. You and Jake have expressed yours and I have shown mine. We can be patient and see if anyone else ways in or you may revert. 3R should prevent an edit war and I will abide by consensus. Once again AlphaEta has stated no decision see please stop putting words in his/hers mouth. Garycompugeek (talk) 19:41, 14 April 2008 (UTC)

Both of the references (CDC and WHO) support the new material, so I'm not compelled to argue one way or the other. I do like the fact that including the CDC reference (in addition to the WHO ref) grants readers access to a broad spectrum of information, but it certainly isn't necessary to support the new sentence. Perhaps Gary could explain exactly why the CDC link is preferred. More importantly, does the newly added information ease concerns regarding article neutrality and balance? Previous comments seemed to indicate that the WHO findings were the primary area of contention, is this correct? Kindest regards, AlphaEta 19:47, 14 April 2008 (UTC)

I feel WHO's statement "but also stated that male circumcision only provides partial protection and should not replace other interventions to prevent the heterosexual transmission of HIV." is not equal to the CDC quote that "male circumcision may not prevent HIV transmission". The CDC quote is part of my effort to balance the article out in this section. Your help is appreciated regardless of personal feelings about this contentious issue. Garycompugeek (talk) 20:27, 14 April 2008 (UTC)

Gary, as far as I can tell, you're comparing the wrong statements. The CDC's statement is this:

• "There are as yet no convincing data to help determine whether male circumcision will have any effect on HIV risk for men who engage in anal sex with either a female or male partner, as either the insertive or receptive partner"

Which we presented as:

• Furthermore, the Centers for Disease Control and Prevention (CDC) indicates that male circumcision may not prevent HIV transmission from men to women, and data is lacking for the transmission rate of "men who engage in anal sex with either a female or male partner, as either the insertive or receptive partner."[15]

And the WHO's statement is this:

• "Clear messages should be developed to inform communities about what is known and what is not known about male circumcision, including lack of data on direct protection for women, or for either partner during anal sex with men or women."

Which we presented as:

• The WHO also indicates that male circumcision may not prevent HIV transmission from men to women, and data is lacking for the transmission rate "for either partner during anal sex with men or women."[14]

Jakew (talk) 20:39, 14 April 2008 (UTC)

Negative Jake. I meant exactly what I said with quotes directly from the article. While both sources cover the same topic the CDC's has more weight and clarity. If you feel they are the same why not compromise with me and drop the WHO source? I have no problem keeping them both as one currently one backs up the other and gives the reader another valuable source. Garycompugeek (talk) 20:54, 14 April 2008 (UTC)

Gary, you're comparing part of the second sentence in one version with part of the first sentence in both versions. Yet the two versions only differ in the second sentence. To show you what I mean, here are longer extracts from the two versions:

• (CDC version) In March 2007 the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) stated that male circumcision is an effective intervention for HIV prevention, but also stated that male circumcision only provides partial protection and should not replace other interventions to prevent the heterosexual transmission of HIV.[14] Furthermore, the Centers for Disease Control and Prevention (CDC) indicates that male circumcision may not prevent HIV transmission from men to women, and data is lacking for the transmission rate of "men who engage in anal sex with either a female or male partner, as either the insertive or receptive partner."[15]
• (WHO version) In March 2007 the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) stated that male circumcision is an effective intervention for HIV prevention, but also stated that male circumcision only provides partial protection and should not replace other interventions to prevent the heterosexual transmission of HIV.[14] The WHO also indicates that male circumcision may not prevent HIV transmission from men to women, and data is lacking for the transmission rate "for either partner during anal sex with men or women."[14]

I've put "also stated" in bold to clearly show that it is present in both versions. The following sentence is what differs between the two versions.

As for dropping the WHO source, I think that would be a mistake, because the present version is potentially confusing. To illustrate why, consider the following scenario:

• Bob thinks that circumcision is a terrible thing, but he thinks that there may be a reduction in urinary tract infection rates.
• Alice thinks that circumcision is a terrible thing, but he thinks that there may be a reduction in urinary tract infection rates.

Now, suppose we said "Bob thinks that circumcision is a terrible thing. Alice thinks that there may be a reduction in urinary tract infection rates." It's technically true, but does it represent the sources fairly? I think not: it creates the impression that Bob is opposed to circumcision, while Alice is in favour of it. In fact, both have very similar positions.

There's a similar situation in this case. The CDC introduce their document by stating that "Several types of research have documented that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex", and the WHO "recommended that male circumcision now be recognized as an additional important intervention to reduce the risk of heterosexually acquired HIV infection in men". But both express caveats, and indicate that there are certain types of transmission in which it may not be protective.

But the problem is, if we quote the WHO's recommendation and the CDC's caveat, we create the illusion that the two are in disagreement. To avoid creating that misconception, we should either a) quote the WHO for both the recommendation and caveat (thus representing the caveat as what it is: a part of a larger whole), or b) quote the WHO's recommendation and caveat, in addition to the CDC's overview and caveat. Since that would involve a large amount of repetition, though, it seems best to just quote the WHO. Jakew (talk) 21:14, 14 April 2008 (UTC)

Oh, one addition: I think we can cite the CDC elsewhere in the article. The reader can benefit from this additional source wherever it is cited; it doesn't have to be in the lead. Jakew (talk) 21:26, 14 April 2008 (UTC)

Corroboration from another source does not imply ambiguities. Garycompugeek (talk) 22:35, 14 April 2008 (UTC)

I'm sure that's true, but I don't understand what relevance it has to the present discussion. Jakew (talk) 22:44, 14 April 2008 (UTC)

I made a few additions to the intro, resulting in the following paragraph:

In March 2007, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) stated that male circumcision is an effective intervention for HIV prevention, but also noted that male circumcision only provides partial protection and should not replace other interventions to prevent the heterosexual transmission of HIV.[14] Furthermore, while the WHO and the Centers for Disease Control and Prevention (CDC) acknowledge that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, both indicate that it may not prevent HIV transmission from men to women, and that data is lacking for the transmission rate of "men who engage in anal sex with either a female or male partner, as either the insertive or receptive partner."[14][15]

Rationale: Gary's primary concern was an overreliance on the WHO meta-analysis and a possible overstatement of the benefits of circumcision on HIV transmission. He also felt we should include a citation to the CDC's interpretation of these findings. A sentence was formulated to address the lack of data for penile to vaginal and penile to anal/anal to penile transmission of HIV in circumcised men. Jake felt that the new sentence did not accurately reflect the level of agreement between these two health organizations. More specifically, the paragraph may be misconstrued to indicate that the CDC and WHO positions are actually at odds with one another. After reading his argument, I agree, and to alleviate this concern I've added extra information to hint at the robust agreement between these two organizations while also accurately and honestly demonstrating the weak points of the meta-analysis. AlphaEta 01:44, 15 April 2008 (UTC)

Well done. Garycompugeek (talk) 02:03, 15 April 2008 (UTC)

So previous to this, we had only about 30% of the lead being about how great the WHO and other advocates think circumcision is for HIV prevention. Now, it's about 50%. The lead is now even more unbalanced than it already was. Male circumcision is not all about being awesome and great and how the WHO loves it, even if that's mostly what it is to the editors here. That part of male circumcision was already overrepresented in the lead, and now it's just ludicrous. Blackworm (talk) 02:11, 15 April 2008 (UTC)

The material was greatly expanded to address previous concerns about balance. If you think it should move from the lead to the body, I won't object. In fact, I'll be bold and give it a shot. Or we can just complain about it, but I doubt that will be too fruitful. Regards, AlphaEta 03:49, 15 April 2008 (UTC)

My being bold hasn't historically been appreciated. When I suddenly see six editors, including admins, some with previous connections, come in here, throw up a neutrality banner, then proceed to edit such that the material is more unbalanced, I tend to be a bit too intimidated to be bold. Or perhaps I'm frozen in confusion. I support your edit, even if overall it gives even more weight to the idea the circumcision "prevents" HIV (by repeating the claim). Here, I'll be bold, too. Blackworm (talk) 06:57, 15 April 2008 (UTC)

The word "acknowledged" seemed like we were stating a truth (i.e., who were they acknowledging it to?). I edited it. Blackworm (talk) 07:31, 15 April 2008 (UTC)

I goofed on the edit summary, it should read that it HAS become highly detailed.... Sorry for the confusion. AlphaEta 03:55, 15 April 2008 (UTC)

While it is not how I would have done it, I also must compromise. AlphaEta has demonstrated just balancing of given data. The addition of the CDC article illustrates more doubt. It's true it corroborates lower HIV infection with circumcision, it also negates those findings lacking data to speculate. It also brings up an important point of geography linking the majority of Americans already circumcised. Continue to provide sources. Your help is appreciated. Garycompugeek (talk) 02:35, 15 April 2008 (UTC)

I would assume any attempt to bring more sources would result in more objections of undue weight or questionable editorial judgments citing WP:SUMMARY. Modus operandi around here. Stick around, your help is appreciated. Have you stopped arguing for the inclusion of the sourced material you brought to this article and which has been reverted? Blackworm (talk) 02:44, 15 April 2008 (UTC)

No I have not. I ran out of reverts at the time and have been researching the matter. Third parties may be quoted as long as they use valid peer reviewed sources and you broke down the source well. Garycompugeek (talk) 03:40, 15 April 2008 (UTC)

(unindenting) I think that if the paragraph is considered in isolation, these are excellent edits. However, we seem to have forgotten what the paragraph is for. I'm now very concerned, because the lead no longer contains any reference to the WHO recommendations. Yet these should be included in the lead, because they "summarize the most important points, [and] explain why the subject is interesting or notable". So either a) we need to write a new paragraph for the lead, or b) we need to move the paragraph back to where it was. I understand and agree with concerns about the length of the paragraph, and for this reason I would suggest that we use something similar to the "WHO version" quoted above, which a) addresses Gary's concern about balance, and yet b) doesn't imply disagreement between the WHO and CDC. Jakew (talk) 11:23, 15 April 2008 (UTC) (edited 12:33, 15 April 2008 (UTC))

Arbitrary section break

Thinking about this some more, I may have a possible alternative for use in the lead (I'm quite happy with the full paragraph in the body of the article):

• The World Health Organisation (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the Centers for Disease Control and Prevention (CDC) state that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, but indicate that it may not prevent HIV transmission from men to women, and that data is lacking for the transmission rate of men who engage in anal sex with either a female or male partner, as either the insertive or receptive partner.[ref][ref]

My rationale is as follows. I have identified the following constraints on the wording:

1. Blackworm has expressed concern about the amount of content dedicated to the HIV issue, and indicated that fewer words would be preferable.
2. Gary has expressed a desire to cite both the CDC and WHO, and has also expressed the view that the second sentence is a stronger caveat than the "but also stated" part of the first.
3. I have expressed the view that we need to accurately reflect the level of agreement between the respective health organisations.

