Talk:Circumcision/Archive 64

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Copyright violation?

Two sentences in the lead may be a violation of Wikipedia's copyright and plagiarism policy. WP:Copyright. Apparently these sentences are almost a word-for-word quote, and although there's a footnote, there are no quotation marks or anything like that to indicate to the reader that it's a quote. "Circumcision is medically indicated for only a few conditions. While there is substantial evidence that circumcised men have a lower risk of urinary tract infections as well as penile cancer and HIV, these conditions are treatable or uncommon or rarely applicable." I hope a temporary change can be done even while the page is protected to bring this in line with the copyright policy. Any suggestions how to fix it? ☺Coppertwig (talk) 23:20, 30 May 2010 (UTC)

Since the current version has other problems, including WP:NPOV problems, I think there are two obvious solutions:

1. Request that an administrator restore the prior version that did not suffer from these problems, or
2. Request unprotection and then restore the prior version that did not suffer from these problems

If we decided to add something about conditions for which circumcision is indicated, that would not be a problem in either case. Further edits would, one would hope, follow discussion and agreement. Jakew (talk) 08:56, 31 May 2010 (UTC)

Or, it could simply be re-written as an attributed quote, thus avoiding the WP:CPVIO, as this is often the only way to deal with concise text (which can be hard to paraphrase without altering the meaning). Mish (talk) 22:51, 31 May 2010 (UTC)

That would address one issue, but since multiple other problems exist, it would be more sensible to address those, too. Jakew (talk) 09:34, 1 June 2010 (UTC)

Actually, I agree with you that there are other problems. In that paragraph, I am unclear how we derive the first sentence from the three sources (it may be problematic as WP:SYNTH, but not as WP:CPVIO, as far as I can see). However, the second sentence does seem clear. This appears to be echoed in the report cited in the third sentence, and a fuller quote for that source would be it's recommendation to ratify the existing postion from 1999:

• "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision."

In alleging plagiarism (which this would represent, rather that WP:CPVIO), it would be helpful to cite the text identified as problematic on one line, and the text from the source(s) that it is supposed to be derive from on the next, emboldening the text that is supposed to constitute the violation in both source and edit, with links to the source(s) concerned.Mish (talk) 10:59, 1 June 2010 (UTC)

Quote the WHO, and cite. Problem solved. There are no other problems, despite some editors' personal objections to the WHO's statement. Blackworm (talk) 17:23, 1 June 2010 (UTC)

The second sentence is problematic as well, Mish. I've outlined some of the problems with those two sentences in #Medical indication (see my post dated 09:52, 26 May 2010). Other problems include: removal of the date for the AMA statement, which is essential as the quote refers to "current" policy statements; removal of the WHO/UNAIDS/CDC HIV paragraph, which is necessary if we're to comply with WP:LEAD ("explain why the subject is interesting or notable, and summarize the most important points"), as well as providing balance for the AMA quotation, thus helping to keep the lead balanced per WP:NPOV. Other problems are: the inclusion of the graph of Sorrells' results, thus giving undue weight to just one of many studies; and replacement of the image of a circumcised penis with one that is a) orange, and b) noticeably smaller than the uncircumcised penis used for comparison, which is dubious from an NPOV perspective. Jakew (talk) 17:41, 1 June 2010 (UTC)

Ah, I thought we were only discussing the WHO statement. If not, then other problems are: the title of the article, which contradicts the definition of "circumcision," the treatment of the topic, undue Western medical focus (a minority of male circumcisions), bizarre analysis of every instrument used in male circumcision except the instruments used to restrain the subject and those cut off the foreskin, undue barring or minimization of language used in reliable sources but opposed by extreme circumcision advocates ("cut", "severed," "amputated", "intact", "excruciating"), minimization of the controversy, minimization of ethical issues, complete lack of treatment of parallels to female circumcision despite sources, the erroneous and misleading implication that circumcision with anaesthesia is painless, and the overall tone treating the foreskin as a foreign body "attached to" and preferably "removed" rather than a part of the body. As a start. Blackworm (talk) 18:30, 1 June 2010 (UTC)

The edit that introduced the two problematic sentences also introduced a number of other problems. Thus, the most obvious thing to do is to revert that edit. There might be other problems as well (this should not be taken as agreement with your specific list), but the solution to those is unlikely to be as straightforward as undoing a single edit. Jakew (talk) 19:36, 1 June 2010 (UTC)

If the goal is to revert the edit and then filibuster on any compromise solutions, then it is not a solution at all. Unfortunately the established procedure here seems to be exactly that. I'd prefer to keep the article locked until the dispute is resolved through consensus. Blackworm (talk) 19:47, 1 June 2010 (UTC)

I tend to agree, much better to work on consensus here, and keep the article locked until that is reached. We do have to remember the readers. Mish (talk) 20:03, 1 June 2010 (UTC)

Well, it's certainly good to see some agreement that major changes should follow consensus (though possibly a little backwards to apply it after the changes have been made). Blackworm, you might want to review WP:AGF. Jakew (talk) 20:32, 1 June 2010 (UTC)

Of course, consensus reached on the basis of the quality of the argument, drawing on the cornerstones of encyclopedic editing - neutrality, notability, accuracy, reliability and verifiability. Mish (talk) 23:39, 1 June 2010 (UTC)

Unindent. We can easily fix the quote by saying:

The WHO states that "Circumcision is medically indicated for only a few conditions. While there is substantial evidence that circumcised men have a lower risk of urinary tract infections as well as penile cancer and HIV, these conditions are treatable or uncommon or rarely applicable."...Zinbarg (talk) 23:53, 1 June 2010 (UTC)

Article ledes shouldn't have lengthy quotes. Jayjg ^(talk) 00:00, 2 June 2010 (UTC)

So, if we cannot include this as a quote, if we were able to find a way of paraphrasing this in a way that did not plagiarize the source (thus dealing with WP:CPVIO), that would be OK?Mish (talk) 00:26, 2 June 2010 (UTC)

So,

• The WHO states there is considerable evidence that circumcision decreases the possibility of a man's urinary tract becoming infected, as well as developing cancer of the penis and contracting HIV infection, noting that these are either rare or else can be treated, and only in a few medical conditions is circumcision advisable.

OK?Mish (talk) 00:36, 2 June 2010 (UTC)

OK. And we leave the AMA statement.

I think Jakew pointed out (but couldn't find again), the WHO is the premier health organization in the world, so a small quote for such a controversial (in wiki) statement should be clearly attributed. We prefer to paraphrase, but there's no hard rule you can't quote when helpful. Frankly, I think the existing paragraph is fine if we just added quotes to the sentences before the AMA statement. Addressing Blackworm's concern, we should remove the CDC citation. The WHO and WHO/UNAIDS statements fully support the sentences.Zinbarg (talk) 04:04, 2 June 2010 (UTC)

No, of course not. The WHO material, as proposed, is misleading, unlike the previous presentation, and the AMA material, as it is currently in the article, is deliberately misleading. That really goes against Wikipedia's policies. Jayjg ^(talk) 03:56, 2 June 2010 (UTC)

How can the SUMMARY from the WHO, the best health organization in the world, free of financial conflicts of interest, become "deliberately" or misleading on any account? Again, note that the existing text is almost a direct quote.Zinbarg (talk) 04:04, 2 June 2010 (UTC)

If you're referring to what Mish writes above (dated 00:36, 2 June 2010), it's not a summary (or at least, it's so inaccurate that it is worse than useless as one). Several of the problems I pointed out previously (in #Medical indication, comment dated 09:52, 26 May 2010) have not been addressed. As one example, the source does not note that HIV is rare, nor does it note that it can be treated. If, on the other hand, you mean the quote from the AMA, that has problems of its own. The first sentence is too vague, as noted previously, and consequently there are better sources that could be cited instead to convey information about the conditions for which circumcision is indicated. The second sentence, if quoted, might be acceptable as a replacement for the existing AMA quote, but when presented alongside it is comes across as soapboxy. Jakew (talk) 09:18, 2 June 2010 (UTC)

This is why I have problems with this page. If you render the source too accurately, that is WP:CPVIO, if you quote it to get round that, that is not allowed in the lead, and if you paraphrase it less closely, that is inaccurate. This does 'look like' a ruse to keep legitimate material out of the lead - but then when I say that I will get somebody popping up whinging about personal attacks. In the mean time, WHO is downgraded in favour of other sources that support a circumcisionist POV. Mish (talk) 09:34, 2 June 2010 (UTC)

It is a difficult article to edit, unfortunately. The subject is sufficiently controversial that you need to handle it very carefully indeed, with great care to apply policy and to be sensitive to possible POV. It's not easy, and even small changes often require a lot of discussion to find something that's acceptable to all (that's why it's so important to get consensus first). Most people, I guess, find that frustrating, but some unfortunately fail to realise that it is difficult for everybody, not just themselves, and make accusations about the agenda of those with whom they disagree. That is indeed a personal attack, and it tends to have the effect of antagonising people.

Your statement that "WHO is downgraded in favour of other sources that support a circumcisionist POV" is perplexing. I presume you are referring to my suggestion that we cite Spilsbury et al instead. The term "circumcisionist" is not in my dictionary, but I assume you mean that Spilsbury et al advocate circumcision. In fact, their concluding paragraph is, if anything, anti-circumcision in tone ("In the interests of best medical practice, the factors resulting in high circumcision rates to treat phimosis in young boys need to be examined. The cost of a circumcision ranges from $100 to $1600, depending on whether an overnight hospital admission and general anaesthetic are involved. In addition, as with any medical procedure, circumcision has a complication risk and raises ethical issues if an unnecessary procedure is being performed on a non-consenting minor. Physicians and parents concerned about preputial adhesions should be encouraged to consider alternatives and to delay circumcision. Young boys with a confirmed diagnosis of phimosis do not necessarily need to be circumcised....") Jakew (talk) 09:54, 2 June 2010 (UTC)

Considering you own a website in the "Circumcision Promotion" section of this article, but all but stopped maintaining it at around the time you joined Wikipedia (which presumably has a readership several orders of magnitude greater), and have co-authored papers with circumcision advocates, I don't think your POV is in doubt. Suspicions of your agenda may or may not flow from those facts, combined with your omnipresence and persistence in circumcision-related articles. I don't think Wikipedia has a solution for editors like you, sadly.

