Talk:Circumcision/Archive 45

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Image of circumcision of Jesus

I disagree with this edit which replaces an image of the circumcision of Jesus with an image of the circumcision of Sultan Ahmed. I think the circumcision of Jesus is far more notable: 1,500 kGh (Jesus circumcision) versus 4.9 kGh (Ahmed circumcision) (kilo-Google-hits). ☺ Coppertwig (talk) 02:14, 10 August 2008 (UTC)

It looks like we have a pretty obvious case of block evasion, meatpuppetry and/or sockpuppetry. User:Signsolid gets warned and stays quiet. An IP from England then appears using his same odd arguments and edit wars until blocked for 24 hours. Another IP from the same place appears less than 24 hours later (a block evasion) with the same odd arguments and continues the edit war. Then Signsolid reappears and continues his deletion attempts against consensus.

I have just discovered that another editor has the same concerns, which were treated with disdain twice and insults, and then goes ahead and ignores those warnings and edits against consensus. What gall!

Solutions?:

1. Immediately block both IPs for block evasion and meatpuppetry
2. Run a checkuser on the IPs
3. If they are sufficiently identical to IPs used by Signsolid, block him/her indefinitely for this dastardly behavior.
4. Possibly use both images, or at least include an image of a more prominent Muslim's circumcision.

In the mean time I will restore the consensus version. Even if we choose to end up with both images, which may be just fine, Signsolid and IPs should not get away with this behavior. -- Fyslee / talk 09:18, 10 August 2008 (UTC)

I have re-instated the Muslim image, to reflect the text indicating that circumcision is practiced by those of the Islamic faith. I have moved the Jesus image so it appears amongst the Christian referencing text. As far a Signsolid, I think an WP:SSP report including that account should be made - as I have already indicated to Signsolid. LessHeard vanU (talk) 11:10, 10 August 2008 (UTC)

I have filed a sockpuppetry report and notified the involved party. -- Fyslee / talk 22:41, 10 August 2008 (UTC)

Bingo! Category:Suspected Wikipedia sockpuppets of Signsolid -- Fyslee / talk 14:18, 12 August 2008 (UTC)

By the way, what circumcision of Jesus? I'm looking at a dozen translations of Luke 2:21, none of which say that he was circumcised. There seems to be a bit of creative translating going on, because only the 1995 God's Word and the 2008 International Standard Version translations say that Jesus was circumcised. All the rest say only that he was at the age "when eight days were fulfilled for circumcising him". Not that it was done.[1] RasterB (talk) 04:42, 22 August 2008 (UTC)

XVII International AIDS Conference in Mexico City

The following paragraph was added to the article on August 8th:

A conference on AIDS in Mexico City, Mexico, on Aug 4, 2008, Governments and health communities were advised they need to increase male circumcision to prevent HIV infection, particularly in vulnerable countries. With no vaccine or cure for AIDS, many health experts believe male circumcision could drive the epidemic into a declining state toward extinction [2] [3].

Some significant findings were announced at the Mexico City meeting, but perhaps we should decide what is worth mentioning and how we should present it before putting it in the text. I figure it will save us some trouble down the line. Respectfully, AlphaEta 03:01, 10 August 2008 (UTC)

Has anyone found any data on whether the African "AIDS-related" mass circumcision drives will have any effect on the U.S. market price of infant foreskins? Was that discussed at the conference? Blackworm (talk) 08:00, 10 August 2008 (UTC)

No, it was strictly related to Africa. You can see a video of the circumcision presentation entitled "Male Circumcision: To Cut or Not to Cut" here Tremello22 (talk) 17:09, 10 August 2008 (UTC)

Wow, an hour and a half of opinion from self-described male circumcision advocates. My head is spinning. Blackworm (talk) 22:04, 10 August 2008 (UTC)

Not all of the presenters are circumcision advocates. From the rapporteur report by Nithya Krishnan.

"Marge Berer gave the opposing commentary. She was especially critical of the fact that including MC in the prevention package of HIV/AIDS would drastically discourage the use of condoms, and would undermine the position of women in some societies. She explained that many men and women in high HIV prevalence countries welcome MC because they are desperate for anything that could help mitigate the problem. She outlined that men should have a right over their own bodies and pressures from organizations such as UNAIDS that are pushing for male circumcision impair this decision making process. In the end, she concluded that MC is dangerous because it will reduce condom use, and marginalize women."

Her Powerpoint presentation included the following statement.

"Men have a right to decide when it's about their bodies."

The first presentation by Alvaro Bermejo has two pro-intact images. The first one says, "Circumcision? Natural? You must be Bananas." They are approximately 13 to 16 minutes into the webcast.

The first question from the audience was from a representative of the International Coalition for Genital Integrity. There was also a question from a representative of Doctors Opposing Circumcision. DanBlackham (talk) 23:48, 10 August 2008 (UTC)

In her speech, she said, ""Men have a right to decide when it's about their bodies. However...." (emphasis mine). Sorry. That "however" gives away the agenda -- it's not really about their bodies. It's about whatever will benefit women more, as she goes on to explain. Note that she objects strongly that women's groups haven't been consulted enough on the question of male circumcision (perhaps some feel women's sexual pleasure will be reduced, or that the circumcised penis isn't as aesthetically pleasing to them, or perhaps they know lots of feminists who want to perform the circumcisions personally), and yet no mention is made whether men's groups have been consulted. It's a joke, really.

And at least one of the speakers described themselves explicitly as advocating circumcision. The rest merely used terms like "when we move forward on promoting male circumcision, we will" and "when we circumcise massive amounts of males"(paraphrasing), rather than the "if" implied by the title of the lecture. In fact, the option "to not cut" is never explored at all, making the qhole lecture laughable IMO. Of course this isn't really relevant to this article. Blackworm (talk) 00:28, 11 August 2008 (UTC)

My favorite part, though, is when the presenter points to a map of male circumcision prevalence, then says that lack of circumcision prevalence is correlated to HIV infection. Then he makes a face, almost as if to say, "not sure." I'll let you decide: compare the WHO prevalence map we have to the WHO prevalence map for HIV infection: [4]. Blackworm (talk) 00:41, 11 August 2008 (UTC)

Yeah, I've always found the circumcision prevalence-HIV infection correlations to be a bit silly (on both sides of the debate). We're getting a bit off topic here. AlphaEta 01:50, 11 August 2008 (UTC)

You know a lot of people have jumped all over that hype about using circumcision to reduce aids, but the study only found that it reduced female to male transference by 60%. So it's like playing Russian roulette with 2 bullets in the gun. Not very smart. I don't know what the "efficacy" of condoms is, but I am certain it's a whole lot better than that. And did anyone study the "efficacy" of whacking off the whole penis? That's probably even better than a 60% reduction. And no one wants to propose doing that? By the way "efficacy" means "effect", not "effective". RasterB (talk) 05:53, 22 August 2008 (UTC)

Probably for the same reason people haven't proposed "whacking off" someone's head to prevent HIV transmission. That would be the most efficacious treatment of all! Technically, efficacy refers to a treatment's ability to produce an effect, not the effect itself. Seriously though, this is getting too soapboxy. AlphaEta 12:31, 22 August 2008 (UTC)

Efficacious was a poor choice of words, as even if it had only a 1% effect it would still have an efficacy. The controversy was that the study was performed by circumcision proponents who only wanted to see the results they were looking for. RasterB (talk) 14:11, 22 August 2008 (UTC)