Meeting these requirements simultaneously is a challenge, to say the least. Adding the CDC as a source requires at least seven additional words for attribution alone, which of course conflicts with the first constraint. At first I thought of deleting the second part of the first sentence ("but also noted...). Then, it occurred to me that with a little restructuring we can actually delete the entire first sentence. As a result, we a) reduce the word count, b) cite both the CDC and WHO in the intro, and c) avoid creating the impression that the CDC and WHO are at odds with each other.

So, any thoughts? Jakew (talk) 15:31, 15 April 2008 (UTC)

My concern is that instead of providing a general overview of the article, we may be trying to add too much detail to the lead. The question then becomes, if the material is detailed in the body, should we simply re-work the existing sentence to become an accurate and inclusive summary? I agree that the WHO finding is one of the more important aspects of this article. Can it be integrated into the existing sentence as follows?

• Opponents of non-medical circumcision condemn infant circumcision as being medically unjustified, an infringement upon individual bodily rights, and a cause of sexual impairment,[9] while advocates of circumcision regard it as a worthwhile public health measure,[10] particularly in light of the WHO's meta-anlysis and recommendation that it should be recognized as an effective intervention for heterosexually acquired HIV infection in men.[WHO ref]

Specific implications for sub-Saharan Africa (... be used to control HIV transmission in Sub-Saharan Africa.[11][12][13]) can be moved to the relevant paragraph in the body, as the WHO recommendation does not limit itself to this geographic area. Regards, AlphaEta 16:38, 15 April 2008 (UTC)

I have a few reservations, but I think I'm happy to go along with that suggestion with one change: change "...WHO's meta-anlysis and recommendation..." to simply "...WHO's recommendation...". The reason is simple: WHO did not perform a meta-analysis (in the conventional sense), but simply reviewed the available evidence (the first - and, to date, only - published meta-analysis of the HIV RCTs was published somewhat later, in PMID 18316997). Jakew (talk) 16:51, 15 April 2008 (UTC)

What part of the opponents' position are we going to focus on, with a phrase like "particularly in light of ..." ? Blackworm (talk) 17:02, 15 April 2008 (UTC)

Are we trying to turn the lead into something it isn't? The current sentence reveals that there is opposition to and support for non-therapeutic and infant circumcision. As far as I'm concerned, pointing out that a debate exists should suffice. However, the sentence also includes some of the arguments used by each side to support their positions. It is not meant to serve as an in-depth analysis of the strenths and weakenesses of each and every argument. The main text is a more appropriate place to conduct such comprehensive analyses. Thanks, AlphaEta 18:56, 15 April 2008 (UTC)

There is no argument presented in support of the anti-circumcision position in the lead. By using a phrase like "particularly in light of," we are making an argument for circumcision in the lead. I suggest we add, particularly in light of state-sponsored mass circumcision programs described as "nominally voluntary" by the BBC.[5] Blackworm (talk) 19:02, 15 April 2008 (UTC)

We're not making an argument for circumcision, just documenting an argument that has been made (eg., "The preventive effect of circumcision against HIV has now officially been accepted by the World Health Organization, the United Nations, and the National Institutes of Health, and some African countries have begun adult circumcision as a public health measure." Schoen EJ. Should newborns be circumcised? Yes. Can Fam Physician. 2008 Jan;54(1):22.). But more importantly this change is an attempt to incorporate the WHO's recommendation into the introduction while, at the same time, addressing your earlier concern about the word count. The result is that we discuss three claims made by anti-circumcision advocates ("medically unjustified, an infringement upon individual bodily rights, and a cause of sexual impairment") and one (albeit more detailed) argument made by pro-circumcision advocates ("worthwhile public health measure, particularly in light of..."). Jakew (talk) 19:31, 15 April 2008 (UTC)

The HIV transmission issue is an integral part of the pro-circumcision position, as evidenced by the link you provided. The circumcision campaign in Rwanda isn't a response to random "public health" concerns, it is specifically a response to the WHO's position. That's why I felt it deserved mention. Of course, there's a good chance I'm wrong, so any serious suggestions are greatly appreciated. AlphaEta 19:34, 15 April 2008 (UTC)

If there is significant objection to the current entry, here's a possible alternative:

• Opponents of non-medical circumcision condemn infant circumcision as being medically unjustified, an infringement upon individual bodily rights, and a cause of sexual impairment,[9] while advocates of circumcision regard it as a worthwhile public health measure,[10] particularly in the control of HIV transmission.[WHO ref]

Thoughts? AlphaEta 19:51, 15 April 2008 (UTC)

The current article state "Opponents of non-medical circumcision condemn infant circumcision as being medically unjustified, an infringement upon individual bodily rights, and a cause of sexual impairment,[9] while advocates of circumcision regard it as a worthwhile public health measure,[10] particularly in light of the WHO's recommendation that it should be recognized as an effective intervention for heterosexually acquired HIV infection in men.[11]" kind of brings us back to where we were originally. While things are a bit more condensed I dislike the WHO reference without a rebuttal. I have studied much of the testing and admit the findings show circumcision reduces risk because the skin is not as soft and susceptible as an uncircumcised penis however it does not prevent, it simply lowers the risk of acquiring. If I was circumcised I would not feel safe having sex with an HIV person without a condom (not sure I would even do that). We must not mislead the reader that circumcision prevents HIV transmission or that condoms or other contraceptives are not a better alternative. Garycompugeek (talk) 20:00, 15 April 2008 (UTC)

(edit conflict; this is in reply to AlphaEta) Problematic, I think, for several reasons. Firstly, I think we need to name the WHO, so that the reader can decide how much credibility to give to their position. Secondly, I'm not comfortable with describing the WHO as an "advocate of circumcision", and I think it's inappropriate and disrespectful to describe them as such. Thirdly, I think it presents a distorted picture of the debate to compare, on one hand, individual authors with anti-circumcision views, and on the other hand, the World Health Organisation. Jakew (talk) 20:04, 15 April 2008 (UTC)

(Outdent.) Jakew writes, We're not making an argument for circumcision, just documenting an argument that has been made... I think that's debatable, but it's moot; the point I was trying to make is that in the opposing case, we are not even documenting any arguments made. We only document the opposition, and present vague grounds (i.e. conclusions) of the opposition without presenting any of their arguments. In the supporting case, we also present conclusions ("public health measure"), but we additionally present facts to support the position (i.e. the WHO's position). Thus we actually present the argument. I much prefer (and support) AlphaEta's above version, which avoids presenting the argument.

I don't believe describing the WHO as an advocate of circumcision is inappropriate nor disrespectful. They clearly advocate not only male circumcision, but mass male circumcision to the extent that state-sponsored programs citing the WHO are now circumcising their males on a "nominally voluntary" basis. I'm not alone in thinking so: WHO and UNAIDS Advocate Circumcision to Fight HIV Infection By Jon Cohen ScienceNOW Daily News 28 March 2007.[6][7] Blackworm (talk) 20:29, 15 April 2008 (UTC)

After reading Blackworm's prior analysis, I understand the point that the current construct supports the pro- position (i.e. public health) with an argument (the WHO's recommendation). The con- position simply notes their views, but does not qualify them with supporting arguments/recommendations. In other words, we bolster the pro- position with the WHO recommendation, but we simply list the con- arguments. If necessary, we can re-word the sentence so as not to mis-represent the WHO's position (by asociation with the citation). AlphaEta 20:39, 15 April 2008 (UTC)

(edit conflict) I don't dispute that since March 2007 they advocate circumcision, Blackworm. After all, their role is to evaluate evidence and recommend accordingly. The problem is that the WHO are no more "advocates of circumcision" than they are "Mycobacterium tuberculosis opponents" or "advocates of clean water", and describing them as any of these presents them solely in terms of their position on a single issue. Compare "WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends." and "WHO is an advocate of circumcision." Don't you see a slight problem?

Since there seems to be some opposition to the present version, which seem to stem from using a single paragraph to express both the controversy and the WHO's views, can I request comments on my alternative suggestion above (dated 15:31, 15 April 2008)? Jakew (talk) 20:46, 15 April 2008 (UTC)

No, Jake, I don't see a problem. Obviously the WHO's position on circumcision is what's relevant here, not the fact that they describe themselves as "responsible for providing leadership..." or the other things you mention. We're not defining the WHO here, we're stating the views of circumcision advocates; and the WHO is among the most prevalent, influential, powerful and outspoken advocates, along with certain organized religions.

To be honest I don't fully understand your suggestion -- you state we can remove the first sentence, but as far as I can tell the paragraph is composed of only one sentence. What sentence are you referring to? Blackworm (talk) 21:04, 15 April 2008 (UTC)

And by the way, Jake, I question your writing, I don't dispute that since March 2007 they advocate circumcision, Blackworm. After all, their role is to evaluate evidence and recommend accordingly. What is the purpose of writing that if not to state your personal view that circumcision advocacy is grounded in a sound evaluation of all evidence? Blackworm (talk) 21:29, 15 April 2008 (UTC)

(edit conflict) Blackworm, there is a difference between "WHO advocates circumcision" and "WHO is an advocate of circumcision" (or, similarly, citing WHO as an example of "advocates of circumcision"). The former describes an act or stance, whereas the other characterises the source itself as an advocate (with connotations of possible bias).