The point of view expressed above is hardly anti-circumcision in tone; it only looks that way next to the fanatical pro-circumcision tone of this article, with any exceptions to that rule constantly under attack. Blackworm (talk) 05:10, 4 June 2010 (UTC)

Comment on content, not the contributor. Jakew (talk) 08:29, 4 June 2010 (UTC)

Jakew, Stop wasting our time. There is consensus here for the existing WHO summary as a paraphrase per Mish's proposal above, or just add quotation marks per zinbarg. —Preceding unsigned comment added by 172.190.114.250 (talk) 13:24, 2 June 2010 (UTC)

No, there isn't a consensus here. Jakew (talk) 15:44, 2 June 2010 (UTC)

Zinbarg, please stop continually asserting a consensus where there is none. Thanks. Jayjg ^(talk) 00:37, 3 June 2010 (UTC)

Consensus edits to Circumcision

Looking way back in circumcision's discussion I found a consensus item that was never implemented. For years, the second sentence in the first paragraph of the introduction read: "The frenulum may also be cut away at the same time, in a procedure called a frenectomy." Please see the discussion archives for the consensus to include the sentence: [[1]] [[2]].Zinbarg (talk) 23:56, 1 June 2010 (UTC)

There was no such consensus, and it's a 3 year old discussion. Time (and articles) move on. Jayjg ^(talk) 23:59, 1 June 2010 (UTC)

Please read the discussions before drawing strange conclusions. Note that the consensus was ignored and actively violated. Guess who.Zinbarg (talk) 03:43, 2 June 2010 (UTC)

I have indeed read the discussions; there was no "consensus" as you describe it, and it's irrelevant anyway, since these discussions took place three years ago. Wikipedia is a wiki. Jayjg ^(talk) 03:54, 2 June 2010 (UTC)

I'm sorry, but what you wrote is inaccurate, and you don't make sense to me.Zinbarg (talk) 04:05, 2 June 2010 (UTC)

It occurs to me that we should review Administrator actions post consensus to insure they are acting in good faith and in accordance with Wiki rules.Zinbarg (talk) 04:18, 2 June 2010 (UTC)

I concur with Jayjg. There was quite obviously no "consensus" in the discussions you cite, Zinbarg. Frankly, these repeated false claims of consensus seem more than a little disruptive, and I would again ask you to stop. Jakew (talk) 08:59, 2 June 2010 (UTC)

Zinbarg missed this[[3]] discussion where Michael Glass recommends

Circumcision is the procedure that cuts some or all of the foreskin (prepuce) from the penis. The frenulum may also be cut away at the same time, in a procedure called a frenectomy. The word "circumcision" comes from Latin circum (meaning "around") and caedere (meaning "to cut").

Strongly in favor (with detailed reasons) of "The frenulum may also be cut away at the same time, in a procedure called a frenectomy."

Zandrous, TipPt, Coppertwig, Michael Glass, and recently Zinbarg, me.

Against are Jayjg, Avi, Jakew.

Jakew, you are proven wrong and dishonest. —Preceding unsigned comment added by 172.190.114.250 (talk • contribs)

Numbers are not, by themselves, a consensus, and it is important to look at strength of arguments as well. Nevertheless, the information you present contradicts your own position. By your own count (which I haven't checked) that's 4 in favour and 3 against, which is obviously a level of agreement that can't be called a consensus — it is clearly a lack of consensus. Jakew (talk) 15:55, 2 June 2010 (UTC)

Zinbarg, four in favor, three against, is not "consensus", and 3 year old discussions are irrelevant. Jayjg ^(talk) 00:27, 3 June 2010 (UTC)

Unindent. I don't know where you got those impressions. First, to me personally your comments are often irrational and barely intelligible; so maybe it's 4 to 2 (applying jakew's demand for quality of argument, though jakew determines "quality"). Second, older discussion is certainly applicable in Wiki because there's no new information. Finally, regardless the true consensus, I've found Jayg violating consensus with reverts once editors have moved on to other good works.Zinbarg (talk) 01:10, 4 June 2010 (UTC)

Your alleged inability to comprehend plain English is irrelevant to the fact that there was no consensus here, and that 2007 discussions aren't relevant any more. Jayjg ^(talk) 02:46, 4 June 2010 (UTC)

You might brush up on Wiki rules and english. "...that 2007 discussion aren't relevant any more." Hello? S/B Discussions dating back to ?(please show me any expiration rule in Wiki) are no longer relevant. You will find that you have violated rules of proper english, and Wiki's value of discussion.Zinbarg (talk) 03:02, 4 June 2010 (UTC)

The article has changed since then, as has the world, so any "consensus" about specific content in the lede would have little relevance today. In any event, it's all irrelevant, since there was no consensus then anyway, and making such false claims is disrespectful and wastes everyone's time. Jayjg ^(talk) 03:45, 4 June 2010 (UTC)

I agree, the The lede hasn't had consensus for years -- and yet it seems a that editors who like the current non-consensus version keep inappropriately removing the POV tag, whose only purpose is to avoid editwars and stimulate a resolution to the multiple open disputes on issues where no consensus for or against was the suggested edits were found; e.g., the title of the article. This should be rectified. Blackworm (talk) 04:49, 4 June 2010 (UTC)

It's very odd that your comment purports to "agree" with something I haven't said. Jayjg ^(talk) 05:08, 4 June 2010 (UTC)

Oh, sorry, I misread your statement. Stricken. I guess the only consensus is the "what's there now" consensus cited by editors who revert edits claiming that the edits do not have consensus. Blackworm (talk) 05:15, 4 June 2010 (UTC)

Not sure what you're really saying at this point. There was a consensus for the lede as it existed before Zinbarg and his sockpuppet IPs started edit-warring over it. Jayjg ^(talk) 03:52, 6 June 2010 (UTC)

Drawer of socks

Please note that recent comments from AOL IP addresses on this page are most likely all socks of User:Zinbarg, abusing multiple accounts to feign consensus. --jpgordon^{::==( o )} 21:55, 5 June 2010 (UTC)

And you say this based on...? Blackworm (talk) 09:05, 6 June 2010 (UTC)

This is the second time... stating this without any evidence is both uncivil and counter-productive. So, put up, or shut up. Mish (talk) 16:56, 6 June 2010 (UTC)

See Wikipedia:Sockpuppet investigations/Zinbarg. --jpgordon^{::==( o )} 17:01, 6 June 2010 (UTC)

It's very odd to see a comment complaining that a different comment is "both uncivil and counter-productive" while simultaneously telling other editors to "put up, or shut up". A startling incongruity, really. Jayjg ^(talk) 20:26, 6 June 2010 (UTC)

Not really, it is common saying, and seeing individual editors being targeted rather than dealing with their arguments gets a bit tedious. I don't understand the incongruity, but then after having pointed out to an admin who used the word "f***" to make a point that his response was profane and uncivil, only to then have a different admin tell me I was being uncivil for explaining my own experience of the topic-area, and the first admin then responding "And I'm sorry about the f***ing swearing but I'm f***ing sick of Wikipedia content being controlled by those who can shout longest and hardest. And that is exactly what is f***ing happening here." - nothing surprises me here any more.

My understanding of sockpuppetry is when a user creates a sockpuppet to masquerade as a different identity - a name by which he operates from. This simply seems to be about a named user occasionally maybe making edits without signing in, which may or may not have happened when he was blocked, and referring to the named identity in the third person. These edits coming from an AOL account, which presumably has millions of users and non-fixed IPs? And you think these are the same person - that's not sockpuppetry. Sockpuppetry would be if Jakew was using Jpgordon as an alias. This is why I was concerned about the allegations - because by suggesting sockpuppetry, not only does this say something about the alleged sockpuppetmaster, but it throws suspicion on other named editors as being sockpuppets. Fortunately, you have now cleared this up - you are accusing him of editing without signing in, and none of the named editors are sockpuppets. Perhaps you could now retract this allegation made on this page accordingly, and revise it to be clear what he is actually accused of - editing without signing in. Mish (talk) 21:40, 6 June 2010 (UTC)

Perhaps I could, but it wouldn't be accurate; he is accused of using multiple accounts and/or IP addresses to feign consensus, and this accusation is confirmed by technical and behavioral evidence. Just because there are lots of AOL IPs doesn't mean individuals using AOL are technically indistinguishable from each other. --jpgordon^{::==( o )} 22:21, 6 June 2010 (UTC)

The "incongruity" is in decrying allegedly "uncivil and counter-productive" comments by others while making them oneself. This needs no further explanation or wikilawyering. As for Zinbarg, he used the AOL IPs to pretend he was another editor, referring to Zinbarg as a different editor, and counting "himself" and "Zinbarg" as separate editors in counts of "consensus". WP:AGF is not a suicide pact, and please don't premise Talk: page comments on the assumption that we're idiots. Jayjg ^(talk) 22:27, 6 June 2010 (UTC)

No retraction of allegation needed. Use of multiple IP accounts in such a way as to create an impression of support for a position, or editing while one's main account is blocked, are policy violations. jpgordon's first post in this thread makes it very clear that it's about IP edits (not-logged-in edits). The sockpuppetry investigation linked to above found that the IP edits appear to be Zinbarg's. WP:SOCK says "Note that editing under multiple IP addresses, without registering, can be treated the same as editing under multiple accounts where it is done deceptively or otherwise violates the above principles. Registered users who edit without logging in are treated the same as if the IP was an alternate account. (Where editors log out by mistake, they may wish to contact an administrator or an editor with oversight access in order to ensure that there is not a misunderstanding.)" I had previously warned Zinbarg about this: (3rd paragraph here:) [4] ☺Coppertwig (talk) 22:39, 6 June 2010 (UTC)

Why was nobody here notified of this happening, and why wasn't there any notice on the user's page about this investigation? Was he informed of this (latest) investigation and given an opportunity to respond to the accusations against him? I see he is now blocked - is this automatic when it is found 'likely' that he 'may' have been editing without logging in. What transpired between that discussion and his being blocked? Or is the finding that it is likely that a user was editing without logging in entail an automatic block? I have a fixed IP address, so have always assumed that will be linked to my account in some way, but I am interested to know how it can be established that somebody who does not have a fixed IP address is the same editor. Can you point me to where I can find that out. Mish (talk) 22:59, 6 June 2010 (UTC)

Using multiple accounts to feign consensus is about the worst thing one can do on Wikipedia, short of outright vandalism, so it doesn't generally warrant a warning; nobody does it accidentally and it is an immediate demonstration of bad faith editing. No, we won't tell you in any detail how checkuser works; that would provide too much information to help bad-faith editors such as Zinbarg avoid detection. However, the checkuser team has checks and balances; if you have issues with my findings, feel free to request that Wikipedia:Sockpuppet investigations/Zinbarg be re-opened for examination by another checkuser. They won't give you any more details than I have, though. --jpgordon^{::==( o )} 23:33, 6 June 2010 (UTC)

Well, I have to take your word for this - I do not have access to the information you have. It seems odd to have a section for comments by the accused, if they are not notified that they are being investigated. If that is the procedure, and they have no opportunity to respond, then why not remove that section altogether? I know of another editor who was accused, and they had the opportunity to state their case. Having looked at the evidence in more detail now, you may well be right - but something in me feels that if somebody is accused of something, they should have the opportunity to defend themselves. Mish (talk) 00:45, 7 June 2010 (UTC)

differentiating infant and adult circumcision

Now the dust is settling, I have looked over the article again, and reviewed my earlier comment about having separate articles. The weight given to cultural and religious aspects of circumcision seems about right - and links to specific religious practices at the head of the page. That leaves adult vs infant circumcision. Given that these are different, certainly from an ethical standpoint, and possibly in practice, I do feel the article would benefit from some work separating out the two issues, so they do not confuse the reader that they are the same thing. I don't think they warrant their own articles, but could be dealt with more explicitly within this article. I understand that there will some overlap, but in terms of ethical critique, use of anaesthesia to minimise trauma, and routine neonatal surgery - these tend to focus on neonatal intervention, rather than adults. I also feel that something needs to be said about how routine neonatal surgery has a cultural aspect, for example comparing North America and Europe. I appreciate this needs to be guided by sources, and cannot be WP:OR. Mish (talk) 00:38, 7 June 2010 (UTC)

I think it would be very useful to separate the issues cleanly. It would hopefully help to structure the controversies about the article making it easier to balance and deal with all concerns. I am not too worried about sources, whatever you write there will be some source. Richiez (talk) 11:26, 7 June 2010 (UTC)

I'm rather dubious about this idea, but I think it would be best to see a concrete proposal before it can be analysed on the merits. Jakew (talk) 12:43, 7 June 2010 (UTC)

Well tackling the highly problematic introduction would be a good start. Richiez (talk) 13:05, 7 June 2010 (UTC)

I'm reluctant to do any work on the text of this article, beyond minor items, because the history of the article suggests this would be a wasted effort. I am simply suggesting a way that would differentiate and clarify the two issues, and allow for focus on the criticisms and advocacy in a way that would limit the impact on the rest of the article. If you don't feel like making those changes, that is up to you. As yet, I have seen no sign that the way it is currently structured has had any effect other than to draw people who are averse to the idea of routine infant circumcision, with the effect that article itself is subject to repeated attempts to insert anti-circumcision views and being a topic that is emotive for many, inevitable edit wars tend to follow. This is because at the heart of the issue there is a conflation of the two separate issues as one issue. Similar issues are not treated as the same - for example genital reconstructive surgery differentiates between adult sex reassignment surgery, Female genital enhancement surgery and childhood intersex surgery. Mish (talk) 14:22, 7 June 2010 (UTC)

Overuse of disambiguation links

Following recent edits, the article now begins with an absurd number (nine at the time of writing) of disambiguation links. This comes across as messy and disorganised, and it is a misuse of disambiguation links. The purpose of disambiguation links is to disambiguate, not to guide readers to subarticles. The only link that actually disambiguates is that to female genital cutting, which is sometimes called "female circumcision" (it seems doubtful that anyone would actually search for "circumcision" when looking for information about that, but it is at least possible). The other links do not disambiguate, and hence should not be there.