Too early for me too see "whacking off" in any form on a penis page like circumcision.... but Aplha is right Raster. I have brought similar points and wholeheartedly agree you however we must stick to our sources not our opinions. Garycompugeek (talk) 13:21, 22 August 2008 (UTC)

The section was way too biased - starting out with saying that everyone should get circumcised to prevent aids, then pointing out many paragraphs later that circumcision has only limited effectiveness in preventing aids, even though that was in the first reference. RasterB (talk) 14:11, 22 August 2008 (UTC)

I see no problem with the modification RasterB made to the sentence, but I would like to point out that "the policies that apply to articles also apply (if not to the same extent) to talk pages, including Wikipedia's verification, neutral point of view and no original research policies." That being said, I'm certain that Raster's earlier speculations were made in good faith. Regards, AlphaEta 14:47, 22 August 2008 (UTC)

Back on track

I don't feel comfortable adding info to the article that is based on meeting abstracts and presentations. Unrefined data is often submitted and presented at these conferences, so there is no good way to verify its content. We can re-address the new findings when, and if, this stuff makes it through peer-review. AlphaEta 04:25, 23 August 2008 (UTC)

Circ/HIV table

The new table is so incomplete that it exhaggerates the correlation between circumcision rate and HIV prevelance. Specific concerns:

• 1. Transposing a table from a single study gives the data undue weight. It disrupts the balance of the HIV portion of the article and may give the impression that the number of epidemiological studies demonstrating a protective effect of circumcision against HIV do not outweigh those that show no effect or the opposite effect (such as the Van Howe article, from which the table was taken). However, pasting a table from one of the studies that show a negative correlation between HIV status and circumcision would be equally objectionable, as it too would give undue weight to a single study.

• 2. The table only demonstrates circumcision status and AIDS, was only weighted according to population, and was not normalized with respect to any specific mode of HIV transmission (needle sticks, breast milk, heterosexual sex, MSM, condom compliance, beetroot consumption, etc...). The correlation could have more to do with any of these factors than circumcision, so why are circumcision and HIV the only variables shown when it's ☺ unclear how often a penis was even involved in transmission? The implicit message is that a positive correlation exists between HIV and circumcision rates, but this may not be the case.

• 3. It is unclear what the table is meant to illustrate with respect to the article. I get that it's in the section of the circumcision article that deals with HIV, but to what end? What point is this meant to highlight?

• 4. No ratinale is given for including a table that only lists Western nations.

• 5. The table (Table 1) from Van Howe, was not part of the meta-analysis. It is simply a compilation of circumcision and AIDS rates derived from WHO data.

• 7. The paper has met with substantial criticism:

O'Farrell and Egger. 2000. Circumcision in men and the prevention of HIV infection: a 'meta-analysis' revisited. Int J STD AIDS. 11(3):137-142.

Moses et al. 1999. Analysis of the scientific literature on male circumcision and risk for HIV infection (Letter). Int J STD AIDS. 10(9):626-628.

• 8. The data used to construct the table is now 13 years old.

It is irrelevant that this table supports the anti-circumcision viewpoint (by showing a positive correlation between circ and HIV rates), my only concern is that the table's quality and educational value is too low for an encyclopedic article.

The Van Howe data can easily be summarized in the text.

Because the threshold for inclusion should be much higher than the threshold for deletion, especially in a contentious article such as this on, I respectfully request that the table be removed from the main page while these concerns are addressed. We've worked well together in the past, and I'm certain we can reach a compromise that will satisfy both party's concerns. Kindest regards, AlphaEta 18:34, 22 August 2008 (UTC)

The fact that it was part of an article that showed a non-correlation between HIV and circumcision is irrelevant . There is no debate to be had over the validity of this data. So I don't see what the problem is? The HIV section at the moment primarily deals with HIV in relation to Africa (the WHO aren't recommending Europeans to be circumcised are they?) so I think data in relation to Europe and America is a welcome addition if you ask me.Tremello22 (talk) 19:04, 22 August 2008 (UTC)

I find the table illuminating in its simplicity. It contrast nicely with the existing WHO data that mainly deals with Africa and mid-east. Does it reflect that circumcision rarely has any bearing on AIDS? I think so, just consider the US. WHO's circumcision campaign is only effective in regions that do not practice safe sex. How its interpreted is not our concern. Let the reader decide. Garycompugeek (talk) 19:42, 22 August 2008 (UTC)

I would say the table is more embarrassing in its paucity than illuminating in its simplicity. My position is that the table dilutes the article because it discounts too many variables to convey any meaningful information about circumcision and HIV. The bottom line is that a compelling rationale for its inclusion has not been provided. What point is this table meant to illustrate? And why is a limited collection of arguably unrelated data notable enough to be given such prominence? And does this give a relatively random collection of data undue credence?

In response to the specific comments:

• "Does it reflect that circumcision rarely has any bearing on AIDS? I think so, just consider the US." Gary, this is EXACTLY the type of assumption that I feared this table would illicit. Because the data was not normalized to a single other risk factor, neither you, nor I, nor anyone else can predict how much bearing circumcision has on AIDS prevalence in the nations listed. Yes, the US has the highest AIDS prevalence on the table, but how many of these cases are attributable to sexual contact? Moreover, how many AIDS cases in any of the represented nations are attributable to sexual contact? What if the US has a higher AIDS prevalence because less people (circumcised or not) are practicing safe sex? What about modes of transmission that don't involve a penis, such as injection drug use or mother-to-infant transmission? Compared with the US, why does Israel (another nation with a high circumcision rate) have such a low HIV prevalence? Because the table is so devoid of meaningful information, we can't answer any these questions, and this is a glaring indication of its low educational value. Despite its notable deficiencies, the inference has already been made that the table somehow supports the notion that circumcision has "little bearing" on AIDS prevalence. I find this puzzling. Correct me if I'm wrong, but I believe the crux of Gary's argument is that circumcision doesn't act as a "surgical vaccine" (another term I find ridiculous) that protects the general population from HIV transmission. This point is valid, but the Van Howe table is a cumbersome and ineffective way to support it.

• "WHO's circumcision campaign is only effective in regions that do not practice safe sex." Is the implication that nations represented in this table have higher condom compliance rates than those which will be affected by a WHO-supported circumcision campaign? If so, how does the condom compliance rate in, say, Mexico compare with South Africa? Because the table lacks such useful information, we can't make a single inference or logical assumption about the relationship between safe sex, circumcision and HIV/AIDS in these nations.

• Both Gary an Tremello claim, in effect, that the table "contrasts nicely with the existing WHO data." Again, this is the kind of assumption that this table should not illicit. The WHO recommendations were based primarily on Randomized Controlled Trials, while the table is simply a compilation of data that has not been normalized to a single variable. This is a classic case of comparing apples to oranges. The table's principal flaw is that it would even allow someone to formulate such a comparison.

• "There is no debate to be had over the validity of this data. So I don't see what the problem is?" As I said above, the problem is that there is no compelling reason for its inclusion, nor is it clear what part of the article is it meant to support. Just because a carefully-selected list of data (weighted only against population) was published in a scientific journal doesn't mean it is worthy of inclusion in an encyclopedic article. The value of data, rather than validity, should dictate its prominence in the article.