As for my suggestion, I proposed to remove the reference to the WHO from the paragraph we're currently discussing, and instead treat the controversy and the WHO recommendations separately, as before, with a following paragraph reading: "The World Health Organisation (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the Centers for Disease Control and Prevention (CDC) state that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, but indicate that it may not prevent HIV transmission from men to women, and that data is lacking for the transmission rate of men who engage in anal sex with either a female or male partner, as either the insertive or receptive partner.[ref][ref]" Jakew (talk) 21:43, 15 April 2008 (UTC)

Sorry, Jake, I don't see a difference. One who advocates/opposes X is an advocate/opponent of X. If calling someone who advocates circumcision "an advocate" has an improper connotation of possible bias, then so does calling one who opposes circumcision "an opponent" (as we have in the lead, currently, with apparently no objection from anyone).

Your proposed edit appears to misrepresent the CDC's position. Nowhere do they state that circumcision reduces the risk; they state that several types of research document that circumcision reduces the risk. The former is a statement of belief in the view, the latter is a statement that research espousing the view exists. Clearly the UN agencies (WHO/UNAIDS) you mention have that view, but it's not clear that the CDC does. Blackworm (talk) 22:01, 15 April 2008 (UTC)

I oppose this edit, which again makes the focus of the lead section the UN agencies' reasoning for their advocacy of circumcision, and subtly interprets the CDC's position as concurring with the UN ("evidence indicates"). All this, while neglecting mention of the CDC's caveats in extrapolating the data obtained in Sub-Saharan Africa to other parts of the world, neglect of mention of any criticism of the view, as well neglect of mention of the "nominally voluntary" mass male circumcision programs underway in Africa that the's WHO's promotion of this view has apparently caused. Blackworm (talk) 23:37, 15 April 2008 (UTC)

Re this sentence proposed by Jakew: "The World Health Organisation (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the Centers for Disease Control and Prevention (CDC) state that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, but indicate that it may not prevent HIV transmission from men to women, and that data is lacking for the transmission rate of men who engage in anal sex with either a female or male partner, as either the insertive or receptive partner." I think this is a little too detailed for the lead: I see the reader's eyes starting to glaze over. Also, the last part seems unnecessary to me. How about just "The World Health Organisation (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the Centers for Disease Control and Prevention (CDC) state that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex". It really means the same thing as the whole sentence, IMO. The word "specifically" could be inserted before "by men" to try to emphasize the limitations, thus performing a similar role as the deleted last part of the sentence. I agree with Blackworm that there shouldn't be too large an amount of space taken up in the lead with the HIV stuff. By the way, Jakew, I like your Bob and Alice point. ☺Coppertwig (talk) 00:54, 16 April 2008 (UTC)

I agree with Coppertwig. Perhaps we are trying to pack the lead with too many details, modifiers and qualifiers. A brief sentence in the introduction noting the effect of circumcision on HIV transmission, as drafted by coppertwig, should suffice. Furthermore, it will direct readers to the relevant, highly-detailed section in the body of the article. AlphaEta 01:29, 16 April 2008 (UTC)

(Edit conflict.) I support a shorter summary in the lead along the lines of what Coppertwig suggests. However, Jakew's "Bob and Alice" analogy fails to note the difference between what the two sources say. Bob and Alice say identical things. The CDC and WHO do not. I've seen no evidence to show that the CDC state that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex -- the CDC source brought indicates that they believe several types of research have documented such a conclusion. These two ideas cannot be considered equivalent. It is apparent from the CDC's subsequent detailed recounting of the studies undertaken and the conclusions drawn, and their caveats regarding universal extrapolation of these conclusions, that they are silent in that source on the WHO's position (which apparently embraces this extrapolation). To present these two sources as one, unified statement implies a unity between the sources that is the product of careless editorial judgement, and not a demonstrated real-world agreement or joint statement. In short, in my opinion, it fails WP:OR. Can I suggest, The World Health Organisation (WHO), other UN agencies, and the Centers for Disease Control and Prevention (CDC) (U.S.) note research concluding that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex. (I'm not rigid about removing UNAIDS although frankly if we were to list every agency of the UN every time they say the same thing (which seems to be all the time), that seems like a case of undue weight through repetition.) Blackworm (talk) 01:37, 16 April 2008 (UTC)

I also agree with Coppertwig. Unless anyone can think of a better suggestion, I think we should stick with this. Jakew (talk) 10:54, 16 April 2008 (UTC)

I'm not sure about your point, Blackworm. The CDC statement says "Several types of research have documented that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex." and "After adjustment for confounding factors in the population-based studies, the relative risk for HIV infection was 44% lower in circumcised men. " These sound to me to be stating that there is such a risk reduction, although I acknowledge some ambiguity in that regard. Your wording also seems accurate and I would accept it. I would avoid having two parentheses in a row either by using a semicolon "(CDC; U.S.)" or by putting "(U.S.)" before "Centers for Disease Control". ☺Coppertwig (talk) 12:18, 16 April 2008 (UTC)

"Note research concluding that" is a little too weak to be a fair representation of any of these organisations: none are merely noting - all three are taking action as a result, whether "consult[ing] with external experts in April 2007 to receive input on the potential value, risks, and feasibility of circumcision as an HIV prevention intervention in the United States and to discuss considerations for the possible development of guidelines" (CDC) or actively recommending in the case of WHO and UNAIDS). I think that the present wording is fine, but I've no objection to changing it to "state that evidence indicates that". Jakew (talk) 13:34, 16 April 2008 (UTC)

I'm afraid I stand by my objection. Not to be difficult, but none of the other quotes brought verify that the CDC state that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex. The two CDC quotes Coppertwig brings could be copied verbatim right into Wikipedia without attribution to the CDC, they are so neutral and verified (the first references research, the second refers to one study). The quotes Jakew brings show that there is interest in further study; that is clearly far from stating that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, on the contrary it could be taken as evidence of the CDC exercising caution in reaching that seemingly bold conclusion. Far from a call to action (I don't see the CDC calling for mass male circumcision, for example), it's a call for consultation. To lump the CDC in with the WHO (who do call for mass male circumcision) in that view is not verified, and thus seems unacceptable. Blackworm (talk) 06:31, 17 April 2008 (UTC)

Upon reflection, I think Jakew's suggestion ("state that evidence indicates that") is close enough to the source that I can abide by it. It's certainly an improvement. I still think it goes further than the source by implying that the CDC hold the view, and cannot understand both your objections to this criticism. Blackworm (talk) 18:26, 24 April 2008 (UTC)

I feel this is important and should be worked into the end of the paragraph... "3) confers only partial protection and should be considered only in conjunction with other proven prevention measures (abstinence, mutual monogamy, reduced number of sex partners, and correct and consistent condom use)." number three of the CDC's closing summary. Garycompugeek (talk) 16:49, 16 April 2008 (UTC)

You mean something like "but also stated that male circumcision only provides partial protection and should not replace other interventions to prevent the heterosexual transmission of HIV"? Jakew (talk) 16:52, 16 April 2008 (UTC)

Yes... See last edit to article. Garycompugeek (talk) 18:10, 16 April 2008 (UTC)

Prevalence info in lead

Jakew, you recently edited the paragraph, in the lead, about the global prevalence of circumcision. I believe your edit has now removed the information I included in order to try to avoid the problems associated with the imprecision of the term common. We are now left with the unqualified relative phrases "most common" and "less common" to contrast different prevalences of circumcision in selected countries. Unfortunately, "less common" is very ambiguous. For example, let us consider a hypothetical world made up of just six countries: a, b, c and x, y, z. If the prevalence of circumcision is 90% in countries a, b and c, and the prevalence is 89% in countries x, y and z, it is logically correct to state that circumcision is most common in a, b and c and less common in x, y and z (if we can agree that 90% equates to common that is). However, if the prevalence in a, b and c is >80% and the prevalence in x, y and z is <20%, then I believe that simply stating that circumcision is most common in a, b and c and less common in x, y and z, whilst logically correct, is extremely imprecise, perhaps even to a misleading and unencyclopaedic extent: it effectively conceals that fact that a large majority prevalence is being contrasted with a small minority prevalence. And where imprecision leads to such a high degree of interpretability, and the cost of greater precision is just a couple of sets of parantheses, four digits, six words, and two percentage symbols, perhaps greater precision should win the day. I suggest that this:

Circumcision is most common (greater than 80% prevalence) in the Middle East, the USA and parts of Africa and Asia. It is uncommon (less than 20% prevalence) in Central and South America, India, China, some southern African states, New Zealand, and most of Europe.

is more encyclopaedic (and therefore preferable) to this:

Circumcision is most common in the Middle East, the USA and parts of Africa and Asia, and less common in Central and South America, China, and much of Europe

What do you think? Beejaypii (talk) 20:31, 16 April 2008 (UTC)

Hi Beejaypii,

I tried to retain your addition of "uncommon", while addressing a serious problem. By saying "circumcision is most common (greater than 80% prevalence) in..." or "is uncommon (less than 20% prevalence) in...", we are implying that what follows is an exhaustive list. Not only is an exhaustive list inappropriate for the lead, containing too much detail, but the above may well omit countries that should be in either category but aren't.