The correct approach for related articles depends on whether this article acts as a summary of that article. If a section of this article summarises that other article, there will be a link at the start of that section. If not, there should be a link in the text. In addition to this, there is also the {{circumcision series}} navigation box at the bottom of the article. Jakew (talk) 12:36, 9 June 2010 (UTC)

OK, but if you intend to do so even-handedly, you should also restrict the religious aspects to the section on religion and culture as well - not before the lead - and as FGM is not covered (by this logic), it shouldn't be there at all; also, the section on controversies does not fit into the article, yet it clearly is in the lead at least, so unless that can be relocated under ethics, it would need to stay where I just put it - before the lead. However, this article appears to act as much as a top-level DAB page as it does an article, so I'm not sure it can be classified a 'normal' article. If it helps decrease this article's magnetism, it may be justified. Mish (talk) 19:50, 9 June 2010 (UTC)

I've no objection to removing the dab link for religious circumcision. FGC is technically a disambiguation link because, as I mentioned, it is at least possible (however unlikely) that someone might search for "circumcision" when looking for information about FGC. It would not be appropriate to disambiguate controversies, since there is no ambiguity: "circumcision" simply cannot be interpreted to mean "circumcision controversies". Disambiguation links should be used to disambiguate, not to advertise related articles. I should note, however, that the controversies article is linked from the lead, so it is easy for readers to find. Jakew (talk) 20:27, 9 June 2010 (UTC)

It is at the moment, but as you have said, describing a debate as 'controversy' without a source that describes it as such is WP:SYNTH, and once you have agreed on the revised text that should go there, that link will be removed. However, as there is a controversy that covers the ethics of routine genital surgery on healthy infants (at least), that article still needs to be linked from the article in some way. Mish (talk) 20:48, 9 June 2010 (UTC)

I don't believe that to be a problem. We've been discussing above the possibility of removing the two sentences describing specific arguments. If we did that, we would be left with a general statement that circumcision is controversial, and there is no shortage of possible sources that we could cite in support of that. Hence it would be easy to solve the SYNTH problem in a way that would allow the link to the controversies article to remain. Jakew (talk) 21:17, 9 June 2010 (UTC)

I still think that it would be helpful to readers and editors alike if this page was clearly marked up in some way, rather than using a link burried in the text. Mish (talk) 22:21, 9 June 2010 (UTC)

As a compromise, how about a more explicit link in the text? Assuming that it could be sourced to everyone's satisfaction (including my own), how about something like "The subject of circumcision has led to a number of controversies; these include whether neonatal circumcision is acceptable or beneficial, and whether it is advisable to implement national programmes for circumcision of adult men as an HIV-prevention strategy (for more information, see circumcision controversies)." Jakew (talk) 22:42, 9 June 2010 (UTC)

The problem is that there are two places that cover this - the one on ethics, and the one on controversies. I would still prefer it if controversy was replaced with something like 'Circumcision is subject to vigorous debate'.(link here) Then, at the end there could be links to both Circumcision controversies#Modern debates, and ethics. And then at the start of the main section about ethics etc. in the text, a link to Circumcision controversies#Modern debates, with the pro & against statements we worked out earlier in the opening paragraph being displaced into the text below, as a second introductory paragraph to that section. It seems we have to have it in the text somewhere, but I am concerned about having material that draws edit warring in the lead. By relocating this down to the text, with a clear link to that article (which may itself need some work) at the start of that section, it could benefit this article considerably. Mish (talk) 23:16, 9 June 2010 (UTC)

disambiguation

Because this page also seems to act as a DAB for religious circumcision and FGM, I have tried to add redirects to more contemporary medical and legal pages dealing with circumcision, but it seems like there is a limit to how much 'about' will hold. So, I have broken these into three 'abouts', and added any missing circumcision articles:

• FGM
• Religion & controversey
• Medical/legal & controversies

Hopefully this will not be problematic - I have left out Circumcision of Christ and Circumcision of Our Lord as these seems very specific - I didn't appreciate some of these articles existed, and my reasoning is that if these are laid out clearly before the lead, rather than being a magnet for edit wars and disruption, this article will clearly point people in the direction of articles that deal with their concerns in more depth - before they get to the lead. Mish (talk) 12:44, 9 June 2010 (UTC)

Note: to avoid duplication I've made this a subsection of the above section. I refer to that section for my views. Jakew (talk) 12:46, 9 June 2010 (UTC)

Arguments or claims?

I was wondering about the best formulation in the controversy part of the introduction. Logically those are claims and not arguments - on the other hand claims may be considered unduly belittling, better ideas? Richiez (talk) 10:10, 9 June 2010 (UTC)

How about "Those advocating/opposing circumcision believe that ..."? Jakew (talk)

Not keen on "claim" - "belief" comes close, especially as both draw different conclusions from similar evidence; "suggest" maybe seems too soft, or "the position of those advocating for / advovating against" seems more neutral. Mish (talk) 10:44, 9 June 2010 (UTC)

We have no idea what they believe, we only know what they state. "Claim" is a word that should generally be avoided, see WP:CLAIM. Jayjg ^(talk) 22:36, 10 June 2010 (UTC)

I agree, 'believe' is a bad idea. Mish (talk) 23:24, 10 June 2010 (UTC)

Okay, scratch that then. Jakew (talk) 09:17, 11 June 2010 (UTC)

Skype

Aplogies for this, I installed skype on my PC the other day, and it appears to have embedded itself in firefox, and was trying to convert ISSN & ISBN numbers into UK telephone numbers. I've disabled it and removed the entries made. Mish (talk) 19:58, 9 June 2010 (UTC)

I wonder if it would be worth to install a wikipedia filter to catch such issues before it gets committed - did you look around if there already were reports of this issue? I am not very familiar with it but this might be starting points: MediaWiki_talk:Spam-blacklist or Wikipedia:Edit_filter/Requested. Richiez (talk) 08:28, 11 June 2010 (UTC)

Hyping sources in intro section

Who on earth is Schoen, Milos and Macris? Upon first glance I would call them prominent activists - so please write it there or leave them away completely. I find it very unfortunate that the position of AMA comes third to that. Richiez (talk) 14:30, 4 June 2010 (UTC)

Yes, an earlier version of the article described them as circumcision proponents and opponents, respectively. We should probably restore that language. Jakew (talk) 14:38, 4 June 2010 (UTC)

I agree that medical considerations are treated secondary to pro/con arguments. We should change the first sentence of the paragraph to read "There is controversy regarding circumcision, as evidenced by prominent activist statments. For example, Schoen argues...Zinbarg (talk) 18:55, 4 June 2010 (UTC)

This looks very reasonable. It also seems a US-centric discussion btw, from a European perspective this looks almost like a religious war. Richiez (talk) 19:53, 4 June 2010 (UTC)

It is odd from a European perspective, because in the USA neonate circumcision is routine and frequent, whereas here it is not. So, while medical circumcision is not a religious practice in the USA, it seems to be a strong cultural practice, in a way that it is not in Europe. Presumably it is difficult to voice that these surgeries are unnecessary when so many people have had them, particularly in a litigous country like the USA. Hence the qualification about consultation with parents, as that gets medical people off the hook. Nobody would dream of advocating clitorodectomy in non-intersex female neonates in consultation with parents - it is simply not a runner, as it is not cultural practice (unless an intersex girl with a large clitoris - although this has now fallen into disfavour).Mish (talk) 21:16, 4 June 2010 (UTC)

Could I ask that we keep our personal views on the subject to ourselves, and focus on making constructive comments about the article? Thanks. Jakew (talk) 21:28, 4 June 2010 (UTC)

Zinbarg's suggestion is already pretty good when you insert "in the USA Schoen argues". Further, there is not just one but many controversies. It would be tempting to be more specific, like saying that some countries/cultures have more controversy than other but I am not sure how much should go into this introduction. On the other hand I would find it perfectly ok to drop the US specific blob from the introduction. Richiez (talk) 20:11, 5 June 2010 (UTC)

We need to be careful of original research. If we say that controversy is evidenced by activist statements, that's an original argument that isn't made by the sources themselves. That's why I prefer to label the authors as proponents/opponents, and let the reader judge for him/herself whether they're evidence of controversy. Jakew (talk) 20:20, 5 June 2010 (UTC)

Unindented. I see your point but the labelling proponents/opponents is begging more questions. The "proposal" is not a new bridge or something but a medical procedure. Before mentioning the particular arguments it would be good to give some background about the discussion.. it is not a strictly medical discussion. There is a long history of proxy pseudomedical reasons used to justify the procedure, long history of flawed research on both sides and recently something of pro/con activist movements.

For the purpose of citing the sources names can be mentioned if it is clear that they are mentioned as notable activists. However if the sources are to be included as relevant medical sources than it could appear like source hyping which in most cases is not a good thing and it did certainly struck me immediately in this article. So if they are not well known activists than it would be an alternative to leave the names away and use just proponents/opponents. That way also arguments from more sources can be easier summarised in the same place should there be the need to do it. Richiez (talk) 23:26, 5 June 2010 (UTC)

An earlier version of the article read as follows. If we were to restore this version, do you think it would address your concerns?

• There is controversy regarding circumcision. Advocates of circumcision argue, for example, that it provides important health advantages which outweigh the risks, has no substantial effects on sexual function, and has a low complication rate when carried out by an experienced physician. Opponents of circumcision argue, for example, that it adversely affects penile function and sexual pleasure, is justified by medical myths, and is a violation of human rights.

Jakew (talk) 09:02, 6 June 2010 (UTC)

As this discussion focuses on the attribution rather than the content, why are you suggesting we simultaneously reduce the content, especially since your prior attempts to remove the phrase "extremely painful" were opposed by the consensus? Do you honestly think no one is going to notice this sleight of hand? Blackworm (talk) 09:09, 6 June 2010 (UTC)

Actually, Blackworm, contrary to your allegation of deviousness, I hadn't noticed that there were fewer arguments. My reason for highlighting it was the way in which arguments were introduced as those of (for example) "opponents of circumcision" rather than naming specific opponents. Jakew (talk) 09:17, 6 June 2010 (UTC)

It is better than the current version. Do you insist on "controversy" as opposed to "controversies"? Yes I would also leave the "extremely painfull" argument and since most of the controversy and this particular source is apparently about neonate circumcision I would try to explain that it can be "extremely painful especially for newborns for whom there traditionally was considerable reluctance to use effective methods of anaesthia and analgesia for something considered a minor procedure". Not sure if the original source fully backs that but I could surely find trustworthy sources explaining that.Richiez (talk) 10:36, 6 June 2010 (UTC)

Since we seem to have consensus on changing the names to the more descriptive "opponents", etc., I've gone ahead and made that change.