• "...data in relation to Europe and America is a welcome addition if you ask me." I completely agree, but quality data would be preferred, and you can't polish a turd.

Finally, I want to clarify my objection. Just as I pulled the Mexico City conference paragraph because it seemed to degrade the quality of the article, so too do I feel this table brings the quality down a "notch or two." My edit history will indicate that I don't have a problem highlighting contrary epidemiological studies, but this is kind of silly. Also, my criticism is specifically aimed at this single addition, and in no way do I mean to discredit the editors who made and are defending it. Much respect to my collaborators, AlphaEta 02:58, 23 August 2008 (UTC)

You liken the data to a turd presumably because it goes against what the WHO is saying. You and the authors of those 2 studies you mentioned both deny what the table shows because of what are essentially "confounding factors". But what about confounding factors in the African trials? It would take a long time to go over all of them and I'm sure you know yourself if you have read the Van Howe report or the criticisms of the trials. Criticism of 2005 Orange Farm Auvert study: here, here (scroll down) and other criticisms of the 3 trials here.

Just to compare confounding factors of the African trials and the data from the table: don't you think that some of the people in Africa use drugs? If anything the data from Africa will be more confounded because there is not as much awareness of the dangers of using a shared needle nor is there as much availability of clean ones - so there will be more shared needles which means the risk of spreading the disease is greater. Also, don't you think gay sex happens in Africa? What about the fact that Africans do not practice safe sex as much or are even educated on STI's and how they are transferred? You are citing "confounding factors" as your objection to the table but the data you want to include has many more confounding factors.

If anything the table is a lot more balanced and scientific than just leaving this section of the article as it was. Why? Because all the countries listed are 1st world countries with the exception maybe of Mexico. The rates of gay people (MenwhohavesexwithMen or MSM), drug users and safe sex, information, etc in these countries are going to be roughly the same. Weighting only happens when there is a discrepancy over a particular variable. So weighting is not needed as much here because it lists a group of similar countries. A country comparison is the most scientific because it cancels out the confounding factors. I think you are under-estimating the intelligence of the reader. As wikipedia's policy states - you shouldn't try to pursuade the reader you should leave the data open to be interpreted by the reader themselves. I think the reader is intelligent enough to make of the data what they will. If they know some information that will have affected the data then good - at least they can decide for themselves. "Let the reader decide" - is wikipedia's policy.

If circumcision had any effect we would be able to see it by this table. Of course we don't - which is precisely why the table should be included. To do otherwise would be hiding information. The people who visit Wikipedia are going to be from the countries listed in the table (1st world) - not Africa. Which is why the table is more relevant to their situation. I would hate for them to be mislead. Tremello22 (talk) 07:51, 23 August 2008 (UTC)

Response to specific comments:

• "You liken the data to a turd presumably because it goes against what the WHO is saying." This argument is incumbent upon the fact that I accept the WHO recommendations. Please demonstrate where I have endorsed the WHO policy. I realize I'm not the greatest communicator on Wikipedia, but I thought that I made the point, multiple times, that the table cannot be related to the RCTs, or the WHO's interpretation of them, in any way. So how could I base my criticism on the idea that it "goes against" the WHO recommendations?
• "You are citing "confounding factors" as your objection to the table but the data you want to include has many more confounding factors." All of the questions (i.e. potential confounding factors) I posted earlier were meant to highlight the low educational value this table. It's literally just a list of numbers, and no effort has been made to clarify what it is meant to illustrate. I was under the impression that graphs, tables and images are supposed to illustrate a particular aspect of a Wikipedia article. The implicit message is that the table demonstrates how circumcision and HIV prevalence are (un)related, but this is not necessarily true (see my argument in the next point).
• "If circumcision had any effect we would be able to see it by this table." NO, this is patently false! To claim that the table suggests a positve correlation (not causative relationship) between circumcision and AIDS is one thing, but to suggest that "any" (your word) effect would be demonstrable on this table absolutely untrue. Circumcision may have a HUGE effect on heterosexual transmission in these countries, but the table cannot demonstrate this, because it doesn't differentiate between transmissions that involved a penis versus those that didn't! This article is about circumcision, so what is to justification for tabulating data that does not even represent its specific effect on AIDS prevalence?

Furthermore, this argument would be valid if the article contained data suggesting that circumcision provides universal protection against HIV among the general population. However, because no part of this article makes that claim, there is literally nothing for this table to counter-balance.

• "But what about confounding factors in the African trials?" I completely agree that the RCTs have problems, which is why I added a sentence addressing these concerns to the article. However, my personal standards are way too high to formulate an opinion based on extremely biased websites or rapid response letters to the PLoS website, which anyone can submit and which are editorial in nature and not peer-reviewed. Nor can I understand how the Van Howe meta-analysis is relevant to the RCTs, since it was published years before they even began. My skepticism also applies to the pro- side of the debate; I simply refuse buy into Robert Bailey's assertion that circumcision is more effective against HIV than previously thought without first reading the data myself.
• "The people who visit Wikipedia are going to be from the countries listed in the table (1st world) - not Africa. Which is why the table is more relevant to their situation." This statement is completely baseless. A substantial number of English-speaking people live in Africa, and this is the English-language version of Wikipedia. I don't like to assume what the reader's motivation was when they land on this page, so this argument doesn't hold much weight.
• "So weighting is not needed as much here because it lists a group of similar countries." Just because you claim that doesn't make it so. If this is part of the rationale for inclusion, it must be substantiated. How are these countries so similar that we can just pretend that population is the only variable that must be weighted?
• "A country comparison is the most scientific because it cancels out the confounding factors." In its current form, this argument isn't even remotely correct. Can you please clarify this, because I must misunderstand what is being implied.

I'll say it again, my primary concern is quality, which is why I have such an aversion to simple cut-and-paste jobs (data, quotation, or otherwise), especially when the introduced data indicates that 16% of Americans were living with HIV in 1995. A sufficient rational for including a collection of correlative data still hasn't been provided, so I ask again: What purpose does this table serve with respect to the article? It supposedly adds balance, but it is unclear what it is balancing. Certainly not the WHO recommendation or RCT data, as these have no bearing on one another. Wikipedia's policy of "letting the reader decide" is adorable, and normally I agree with it, but it doesn't allow us to dump stuff into an article with no regard for notability, weight or point of view, and then claim it is immune from deletion because we would deprive the reader of their ability to decide. In my mind, the threshold for inclusion has not yet been met, and as a frequent contributor to this article, it is quite embarrasing that the message continues to be sent that we don't understand the difference between causation and corrleation. Respectfully, AlphaEta 18:55, 23 August 2008 (UTC)

I agree with AlphaEta. Including that table is undue weight. What point is it trying to make, and is that point NPOV? Including only western countries is insufficiently international. I'm not sure if it would even be appropriate in any of the subarticles. Coppertwig (talk) 19:15, 23 August 2008 (UTC)

I am not convinced this data is not notable for inclusion. The section is "HIV and other sexually transmitted diseases" and we list sources talking about circumcision as a preventative measure. As a counter to this there is a table from another scientific source presumably showing Western countries circumcision rates side by side their AIDS rates and to properly weight that data you are given the population. No one is claiming this to be any type of direct correlation to WHO's RCTs. I agree the table does not isolate penal-vaginal transmission but is meant to encompasses anyone who has been identified with AIDs however that does not invalidate the table because it has never claimed direct correlation with WHO's RCTs. My main concern is the data accurate enough for inclusion? Alpha I respect your and Coppertwig's opinions but still not convinced the table deserves this amount of condemnation especially if the figures are accurate. More thoughts from more editors may be enlightening. Garycompugeek (talk) 20:40, 23 August 2008 (UTC)

Gary brings up an excellent point about the accuracy of the data. Here's how Table 1 was generated: AIDS prevelance from 1995 was plotted against "estimated circumcision rates" and the data points were weighted for population, using data from 1990. How were the circumcision rates from Table 1 were estimated? There doesn't appear to be any indication of when the circumcision data was gathered, and from what source. However, I think that was the point. In the very next paragraph, Van Howe states:

As with the previous map studies, this analysis ignores a number of important risk factors including cultural sexual practices. The results illustrate the inaccuracy and lack of power associated with this type of investigation.