If you're concerned about "less common", then please suggest some other alternatives. Jakew (talk) 20:43, 16 April 2008 (UTC)

Ok Jakew, I see your point. How about this:

The prevalence of circumcision varies across the globe. For example, it is greater than 80% in the Middle East, the USA and parts of Africa and Asia, whilst it is less than 20% in Central and South America, China, parts of southern Africa, and most of Europe (these lists are not exhaustive). According to the World Health Organization (WHO), global estimates suggest that 30% of males have been circumcised.[8]

What do you think? Beejaypii (talk) 22:35, 16 April 2008 (UTC)

If you say "for example", then I think it's unnecessary to also say "these lists are not exhaustive", and I would mildly prefer leaving it out for brevity. ☺Coppertwig (talk) 22:43, 16 April 2008 (UTC)

(edit conflict) Much better. I suggest three small changes (deletions struck out):

• The prevalence of circumcision varies across the globe. For example, it is greater than 80% in the Middle East, the USA and parts of Africa and Asia, whilst it is less than 20% in Central and South America, China, parts of southern Africa, and mostmuch of Europe (these lists are not exhaustive). According to the World Health Organization (WHO), global estimates suggest that 30% of males have been circumcised.[8]

My rationale: Firstly, "much" is somewhat better, and "most" may even be inaccurate, depending on whether we're talking about number of countries, land area, total population, and indeed what definition of Europe one uses (for example, if one includes Turkey and the Muslim states in Eastern Europe). Hence "most", to my mind, raises more questions than it answers, and is a little WP:ORish, too. Secondly, I think that the parenthetical comment is redundant, since the sentence begins with "for example" which, to my mind, makes it clear that these are just examples. Finally, since these are examples, it makes sense to give the same number of examples (4) of each. Jakew (talk) 22:47, 16 April 2008 (UTC)

I believe that it is most accurate to state that circumcision is not usual in most of Europe. This is true of Northern and Western Europe and also Russia, where circumcision is largely confined to the Muslim and Jewish minorities. In the Balkans, circumcision is again largely confined to Muslim and Jews and not to the other religious groups. My understanding is that Muslims are in a majority in Albania, Bosnia and around Kosova. Turkey is overwhelmingly in Asia Minor but even including European Turkey, most of Europe is not predominantly Muslim or Jewish. Michael Glass (talk) 23:05, 16 April 2008 (UTC)

Jakew and Coppertwig, I too had my doubts about the parenthetical comment. The second and third opinions you've offered have convinced me it should be removed. However, with a nod to the comments of Michael, and looking at the map in the WHO information package referenced by the paragraph, I don't think the phrase "much of Europe" is adequate. I suggest the following version:

The prevalence of circumcision varies across the globe. For example, it is greater than 80% in the Middle East, the USA and parts of Africa and Asia, whilst it is less than 20% in Central and South America, China, and most of the countries of Europe. According to the World Health Organization (WHO), global estimates suggest that 30% of males have been circumcised.[8]

How's that? Beejaypii (talk) 23:19, 16 April 2008 (UTC)

Good, Beejaypii. How about "most European countries"?

Isn't it misleading to say that the prevalence of circumcision is greater than 80% in the U.S.? Perhaps over 80% of males are currently circumcised, but I think the rate of circumcisions of newborns is lower than 80%. (Not sure.) "prevalence of circumcision" could be understood as meaning "prevalence of the custom of circumcision", in other words, that over 80% of newborns are regularly circumcised. I'm not keen on the word "prevalence", anyway -- makes it sound as if circumcision is superior or something. How about "The percentage of males who have been circumcised varies across the globe. ..."

Quoted from manual of style: "In American English, U.S. is the standard abbreviation for United States; US is becoming more common and is standard in other national forms of English. ... When the United States is mentioned along with one or more other countries in the same sentence, U.S. or US can be too informal, and many editors avoid it especially at first mention of the country (France and the United States, not France and the U.S.). ... U.S.A. and USA are not used unless quoted or as part of a proper name (Team USA)." Therefore it should be probably "United States" and otherwise "U.S." or perhaps "US", not "USA". (What spelling convention is used in this article?) ☺Coppertwig (talk) 01:43, 17 April 2008 (UTC)

Looking at the cited source, it does actually say "prevalence" in the title, so I don't think that's a problem. However, the US is categorised as "20-80%", not >80%. (Another problem caused by introducing such specific language - when I expressed concern about omitting countries that should be in either category but aren't, I completely forgot about the risk of including countries in either category but shouldn't be!)

I think that "most European countries" suffers from the same problems as "most of Europe". There would be a similar problem in saying ">80% in most of Africa" - it may well be true, but it might not be, depending on definitions, and in any event we'd need to cite a reliable source to avoid original research. Jakew (talk) 15:10, 17 April 2008 (UTC)

Jakew, you are are correct: the US is incorrectly categorised in the way you describe. I'm afraid this was simple human error on my part.

Would you mind providing an example of a definition of the phrase "most European countries" which would cause the statement "The prevalence of circumcision ... is less than 20% ... in most European countries" to be untrue in relation to the map provided in the cited source? And is it really original research to observe said map, see that most of the European countries are coloured yellow (which is the colour used to indicate "< 20% prevalence" according to the map legend) and deduce that the prevalence of circumcision is less than 20% in most European countries? Isn't that an "obvious deduction" (wp:notor)? Beejaypii (talk) 07:59, 18 April 2008 (UTC)

Beejaypii, I recognise that this was a simple human error on your part, and I don't blame you for it, but wouldn't you agree that it illustrates rather nicely why we need to rely upon the analyses of reliable sources, especially for more complex claims such as "most" (ie., >50%) of a geographical area with more than one definition? Jakew (talk) 11:18, 18 April 2008 (UTC)

Global prevalence should be stated before individual regions. This paragraph is disputed owing to the fact that the WHO estimate of 30% is among the highest quoted in reliable sources, which present a range of one-sixth (16%) to one third (33%). These truths are in the prevalence of circumcision article, but Jakew has incomprehensibly refused to allow the one-sixth figure to appear in any form in the circumcision article lead section. Now, it seems we are stating more WHO estimates as fact without attribution to the WHO, with odd, potentially misleading prose apparently extrapolated from a WHO prevalence map, where the lowest prevalence category is "less than 20 percent." If I said "less than 20 percent of planet Mars is composed of water," that may be technically true, but it is misleading in that it implies that the percentage is somewhere close to 20%, not 0.0% as the case may be. Similarly, stating that the prevalence of circumcision is "less than 20%" in China or other areas has the same problems. Rather than base our detailed prose on such vague estimates, we should present the ranges of global prevalence estimates, and keep estimates about regional prevalence attributed and with a similar level of vagueness ("common," "less common," "more common") as the sources. Blackworm (talk) 19:09, 17 April 2008 (UTC)

Consent and the Levinson article

At present, the part of the Consent section reads as follows:

In a cultural or religious context, Levenson argues that circumcision is of significant enough importance that parental consent is sufficient and that any possible misgivings surrounding the issue of consent are not significant enough to limit the exercise of infant/childhood circumcision. [8].

The Levinson article is a significant discussion of circumcision from a Jewish perspective which ridicules the idea that the only one to consent to circumcision is an adult. It says:

The only persons who may consent to medically unnecessary procedures upon themselves are the individuals who have reached the age of consent," goes the Declaration of the First International Symposium on Circumcision--is like saying that he will at the same point decide what his mother tongue will be."[9].

I have no objection to Levinson's article being linked to the Circumcision article but this does not amount to the detailed argument in favour of parental consent that is attributed to him. Therefore the argument wrongly attributed to Levinson should be removed from the article forthwith. Michael Glass (talk) 12:46, 22 April 2008 (UTC)

I agree that the attribution is incorrect, Michael, but I suspect that it ought to be attributed to Adrian M Viens (Value judgment, harm, and religious liberty. J Med Ethics 2004;30:241-247)

To quote:

• What anticircumcision proponents maintain is that parents are unjustified in believing their child would also maintain their religious values. It is argued that because we do not know if a child will decide to become a follower of their parents’ religion, it would be better if circumcision decisions were delayed until adulthood, so that if an individual wants to remain a member of the religious community and his uncircumcised status was a barrier to religious marriage or burial, he could consent to the procedure as an adult. The problem is that such decisions are not seen to be able to be delayed until this time—the religious significance of the procedure is to be done in childhood. ... Anticircumcision proponents argue that in as much as it is important for parents to be accorded religious liberty (that is, the freedom to appeal to religious principles to guide their moral choices), concomitantly, it is just as important for the child to be accorded religious liberty (the freedom to choose whether he wants to join his parent’s religion, another religion, or no religion at all). It is maintained that people are not born with a particular set of religious beliefs and it is not a child’s choice to be brought up under certain religious traditions or customs. A valid point; however it would be untenable in practice not to make decisions for children because they may have chosen differently. Infants and children cannot make decisions for themselves, and parents have a duty to make decisions on behalf of their child concerning their wellbeing, such as religious upbringing, choice of schooling, immunisation, living environment, dietary requirements, insurance and investments for the child, and so on. Parents need to have the freedom to make decisions for their children based on what they view as best, on the balance of benefits and risks. ... As it presently stands, there is an absence of sufficient evidence or persuasive argumentation to warrant changing the current policy—that parents should have the freedom to make an informed and well deliberated choice concerning whether the procedure is in their son’s interest.

Jakew (talk) 13:27, 22 April 2008 (UTC)

WP:SOAP. Odd, however, that the "Declaration of the First International Symposium on Circumcision" isn't mentioned in the article. Perhaps if it took a more positive spin, it would be. Blackworm (talk) 14:26, 22 April 2008 (UTC)

Banning Jakew from editing this page any longer

Folks, while I think Jake must be a fine and upstanding gentlemen, it seems to me that if his contributions to this article were to be considered as a whole, it would become pretty clear that, no matter how much he may protest, he is pushing an agenda. He tirelessly monitors this specific article, so much so that he has a barnstar awarded for it and now has taken to posting missives in support of one viewpoint.

While his enthusiasm is certainly there, I would argue that it has taken on an oppressive quality over the years: smacking down and/or ruthlessly engaging anyone who dares to contribute in a way he does not consider within the guidlelines. And while he may argue that he is within the letter of the guidelines, I think he's missing the overall rationale and has fallen pretty clearly outside anything reasonable.