I don't insist on controversy, but I can't immediately see a better alternative. Might it not look a bit odd to use the plural?

I haven't changed the arguments. I'm reluctant to include a wordy explanation of one of the arguments in the lead, as I think it would increase the weight given to the opponents' arguments. It seems that the best way to avoid giving undue weight to one or other viewpoint is to try to keep the number of arguments and word count roughly equal. Jakew (talk) 10:46, 6 June 2010 (UTC)

Unindent again. Still needs some improvement: "is best performed during the neonatal period". This is the argument of some advocates, not nearly all. This is one of the reasons it should be immediately obvious that there is not just one controversy. Richiez (talk) 11:41, 6 June 2010 (UTC)

I guess that's probably true of most (if not all) of the other arguments, too: not every advocate/opponent makes every argument. I suppose we could say "some advocates", etc., but do you really think the reader will assume that we mean that every advocate makes that argument? It seems a bit of an unlikely interpretation. Jakew (talk) 12:20, 6 June 2010 (UTC)

I prefer if feasible the "opponents argue" etc. language rather than naming people; however, this change re-introduces a WP:V problem which was raised a while ago by Zinbarg, and which was the reason the names were put in in the first place: that it claims that advocates of circumcision argue that it's best performed during the neonate period, yet I remember seeing evidence of only one such advocate, not plural, (i.e. Schoen). We don't necessarily need another ref in the article, but can someone mention a ref here on the talk page supporting the statement that advocates (plural) argue that it's best performed during the neonate period? One more ref showing one more advocate would be enough. Otherwise we have to change the wording somehow: make "advocates" singular; use names again; delete the argument about neonates; or use different wording, e.g. "Arguments that have been raised in favour of circumcision include ...", or "Advocates raise arguments including ..." etc. In my opinion the current wording doesn't require that we establish that all advocates make those arguments, but does require that we establish that more than one does.

I just did a web search; maybe this ref would do? [5] (just to mention here on the talk page to establish that more than one person has argued it's best performed in the neonatal period).

See the discussion at Talk:Circumcision/Archive 59#Advocate versus advocates. (I easily found the link to the earlier discussion by referring to the Archive guide; editors are encouraged to add links to this guide, which is edited by hand and complements the Archive index which is maintained automatically.) ☺Coppertwig (talk) 16:53, 6 June 2010 (UTC)

I don't think we can make the neonatal period argument a special case. We either need multiple sources for every argument or one source is sufficient for every argument. Morris makes the same arguments as Schoen (I think) in this article, but if we combine the two then surely that's WP:SYNTH? I have no problem with including the "Arguments that have been raised in favour of circumcision include ..." language. Jakew (talk) 17:28, 6 June 2010 (UTC)

I don't think it's WP:SYN. Basic arithmetic (1 + 1 = 2) is allowed. In any case, I'm at this point in time willing to assume the WP:V requirement has been met for use of the plural "advocates". I oppose labelling someone as an "activist" in an article (as I think someone suggested above) unless a source is found which states that they're an activist. Trying to describe the authors might lead to endless discussion about how to word it. ☺Coppertwig (talk) 22:45, 6 June 2010 (UTC)

I agree re "activist": it seems to be a word with too many connotations. What do you want to do about your earlier suggestion ("Arguments that have been raised in favour of circumcision include ...")? Jakew (talk) 09:10, 7 June 2010 (UTC)

I think it was not a good idea of me to call them activists. Citing by name is not acceptable either. This is just an introduction and has to stay short - however before listing arguments it clearly needs something like an intro into the discussion. How about "There are controversies about medical and ethical aspects of circumcision.". Also, no matter whether you find 3 or 11 advocates who think that it should be best performed on newborns it must still remain clearly visible that not all advocates think this. "Arguments that have been raised in favour of circumcision include" looks like a good formulation however the problem whether it should be performed on newborns is still a different one and needs to be addressed separately.Richiez (talk) 11:08, 7 June 2010 (UTC)

I've made the "Arguments that have been raised in favour of circumcision include" change. As noted previously there is no justification for treating the best performed on newborns argument differently from other arguments. Jakew (talk) 12:40, 7 June 2010 (UTC)

The neonate issue requires separate treatment. It is not an argument pro-circumcision but rather how or when. The whole section is about US neonate circumcision and nothing else so it should be clearly visible. Richiez (talk) 13:04, 7 June 2010 (UTC)

I would suggest "advocate" rather than "activist" is worth considering, although I see you have gone ahead and made the change anyway. Mish (talk) 14:08, 7 June 2010 (UTC)

The change I made avoids using either "advocate" or "activist", and my impression was that there was consensus for it. I'm happy to self-revert if I was mistaken... Jakew (talk) 14:27, 7 June 2010 (UTC)

I'm not that bothered, as long as it is not activists. Finding a way of phrasing 'opponents of circumcision' as 'advocates opposed to circumcision' might be a bit long winded, and would need to be paralleled by 'advocates who support circumcision' for neutrality. Mish (talk) 14:43, 7 June 2010 (UTC)

NB, as per the discussion below, the summary of the source argument is not accurate:

• Those raised in opposition to circumcision include that it adversely affects penile function and sexual pleasure, is justified by medical myths, is extremely painful, and is a violation of human rights.

Should read

• Those raised in opposition to neonatal circumcision include that it adversely affects penile function and sexual pleasure, is justified by medical myths, is extremely painful, and is a violation of human rights

The source is discussing neonatal circumcision. Mish (talk) 14:50, 7 June 2010 (UTC) The same problem is present in the pro argument:

• Arguments that have been raised in favour of circumcision include that it provides important health advantages which outweigh the risks, has no substantial effects on sexual function, has a low complication rate when carried out by an experienced physician, and is best performed during the neonatal period.

Should read:

• Arguments that have been raised in favour of neonatal circumcision include that it provides important health advantages which outweigh the risks, has no substantial effects on sexual function, has a low complication rate when carried out by an experienced physician, and is best performed during the neonatal period.

However, there are other problems, in the use of weasel words, which should be excised. Something ought to also be stated in the 'against' section about the specific harm to health that can occur as a result before these two can be said to sit side by side neutrally.Mish (talk) 14:57, 7 June 2010 (UTC)

• Arguments in favour of neonatal circumcision tend to include that it provides health advantages which outweigh the risks, has no substantial effects on sexual function, has a low complication rate when carried out by an experienced physician, and is a procedure best performed during the neonatal period.
• Arguments against neonatal circumcision include that the associated health risks outweigh the benefits, adversely affects penile function and sexual pleasure, is justified by medical myths, is painful and traumatic, and is a violation of human rights.

I'd suggest this is better balanced, and loses words like 'important' and 'extremely'. Mish (talk) 15:03, 7 June 2010 (UTC)

That's actually quite a lot worse. You've disturbed the balance such that instead of having equal numbers of points for each side there are now five points (six if we count "traumatic") for the arguments against versus four for those in favour. Jakew (talk) 15:18, 7 June 2010 (UTC)

That's progress then, at least we agree that these both deal with neonatal circumcision specifically, rather than just circumcision as it currently stands then.

I disagree that it is less balanced, but understand the point that it is not as balanced as it could be.

Let us drop painful in favour of traumatic then, as this is in the source, and trauma covers pain as well as emotion and physic.

We could also drop the sexual pleasure, to align with the 'pro' statement (incorporating sexual pleasure as part of sexual function - apart from for certain religious groups who believe sexual function is purely procreative, and not for enjoyment, this should not be problematic).

I don't think much of this source, as it is strident and incoherent, and would like to lose the emphasis on medical myths myself, but this is intrinsic to this source.

breaking section for accessibility

There is a better source here,[6] which although not as strongly argued may serve to give a more balanced counter-argument to the one given.

• Arguments in favour of neonatal circumcision tend to focus on health advantages throughout life as outweighing the risks in childhood, having a low complication rate when carried out by an experienced physician, there being no substantial effects on sexual function, and being a procedure best performed during the neonatal period.
• Arguments against neonatal circumcision tend to focus on health advantages in adulthood not being relevant for childhood surgical intervention and that childhood benefits are offset by other treatment options, thereby the risk of harm outweighing any putative benefits, and the ethical issues of removing healthy tissue without consent of the individual.

This maintains the 4-4 ratio, and is based on corresponding sources.Mish (talk) 17:18, 7 June 2010 (UTC)

I think that's a lot better than your previous suggestion, but it's not completely neutral. The description of the arguments in particular is rather too close to arguing the points themselves, rather than noting that they are made. I also think that some of the arguments could be put better. Finally, I do not agree with focusing on arguments re neonatal circumcision specifically, as it gives the misleading impression that only neonatal circumcision is controversial. In fact, to some extent there are controversies surrounding circumcision at any age (such as of adult males in the context of HIV prevention, for example), and many of the same arguments are employed.

I've therefore rewritten your suggestion as follows:

• Authors in favour of circumcision have argued that it has significant health advantages throughout life outweigh the risks, has a low complication rate when carried out by an experienced physician, that there are no substantial effects on sexual function, and that it is a procedure best performed during the neonatal period.
• Those against circumcision have argued that health advantages in adulthood are not relevant for childhood surgical intervention and that childhood benefits are offset by other treatment options, that the risk of harm outweighs benefit (if any), and that it is unethical to remove healthy tissue without consent of the individual.

Personally I think the text in the current version of the article is stronger than this, but I would not strongly oppose its inclusion. If you agree with it, I suggest waiting for a few days to see whether there is consensus, as the listed points in this paragraph have proved to be contentious in the past.

Note: when trying to make the prose more neutral I noticed that the "arguments for X" construction implies that the argument itself is valid, so I've instead used the "Persons arguing X have said", which neither implies that arguments are valid nor invalid, but merely notes that they have been made. Jakew (talk) 17:46, 7 June 2010 (UTC)

It is not about counting how many arguments each party has. The arguments that are there must be summarised correctly. I dont see how you can do that without cleanly separating the issues of neonate, adult and religious circumcisionRichiez (talk) 20:07, 7 June 2010 (UTC)

Actually, the number of arguments that we could summarise is enormous, so clearly including them all is impractical. That being so, we must obviously select some arguments, and we need to do so in accordance with WP:NPOV, which requires us to pay attention to the amount of weight given to each point of view. That's why I'm insisting on equal numbers of points: it's the most fair way to ensure that we give each viewpoint equal attention. Jakew (talk) 20:25, 7 June 2010 (UTC)

@Jakew, thanks, but re your previous comment, I'm afraid that omitting that these relate to neonatal circumcision is synthesis. Both sources are concerned with the pros and cons of neonatal circumcision, not circumcision generally (with one source arguing how neonatal circumcision is preferable to adult circumcision). Adult circumcision and HIV prevention may be controversial (less so though when individuals can choose than when they cannot, but clearly controversial when carried out as a national healthcare strategy in place of potentially more effective strategies), but arguments for anad against with adult consent are different from those that apply to children. Not to be clear in the way we represent sources on this could mislead our readers. Mish (talk) 20:39, 7 June 2010 (UTC)

Strictly speaking, Mish, the entire paragraph is synthesis. Neither source by itself establishes a controversy; only by using both do we present a controversy. That's synthesis, technically, but nobody has objected to it (at least until now) because a) rather than harming NPOV by promoting arguments of one side it actually helps NPOV by giving information about the range of views up to each extreme of the POV spectrum and b) WP:LEAD suggests that the lead should discuss "any notable controversies". I'm not entirely convinced that omitting a word constitutes synthesis, but if synthesis is a concern then one solution may be to remove the paragraph, or replace it with something less detailed but better sourced. Jakew (talk) 09:12, 8 June 2010 (UTC)

@Jakew: if you insist counting arguments and not separating neonate circumcision then I find it odd that you do not merge the arguments of the early Christian circumcision controversy and other controversial issues with this section and count the arguments. Also this article is in the scope of the WP medicine project. The arguments of single researchers of questionable neutrality or outspoken activists like those mentioned can not come before the AMA statement unless this is clearly marked as political or religious statement. Richiez (talk) 08:42, 8 June 2010 (UTC)

I'm not sure that it would be informative to present two thousand year old arguments alongside those of the past few years. I would have some concerns about moving the paragraph after that of the AMA & WHO, as it would seem more appropriate for these authorities to have the "last word", as it were. But see above for a possible solution. Jakew (talk) 09:12, 8 June 2010 (UTC)

I did not claim it would be informative but that it would follow your logic of counting arguments. I claim the current state is a significant distortion of arguments presented by not just 2 persons. The claim that "Neither source by itself establishes a controversy" is hard to follow, maybe the 3 cited authors never used the word controversy (which I find hard to believe) but many others did and you claimed this subsection ought to summarise arguments from several sources.