The whole point was to illustrate how correlations using spurious data can produce misleading "evidence". AND THIS HAS NOW BEEN POSTED TO WIKIPEDIA FOR 24+ HOURS! Van Howe has outsmarted us all! AlphaEta 22:47, 23 August 2008 (UTC)

I don't think I was outsmarted - I knew all along the table didn't cite its sources and that the data for HIV prevalence and population were taken at different times. But I figured what the hell, since the pro-circ movement is using HIV prevention to promote circumcision based on flawed studies I assumed accuracy wasn't of the upmost importance and went ahead and added it. I was making a point, just like Van Howe is - it is OK for the African RCT's and other studies to ignore all the factors which could confound the data to work in the pro-circ's favour but when it comes to tables and studies showing the opposite result you suddenly have a problem with accuracy. But I think I made my point... :) Tremello22 (talk) 00:20, 24 August 2008 (UTC)

Oh yes, you definitely made "a" point. AlphaEta 00:46, 24 August 2008 (UTC)

The whole idea of randomized controlled trials is to take care of what would otherwise be confounding factors and isolate the effects of one variable. This table is not based on a randomized controlled trial; it does nothing to eliminate the effect of confounding variables. ☺ Coppertwig (talk) 02:23, 24 August 2008 (UTC)

First, that is an argument against any conclusions one might draw from the table, it isn't a strong argument against the attributed presentation of the data. (Compare my argument stating that the WHO map's choice of circumcision prevalence categories also may be WP:UNDUE.) (AlphaEta's 16% HIV in US issue was addressed by an edit of mine.[5]) That edit makes clearer what I think may be the encyclopedic interest in the presentation of the table; it is a table that shows the relationship in many countries with relatively low AIDS prevalence. Ultimately, that the table is incomplete, or that it doesn't explicitly demonstrate the conclusions of other sources on the effect of male circumcision on AIDS transmission, is not an argument against its inclusion. At best, if someone can cite a reliable source that specifically criticizes the incompleteness (or the misleading nature) of the Van Howe data (i.e., not his conclusions, no mention of which is made in the edit), then there may be an argument to suppress the table and instead relate the dispute in the text.

Coppertwig, there is always the possibility of confounding, even though it seems less likely through investigation. But ultimately, you're arguing using a different source against the presentation of this source's data, on very weak grounds, in my opinion. (Just because a study chooses to control for some variables does not mean that ALL variables are accounted for. That's why there are studies that seek confounding variables and fail, and yet for some reason the researchers still assume that confounding exists, for example the one discussed here. It's still a model, albeit a better one that one with fewer controls, not a statement that the variable under consideration was completely "isolated.")

Anyway, what we should assess, rather than the quality of the argument that the data is apparently making, is the quality of the data we are presenting. Is it good data? Well, it's attributed to a source, if not an apparently very prominent one. Does someone think it relevant? Van Howe apparently does, and so do the editors of the journal it was published in. So I'd support presenting what conclusions, if any, the author has, rather than overwhelming us with this huge table that is apparently easily misinterpreted based on quick reactions (we have some editors apparently asserting without evidence that the raw data in the table is attempting to show a positive correlation between circumcision status and prevalence of HIV infection -- that is definitely unclear from the table, however). If there are relevant criticisms, perhaps they should be presented as well. Blackworm (talk) 04:53, 24 August 2008 (UTC)

Blackworm, I'm afraid one of your supporting arguments may be incorrect. No Wikipedia editor is interpreting the raw data from Table 1 to suggest a positive correlation exists between these two variables. Van Howe did that for us:

If the World Health Organization data from 1995 for AIDS prevalence[ref] are plotted against estimated circumcision rates (Table 1) and the data points are weighted for population, a positive correlation (Figures 1 and 2) is found between circumcision and AIDS prevalence (slope=14.95, 95% CI=13.19-16.71, R2=0.69) in first world countries[ref].

Figs 1 and 2 were constructed with almost no manipulation of the data. This is a minor point, though.

If someone wants to present Van Howe's meta-analysis in the text, I don't think anyone would have a problem with that. Of course, O'Farrell and Egger's and Moses et alii' criticisms could be included as a counter-point. AlphaEta 12:23, 24 August 2008 (UTC)

Well, okay, but then it's clearly the weighing of the data points for population that creates this correlation -- that weighing exists in the figures and in Van Howe's analysis, but it's not a part of the table itself. (Israel and Spain, for example, seem to counter the correlation.) As I understand it, Van Howe's entire point is that drawing conclusions about circumcision status affecting AIDS prevalence in this kind of analysis is weak (as you quoted above). But again, the table is just data from a source, it's not an analysis of the data (e.g. a finding of correlation). Arguments based on the idea that subsequent studies have "debunked" Van Howe seem to be WP:OR without some sources saying so; and if indeed such comments have been made, they should be included too.

I re-iterate that I think the table gives too much weight, and is too easily misinterpreted, and thus we should simply relate Van Howe's conclusions. If the goal is to question the applicability of the WHO's aborted trials to first world countries, there are plenty of other sources that do so, for example the government sources (CDC) in the US, and in Australia (from one of your posts: The policy statement of the Australian Federation of Aids Organizations simply states that the "African data on circumcision is context-specific and cannot be extrapolated to the Australian epidemic in any way." Blackworm (talk) 21:23, 24 August 2008 (UTC)

coppertwig that was the point I was trying to make - the RCTs do not control for confounding factors which you would know if you had read the criticisms of the trials in the links I provided. They even knew some of the participants had HIV before the trial got going. Oh, and they didn't even tell them. Then they had the audacity to stop the trial on 'ethical grounds'. I wouldn't be surprised if all the HIV positive people were in the non-circumcised group.

Just to talk about confounding factors in relation to the premise that trials in Africa can be transferred to judge circumcision's effect on HIV transmission in 1st world countries:

How do you know that men in the trial weren't infected through anal sex or drug use? Given that there is less education in Africa on using shared needles and safe sex practices, how can HIV reduction be used as an argument for circumcision in 1st world countries? There are other things such as the hot climate, nutrition.. the list goes on. That table was more scientific and truthful of the real situation in 1st world countries in terms of circumcision's effect on HIV transmission even though it used data from different time periods.

Only a few things are wrong with the table. The first is that the prevalence of circumcision data doesn't have a source. Although this wasn't a problem when it came to the prevalence map, where my concerns over source were largely ignored. This is what I mean by double standards. The second problem is that the AIDS rate (it was just a typo that made the USA have a 16% AIDS rate - I can't believe, Alpha, you didn't realise that) is from 1995 and the population data is from 1990. Now would those 5 years have made a difference to the conclusions drawn from the table? I doubt it.