Again, this is only my opinion, but I think it's now past the point of common sense and wonder if anyone here agrees with me? Jake, would you consider holding off on touching this page for some period like 30 or 60 days - just to see what might flourish? Lexlex (talk) 04:30, 24 April 2008 (UTC)

Not going to happen, especially since this bizarre edit of yours will be pounced upon as clear evidence of your lack of good judgment. If anything your post above distracts from the real issues, and by association diminishes the arguments of those who may indeed believe this article is unbalanced toward one viewpoint, or that Jakew and his longtime supporters here have in fact displayed a disregard for neutrality and a disregard for any editor who would bring to light any sourced material critical of circumcision. Blackworm (talk) 04:53, 24 April 2008 (UTC)

Really? That's a rather agressive response. Wow. A one time attempt at semantic consistency is considered a lack of good judgement? My goodness, how weird. Truly, would you not agree that this article is being monopolized and it's really becoming rather silly? What might you propose? Lexlex (talk) 06:42, 24 April 2008 (UTC)

I apologize if my response startles you, but it is peanuts compared to the accusations of POV-pushing and bad faith that routinely fly here, on the basis of things very similar to your edit I link above. I've proposed plenty in the last three or four archives of this Talk. I would propose that more editors who don't have much of an opinion on the topic read past discussions and join in current discussions, but that is beyond my control. I am not affiliated with an e-mail network or a Wikiproject. The only RfC in recent memory attracted one outside editor. I'm not that surprised, as this topic seems to instill fear of being labeled an "anti-circumcision zealot" or worse, as has been done by the administrators here. Blackworm (talk) 07:05, 24 April 2008 (UTC)

Oppose. Jakew's contributions to this page are very valuable. He helps the page maintain stability, precision of factual accuracy, and NPOV. Every editor has a personal bias. From each person's POV, their own POV is exactly neutral and all the others are biassed one way or another. The interaction among editors of different POV's tends to help produce a NPOV article. Jakew has an excellent understanding of Wikipedian NPOV and is very skilful and diligent at finding ways to word the article so that it does not claim even slightly more than what the sources say. I've learned from Jakew while working together on this page about details of how to implement the NPOV and NOR policies. This page gets frequent contributions from drive-by editors ranging from vandalism to well-meaning but in most cases off-base edits, and Jakew's tireless monitoring helps maintain a quality article, keeping only those few edits which improve on an already carefully honed article.☺ Coppertwig (talk) 11:13, 29 April 2008 (UTC)

Wait a second! This whole discussion is out of order. I shouldn't have participated in it. This page is for discussion of the content of the article Circumcision. Comments about individual editors are not appropriate here. Maybe you want dispute resolution. This discussion should be closed. ☺ Coppertwig (talk) 23:46, 29 April 2008 (UTC)

Yes, you're likely right, both of you. It isn't going to happen and it's likely that this topic probably runs afoul of something in the tome of wiki. As an admitted "drive by editor" I thought the point of this project was to allow the contribution of many, not a single-faceted, strict interpretation of "rules" by some self-appointed few. I'm just a bit annoyed at the amount of, for lack of a better term, "mental masturbation" that seems to go on here and was making a vain attempt to bring some sense of respite - at least for a little while. Masturbate away gentlemen, with much gusto and grunting if you please. I'll go do something else with my time. Lexlex (talk) 06:25, 30 April 2008 (UTC)

Circumcision since 1950

This section starts off with an incomplete discussion about changes in incidence, and then veers into the completely irrelevant. The third par - "In some South African ethnic groups, circumcision has roots in several belief systems, and is performed most of the time on teenage boys" - has presumably been true since white colonization. It should be deleted. The next paragraph, though it cites sources that discuss incidence, addresses itself to motivations for choosing infant circumcision in the US. There is no reason to believe that parental motivation (primarily social conformity plus "perceived medical benefit" in unknown proportions) have changed since 1950. Worse the first sentence - "A study in 1987 found that the prominent reasons for parents choosing circumcision were 'concerns about the attitudes of peers and their sons' self concept in the future,' rather than medical concerns" - misrepresents its source, which says: "The strongest factor associated with the circumcision decision was whether or not the father was circumcised." The second sentence seems to have no purpose except to introduce a speculation that has no evidentiary basis in the study itself. It would seem best to delete the entire paragraph. The two obvious trends since 1950 are the steep declines in incidence for all English-speaking countries beside the US, and the rise in incidence in S Korea. It would seem logical to therefore exand the first paragraph to include Australia, New Zealand and (white) South Africa, where rates have declined from > 80% to < 20%. Johncoz (talk) 20:03, 24 April 2008 (UTC)

Prevalence of circumcision

This section seems to have two major problems.

1. It confuses prevalence[10] and incidence[11]. These are only the same in countries that have had stable incidence rates for several generations, and the mix-up is very confusing for the reader.

2. More seriously, it fails to give the expected overview of global prevalence by region and religion, and instead seems to randomly pick a handful of countries. For a general article on circumcision it should provide a short snapshot of the findings in the main prevalence article (which also needs some work). I suggest something like the following:

Estimates of the proportion of males that are circumcised worldwide vary from one sixth to a third. WHO has estimated that 664,500,000 males aged 15 and over are circumcised (30% global prevalance), with almost 70% of these being Muslim. Excluding majority Muslim countries and Israel, prevalence in Latin America and Eurasia is less than 20% (often much less), with the exceptions of the Philippines, which has a prevalence greater than 80%, and South Korea, which is approaching that level. Estimates for individual countries include United Kingdom 16%, Spain and Denmark < 2%, Finland and Brazil 7% and Thailand 13%.

WHO estimates prevalence in the United States and Canada at 75% and 30%, respectively, though there is wide variation in published estimates for the US with figures as low as 56%. Prevalence in Africa varies from less than 20% in some southern African countries to near univeral in North and West Africa. Both Australia and New Zealand, like Canada, are experiencing long-term drops in prevalence as a result of declining incidence rates since the 1970s. The change is strongly age-graded, with a 2000-01 Australian survey finding 32% of those aged 16-19 years circumcised, 50% for 20-29 years and 64% for those aged 30-39 years.

The citations for all these figures already exist. Note that I have rounded the percentages, since giving such guesstimates to one or two decimal places conveys an altogether unreal impression of accuracy. Johncoz (talk) 20:03, 24 April 2008 (UTC)

This looks very good. Your use of percentages is much more consistent than the current section. Also, it maintains a neutral point of view and is well written. My advice is to be bold and add it to the article (with references). We can hash out the details here. Kindest regards, AlphaEta 23:19, 24 April 2008 (UTC)

I have a couple of concerns about this proposal. First, while the figures may well be sourceable, there seems to be rather a lot of interpretation and synthesis. It's possible that sources can be found for this, of course, but I'm concerned that it may be original research. Second, "Excluding majority Muslim countries" seems to be a rather odd (and not entirely neutral) way of expressing things - one could just as easily say "excluding non-Muslim countries, the rate is high in...". But perhaps this is how the source in question puts it?

I certainly agree with the desire to give an "overview of global prevalence by region and religion", as Johncoz puts it. Jakew (talk) 23:35, 24 April 2008 (UTC)

It looks good to me. I don't see anything odd about saying "excluding majority Muslim countries"; a statement has just been made about Muslims (70% of world circumcisions) so it's natural to then also comment on relatively non-Muslim areas. Mathematically it's the most concise way to describe the situation. Maybe "other than" would sound better than "excluding". I think Johncoz has done a good job of describing the whole world as opposed to the current version which I suppose is basically the summary I arrived at mostly by deleting material from the previous longer version. NOR doesn't mean we always have to use precisely the same words as the sources. Thanks for clarifying the definitions of prevalence and incidence. ☺ Coppertwig (talk) 23:54, 24 April 2008 (UTC)

Jake, it is worrying to me that you feel there may be OR-violations, since that is something I have scrupulously tried to avoid. It would be helpful if you could specify which passages are concerning you so we can either discuss or I can alter, if required. [[User:Johncoz|Johncoz](talk) 00:40, 25 April 2008 (UTC)

Johncoz, it's difficult to make any definite statement until I can see a version with sources. At the moment I can only guess, based on asking myself how I'd go about sourcing the material. However, the sentences I'm concerned about include "Excluding majority...", "Prevalence in Africa...", and especially "Both Australia". We'd need sources for these, per WP:NOR: "All interpretive claims, analyses, or synthetic claims about primary sources must be referenced to a secondary source, rather than original analysis of the primary-source material by Wikipedia editors." Jakew (talk) 10:39, 25 April 2008 (UTC)

Jake, I have placed my proposed version with all citations on my user page. Check it out and let me know what you think Johncoz (talk) 20:15, 25 April 2008 (UTC)

Thank you, Johncoz. I was mistaken about the sentence beginning "Prevalence in Africa". It looks very good indeed, but I would like to propose some improvements.

• The sentence beginning "Excluding majority Muslim" seems to contain some synthesis and interpretation. I propose to replace it with something much closer to the sources, such as: "The prevalence in low in Latin America.[cite Drain or WHO] Circumcision is nearly universal in the Middle East and in Central Asia, but is generally low elsewhere in Asia.[WHO] In Europe, circumcision is generally associated with religion or immigration.[WHO]"
• The sentence beginning "Both Australia and New Zealand, like Canada" is a synthesis of three sources. What's needed is a single source. I don't know of such a source, but the WHO document (p17) covers both Australia and Canada. I would therefore suggest editing the sentence to read "Both Australia and Canada...", and attributing the sentence to the WHO. I'd also suggest deleting the following sentence, which gives a disproportionate amount of detail to Australia.

Jakew (talk) 21:48, 25 April 2008 (UTC)

Jake, thankyou for your feedback. However, I find myself disagreeing with your assessment.

• I don't believe there is any "synthesis" or "interpretation" happening. Though there may be several different facts in each sentence, each fact is independently supported by reference to a verifiable source. The empirical reality that the UK, Australia, NZ and Canada have all experienced large falls in circ rates over the past few decades is surely well supported by the sources and uncontroversial, and combining these facts in one sentence is hardly synthesis. Interpretation would be to suggest a common reason for these trends without having a secondary source to reference.
• More seriously, your suggested redraft deletes verifiable content with vague generalisations. Eg "the prevalence is low in Latin America" when the WHO doc actually says "A recent multi-country survey found no countries in Central or South America with circumcision prevalence greater than 20%"; that survey was Drain, which I reference. Even worse, "In Europe, circumcision is generally associated with religion or immigration" changes gear from hard data to a discussion of the reasons for prevalence, a distinctly backward step, IMHO. I would suggest my formulation (with footnotes) precisely represents the situation displayed in the WHO map.
• The last sentence is intended as an illustration of the trends in all non-US English-speaking countries. We could use UK or Canadian data to a similar effect, but Richters is the most recently published and based on a very substantial survey. Since these falls are in fact the most substantial change in circumcision prevalence globally for 50 years (apart from South Korea), it would seem to be worth the extra few words in what is already a pretty tight section.Johncoz (talk) 23:00, 25 April 2008 (UTC)

Johncoz, allow me to respond:

• If each fact is independently supported by reference to a verifiable source, yet no verifiable source makes the overall claim (in this case, that that "the UK, Australia, NZ and Canada have all experienced large falls in circ rates over the past few decades"), then it is synthesis. Please see WP:SYN.
• Re "the prevalence is low in Latin America", I have no objection to being a little :more specific. How about "the prevalence is reported to be <20% in Latin America"?
• Re Europe, the problem is that a colour-coded map is a primary source. Per WP:NOR, "Any interpretation of primary source material requires a reliable secondary source for that interpretation." Unfortunately, the WHO document contains relatively little discussion of Europe; the only relevant material I could find was "...currently, as in the rest of Europe, neonatal circumcision predominantly related to Muslim or Jewish religion, medical indications or immigration from circumcising countries.", which I attempted to paraphrase.
• I would suggest that we need to find a source that makes generalisations about trends in non-US English-speaking countries, and use any illustration from that. Jakew (talk) 23:16, 25 April 2008 (UTC)

Jake, it seems we agree on Latin America ;-)

• On Europe, my proposed text is doing no more than summarising in a few words what is in the main prevalence of circumcision article:

Less than 20%

The following countries have a circumcision rate of less than 20%: Iceland,[5] United Kingdom,[5][28] Ireland,[5] Sweden,[5] Norway,[5] Finland,[5] Denmark,[5] Estonia,[5] Latvia,[5] Lithuania,[5] Portugal,[5] Spain,[5] France,[5] Switzerland,[5] Italy,[5] Netherlands,[5] Belgium,[5] Slovakia,[5] Germany,[5] Poland,[5] Czech Republic,[5] Hungary,[5] Greece,[5] Bulgaria,[5] Romania,[5] Moldova,[5] Ukraine,[5] Austria,[5] Belarus,[5] Russia.[5]

Where footnote 5 is in fact referencing the WHO map as its primary and only source. Whats's the difference?