Overall it needs more work than just adding "neonate" in 2 places but it would be a good start if we could finally agree to separate the issues cleanly. There are certainly very interesting issues about adult circumcision as well that should be mentioned and fall into the scope of body modification but this would be utterly unsuitable to be discussed "logically close" to neonate circumcision. Richiez (talk) 09:46, 8 June 2010 (UTC)

Hi Jakew. Placing the two 'sides' together in a single paragraph is not synthesis, because they form the only two articles in a section of the journal devoted to the topic:

"Debates"

Should newborns be circumcised?: YES

Edgar J. Schoen

Can Fam Physician. 2007 December; 53(12): 2096–2098.

Should newborns be circumcised?: NO

Deirdre Andres

Can Fam Physician. 2007 December; 53(12): 2097–2099.

I'd suggest that the debate is significant enough for a journal aimed at General Practioners / Family Physicians to present it in a neutral and balanced way, side by side within the journal, and given equal weight. This suggests to me that this is the most uncontroversial way of presenting the controversy. As you will see from the title, they are the same title, one with a 'No' response, one with a 'Yes' response, and we are presenting them in the same sequence as the journal. You will also notice that the title specific in it being about neonates, rather than circumcision generally. Mish (talk) 15:55, 8 June 2010 (UTC)

The synthesis is in the first sentence, Mish. Neither of the two sources asserts that there is controversy, so clearly this assertion (and hence the raison d'etre for the entire paragraph) is synthesised from the two sources. I continue to oppose limiting discussion to neonatal circumcision only, for reasons explained previously. Another possible solution might be to include material about another selected controversy as well, but to keep the paragraph small this would require cutting back on the neonatal material. Jakew (talk) 16:03, 8 June 2010 (UTC)

Actually, I'd not have a problem against losing the statement about controversy, which really acts as a link to an article that covers the controversies fairly comprehesively. The link could be added to the redirect at the head of the article, and de-linking the opening sentence, and simply stating there are arguments for and against neonatal circumcision, opening with the two summaries (shortened iof necessary). We could lose the break to the following paragraph and pull up the AMA position as the end of that paragraph. That leaves the short paragraph about HIV & circumcision. Would you suggest a brief mention of debates about adult circumcision would form a separate paragraph, or could it fit in with the HIV paragraph? My feeling is that the HIV debate may apply to circumcision generally, which means it couldn't form part of the adult debate - so perhaps that could be a short paragraph in its own right? It is working a bit arse-about-face, but the lead is supposed to be reflective (intro/summary) of the article as a whole - but perhaps by clarifying this in the lead, we can approach the issues in a similar way in the text.

However, having said this, I wasn't aware how comprehensively these issues were dealt with under 'controversies'. I am now starting to wonder whether we need to say much more in the lead than that there are arguments for/against neonatal & adult circumcision, including HIV prevention, with sources - and push the material we have now into appropriate sections in the text, and ensuring there is a clear link to the controversies article as well. That way we can make it clear to readers (& editors) where this is dealt with, but keep the treatment of the 'issues' in this article to a minimum. The controversies section would need to be monitored in tandem with this article, and something stated at the top of the talk page that will not be archived that makes it clear this is not the place for developing coverage of controversies or arguments for/against - pointing to that article. I am not sure that its current title is the best possible title, but that is a separate discussion. Mish (talk) 17:05, 8 June 2010 (UTC)

If we include a single sentence, essentially saying that there are controversies, that sentence would be fairly easy to source, and could be linked to the controversies article.

I'm not altogether comfortable about joining the AMA paragraph with the controversies para. I think they're separate and should be treated as such. Jakew (talk) 17:25, 8 June 2010 (UTC)

Looking at this again, in conjunction with my comment further down about the weight given to religion in the lead, it seems that much of the lead is off-topic, because it relates to other articles linked to from within this one. Slimming religion and arguments for/against medical circumcision (of neonates), would leave the lead with about four sentences at most - and little on the topic itself. Mish (talk) 17:17, 8 June 2010 (UTC)

This article is in summary style, Mish. That means that some sections of this article act as a summary of other, larger articles. It is not correct to say that this material is off-topic in the lead; a short summary of the summary is not necessarily inappropriate. Jakew (talk) 17:25, 8 June 2010 (UTC)

OK, I get your point, but 1/3 about religious circumcision, the info about infant circumcision controversy, the detail about the AMA on infant circumcision, WHO on HIV... doesn't leave much in the lead that is actually about circumcision. Mish (talk) 18:18, 8 June 2010 (UTC)

Why isn't religious circumcision "actually about circumcision"? Jayjg ^(talk) 02:26, 9 June 2010 (UTC)

Please don't put what I say out of context, synthetically putting words in my mouth in way they were not stated as in the way you have rendered them, that is uncivil. 1/3 of the lead devoted to one brief section in the text - while hardly anything is stated about the act of circumcision within the lead. This is not uncommon. Conversiona therapy has similar problems - lots about arguments for and agains, controversies, people - but little in the article that explains what conversion therapy is. This article does have details about the act/process, but the lead does not reflect the text particularly well. Mish (talk) 08:16, 9 June 2010 (UTC)

I haven't put anything you said out of context, or "synthetically" put words in your mouth. If you didn't mean to say that, please feel free to re-state it more accurately. Jayjg ^(talk) 22:30, 10 June 2010 (UTC)

If you did not understand what I said, then I guess I ought to. I meant the surgical process, not the cultural practice. That is in the article, and what the article is about to some extent, but there is little in the lead - there is a lot in the lead about the cultural practice which is deternined by a certain religious beliefs, but not that much in the article - because there are other articles that cover this more comprehensively. (They may go into detail about the process specific to religion - I wouldn't know, because that is of little interest to me).Mish (talk) 23:33, 10 June 2010 (UTC)

I fully understood what you said. and responded to it accurately. If you meant something different, you should have stated it differently. The cultural practices are no less "actually about circumcision" than the surgical processes. Jayjg ^(talk) 03:36, 13 June 2010 (UTC)

We do actually explain that it is the removal of the foreskin. Beyond that it's difficult to generalise because there are so many different techniques. Jakew (talk) 09:16, 11 June 2010 (UTC)

Sure, but if you look at the article, the medical issues section is by far the most susbtantial, and even just the first three subections of that section deal with issues about circumcision itself (particularly neonate) and this dwarfs any other section apart from the parts that deal with HIV. So, having a paragraph that takes up appx 1/3 of the lead, yet represents one of the smallest sections in the text, and less than a line on the medical process itself, which is one of the largest groups of sections, against a fairly balanced spread between 'controversies' about the ethics of neonatal and HIV prevention - it just seems unrepresentative of what this article is about. If anything the balance needs to be the other way around. One or two short sentences on history/culture/religion, and 1/3 on the process. Mish (talk) 10:45, 11 June 2010 (UTC)

There is no doubt that the medical practices section could be more tightly summarized, and the detail included in the actual sub-article. Jayjg ^(talk) 03:36, 13 June 2010 (UTC)

Not really necessary, this article falls under Medicine, Sexology and Body Modification Projects - cultural practices and religion normally come under projects covering sociology/cultural studies/social anthropology and/or religion projects respectively (as I would expect lower-level articles about the religious practices to be under the appropriate project) - so the emphasis on the medical practice is not undue. As per my previous statement - given the project scope of this article, I'd expect the focus to be on the practicalities of the subject, less than the cultural aspects (apart from where countries like the USA make medical practice a cultural practice). Mish (talk) 20:24, 13 June 2010 (UTC)

The projects an article "falls under" are irrelevant to how much material should be devoted to which aspects of it, and have no bearing on appropriate content. Projects are a way of organizing editors, not content. Cultural practices are no less relevant or important than medical, which already have a full article devoted to them. This article needs to summarize that medical information more tightly, per WP:SUMMARY. Jayjg ^(talk) 21:14, 13 June 2010 (UTC)

It is relevant because an article under medicine has different policies and guidelines to those applicable generally; for example, the sourcing standards that apply here are those of that project. However, this is a bit of a red-herring, because the issue is not whether the article limit its coverage of medical aspects, but whether the lead is balanced in that it is dominated by a large paragraph about religious and cultural aspects, a short paragraph about the social issues affecting neonates, a short paragraph about HIV prevention, but very little about the medical practice of circumcision itself. Mish (talk) 21:29, 13 June 2010 (UTC)

However, if you want to have another discussion about reducing the amount of information about the medical aspects within this article, given there is an article which covers this in some depth, I'd support you in that. Mish (talk) 21:34, 13 June 2010 (UTC)

I agree with Jayjg that the project classification of the article doesn't determine its scope. Furthermore, the Wikipedia policies for medical stuff apply to the medical aspects of the article; historical statements in the article are still covered by Wikipedia policies about history, etc. ☺Coppertwig (talk) 23:18, 13 June 2010 (UTC)

I also agree with Jayjg. The fact that this page is tagged with a number of WikiProjects means simply that at least part of its content may be of interest to members of the respective projects. Application of sourcing standards requires a certain amount of common sense, but as a rule of thumb the higher the standard of sourcing the more likely it is to satisfy the requirements of every potentially applicable policy or guideline. Jakew (talk) 11:20, 14 June 2010 (UTC)

Uncircumcised photos--misleading?

I have this problem with the pair of photos showing an uncircumcised penis. The one that shows the penis erect shows it with the foreskin fully retracted. That could imply that when an uncircumcised penis becomes erect, the foreskin is necessarily back--as if the penis "grows out of its skin," and the glans necessarily emerges. That's not true. An uncircumcised penis can be erect, and the foreskin can still--at least largely--cover the glans. 71.126.140.136 (talk) 10:47, 14 June 2010 (UTC)Stephen Kosciesza

Assuming that we could find such a photograph, wouldn't there be a similar problem if we replaced it with an image in which the foreskin covered the glans when erect? Then it could be taken to imply that foreskins typically don't retract upon erection. Actually, it would be worse, as the majority of foreskins (from my own observations; I hope you'll excuse a little original research) do retract upon erection. Fortunately, the article is about circumcision, not uncircumcised penes, nor foreskins, and consequently it's reasonable to expect readers to read the foreskin article to learn about what foreskins do or do not do. Jakew (talk) 11:14, 14 June 2010 (UTC)

Moving forward

I've restored the previous version until consensus can be achieved on any changes. I have temporarily restored the POV tag, which I intend to link to this talk page section.