The fact that the countries are relatively similar means that the confounding factors are cancelled out. Granted, the levels of drug use, MSM, education level and other confounding factors won't be exactly the same across these countries, but it will be close. And so, if a reduction in HIV transmission is to be used to promote circumcision in the USA, shouldn't the effects be noticeable, not least notable in the table?

My point about 1st world people making up most of the readership of this article still stands. Conclusions drawn from flawed trials in Africa are totally irrelevant to 1st world people. Say an expectant mother (from the USA - which will be where most of the readers will be from) were to read this article - she would get the false impression that having her son circumcised would protect him to some degree against HIV contraction - which looking at the table - it doesn't. I've added a subheading as a compromise.Tremello22 (talk) 10:15, 24 August 2008 (UTC)

Please correct me if I'm wrong, but didn't you claim to have knowingly included a flawed table in this article simply to make a point (at least that was the impression given by your previous comment). Now, a renewed effort is being made to legitimize the table and imply that it is somehow useful?

• "Now would those 5 years have made a difference to the conclusions drawn from the table? I doubt it." The entire point Van Howe was trying to make was that the 5 year difference between acquisition of population and AIDS prevalence data, along with mystery circumcision data, could have made a HUGE difference. It was meant to demonstrate that methodologies used by previous studies, which showed a negative correlation, were flawed.
• "The fact that the countries are relatively similar means that the confounding factors are cancelled out." Prove it.
• "Conclusions drawn from flawed trials in Africa are totally irrelevant to 1st world people." Prove it. This table doesn't.
• "...she would get the false impression that having her son circumcised would protect him to some degree against HIV contraction...." Prove it.

And yes, I realize the 1000-fold inflation of AIDS prevalence was a simple oversight, along with misidentifying the syndrome for the virus, and using the wrong title in the citation. I don't believe that any of these mistakes were intentional. AlphaEta 12:55, 24 August 2008 (UTC)

The point I am trying to make is that both the table and the WHO conclusions are flawed and yet the table is not allowed but the WHO conclusions are. Furthermore they get a place in the opening paragraph. It is just blatant hypocrisy. You say "prove it" to a lot of my points yet I don't know if there is a way to convince you, I am just using common sense. Tremello22 (talk) 13:19, 24 August 2008 (UTC)

Then why not add more material to the article that is critical of the WHO conclusions? What is the point of doing it in this round-about, "gotcha" sort of manner? So long as it is supported with verifiable sources, it stands a much better chance of retention. AlphaEta 13:28, 24 August 2008 (UTC)

Why should I have to do it? It obviously doesn't bother you enough to change it, because it fits your point of view. Anyway, I probably will some time in the future when I have time. No doubt you'll just "undo" it. Tremello22 (talk) 13:50, 24 August 2008 (UTC)

Tremello, for the second time in 24 hours, let me point out that it did bother me, and I did do something about it! I don't know how to say it more clearly. If you want to add more, feel free. And again, you don't know what my point of view is regarding the specific WHO recommmendations, because I haven't declared them! AlphaEta 14:24, 24 August 2008 (UTC)

Image in Circumcision procedures section

Alpha why did you remove this? You ask : Why do I keep assuming the motivations and habits of the readers? Isn't that what we are supposed to do? It is a way to make the article better and cater for the readers needs. I think readers coming to this article would like to see this. Tremello22 (talk) 13:50, 24 August 2008 (UTC)

The rationale for adding the image was that "people may not navigate to [the] plastibell page." Yes, but maybe they will. If this alone justifies adding images, why not add illustrations for every page that people "may not navigate" to? I'm not arguing that the illustration, itself, is inappropriate, I'm just not certain why a plastibell image, per se, is "sorely" (intentional or not, good word choice) needed. And again, I have no idea what readers would "like to see" when they land on this page. Of course, my logic may be completely flawed. That's all, AlphaEta 14:24, 24 August 2008 (UTC)

After a little more thought, I have more concerns about the image:

• Considering that the majority of circumcisions have likely been done using little more than a sharp object, an index finger and a thumb, I think the section already overemphasizes modern, relatively safe, clinical methods of foreskin removal. The plastibell was developed only 50 years ago.
• With regard to the effectiveness of the illustration, it contains no labels, and because the foreskin has already been ablated, no mechanistic aspect of the device is highlighted. Someone unfamiliar with the plastibell won't even recognize the ligature. It's a sup-par illustration for the main circumcision article. AlphaEta 16:27, 24 August 2008 (UTC)

I agree with AlphaEta that the section is grossly unbalanced in favour of modern, sterile, sometimes anaesthesized procedures on infants, as this seems to be the minority case worldwide. I believe I echoed that sentiment long ago, here. On the other hand, the image has explanatory value. I suggest that both the image and an expanded coverage of actual worldwide circumcision procedures (along with perhaps, another image) might be a good solution. Blackworm (talk) 04:56, 29 August 2008 (UTC)

Pain or ethics

A few months ago, Blackworm added the following sentence to the section addressing pain and pain relief:

Williams (2003) argued that human attitudes toward the pain that animals (including humans) experience may not be based on speciesism; developing an analogy between attitudes toward the pain pigs endure while having their tails "docked", and "our culture's indifference to the pain that male human infants experience while being circumcised."[Williams ref]

I think this is one of the most thought-provoking and interesting concepts in the article, but I'm curious if it shouldn't be in the "Ethical issues" section instead of the "Pain and pain relief during circumcision" section. It doesn't address pain, per se, but instead indicates how pain may be viewed as acceptable when it is part of the cultural norm vs. unacceptable when is is out of the ordinary (inflicted on farm animals or otherwise). At least that's my interpretation of Williams' point, but I may be misreading it. Thoughts? AlphaEta 00:07, 28 August 2008 (UTC)

I think it's more about the ethics than the pain, so yes, that move makes sense to me. Blackworm (talk) 08:18, 28 August 2008 (UTC)

The sentence was moved to a newly created subsection ("Acknowledgment of pain") in "Ethical issues". A better transition is probably needed to improve readability and flow. AlphaEta 02:09, 30 August 2008 (UTC)

Totallydisputed

The Topic is dishonest, because the reader is not informed about basic facts:

1. The prepuce is ½ mucosa. Mucosa is different from skin. "Foreskin" is slang and should be defined in the intro before use in the topic.

2. Frenectomy integral to many circumcisions; between 20 – 33% require this significant required co-surgery [6] [7], and this totally omitted fact belongs in the introduction.

3. Meatal stenosis is a common complication (8 – 10% US neonates) of circumcision [8], where meatodomy is best practice treatment. Look at meatodomy pictures and consider sexual effects...

4. Sexual effects are misrepresented or omitted.

5. Sorrells discussion is misrepresented (in the subsection).

6. Pain of the Jewish procedure is misrepresented.

7. Jewish "commandment" in the intro and discussion ... versus the covenant, which was just the tip past the glans.

8. Physical damage from the current radical Jewish and Muslem ritual can be reduced if the mogen clamp is used properly. The covenant (it was also the original Muslem technique) can be met using the original procedure (just the very tip).