• On the issue of non-US English-speaking countries, I am not keen to be making any generalisations, implicitly or explicity, but simply in presenting the facts and letting the reader draw their own conclusions. So perhaps this might work for everybody. 1) Delete ", like Canada," and attach the Wirth citation to the first mention of Canada (so at least we cover the fact that there has been a change. 2) Add a final sentence: "Prevalence in the UK is also age-graded, with 12% of those aged 16-19 years circumcised, and 20% of those aged 40-44 years", referencing Davis et al. That way we enrich the content while avoiding any appearance (however tenuous) of "synthesis" (we also lose the Montreal Gazette citation, which is a pretty low quality source). Does this work for you? (I've made the changes on my user page so you can more easily evaluate them. Johncoz (talk) 00:56, 26 April 2008 (UTC)

I have also removed the parenthetical "(often much less)" from the draft, as it was redundant given that specific examples of the range of values follow. Johncoz (talk) 01:49, 26 April 2008 (UTC)

Included Colombia and Taiwan estimates (from peer-reviewed sources) in the examples list, providing a much better balance. Also appended some word counts. Any further comments or suggestions for improvement on the draft most welcome.Johncoz (talk) 05:12, 26 April 2008 (UTC)

Johncoz, the WHO map contains no more and no less information than a table of countries and percentages, so for the sake of argument, imagine that it is. The list you quote, then, is nothing more than a simple re-expression of the "table" itself. However, if we state "Excluding majority Muslim countries and Israel, prevalence in Latin America[5] and Eurasia[1] is generally less than 20%[6] with the notable exceptions of...", this contains more information than is present in the "table", since it is an analysis of the table. The "table" itself does not contain the division into Muslim/non-Muslim countries, nor a subdivision of non-Muslim countries into exceptions, etc. If the source in question was a table of schoolchildren and their heights, we couldn't stratify by gender and calculate the mean height & 95% CI ourselves; we'd need a source for that. This is no different.

Re non-US English-speaking countries, I've had a look at the (current) version of the 2nd paragraph on your user page, and I think it's a definite improvement. However, we need to delete Wirth from the sentence "WHO estimates prevalence in the United States and Canada[14] at 75% and 30%, respectively[1]", as this is actively misleading (Wirth is not the WHO). Also, we need to delete "Prevalence in the UK is also age-graded...", as we're already covering UK prevalence in the preceding paragraph, and this serves no purpose here except to perform implied synthesis by juxtaposition.

The sentence "Both Australia and New Zealand are experiencing long-term falls" needs to be made closer to the cited source (suggest "In both Australia and New Zealand, the circumcision rate has recently declined.")

Finally, I wonder if we could reduce the number of references cited, perhaps by extracting examples from, eg., the WHO document. The current version on your user page is 6,874 bytes, which is probably due to the large number of refs. Jakew (talk) 11:03, 26 April 2008 (UTC)

Jake, some useful suggestions - let me deal with them in reverse order.

• I agree there is an issue with many citations, but I cannot see a way around it without compromising verifiability. I have tried to recycle as many references as possible. The WHO document, which in many respects is a tertiary source, has some severe limitations and egregious factual errors (look at the adult male population figures for the UK and Australia in table 1, for instance). I'd welcome any specific suggestions.
• I am happy with the existing wording of the OZ/NZ sentence (note that Richters is also a source), since the stated fact is not disputed by anyone commenting on this trend, but I will nonetheless have a second look at the wording in search of an acceptable compromise.
• The final two sentences are not about overall prevalence, but about age-grading - which is a crucial point about past and future prevalence trends. Having made the addition in the response to your earlier criticisms, I am now strongly in favour of retaining it.
• I am happy to delete the Wirth citation. On reflection, you are quite right - it does not sit comfortably there.
• The Latin America and Eurasia phrasing looks like becoming a real sticking point. Having carefully considered your response, I maintain my position that this sentence (with its footnote) does no more than precisely state what is both in the WHO map and the main prevalence article. If this is disallowable "analysis", then we may as well delete the other 2.5 million articles on Wikipedia, IMHO. It is also an extremely economical way of presenting a large swathe of data in what is of necessity a very short overview (as Coppertwig noted). Perhaps other editors may have some views on this question.
• I will advise here when I have updated the draft. Regards, Johncoz (talk) 12:34, 26 April 2008 (UTC)

Thank you for your response, Johncoz. I'll look forward to reading the updated draft. In the meantime, a few comments, in no particular order:

• I don't think that it's essential to reduce the number of citations, but it would be desirable to reduce their number by citing secondary sources with data for several countries instead of primary sources. Another option may be to simply cite fewer specific examples. I would regard any unpublished criticism of the WHO document as original research by definition.
• I think you're overreacting in saying that 'If this is disallowable "analysis", then we may as well delete the other 2.5 million articles on Wikipedia'. This is a problem with a single sentence in a mostly excellent proposed addition to an article. The basic principle of WP:NOR is that if an analysis has not been published in reliable sources then we shouldn't publish it either. The alternatives aren't that terrible: we either remove the claim or we find a reliable source that makes it (or an approximation, as in my earlier suggestion). This also applies to the "crucial point about past and future prevalence trends" - if it's that crucial, it will already have been made in a reliable source, and if it proves impossible to find such a source, it may not be all that crucial.
• Whether or not the stated claim is disputed is largely irrelevant. If we're attributing a claim to a source, we can't extrapolate beyond that source, otherwise the claim is not only unverifiable but the source is misrepresented. In this respect, citing sources in Wikipedia carries a "promise" that the reader can verify that claim attributed to the source is actually made by the source. Jakew (talk) 13:24, 26 April 2008 (UTC)

I have updated the draft. On the points you raise, Jake …

• "I would regard any unpublished criticism of the WHO document as original research by definition." So would I. One can only hope a peer-revoewed critique will appear in the future.
• On the examples, reliable prevalence data for non-English-speaking countries is as rare as hen's teeth and I am not aware of any source that has pulled together these studies (apart from pro and anti circ propagandists). That's why we have encyclopedias.
• On age-grading, both sources (Davis for the UK and Richters for Oz) explicitly mention age-grading, and link it to a historic decline in incidence. So we don't have a problem.
• In relation to the "Excluding Muslims ..." sentence, consider this. The WHO map is in fact not a table but a totally unlabelled map. Whoever compiled the main prevalence article must have painstakingly compared the splotches of colour with an atlas in order to generate the lists. Was this creating information that was not in the source? Yes. Was it "original research" in the sense of WP:NOR? Of course not. Utilising basic geographic (including demographic) data to clarify source data is not OR. Johncoz (talk) 18:36, 26 April 2008 (UTC)

(unindenting) Johncoz, am I correct in thinking that this diff represents the sum of your changes? Assuming that it does, a few comments:

• Agree with the removal of Wirth (also, I'm pleased to note that this reduces the number of references by one).
• The sentence "The circumcision rate has declined sharply in Australia and New Zealand since the 1970s, leading to an age-graded fall in prevalence, with a 2000-01 survey finding 32% of those aged 16-19 years circumcised, 50% for 20-29 years and 64% for those aged 30-39 years." is now problematic for two reasons. First, it is misleading, as the second of the two sources is a survey of Australian data, yet it is presented as data for both Australia and New Zealand. Second, it is synthesis of two sources to advance a claim made by neither. One source (Richters) states that circumcision rates in Australia have fallen since the 1970s. The other source states that rates in both countries have "fallen considerably in recent years". The correct thing to do is to report on what one or the other says, not to try to synthesise the two.
• And I've discussed the problems with "Excluding majority Muslim..." above.

Regarding the above points:

• I'm glad we both agree that such unpublished criticism is original research.
• There is some prevalence data in Drain and WHO that may be usable.
• Re age-grading, there isn't an WP:NOR problem with citing either Dave or Richters. The trouble comes when we use them both together, to advance a position stated by neither. In this case, both the juxtaposition and the choice of wording ("Prevalence in the UK is also age-graded") appear to advance your stated belief that there have been "steep declines in incidence for all English-speaking countries beside the US", and what you need to do instead is to find a source that makes this specific claim.
• Finally, regarding "excluding muslims", we could certainly consider removing the information in that article, but I have to say that I don't find your argument persuasive. The WHO labels their map "Global Map of Male Circumcision Prevalence at Country Level", so there can be little doubt that the "splotches of colour" are, indeed, countries. Reading the map requires no more special skill than reading English, and indeed this task could easily be automated. This contrasts sharply with a) taking the map, b) taking additional data from elsewhere, c) stratifying the resulting data by both circumcision prevalence and dominant religion, and d) making generalisations about the results. For such analysis, as WP:NOR clearly states, we must cite a reliable source. Jakew (talk) 21:37, 26 April 2008 (UTC)

Johncoz has my support for this redraft. It summerizes in a clear concise manner. Garycompugeek (talk) 02:05, 25 April 2008 (UTC)

Jakew, re "excluding muslims": I suppose you may be right. For example, (in the spirit of WP:SYN), if a different source is used for the religion data, we wouldn't know whether they're using a definition of religion that's relevant to circumcision rates, e.g. with respect to practicing versus non-practicing members of a religion, or whatever. However, in the spirit of WP:IAR: are you just applying the SYN rule for the sake of it, or do you really think there's an important concern here? After all, this is an overview using rounded-off numbers. Look at it this way: suppose we said "Except for African countries..." and then somebody objected because the list of which countries are or are not in Africa wasn't from the same source as the data. Wouldn't that be taking NOR too far? ☺ Coppertwig (talk) 22:12, 26 April 2008 (UTC)

Coppertwig, I think this sentence violates WP:NOR in several ways, including but not limited to WP:SYN. Regarding primary sources such as maps, we're supposed to "make no analytic, synthetic, interpretive, explanatory, or evaluative claims about the information" therein. In my view, this sentence does most if not all of these.