I will now attempt to summarise the contested changes, as well as my own sense of current consensus (if any), and scope for possible compromises. Inevitably, this will be written from my own point of view, so I invite constructive criticism.

• In the AMA paragraph in the lead, removal of the date (1999). This seems unlikely to gain consensus, as the date is required for the reader to understand what is meant by "currently" in the quote.
• Addition to the above paragraph of "Circumcision is medically indicated for only a few conditions." This seems unlikely to gain consensus in its present form, as objections have cited NPOV problems and lack of precision. Two alternatives have been proposed: using a quotation from the same source, or quoting/paraphrasing another source instead. Current objections to the first are that it is too vague and uninformative. Objections to the second are that may "support a circumcisionist POV" and that the source itself has less authority than the WHO. A third possibility (not yet discussed) is not adding anything. Further discussion of these possibilities might be fruitful.
• Addition to the above paragraph of "While there is substantial evidence that circumcised men have a lower risk of urinary tract infections as well as penile cancer and HIV, these conditions are treatable or uncommon or rarely applicable." This seems unlikely to gain consensus in its present form, as objections have included NPOV problems as well as misrepresentation of the source. A quote has again been proposed as an alternative. There may be some possibility of compromise if this replaces the AMA quote. Further discussion might be worthwhile.
• Removal of the WHO/UNAIDS/CDC paragraph. There seems to be a rough consensus that the lead should contain this. However, there is some agreement that it could be shortened, and that it could be modified to clarify that WHO and UNAIDS are a single source. Further discussion might constructively explore these issues.
• In the "sexual effects" section, addition of a chart showing the results of Sorrells et al. This seems unlikely to gain consensus, objections have cited UNDUE concerns. My sense is that further discussion is likely to go around in circles.
• Replacement of Image:Flaccid and erect penis.jpg with Image:Circumsised penis - Flacid and Erect - High Res.jpg. Consensus on this is difficult to judge, owing to canvassing problems in a recent discussion. Objections to the first image have mainly focused on the bright white background (with disagreement as to the cause). Objections to the second have focused on the fact that it has an orange cast, and that it is noticeably smaller than the uncircumcised penis presented for comparison. I have found commons:File:Circumcised penis - Flacid and Erect - High Res2.jpg, which solves the orange cast problem, but it would still be desirable to present similar penes — one possibility may be to find an alternative uncircumcised image.

Jakew (talk) 09:38, 3 June 2010 (UTC) (edited 10:42, 3 June 2010 (UTC))

As I read it, the AMA's current position is endorsement of the 1999 statement - as in if it ain't broke, don't try and fix it. So the 1999 position is still the current position. Mish (talk) 11:32, 3 June 2010 (UTC)

As far as I know, their 1999 statement is indeed their current policy, but when they use the word "current" it obviously means "at the time of writing". The quoted sentence begins, "Virtually all current policy statements from specialty societies and medical organizations" (emph. added), so the question is, current as of when? 1899? 1999? 2009? By supplying the date of the statement we provide information that is necessary to interpret the sentence. Jakew (talk) 12:37, 3 June 2010 (UTC)

I would like some explanation as to why my paraphrase was problematic, as opposed to simply saying that it is innacurate, or not NPOV. Mish (talk) 11:32, 3 June 2010 (UTC)

I hadn't specifically noted your suggestion above, Mish, and I apologise for overlooking it. I did comment briefly on the problems in my earlier edit of 09:18, 2 June 2010. I see three specific problems with it. Firstly, "noting that these are either rare or else can be treated" is not true to the source: your words imply that every condition is either rare or treatable, but this implication is not present in the source, which states "some of these conditions are rare while others are uncommon or treatable" (a valid interpretation of which is that still others are neither). Secondly, when the source comments on conditions that are rare or treatable, that is a clear reference to the conditions listed in the same sentence: reproductive tract infections and penile cancer. The source does not suggest that HIV is treatable or rare, but your paraphrasing does. Finally, the final part of the sentence ("and only in a few medical conditions is circumcision advisable") still suffers from the vagueness of "a few", and I think it is inappropriate to combine circumcision as prevention and circumcision and treatment in the same sentence. Jakew (talk) 12:37, 3 June 2010 (UTC)

Moving forward is actually backward (away from consensus). Please read discussion for each of the changes made, and you will find more editors in favor of the WHO summary ect text. You should also find a better quatlity of argument.Zinbarg (talk) 16:42, 3 June 2010 (UTC)

I just read Jakew's above writing, and found that all of the topics of discussion had already been fully covered. Again, the consensus was to the unbiased text, picture, and graph.Zinbarg (talk) 16:52, 3 June 2010 (UTC)

I hadn't taken the time to view Jakew's proposed picture, which doesn't have the bright light coloration. I can't waste an edit, but next time I'll include Jakew's suggested picture.Zinbarg (talk) 17:13, 3 June 2010 (UTC)

@J. Right, so amend it to accommodate this 'some' that you see as implying that some things in the list cannot be treated, or are rare, or are uncommon (HIV infection is treatable).

@J. If the 1999 statement has not been superceded or revised, it is their current position, and continues to be so until that is revised. If you believe this is not their current position, what is the evidence? Without evidence to contrary, supposing that there view would ve different if they had a more recent position is speculative. This is the position today - if they change their position tomorrow, then we update the text. Mish (talk) 19:16, 3 June 2010 (UTC)

Regarding your paraphrasing, I think it would be difficult to paraphrase accurately, and for that reason I find a quote to be the least bad of the options suggested so far. Incidentally, it would not be possible to enlarge the list — since it is attributed to the WHO it must say what they say and only what they say.

Regarding the AMA's statement, since I've already agreed with you that the AMA's 1999 statement is their current policy, I'm not sure why you're asking me to provide evidence to the contrary. If we were discussing a situation in which the AMA were acting as a primary source regarding their own policy, the fact that their policy is current would be more relevant. However, the quoted sentence is not about their policy; instead it is about the policies of other organisations. The AMA have no direct control over these other organisations. What they did in 1999 was to report on the contents of other organisations' policy statements that were, at the time, current. It seems improbable that they meant to describe the policy statements of other organisations eleven years in the future: how could they possibly know what those might be? It also seems unrealistic to suppose that the AMA would monitor day-by-day whether that sentence is still true, so that they can instantly retract or revise it when it is no longer accurate — would they employ someone specially? Clearly, they meant to describe the policy statements that were then available when the report was published — any other interpretation would seem to be absurd. Jakew (talk) 19:53, 3 June 2010 (UTC)

OK, so why not just say that since 1999, the AMA has continued to endorse the AAP's position, which is that there is while there are benefits, there is insufficient scientific evidence to warrant routine circumcision. Mish (talk) 21:04, 3 June 2010 (UTC)

• Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. [7]
• The AMA supports the general principles of the 1999 Circumcision Policy Statement of the American Academy of Pediatrics, which reads as follows: Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision.[8]Mish (talk) 21:04, 3 June 2010 (UTC)

The reason why we quote the AMA in the lead is to be able to give an overview of what medical organisations as a general rule, say, and the AMA seems to be the best available source for that, even though it's not perfect. In contrast, if we were to discuss the policy of the AMA, the reader wouldn't have any information at all about other policies. Also, it might come across as rather US-centric. In principle, I guess I'd be willing to go along with it, but I'd have some reluctance, and would find it difficult to defend if anyone were to challenge it in future. Including the words "stated in 1999" seems an awful lot simpler... Jakew (talk) 21:31, 3 June 2010 (UTC)

No problem:

The Australian College of Pediatricians (1996):

• Neonatal male circumcision has no medical indication. It is a traumatic procedure performed without anaesthesia to remove a normal and healthy prepuce. http://www.cirp.org/library/statements/acp1996/

This is currently endorsed by the Royal Australasian College of Physicians [9], summarising the ACP as: “Neonatal male circumcision has no medical indication"; and placed alongside their support for recommendations of the Canadian Pediatric Society and the AAM, which they summarise as "we can not recommend a policy of routine newborn circumcision". The Canadian position is:

• The overall evidence of the benefits and harms of circumcision is so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns.[10]

The Canadian position puts the cost-benefit unto perspective, that there is evidence of benefit in a small number of cases (<2%), these do not outweigh the risks associated with circumcision that are manifest in a small number of cases (<2%).

TBH, I would opt for the CPS statement, as it puts the risks and benefits in perspective, and concisely explains why it is not recommended. Mish (talk) 21:49, 3 June 2010 (UTC)

Citing the CPS instead merely shifts the problem instead of solving it. It suffers from the same problem as citing the AMA, but instead of being US-centric it's Canada-centric. The lead hasn't enough space to cite multiple policy statements — and we already do that in the body of the article, anyway. Jakew (talk) 21:55, 3 June 2010 (UTC)

Sure, if that's the problem, just say that the positions of several countries medical (USA, Canada, Australia, New Zealand) associations correspond to that of the AAP - that routine neonatal circumcision is not recommended, in most cases because the benefits do not outweigh the risks. Mish (talk) 22:24, 3 June 2010 (UTC)

We can't — that's WP:SYNTH. See why we currently cite the AMA? Jakew (talk)

You can add Britain to that list as the BMA's ethics statements (2006) endorses the BAPS position: "The British Association of Paediatric Surgeons advises that there is rarely a clinical indication for circumcision." [11] The BAPS statement istelf only indicates a limited set of circumstances where circumcision applies. The GMC withdrew its interim statement on circumcision in 2007. Mish (talk) 22:53, 3 June 2010 (UTC)

Not really - if you use the Australia and New Zealand position, they endorse the Canadian and AMA positions - so that is not synthesis. A single source that is not Australasia-centric, yet covers a significant part of the English-speaking world, which is the most relevant in an English encyclopedia. Mish (talk) 22:53, 3 June 2010 (UTC)

• The Royal Australasian College of Physicians, follows the the ACP position: “Neonatal male circumcision has no medical indication" along with the recommendations of the Canadian Pediatric Society and the AAM: "we can not recommend a policy of routine newborn circumcision".[12]

Problem solved, if you want it solved .Mish (talk) 22:53, 3 June 2010 (UTC)

I would note that we covered all this already. The 1999 AMA statement addresses the position of medical associations re neonatal circs. I presented a long list of those associations, the dates of their statements, and the gist (do not recommend). Point is, most are post "gold standard" HIV findings. Thus the AMA statement is current, effectively as current as the 2007 WHO/UNAIDS publication Jakew wants to highlight. Our audience is well served using the AMA statement without any date. Finally, none of the med assoc statements make much of the HIV benefits (being less than UTI benefits, for example). Therefore, putting great emphasis (as Jakew attempts) is misleading relative to UTI's (which he chooses to not mention). It is also misleading, because "limited public health benefit" will be found where incidence is less than 3%. The only english speaking country where there's that much HIV is So Africa (thus the limited applicability for our audience). Instead, we are using the 2007 WHO summary. But, as Mish suspects, I think some editors seek bias.