9. Gross emphasis on ~cancer uti hiv premosis ect is pro-bias, versus cost benefit metanalysis showing no gains.TipPt (talk) 17:00, 29 August 2008 (UTC)

1. Bring reliable sources and quote.

2. Not at all clear from sources, which discuss circumcision in a medically required context.

3. Okay, but where is the "dispute" on this?

4. Bring sources.

5. How? Bring sources.

6. How? Bring sources.

7. Bring sources.

8. Bring sources.

9. Disagree. We both reflect the literature commenting on these issues, present balancing language in each case where applicable, and properly reflect the cost-benefit meta-analyses. Let the reader decide.

May I suggest you take these one at a time, and discuss them before throwing many, many disputed edits into the article? Thanks. Blackworm (talk) 17:25, 29 August 2008 (UTC)

I remember you and Avraham from prior edits wars. You guys are in violation of Wikipedia:Troll#Misuse_of_process.

Incise and excise are the same to the word ... cut ... the frenulum = frenectomy. Frenectomy occurs in 20 - 33% of circumcisions.

One of the authors in the frenectomy cites is a mohel and both authors usually perform circumcisions ritually!TipPt (talk) 21:45, 29 August 2008 (UTC)

I won't waste my time in wars. You know the sources (having blocked them repeatedly), and their value (cost/benefit studies). For now, all we can hope for is a little honesty, revealed motives, and the factual tag.TipPt (talk) 21:45, 29 August 2008 (UTC)

Avraham and I have often been in conflict; therefore the fact we agree here that you are proceeding inappropriately here seems to indicate that you, not us, are out of line. You need to show a willingness to present sources, and suggest edits, not make vague, disjointed, uncited claims about article neutrality and editor bias and expect us to allow you to make dubious edits or throw the article or Talk page into disarray. I haven't checked your meatal stenosis source, and perhaps Avi erred in reverting that part of your edit; but that can be politely challenged and discussed here.

Incise means "to cut into"[9] (the source said "incise") and excise means "to cut out"[10](click on entry 3). Your edit suggests an excision. It also suggests that this is commonly true of all circumcision, not circumcisions sought because of a medical indication.

I have no problem with your not wasting time in "wars." If you don't want your edits questioned or discussed, don't edit. If you have already given up on discussion with me, then your next move is to seek a third opinion, open a request for comment, or seek other dispute resolution.

I really hope you will try to engage your fellow editors, since I believe you can indeed improve this article. Regards. Blackworm (talk) 21:51, 29 August 2008 (UTC)

I'll fix the statement to read cut instead of cut away. It's actually two steps .. cut and drawn down (using a clamp) or up (by a mohel) and removed along with the prepuce. Regardless, to cut the frenulum is a frenectomy so at least leave that.

Chordee was cited in ritual circumcisions as well as medical (the first source). The patients in the second source [11] sought circumcision for religious (not medical) reasons.

The meatal stenosis statement and cite should not have been reverted. It is a common complication and the standard treatment is meatodomy.

You should at least leave the topic tag while we work out the several factual problems. Yes, the next step will be request for comment; thank you for evidence.TipPt (talk) 00:40, 30 August 2008 (UTC)

Sexuality

The current boyle paragraph is vague. Here is a prior agreed (honest) version:

Boyle et al. (2002) argued that "structural changes circumcised men may have to live with are surgical complications such as skin tags, penile curvature due to uneven foreskin removal, pitted glans, partial glans ablation, prominent/jagged scarring, amputation neuromas, fistulas, severely damaged" or removed "frenulum, meatal stenosis, uncomfortably/painfully tight shaft skin when erect, and keratinisation." ..."The loss of stretch receptors in the prepuce and frenulum and an associated diminution in sexual response" may reduce a "circumcised man’s ability to achieve arousal." …"Due to the neurological injury caused by circumcision, and the resultant reduction of sensory feedback" erectile dysfunction and premature ejaculation may be a complication of male circumcision, potentially making "intercourse is less satisfying for both partners when the man is circumcised." Taves (2002) argued that the foreskin may have an intromission function, facilitating penetration,[12], and Bensley et al. (2003) argued that circumcision may decrease vaginal wetness and orgasm in female partners.[13] —Preceding unsigned comment added by TipPt (talk • contribs) 19:50, August 29, 2008

To help facilitate discussion of TipPt's proposal, here's a list of prior threads related to the issue (including debate of the Boyle et al. paragraph):

• "Sexual Effects" from Archive 29
• "Sexual Effects (continued)" from Archive 29
• "Sexual Effects comparision with bold to note added to current version" from Archive 27
• "Sexual Effects" from Archive 26
• "Work in progress ... Proposed Sexual Effects intro paragraph" from Archive 22

Other thread addressing sexual effects:

• "Sexual effects section" from Archive 41 (devolved into nonsense)

Hope this helps, AlphaEta 01:39, 30 August 2008 (UTC)

The last one helped, thanks. The others are long wasted arguments with jakew. AlphaEta ... Do you agree that the paragraph be more specific (using more specific sentences in the Boyle source?TipPt (talk) 17:55, 30 August 2008 (UTC)

One more thanks ... you show evidence of how a troll works with a gang at his side.TipPt (talk) 15:41, 31 August 2008 (UTC)

Sources you requested

Source for change from minor to radical: "Long before this, many of the Persians were circumcised and "became Jews, for the fear of the Jews had fallen upon them" (Esther 8:17, Heb. text; Josephus, Ant., XI, 6:13). The Book of Jubilees insists upon he strict observance of the law, and protests against those that "make the members of their body appear like those of the gentiles" (xv, 26, 27). During the period of Greek rule in Palestine, when those that kept the laws of Moses were put to death by the gentile tyrants (1 Maccabees 1:63; 2 Maccabees 6:10), some Jews, under Greek influence, "made themselves prepuces" and turned away from the ways and traditions of their fathers (1 Maccabees 1:15, 16; Joshua Ant., XII, 5:1). To this epispastic operation performed on the athletes to conceal the marks of circumcision St. Paul alludes, me epispastho (1 Corinthians 7:18). Therefore Jewish circumcision, in later times, tears the membrane that remains after circumcision given in the ordinary way, among the Arabs for instance, and thus defeats even the surgeon's skill."[14]

You probably won't permit this but...[15]

We can use this source. "The circumcision which Abraham performed on himself and other male members of his household was the removal of the tip of the prepuce. This procedure is referred to as Milah by Jews and was practised by Jews for approximately 2,000 years." [16]

Mogen clamp ... "follows the angle of the corona to avoid removing excess skin ventrally and to obtain a superior cosmetic result." [17]

Amer Fam Physician 1996; 54:177-82. Mogen Clamp Demonstration. "More foreskin is removed dorsally than ventrally." [18]

"In the literature, the fewest complications with this method have been reported in the context of circumcision in 8 day old babies." Manual for Male Circumcision Under Local Anaesthesia.pdf, WHO Oct 06.TipPt (talk) 19:36, 30 August 2008 (UTC)

I am uncertain that the Catholic encyclopedia is a reliable source for Jewish traditions. The more appropriate sources would be the Shulchan Aruch, specifically Yoreh Deah where Brit Milah is discussed. Similarly, the Brisbane Court decision is less of an authoratative source on Milah than the corpus of Jewish law which defines the process. -- Avi (talk) 01:28, 31 August 2008 (UTC)

I read through Yoreh Deah where Brit Milah is discussed, and neither the original nor current radical technique is mentioned.