Am I just applying this rule for the sake of it? Categorically not, for several reasons.

One of these is that, generally speaking, this kind of analysis can be susceptible to errors, and we owe it to our readers to ensure that they receive information that has gone through publication processes (peer-review, etc) that have been set up to check for such errors. This policy, as with others, is beautifully designed, and properly applied helps to minimise the chances of that happening. Also, given consistent application of WP:V and WP:NOR, readers should be able to expect that the cited sources will likely give further information (as is true with most other sources). For example, suppose we could find a source that stated that "Excluding majority Muslim countries and Israel, prevalence in Latin America and Eurasia is generally less than 20%". If I were reading that, I might want to read the source in more detail, with the expectation that I'll be able to find out about the sources used in this analysis, how "majority Muslim" was determined, etc. Why violate that expectation?

Another reason is that WP:NPOV requires us to represent, with appropriate weight, significant views that have been expressed in reliable sources. When an analysis proves to be so difficult to source then I think that's a clue that we're trying to represent a view that hasn't been expressed in reliable sources, and that's an WP:NPOV minefield (for example, if Wikipedia is first to publish this interpretation, we could find scholars citing us, and perhaps criticising the analysis, so what then? "Wikipedia says X but author Y disagrees" is absurdly self-referential...). That problem doesn't occur when we stick with statements that have been made elsewhere (even if they aren't ideal), for example in my suggestion of 21:48, 25 April 2008.

Finally, as I commented above, "Excluding majority Muslim countries..." is somewhat non-neutral. Even phrased differently, the underlying message of the sentence structure is that majority Muslim countries are unimportant (consider "excluding families of immigrants, the population of England is 100% white" - how would a black person feel about that? And what about "the population of England is 10% black, 6% other, and 84% white"?). Again, if we stick to published analyses, this problem doesn't occur (or if it does we can at least attribute the claim).

I think that there's rarely a case for applying WP:IAR to the core policies, and I don't think this is such an occasion. Jakew (talk) 23:09, 26 April 2008 (UTC)

OK, how about this approach: the question is whether we're talking about an unambiguous list of countries or not. If we say "excluding countries listed in Table 3 in publication X, ..." then that's unambiguous. (I think.) In that case, it's simple application of logic and is OK and does not violate WP:SYN (I think). Just saying "countries with majority Muslim population" is probably not unambiguous and may change with time, but it might be possible to say "countries listed by publication X as being majority Muslim countries", even if publication X has nothing to do with circumcision.

This doesn't solve the possible connotations of the use of the word "excluding", but I figure if we're going to use "prevalence" because it's technically correct and we ignore its connotations, we can do the same with "excluding". As someone who tends to think like a mathematician, I would tend to exclude the application of any argument that excludes the use of the word "exclude". ☺ Coppertwig (talk) 00:02, 27 April 2008 (UTC)

Coppertwig, thinking over your suggestion it occurs to me we could just link to Majority Muslim countries article, which has a spiffy table that presumably is updated as new data comes to hand. Johncoz (talk) 03:05, 27 April 2008 (UTC)

The problem then is how do we ensure that it is correct? To set aside, for the moment, the issue of WP:SYN, here is what I would want to do (or see) before I could be confident that there were no errors. First, I would want to convert the WHO map into a table (fairly straightforward). Then, I would want to add a column for % Muslim, taken from that article (as an aside, do we know if that article is complete?). Finally, I'd need to add a boolean-valued column to indicate whether the country is in Eurasia. Only when all this is done could I even check the assertion.

What I don't understand is this: what is so terrible about the alternative (citing verifiable analyses such as, eg., my suggestion of 21:48, 25 April 2008)? Jakew (talk) 11:27, 27 April 2008 (UTC)

I will put together a table along the lines you suggested, Jake. I was going to check the accuracy of that data anyway, and tabulating it systematically is probably a good idea. Johncoz (talk) 13:43, 27 April 2008 (UTC)

Jake, I fear we are in danger of losing sight of our goal here, which is to provide a snapshot in about 200 words of global circumcision prevalence that is accurate (ie true), properly sourced and consistent with Wikipedia guidelines and the main article on the subject. A tall order, but I would suggest the draft text does a substantially better job than the existing section. And the consensus in this discussion seems to favour that judgement, particularly since no one has raised any issues in relation to the facts as stated.

On Eurasia, the question surely is: does the sentence accurately convey what the reader will see on the WHO map (which by the way is not a primary source), should they consult it, or what they will read if they go to the prevalence article? The answer is surely yes. There is in fact no dispute about which countries are “majority Muslim” with the exception of Kazakhstan (est. 47-53%), which I have now added to the footnote of 20-80% exceptions. The importance of Islam to circumcision prevalence is surely clearly stated in the very first sentence (“with almost 70% of these being Muslim”).

On age-grading, it is simply a fact clearly stated by the sources that prevalence is age-graded in the UK and Australia as a result of earlier declines in child incidence. There is no controversy I am aware of about this fact (it is just the way the demography works), and the text does not seek to draw any further conclusion. There is no synthesis. The same falling incidence is of course true for New Zealand and Canada, as clearly stated in the History of Circumcision article and many sources, but having already deleted the Canada reference in response to your objection I would be happy to delete NZ as well rather than pile on yet another citation if you believe mentioning it in the text is “misleading”.Johncoz (talk) 01:48, 27 April 2008 (UTC)

Johncoz, although there are a few remaining issues, I would certainly agree with your statement (that "the draft text does a substantially better job than the existing section"). As far as I'm concerned, the Australia sentence is now okay. I refer to my comments above about the Eurasia sentence. Jakew (talk) 11:27, 27 April 2008 (UTC)

I'm not sure if I'm following the whole discussion (is there a draft somewhere that's being edited?) but I have another suggestion: how about saying "In n₁ countries the rate is over 80%; in n₂ it's between 20% and 80%, and in n₃ it's below 20%." (replacing the n's with numbers), or else "In some countries the rate is over 80%, and in some of the others it's less than 20%". (I haven't consulted the source. Blackworm, these are draft sentences that may need some work and indicate nothing about my beliefs.) The reader could refer to the main article on the topic to get the details i.e. which countries.

Re synthesising two sources about falling rates: I think it is possible to synthesise them: I think you can say that the rate has fallen in both countries. That takes a subset of the information of each source. ☺ Coppertwig (talk) 17:24, 27 April 2008 (UTC)

Jake I have concocted a table as requested after reconciling the WHO map with the mainprevalence of circumcision article, the Majority Muslim countries table and external sources (eg atlas) where required. It's quick and dirty but has the info. The good news is that it fully verifies the accuracy of the Eurasia sentence. On the downside(s)the Majority Muslim countries table is inexplicably missing Albania and Kyrgyzstan, however there is an even better table at Islam by country, and I propose to link to that; and the prevalence article it turns out has many major omissions (eg China Taiwan), which I have noted in the table.

The draft is on my user page. Johncoz (talk) 17:48, 27 April 2008 (UTC)

[←outdent] Could we bring the draft to this talk page? It may help alleviate confusion. Thanks, AlphaEta 20:05, 27 April 2008 (UTC)

Sure. Here's a copy of the current draft text. I'll leave the master with references on my user page as a convenient location for edits and change control.

Estimates of the proportion of males that are circumcised worldwide vary from one-sixth[3] to a third.[4] WHO has estimated that 664,500,000 males aged 15 and over are circumcised (30% global prevalance), with almost 70% of these being Muslim.[1] Excluding majority Muslim countries and Israel, prevalence in Latin America[5] and Eurasia[1] is generally less than 20%[6] with the notable exceptions of the Philippines, which has a prevalence greater than 80%,[7] and South Korea, which is approaching that level.[8] Estimates for individual countries include Spain[7], Columbia[9] and Denmark[10] less than 2%, Finland[11] and Brazil[7] 7%, Taiwan[12] 9% and Thailand[7] 13%.

WHO estimates prevalence in the United States and Canada at 75% and 30%, respectively.[1] Prevalence in Africa varies from less than 20% in some southern African countries to near universal in North and West Africa.[5] The circumcision rate has declined sharply in Australia since the 1970s, leading to an age-graded fall in prevalence, with a 2000-01 survey finding 32% of those aged 16-19 years circumcised, 50% for 20-29 years and 64% for those aged 30-39 years.[13][14] Prevalence in the UK is also age-graded, with 12% of those aged 16-19 years circumcised, and 20% of those aged 40-44 years.[15]

Johncoz (talk) 22:17, 27 April 2008 (UTC)

There appears to be broad agreement that the current draft text is superior to the existing section. That being the case, I will now make the change.

There is a continuing discussion about the Eurasia sentence. The current status of that discussion is summarised (by jakew and myself) at the NOR noticeboard. Johncoz (talk) 18:24, 28 April 2008 (UTC)

More deceptive figures.

The World Health Organization (WHO) stated that studies of three trials provide compelling evidence that male circumcision provides a 50–60% reduction in HIV transmission from female to male.