I think Jakew's goal is to cast doubt on the AMA statement, because "gold standard" (Jakew calls them) HIV findings came later. Actually, HIV benefits were well known in 1999. But regardless, the AMA monitors and updates their statements regularly for new information. And most of the underlying medical association statements are post gold standard findings. Cast doubt, and then Jakew puts HIV text in it's own paragraph, at the very end of the introduction, and exaggerates the sources and the public health benefit, while completely ignoring more important benefits.Zinbarg (talk) 01:28, 4 June 2010 (UTC)

Please stop "deliberately asserting false information", it's not helpful for discussion. The AMA statement is "current" as of the date it was made, 1999, and the HIV benefits were not known until the results of the relevant studies became know in the mid 2000s, not in 1999. Jayjg ^(talk) 02:44, 4 June 2010 (UTC)

It's not really a solution, Mish, because it doesn't give any indication of typical statements, and it's still limited to the English-speaking world, while Wikipedia is supposed to be global in scope. Also, by including only the parts of the AAP and CPS statements with which the RACP agrees it gives the RACP a great deal of weight. It's just one organisation, and selected other organisations with which they happen to agree with at least part of their statements. Jakew (talk) 09:00, 4 June 2010 (UTC)

Unindent. Then why are HIV benefits treated (post "mid 2000's) similarly to the 1999 AMA statement and others? "...found a statistically significant association between lack of circumcision and elevated risk for acquisition of HIV (relative risks 2.3-8.1)." "...Regardless of these findings, behavioral factors are far more important risk factors for acquisition of HIV and other sexually transmissible diseases than circumcision status, and circumcision cannot be responsibly viewed as "protecting" against such infections." It's really silly to debate, because You and a couple other editors revert away consensus.Zinbarg (talk) 03:10, 4 June 2010 (UTC)

What do you mean by "HIV benefits were well known in 1999"? Please explain. Also, please review the meaning of the word "consensus". Jayjg ^(talk) 03:48, 4 June 2010 (UTC)

I support the inclusion of the dates of all sources, in the article text, whether being cited by us directly or by sources we cite when we discuss their references to other sources. As it has not yet been demonstrated that the disputed African HIV studies that were ended early have had any impact on any Western major medical organizations' policy regarding routine neonatal circumcision of males, I support the current version of the AMA quote as a perfectly acceptable summary. Blackworm (talk) 04:56, 4 June 2010 (UTC)

The HIV issue is a bit of a red-herring, surely? Adults contract HIV sexually, neonates do not, so discussion about circumcision and HIV is an adult issue - this is about childhood circumcision. It is important not to conflate the two. The statements relate to neonate circumcision, and it is hard to see how neonate circumcision can prevent HIV in children - as children don't tend to acquire HIV that way. To muddle up the benefits of neonate circumcision for childhood medical issues, which is low, and adult medical issues, is dubiously synthetic.Mish (talk) 08:16, 4 June 2010 (UTC)

Children have a way of becoming adults, Mish, which is probably why hundreds of sources discuss HIV in the context of neonatal circumcision. Jakew (talk) 09:00, 4 June 2010 (UTC)

That circumcision was protective against HIV was strongly suspected in 1999, but at that time there was only observational evidence, which is not proof of causation. The publication of the RCTs in 2005 and 2007 established causation, which is why they had such an impact on, for example, the World Health Organisation. Very few English-language policy statements have actually been released since that time (I have no idea about non-English language statements, but I presume that the countries that have started circumcision programmes have done so with the support of their respective medical associations). The main changes were that AUA released a statement adding a recommendation that circumcision should be presented as an option for health benefits, and the RACP issued (and then withdrew) a mini-statement that was more accepting of parental choice.

But this is indeed pointless to debate. It doesn't get us anywhere. Jakew (talk) 09:00, 4 June 2010 (UTC)

The Australian statement draws on Australian, US and Canadian medical consensus, is more recent than the AMA (which it affirms), and specifically addresses the issue of HIV research in sub-Saharan Africa, as well as clearly laying out that the risks outweigh any potential benefit for children:

1. Urinary tract infections affect 1%-2% of boys, and may be about 5 times less frequent in circumcised boys, whilst circumcision has a complication rate of 1% to 5%. On current evidence routine neonatal circumcision cannot be supported as a public health measure on this basis.
2. While there is some evidence, particularly from sub-Saharan Africa, that male circumcision reduces the risk of acquisition of HIV, evidence is conflicting and would not justify an argument in favour of universal neonatal circumcision in countries with a low prevalence of HIV.
3. Penile cancer is a rare disease with an incidence of around 1 per 100,000 in developed countries. Even though the evidence suggests neonatal circumcision may reduce the risk 10-fold, the rarity of the condition and its other recognised predispositions are such that universal circumcision is not justified on these grounds alone.

So, the concise statement by them seems to be the best possible statement available at this time:

• "there is no medical indication for routine neonatal circumcision" (bold as in the source).

This fully covers the positions of Australasia, USA and Canada, at least. without being US-centric. Mish (talk) 09:46, 4 June 2010 (UTC)

I refer to my above comments (which begin "It's not really a solution, Mish..."). Jakew (talk) 10:26, 4 June 2010 (UTC)

Children do have a way of becoming adults, but I have problems understanding why the medical profession feels it necessary to carry out genital surgery on a child for something that might happen in adulthood - for example, constructing a vagina in a neonate who will be unlikely to use this until after puberty. Ditto for circumcision, removing the foreskin in case they have sex with somebody who is HIV+ when they are an adult? You are right that the sources discuss this - and as I have shown, these authorities dismiss this as a reason for routine infant circumcision. However, for some reason we are expected to downplay such authoritative statements as secondary to research which is as yet incomplete, and has been criticised methodologically? It is an international encyclopedia, however, it is an English encyclopedia. If medical authorities in non-English speaking countries differ in their approach, that should be dealt with in non-English sections of the encyclopedia, noted in the text here somewhere - but it is not relevant for the lead. The issue of options and parental choice can be dealt with in the text, but the key point of consensus of these organisations is that it is not recommended - regardless of what the WHO says. The WHO is not the overriding authority, for example. DSM is king in North America, and other countries refer to it. But there is also ICD, and many countries refer to that in favour of DSM. In the UK, specialists usually refer to ICD not DSM. ICD is published by WHO. It happens that there is a huge amount of overlap. But, in the USA, and I believe Canada and parts of South America, refers to DSM rather than ICD. So, just because WHO says something, it isn't necessarily more significant than what countries themselves state and do. This is because coming under the UN, the WHO has no institutional authority. If somebody does not follow WHO guidelines, there is no sanction applicable - unless it happens in a country where the guidelines are incorporated into their own guidance. If somebody is carrying out botched circumcisions in the UK, or conducting an irregular approach to sex reassignment, they appear before the General Medical Council, not the WHO - and it is only if they are in breach of UK medical guidelines that they are sanctioned. Only if the UK guidelines conform to the WHO guidelines will there be a sanction. So, in the UK, case precedent has indicated that foreign guidelines can be applicable, in some cases, as long as those are seen as being generally accepted as practice within the UK. The WHO does not override national policy or guidance, and by presenting it as a superior source is misleading to readers. In this case, the consequences are clear, by deferring to the WHO, one might think that there is support for routine circumcision, when there is not, and there is not because it is clearly identified that the hypothetical benefits in adulthood do not outweigh the harm in childhood. Mish (talk) 10:17, 4 June 2010 (UTC)

Okay, several issues here:

• First, this isn't the place to debate whether neonatal circumcision is appropriate to prevent adult diseases. Such a debate is pointless, and in any case can only be original research.
• Second, your argument that the lead should include only authorities in English-speaking countries is incompatible with the global scope of Wikipedia, in which English-speaking and non-English speaking countries are equal.
• Third, nobody has claimed that the WHO is an overriding authority, so it is perplexing that you should raise this issue. Jakew (talk) 10:26, 4 June 2010 (UTC)

• First, precisely my point. It is synthesis to conflate the two issues, and the statements are clear - it bears no relevance, as the medical authorities make clear that this issue does not outweigh the potential harm, and does not recommend routibe neonatal circumcision.

• Second, these are the only sources that there appear to be sources for, apart from Canada, which also has them in French. Obviously, we are not in the position of translating non-English sources for use in the article, as that really would be original research and uncommon for the English encyclopedia. So, we have to use the authoritative sources in English that are available - such as those I and others have pointed out.
• Third, then why are they being cited as some kind of authority, whilst genuine authorities are not being accommodated in this instant? It seems to me that given the overwhelming dominance of US-centrism in the encyclopedia as a whole, it would be preferable to accommodate a non-US authoritative statement like that of Australia and New Zealand, which also incorporates the earlier USA and Canada authoritative positions; it is also more recent and up-to-date than the AMA position, and it is more concise. Surely authoritive position statements on neonatal circumcision count for more than recent research about the effects of circumcision on HIV amongst adults (which has yet to be fully tested outside sub-saharan Africa), and the WHO's opinions about that? Mish (talk) 11:11, 4 June 2010 (UTC)

• First, it is not inherently original synthesis to discuss HIV in the context of neonatal circumcision, since multiple sources already do that. However, as far as I can tell, nobody is actually proposing to add any material discussing HIV in the context of neonatal circumcision, so I am unsure why you raise that point. I should also remind you that this article is not about neonatal circumcision specifically, but rather circumcision in general. Consequently arguments of the form (to paraphrase) "this isn't relevant to neonatal circumcision, hence it should be excluded" are invalid.
• Second, as noted previously, we already have the AMA sentence about other policy statements. That reads: "Virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice." I can't see anything in there about the language of these statements. Can you? So, on one hand we have a secondary source about "virtually all" statements (English or otherwise), and on the other hand a statement about the RACP and a couple of other statements which they agree with. The former seems far more global in scope, and hence more appropriate for inclusion in the lead.
• Third, the WHO are an authority, albeit not an overriding one, and their viewpoint is both notable and influential. To suggest that they are not a "genuine authority" is a dubious argument that is original research at best. Jakew (talk) 11:40, 4 June 2010 (UTC)

Sure, but the discussion was, I thought, that the AMA source's date needed to be clearly stated, rather than attribution as their current position. Using a more recent source which acknowledges the AMA statement gets around this, as it is more recent, and more inclusive - does the AMA's inclusion cover a statement of Australasian consensus that antedates it? Dubious - especially if there is not a reference for that; whereas by referencing the US consensus, Australasia's clearly does include it.

Sure, my point is that the WHO is no more significant or notable than the AMA, or the Canadian or Australian consensus positions which followed on from it, not that it is insignificant.

The issue about adult vs. infant circumcision is not trivial, as they are two different things - and therein lies much of the controversey surrounding it as an issue. Adult circumcision involves patient consent, while childhood circumcision only allows for consent by proxy. Adult circumcision is not that controversial - because if there is evidence that there is a benefit in relation to HIV prevention, then the individual has the ability to choose to have it or not (unless there is coercion, similar to the coercion to be sterilized under Indira Ghandi). The article really does need to separate out these two issues, and ideally should be three distinct articles - neonatal medical circumcision, adult medical circumcision, and religious ritual circumcision, with a brief page that acts as a redirect to these three as well as specific forms of female genital mutilation that are often referred to using circumcision. By separating out these three aspects more clearly, some of the issues that have bogged it down will diminish, and allow for a clearer focus on those that remain on the articles where any disagreement is appropriate, and hopefully allowing for progress. Mish (talk) 13:54, 4 June 2010 (UTC)

You are correct that the discussion has involved the date of the AMA statement, which is included so that the reader can understand what is meant by "currently". I have yet to see an argument why we should want to "get around" this: the fact that they said this in 1999 is indisputable, so what, exactly, is so terrible about simply saying so? Rather than rushing to find ways around this "problem", wouldn't it be sensible to look at it calmly and decide whether it really is a problem at all? Using a more recent source would be fine if that source said the same thing, but that isn't the case. The AMA quote discusses "virtually all" organisations, whereas the RACP discusses three. That's quite a difference in scope. Clearly, though the RACP may be more recent, the AMA quotation is vastly more general. It's also more neutral and useful as an overview as well, because the AMA are making a general statement about statements as a whole, while the RACP are making a more specific statement about statements with which they agree (compare "Fred, Bob, and me drink water to stay alive" with "human beings drink water to stay alive").