Shulchan Aruch, was ... "composed by Rabbi Yosef Karo in the 16th century (a VERY long time after the change). One man is not better than a modern court finding with balanced (open) discovery.

I did read in the Wiki Brit Milah that "the Talmud explicitly notes that a male child is relieved of his responsibility to undergo circumcision if he has had three older brothers die due to complications from the procedure." Avi, I remember showing you an article finding very high rates of infection following radical ritual circumcisions. In ancient times (before antibiotics), the radical procedure was fairly dangerous.

For example, "A peculiar martial custom is mentioned in 1 Sam 18:25,27 (compare 2 Sam 3:14), where Saul is represented as asking "a hundred foreskins of the Philistines" as a dowry from David for the hand of Michal. This does not seem to have been an exceptional booty in war, especially if it meant that no very careful operation was expected to be performed, but the act became practically equivalent to extermination."

I'm concerned with Moslems and their (even more than Jewish) extreme removal of tissue. Circumcisions today are mostly on Moslems. I can't find the article stating common origin (Egyptian) and technique (just the very tip, unless it was an essentially a death sentence). The issue is less important with limited audience.TipPt (talk) 15:36, 31 August 2008 (UTC)

TipTp, that is where you are mistaken. The Jewish tradition follows the Shulchan Aruch, not some non-Jewish court somewhere in Australia. Unfortunately, this is one of the places where your preconceived point-of-view separates from verifiable fact. Please realize that you are completely mistaken in denouncing the relevance of the one of the seminal texts of Jewish Law, and the bedrock (filtered through centuries of responsa, it is true) of Jewish law. If you ask any person who is even somewhat knowledgeable about how Jewish law and custom has come down through the millenia, you will see that you are mistaken.

TipTp, you must also remember that you may not use wikipedia as a soapbox for anti-circumcision rhetoric. As it stands teh now, the article is tenuous, but at least through the combined efforts of editors from various backgrounds, the article is achieving a neutrality in proportion to accepted reliable sources. For you to come in and start making radical changes to specifically make the article have a more anti-circumcision slant than the corpus of world literature represents and misstating (I presume through ignorance as opposed to maliciousness) Jewish tradition, even when corrected by people who have spent decades in its study (such as myself), is not proper wikipedia behavior, and may be construed as disruptive editing. Please keep that in mind as we go forward, and remember, if you would like to take an activist stand, there are plenty of places to do so, but wikipedia is not one of them. Thank you. -- Avi (talk) 16:46, 31 August 2008 (UTC)

Again, the source you cite does not address technique at all. Technique (amount removed and how) is the issue being discussed here. Please provide a source that backs your claim that the current radical procedure is the covenant procedure.TipPt (talk) 16:56, 31 August 2008 (UTC)

Where are you discussing technique other than "Male circumcision is the removal of some or all of the foreskin (prepuce) from the penis." in the lede? What is wrong with the dictionary definition? -- Avi (talk) 17:03, 31 August 2008 (UTC)

You removed frenectomy from the procedures section as well as the lead avi. Both without logical explaination.

A dictionary is not comprehensive like an encyclopedia! Again, frenectomy is commonly performed with and because of circumcision. It's common (20% - 33%) and intergral, so it belongs in the lead.TipPt (talk) 17:11, 31 August 2008 (UTC)

No, it does not belong in the lead, as it is not circumcision. Furthermore, 20%-30% of the time is not common, and it is undoubtedly not integral; it is at best related. -- Avi (talk) 17:49, 31 August 2008 (UTC)

You evidently didn't read the published articles avi. The surgeons found is necessary to cut the frenulum to solve chordee among elective patients.TipPt (talk) 19:52, 31 August 2008 (UTC)

I have several questions for Avraham ("Avi"). If males died 20-30% of the time they were circumcised, would that be "not common" and "at best related?" Or does the subjective, perceived gravity of the occurrence affect its "commonness" and therefore its "relation" to the topic?

Also, why are you vaguely challenging the Catholic Encyclopedia on WP:RS grounds? If the statement is attributed, and the reader decides, what's the problem? The Jewish Encyclopedia is cited several times in the Baptism article, and is even the first external link. Do you oppose that there? Blackworm (talk) 00:41, 2 September 2008 (UTC)

Hi, Blackworm. Regarding your second question, in my opinion, the Catholic Encyclopedia should not be used as a source for Jewish Law, when Jewish Law itself is available in the form of the Talmud, Maimondedes, the Bet Yosef, the Shulkhan Aruch, and the major later responsa/commentaries that have been quoted as case precedent over the past number of centuries. Regarding your first question, if males died 20% to 30% of the time due to circumcision, that is directly related to circumcision. Frenectomies may occur at the same time as circumcision, but are not part of the process. If 50% of the time after a baby is circumcised it is also inoculated, would we say that innoculation is a part of circumcision? Post hoc ergo propter hoc is a classic logical fallacy, as is confusing correlation with causation. I think in this case, frenectomies occuring less than one third of the time after a circumcision is not something noteworthy about circumcisions themselves. Thoughts? -- Avi (talk) 03:44, 2 September 2008 (UTC)

So it is the "directly related" part that is unclear, not the commonality? That part of your argument wasn't clear. It is clear to me that thousands of frenectomies occur directly as a result of circumcision. Here is how I see it: frenular chordee is a medical condition that requires treatment.[19] The treatment is frenectomy. No, or almost no boys undergo frenectomy unless they have been circumcised. Would else would it suggest to you, if 20%-30% of circumcised boys undergo frenectomy as a treatment for frenular chordee, and almost no boys demonstrate frenular chordee unless they have been circumcised? Is this where you argue it could be a coincidence? What else would it be correlated with? What is a possible confounding factor?

Your analogy with inoculation is bogus because it doesn't state how many other children also are inoculated. We assume many of the others are, because inoculation is near-universal in many cultures. Misleading.

I don't think there is a reasonable denial that there is a link between circumcision and frenectomy, worthy of mention, in light of the source I present above, in which all frenular chordee (requiring "treatment") was "demonstrated" "after" circumcision. Do you continue to argue otherwise? I posit that your argument equates to a denial of the causation where a boy "demonstrates" death from bleeding "after" circumcision. Thoughts?

I think if there is an apparent mismatch between the statements of the Catholic Encyclopedia with respect to Jewish law, and the sources you bring, it should be noted here. Is there? Basically, you're asking to suppress a source on reliable source grounds because it isn't "the best" source -- but that's not what reliable source means. It means, "we can be reaonably sure the Catholic encyclopedia [a presumably reputed source of information] says what we say it says." Their view is verified to be their view. What is the policy that says otherwise? Also, if you have a source contrasting their position, bring it and let the reader decide. That's how Wikipedia works, or at least I'm told. Right? Blackworm (talk) 07:39, 4 September 2008 (UTC)

Excuse me for butting in here, but this is getting a bit black and white - and surely it depends on the circumstances.

More often than not, a frenectomy happens because a circumcision is performed ineptly (or because the person performing the frenectomy just doesn't care). In that situation, the circumcision and the frenectomy are serial events and a complication arising from the frenectomy is a direct consequence of the circumcision procedure.

An inoculation given at the same time as the circumcision is wholly unrelated parallel event.