This is a relative risk reduction. In absolute terms it reduces the risk from 0.3% per sexual contact to 0.12-0.15%. So an absolute risk reduction of less than 1/5th of 1%. Big fucking whoop. HIV is not nearly as easy to spread as American propaganda over the last 20 years has implied to children, and it is despicable to claim this as a valid medical pretext for circumcision. --76.222.55.11 (talk) 19:28, 25 April 2008 (UTC)

Please see WP:TALK. I can only suggest that you write to the WHO and explain your concerns. Jakew (talk) 21:57, 25 April 2008 (UTC)

There's a valid point in there. We find it normal to repeat that "male circumcision provides a 50% reduction in HIV..." without discussing absolute risk, but then we say "more circumcised men reported having been diagnosed with genital warts compared with uncircumcised men (4.5% and 2.4%)" instead of something absolutely frightful and unacceptable derived from the exact same information, like "being circumcised increased reporting of genital warts by 87.5%." It's spin; it's right there in the sources' presentation of the data (especially circumcision advocates like the WHO), and it's sometimes right here in our rewording of sources. How does one cut through it? By consistently taking the same spin as the sources? Blackworm (talk) 22:46, 25 April 2008 (UTC)

What you call "spin", Blackworm, is the interpretation of data as it appears in reliable sources. Obviously our coverage needs to be close to that interpretation, because our role is to express "significant views that have been published by reliable sources", not to express the view of Wikipedia editors who have their own personal interpretation of data that have been published in reliable sources. Jakew (talk) 23:50, 25 April 2008 (UTC)

When reporting the WHO's recommendation, I agree with Jake that we should keep the relative percentage as reported in the citation. However, I think Blackworm has salvaged a valid point from the original post. Reporting the relative risk as indicated by the WHO does not preclude us from adding absolute risks for each individual, randomized, controlled trial:

• In Kisumu, Kenya, "the 2-year HIV incidence was 2.1% (95% CI 1.2-3.0) in the circumcision group and 4.2% (3.0-5.4) in the control group (p=0.0065)...."
• In South Africa, "There were 20 HIV infections (incidence rate = 0.85 per 100 person-years) [0.85%] in the intervention group and 49 (2.1 per 100 person-years) [2.1%] in the control group...."
• In Rakai district, Uganda, "the modified intention-to-treat analysis, HIV incidence over 24 months was 0.66 cases per 100 person-years [0.66%] in the intervention group and 1.33 cases per 100 person-years [1.33%] in the control group...."

Does this serve as a possible solution? AlphaEta 00:53, 26 April 2008 (UTC)

I think it's an excellent solution to the problem of the presentation either RR or absolute risk. Since Jake seems to concede above that the text is the interpretation of the WHO (and not editors here), it would follow that we must make must that clear throughout. We could do something silly like preface the entire section with "Everything below is the view of the WHO." I would rather, though, use the data referenced by the WHO, see the data consistently separated from the WHO's statements, and presented as neutrally as possible, exactly as AlphaEta does above. Then, we can state the WHO's conclusions and recommendations (e.g., mass male circumcision).

I will begin to look at the sources and see how to properly integrate them into the above suggested edit, making minor revisions as necessary. Jake, would you like to help? Is there anything in the above you find to be accurately sourced, with a source you know? Blackworm (talk) 01:26, 26 April 2008 (UTC)

I agree it is worth preparing a draft. An extraordinary number of people (who are not statistically savvy) come away with the impression that for instance there is a 50% chance of contracting HIV if one is uncircumcised. The same thing happened with HRT some years ago. Providing absolute risks as an adjunct is a good way of helping to clarify this without distorting the data.Johncoz (talk) 02:07, 26 April 2008 (UTC)

Blackworm, you've misunderstood. I'm not saying that the text is the interpretation of the WHO specifically; I'm saying that it is the interpretation in the sources (this is also true of the trials themselves. To quote examples from the abstracts linked above: "a reduction in the risk of acquiring an HIV infection of 53%", "a protection of 60%", "estimated efficacy of intervention 51%").

I'm not convinced that quoting absolute figures is useful to the reader, since they depend upon the prevalence of the disease, which varies dramatically by population. Relative risk is somewhat more useful in general statements, and since secondary sources generally focus on these figures, it makes sense for us to do the same. I would suggest adding detailed information about the individual trials to medical analysis of circumcision. Jakew (talk) 11:24, 26 April 2008 (UTC)

[edit conflict.] Sorry, in case it's not clear, I'm referring to ideas for the edits presented in the previous discussion section as well. Blackworm (talk) 02:10, 26 April 2008 (UTC)

Possibly the meaning of relative risk could be made clearer to the reader by using a phrase like "approximately half as many circumcised men contract HIV ... as compared to circumcised men". (This sentence would probably need some work to make sure it's accurate etc.)☺ Coppertwig (talk) 14:13, 26 April 2008 (UTC)

Jake, I haven't misunderstood anything. The statement above says "the WHO [...] compelling evidence [...] provides ..." Yes, WHO, we know; circumcision is compelling and a provider of great things. Let's present the data, including absolute risk in the trials, then the WHO can tell us how this data is "compelling evidence" and how males in Africa should be lined up and circumcised on a "nominally voluntary" basis. Presenting an interleaved mix of WHO circumcision advocacy and data is why people are coming here saying this article reads like a circumcision brochure.

Our job here is to have the reader understand the topic. The relative risk is important, since it's the goal of these studies to find it, but the absolute risk is too, to put the relative risk in context. We do this already for penile cancer, for example, where even the 200%-2100% relative risk increase we state ("3 to 22 times") isn't enough for medical organizations to recommend circumcision as a preventative option, due to the very tiny absolute risk. Let the reader decide.

Coppertwig, your suggested edit extrapolates the results of these trials to all men. It seems you believe that it is a fact that circumcision reduces all males' chances of contracting HIV by 50%, and we should present it as such without attribution of the view. I disagree. Blackworm (talk) 18:40, 26 April 2008 (UTC)

Reading the HIV article I have noticed they use a similair quote "A meta-analysis of twenty-seven observational studies conducted prior to 1999 in sub-Saharan Africa indicated that male circumcision reduces the risk of HIV infection" sourced to Weiss, H.A.; M.A. Quigley, R.J. Hayes then balance it with "However, a subsequent review indicated that the correlation between circumcision and HIV in these observational studies may have been due to confounding factors." sourced to Siegfried, N., Muller, M., Deeks, J., Volmink, J., Egger, M., Low, N., Walker, S. and Williamson, P.. Concerning the importance we seem to be placing on this I find this new source illuminating. Garycompugeek (talk) 20:09, 26 April 2008 (UTC)

I think the newer randomized controlled trials make those results obsolete. Basically, they're just saying we don't know; but after the RCT's we're much more certain. ☺ Coppertwig (talk) 21:04, 26 April 2008 (UTC)

You're correct, Coppertwig. Siegfried et al. said this about the RCTs then underway: "Although the positive results of these observational studies suggest that circumcision is an intervention worth evaluating in randomised controlled trials, the current quality of evidence is insufficient to consider implementation of circumcision as a public-health intervention. Therefore, the results of the three randomised controlled trials underway will provide essential evidence about the effects of male circumcision as an intervention to prevent HIV infection." Jakew (talk) 21:42, 26 April 2008 (UTC)

Because the OP was allowed a soapbox moment to highlight the relatively low risk of contracting HIV per sexual encounter, I request that the same luxury be afforded to me so that I may point out how this risk actually translates into new cases in the field. According to UNAIDS, 2007 saw 1.7 million new cases of HIV in sub-Saharan Africa (this staggering number is actually much improved from 2001). Multiple studies conducted in the 1980's and 1990's indicated that approximately 80% of new HIV infections in Africa are the result of heterosexual contact.[12], [13], [14] If this holds true, then 1.36 million people acquired this disease last year as a result of a "low risk" encounter! More recently, researchers have suggested that perhaps the estimate of heterosexual acquisition was overstated.[15] For the sake of argument, let's say only 40% of new cases in Africa are the result of heterosexual encounters. This still means that 680,000 people contracted a virus that leads to an incurable illness. Furthermore, the areas most greatly affected by HIV lack sufficient stocks of anti-retrovirals and other treatments to keep AIDS at bay. Yes, HIV is nowhere near as easy to contract as herpes and other viral STDs, but it is far from a propaganda effort to suggest that heterosexual spread is a real threat. I shall now step down from the soapbox and promise not to make a habit of it. Please check my math and let me know if there are errors in my extrapolations. Kindest regards, AlphaEta 03:25, 27 April 2008 (UTC)

Based on the above responses from my previous post I do not believe the general thrust of my meaning was understood. Based on the data I believe that circumcision can decrease chance of HIV transmission in any orifice, not propaganda. The point was if the one source was cancelling out the other sources perhaps we should only use the follow up sources of the controlled trials? Another point, to keep things in a balanced perspective, is Only WHO and UNAIDS seem to be advocating it as a way to fight HIV. The major medical schools of thought seem to believe this alone is not justification for circumcision leading us to believe there are better methods to avoiding HIV. I know we source this at the end of the original WHO statement but it seems to get diluted in the article. Garycompugeek (talk) 19:15, 28 April 2008 (UTC)

Gary, only two policy statements have been issued/revised since the publication of the three RCTs. One of these was the joint WHO/UNAIDS statement, and the other was the AUA statement. For obvious reasons, we can't know how any other medical organisations view the issue until they issue their new policies. Jakew (talk) 19:37, 28 April 2008 (UTC)

Be Bold

There are many well thought out suggestions above, and some I feel might be too complicated for the reader. Overall I urge Johncoz to make the changes that he feels are correct and let the wiki process do the rest. Remember the article belongs to the encyclopedia not Jakew and final decisions lay with the community. Garycompugeek (talk) 12:44, 26 April 2008 (UTC)

As you may have gathered, I am new to the Wikipedia community. But my understanding of the protocol for a substantial change to a "controversial" topic is that it should be discussed on this page first and if there is disagreement, reasonable steps should be taken to reach a consensus. (And yes, I am trusting in the fact that the article does not belong to any individual or group). I have no doubt that the wiki process will further improve whatever emerges out of this discussion, but in the meantime I am in no special hurry. Johncoz (talk) 18:55, 26 April 2008 (UTC)

Speed is not of the essence and I have surmised your caution. By all means please take your time. Please view this as encouragement for you seem to have consensus forming. Garycompugeek (talk) 20:01, 26 April 2008 (UTC)