Moving on, I don't think your idea of splitting the article into three is workable, because the subject matter does not divide so easily, and sources often do not address, say, neonatal circumcision specifically, but circumcision in general. There are more similarities than differences, so there would be massive duplication, with essentially the same information about (for example) how it is done, the medical risks and benefits, and prevalence in each article. Not a good situation. Jakew (talk) 14:27, 4 June 2010 (UTC)

That is easily dealt with, the top level article would be strictly medical, detailing procedures, with the lower level articles detailing the non-medical issues, such as ethics, human rights, social factors, sensation in adulthood, consent, as well as medical POVs about whether routine procedures are good or bad where there is no patient consent, and so on, extent of trauma, etc. The problem about the date is that when presented against more recent research that has also been received critically and about which there is no consensus, it could mislead the reader into thinking that incomplete research carried out after 1999 might in some way have superceded the position statements from 1999 - when obviously that would be misleading, because no statements have been forthcoming since then. The 1999 position is the current position, and continues to be so until (if ever) it is revised. The RACP obviously discusses more than three - by extension, as those three include others themselves, namely the pediatric associations of those countries. So, the Australasian consensus represents at least eight major associations, two from the USA, two from Canada, two from Australia, and two from New Zealand. the only omission appears to be the UK and Ireland. Whereas, the AMA statement's "virtually all" presumably means "virually all in the USA", because the only reference there I can find that is not to a US medical organisation is the BMA, which makes the scope international only in so far as it covers the USA associations and one British medical association - which to me suggests a more limited international focus. You also have the problem that as the BMA has now deprecated its last position statement, and is still waiting on pediatric consensus upon which to base a newer one, the only non-US source they mention is now redundant anyway. I am not sure what the point is of making a distinction between the American statement being about the consensus positions, and the Australasian statement being about the consensus positions they agree with. That appears to me to be a spurious distinction. Mish (talk) 14:57, 4 June 2010 (UTC)

Regarding the split, I'm not convinced that the problem would be easily dealt with, and although I'd be willing to consider a detailed proposal with an open mind, I suspect that I would likely oppose such a proposal.

Regarding the date, I do not see why the reader would be misled. First of all, the sentences are about different subjects: the AMA sentences are about whether circumcision of all newborn boys is recommended, whereas the WHO/CDC paragraph is not about recommendations, but instead about whether circumcision has a specific effect (reducing the risk of HIV). (As it happens, the WHO do actually recommend circumcision programmes, but that's not currently noted though arguably it should be.) Secondly, even if they were about recommendations (which they are not), two organisations would not by any stretch of the imagination constitute "virtually all" medical organisations, so it does not negate the AMA's sentence. (Incidentally, you have again made the mistake of confusing the AMA's position with the position of other organisations. The AMA's 1999 position is their current position, but they have no way of preventing other organisations from updating their policy statements in the meantime, and at least some have done so.)

I don't see any evidence that the AMA statement means only American organisations; that is not what the source states, and they don't actually cite any specific sources for this sentence, and what they cite or don't cite elsewhere in the document is irrelevant. Finally, the distinction between a general statement about policies and a specific statement about policies is an important one, because the former is much more valuable. For example, consider this statement: "Brian Morris, Edgar Schoen, and Aaron Fink have written in support of circumcision of all newborn boys". That statement tells us that at least three authors support circumcision of all newborn boys. It provides no information about any other authors, nor does it indicate whether this view is commonplace or whether these authors are unusual. Now consider this statement: "Almost all authors agree that circumcision of all newborn boys is desirable." That is a much more informative statement (or it would be if it were true), because it provides information about whether this viewpoint is representative. Jakew (talk) 15:40, 4 June 2010 (UTC)

I don't see any evidence that the AMA statement means international specialty societies and medical organizations, rather than US alone; that is not what the source states, and they don't actually cite any specific sources for this sentence. However, if you look at the references, the only organisational position statements are:

5. Task Force on Circumcision, American Academy of Pediatrics. Circumcision policy statement. Pediatrics. 1999;103:686-693. 8. Fetus and Newborn Committee, Canadian Paediatric Society. Neonatal circumcision revisited CMAJ. 1996;154:769-780. 9. Australian College of Paediatrics. Position statement: routine circumcision of normal male infants and boys. 1996. 10. The Australian Association of Paediatric Surgeons. Guidelines for Circumcision. Queensland, Australia. April 1996. 11. American Academy of Pediatrics. Report of the Task Force on Circumcision. Pediatrics. 1989;84:388-391. 12. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. In: Guidelines for Perinatal Care, 4th ed. American Academy of Pediatrics; 1997. 13. American Academy of Family Physicians. Fact sheet for physicians regarding neonatal circumcision. Am Fam Physician. 1995;52:523-526. 14. The case against neonatal circumcision. BMJ. 1979; i:1163-1164.

So, given the status of the organisation, they will be citing those they have referred to in the text, and that the organisations they refer to fall within this group (otherwise they would be listed). Of these, most of the international sources have been superceded since 1999, and are covered in the Australasian position statement. Perhaps the best way round this is to state that most anglophone medical authorities do not recommend routine neonatal surgery, and provide both sources in verification of this statement, as it covers it all.Mish (talk) 16:51, 4 June 2010 (UTC)

As I pointed out above, the sources they cite elsewhere in the document are irrelevant, since they do not cite any for that particular sentence. (There is no reason to believe that the AMA mean only policy statements that they've cited in the same document.) Your position that "Virtually all current policy statements" means "Virtually all US current policy statements" appears to be original research. As for your suggestion, it's problematic in several ways. Firstly, a statement about anglophone countries is less useful than one about all countries. Secondly, I don't think we have a source stating that most anglophone organisations do not recommend circumcision, and neither source states this. Thirdly, the AMA source is dated 1999 and the RACP source is dated 2004, so even if the sources did make statements about anglophone organisations the most we could say is that they stated this at those particular times. Jakew (talk) 17:20, 4 June 2010 (UTC)

So, it would be more accurate to say that the last time the AMA reviewed the research, in 1999, they acknoweldged the potential medical benefits of neonatal circumcision, but data was insufficient to recommend routine circumcision for newborn males; while the most recent policy statement is from the Royal Australasian College of Physicians in 2004, who state that “neonatal male circumcision has no medical indication". Mish (talk) 18:18, 4 June 2010 (UTC)

Once again, those are statements about individual policies. Statements about multiple policies (such as that of the AMA when acting as a secondary source) are more informative. Jakew (talk) 18:23, 4 June 2010 (UTC)

Unindent. Jakew, you confuse form versus substance, and the effect is to inaccurately degrade the statement. POVZinbarg (talk) —Preceding undated comment added 18:57, 4 June 2010 (UTC).

Incidentally, re translating (in a comment above): See WP:Verifiability#Non-English sources. Yes, Wikipedians can use non-English sources as references and can put their own translations of quotes into the article if no published translation can be found. The scope of this article is circumcision globally, not just circumcision in English-speaking countries or circumcision as discussed in English-speaking sources. ☺Coppertwig (talk) 23:02, 6 June 2010 (UTC)

In that case you'd better get translating if you want this to be an article that has worldwide scope. It is still important for an article in an English encyclopedia to ensure that its coverage is relevant to people in English speaking countries - so that still needs to be dealt with comprehensively as what it is. If people in non-English speaking countries take a different approach, that needs to be covered as what it is. Europe, for example, (like Britain, Australasia and Canada) has different approach to the USA - but would need French, German, Slovakian, Dutch, Scandanavian, Polish (etc.) sources translated. And so on, for non-English speaking parts of Africa, South America, India, the Far East, etc. Mish (talk) 15:13, 7 June 2010 (UTC)

Yes, it would probably be helpful to add info from sources from other languages. I can read French and maybe kindof read German, if anyone wants to draw sources in those languages to my attention (noting that I don't have unlimited free time though). There's probably considerable scope for improving the article based on sources in other languages. However, I suspect most of the scientific information, and sources such as the UN, are published in English, so the current article may not be as far from complete as one might think. I've looked at the French Wikipedia circumcision article; its scope was considerably different (covering subincision etc.) I didn't happen to notice any interesting sources. Mostly it was unsourced, as far as I remember. Maybe I'll look again someday. ☺Coppertwig (talk) 23:14, 13 June 2010 (UTC)

Re "1999":

• I agree with Blackworm's suggestion to attach dates in the text to all references, (throughout the whole article, I mean, whether or not Blackworm meant that) not only to solve the "1999" disagreement, but also to provide useful convenient information both to readers and editors. If anyone has raised objections to this idea please link to or re-state them, as I don't quite remember (sorry). C
• Jake, you say you don't understand how it can mislead. Let me try to explain. Wikipedia articles don't only state things; they also imply things, and the reader knows that. If a date is supplied for one ref but not others, the reader will wonder why; the date seems emphasized. If the article says "stated" and not "states" or "has stated" or "has as its policy", the reader will wonder why. The next paragraph has "state". The reader might not realize that the date is there because of the word "currently", and might jump to conclusions and think it's some other reason; handling implications can be tricky. By emphasizing time in this way, the article could seem to be implying that there may be some doubt about whether the 1999 statement is still applicable; it could be taken as implying some situation such as that we the Wikipedian editors have heard rumours that the AMA is planning to post an updated policy soon, or that they've already posted multiple updated policies since then but that we're not quoting them in the lead because they don't happen to summarize other medical association positions or because we're describing the historical situation or for some other reason. I consider the "stated in 1999" wording good enough and perhaps mildly prefer it, but I see the problem raised by others. Insofar as it's a statement about policies of other organizations it seems to apply to that time, and "currently" seems to me to emphasize that interpretation; but insofar as it's also a statement about their own policy (they being one included among the associations they're commenting about) it's a speech act which they can continue to endorse or can rescind, and needs to be treated differently. C
• "In a policy paper adopted in 1999, the American Medical Assocation states, ..." I propose this wording, whether or not dates are attached to all other refs in the article. C
• "The American Medical Association states, "All current [as of 1999] ..."" (Another alternative.) C
• Removing the date (or attaching dates to all refs in the article) and replacing the word "currently" with an ellipsis; however, this is problematic as it could be seen as misrepresenting their position by removing a meaningful adjective with which they intended to restrict its scope. Mildly opposed by me but nevertheless proposed as a possible compromise. C
• Er, I just noticed it's already been modified anyway, to "The American Medical Association report of 1999, which was "…confined to circumcisions that are not performed for ritualistic or religious purposes," states that ..." This seems good to me: use of present tense is an improvement, and mentioning the scope improves precision. I prefer that comments not be interspersed (either within my comments or within others'; I find it hard to follow who said what) but just in case I've signed each paragraph. ☺Coppertwig (talk) 22:23, 19 June 2010 (UTC)
• Perhaps both the AMA and the RACP statements could be cited in the lead; the AMA one having the advantage of being more comprehensive, and the RACP more recent. By the way, citing AMA is not the only way to avoid SYNTH. If several associations each have a position that can be reasonably summarized by a Wikipedia article with certain words, and the summary is the same words for each, then a sentence mentioning them together can be constructed (IMO). ☺Coppertwig (talk) 22:29, 19 June 2010 (UTC)