If, on the other hand, a frenectomy is performed for a specific and premeditated purpose - and a complication then arises - then, IMHO, the frenectomy, and only the frenectomy (or the person performing it), is to blame.

It is similar to the argument about infant circumcision being one of the most painful surgical procedures you can perform. It is to a point - if it is performed without an anaesthetic - BUT it isn't if it is performed with an appropriate anaesthetic. If the circumcision is performed without an anaesthetic, blame the choice (and the people making the choice) not to administer an anaesthetic - don't blame the procedure itself. Finn (talk) 16:32, 2 September 2008 (UTC)

Hi, Blackworm. I understand your point, but Finn may have expressed my concerns more clearly than I have. While it is true that inoculations are further removed from circumcisions than frenectomies, and that I was using the reductio ad absurdum technique, it remains true that frenectomies are not a part of the circumcision procedure. At best, they are a procedure whose necessity arises less than one-third of the time after a circumcision. I could even understand a reference to frenectonmies in the Complications from circumcision section as it appears (and I have not done the research, I am taking your word on this) that the need for a frenectomy arises from improperly performed circumcisions. But there is no good reason why this procedure needs to be referenced in the lead of the article. Thoughts everyone? -- Avi (talk) 14:28, 4 September 2008 (UTC)

Regarding the use of the Catholic Encyclopedia, yes, the encyclopedia is a reliable source in and of itself, but it is not the most appropriate source for the information that we are discussing, any more than the Encyclopaedia of Islam would be the appropriate source for the article on Christian veneration of Jesus. If we are interested in what the Jewish technique is, use the Jewish sources, not the Christian sources. -- Avi (talk) 14:32, 4 September 2008 (UTC)

Frenectomy

Relevant discussion at

→ Talk:Circumcision/Archive 29#Avi reverts away frenectomy → Talk:Circumcision/Archive 30#Frenectomy in the intro paragraph

The child may also get a measles inoculation at the same time. What is so important about a different procedure that it must be placed in the article at all, let alone the lede? -- Avi (talk) 14:54, 31 August 2008 (UTC)

The frenectomy meant here means removing part of the penis, not the operation involving the tongue or some other part of the body. My first reaction was that of course it's relevant.

However, a Google Scholar searches suggest that the two words don't tend to be associated. A search for "circumcision frenectomy" returned only 7 hits (compared to 104000 for "circumcision" and 419 for "frenectomy"), and those 7 hits generally didn't seem to be about doing frenectomy and circumcision at the same time but had, for example, the two words included in a list of various operations. A search for "frenulum circumcision" returns 503 articles, but scanning over the first few pages of hits, almost all of them didn't seem to be about removing the frenulum but seemed to be mentioning it in some other context.

This article is about circumcision, not about a number of other operations such as subincision which can be done to the penis. ☺ Coppertwig (talk) 15:32, 31 August 2008 (UTC)

I provide two published studies Coppertwig. Please provide a source that refutes their findings that frenectomy is common (20% - 33%) with circumcision.

The cases in the first (where circumcisions were "elective" not medical) and all cases from the second (pre bris) source, a frenectomy would not have been performed in the absence of the circumcision.[20][21].

In addition to the relatively tight skin causing chordee after circumcision, we find chordee caused directly by circumcision. [22].

As an aside, you can produce chordee in almost all intact males if you pull sufficiently down on the prepuce. Post circumcision, chordee left unrelieved (by frenectomy) impairs healing of the wound (per a mohel). Frenectomy is integral and coincident to circumcision, regardless your google scholar search tally. FYI, my search of circumcision frenectomy in google produces 4300 results, several stating at least coincidence.TipPt (talk) 16:18, 31 August 2008 (UTC)

If I recall correctly, Jake has argued this point with you many times before. Please add them to the article on frenectomy, but not here. Thank you. -- Avi (talk) 16:48, 31 August 2008 (UTC)

Jake just reverted me endlessly without logical basis (other than rabid pro-circ statements with you and others in the gang). Please address my specific published findings that frenectomy is common and intergral to circumcision.TipPt (talk) 16:52, 31 August 2008 (UTC)

Actually, Jake almost always posted detailed, logical explanations on this talk page. More often than not, Tip, 'twas you who reverted sans explanation. And as for "gang," it is telling when you need to resort to argumentum ad hominem as opposed to merits. If large numbers of editors saw fit to revert your edits, it is more telling about your edits, than the editors, I'm afraid. -- Avi (talk) 17:00, 31 August 2008 (UTC)

I invite the reader to look at prior discussions (me with Jake and often you) to make their own conclusions about "detailed, logical" from Jake (and you). Please keep to the issue at hand with proper sources (you have provided NONE).TipPt (talk) 17:05, 31 August 2008 (UTC)

Your sources discuss that frenectomies can occur. Not that they are a part of circumcision. At best, you should put a link to Frenectomy under "See Also" such as http://en.wiki.x.io/w/index.php?title=Circumcision&diff=235410218&oldid=235404938 Anything more would be a violation of WP:UNDUE. -- Avi (talk) 17:52, 31 August 2008 (UTC)

The sources find circumcision and frenectomy coincident and part of the overall procedure (for cosmetic result ect). 20 - 33% is not undue emphasis!

The sources AVI cited ("Yoreh Deah where Brit Milah is discussed") DO NOT even mention technique. Do not cite sources that do not support your claims.17:56, 31 August 2008 (UTC)

TipPt, you said you had cited two studies: but the second link you give seems to be to a letter to the editor, not to a study.

It's (the second cite [23]) is a medical association published survey from qualified practioners. Wiki recognizes such as valid.TipPt (talk) 20:02, 31 August 2008 (UTC)

The first link is to a study in 1990, nearly two decades ago. What does it demonstrate? I've only accessed the abstract, and it seems to be talking about a technique that was used on subjects in that study, possibly as a trial of a new procedure; it's not clear from that abstract whether the procedure mentioned is used regularly (and if so, in what countries and during what decades). ☺ Coppertwig (talk) 18:02, 31 August 2008 (UTC)

I have read the full "first study" [24], and it is regularly used and thus described for edification in the US. The procedure (frenectomy) is to alleviate frenular chordee resulting from elective circumcisions.TipPt (talk) 20:02, 31 August 2008 (UTC)

Once again, TipPt, I do appreciate your making my arguments for me. Your "crusader" mentality and your overwhelming point-of-view allow you to post absolute inaccuracies with the utmost of confidence . Perhaps you do not know what Yoreh Deah is, but ask an Orthodox rabbi, they may help you. Oh, and check יורה דעה ס' רס"ד סע' ג-ו for the Jewish technique. Of course, there is some difference of opinion between European and Iberian traditions as brought in the TaZ’s and Shach’s glosses on those sections. -- Avi (talk) 18:07, 31 August 2008 (UTC)

You provide non relevant (not discussing technique). Now you provide a lecture and still no sources that support your claim. I invite you to provide a scholarly source for your claim that the current radical practice was the original covenent practice.

Readers should be aware that avi has changed this discussion conteent without personal attribution.TipPt (talk) 18:12, 31 August 2008 (UTC)

I just gave you the source in Yoreh Deah, it is not my fault that you cannot find it . It is difficult to converse with someone who refuses to accept facts demonstrating that they are incorrect. When it comes to the Jewish tradition, I think I have a somewhat better understanding of the sources than you do. Can you even read Hebrew or Aramaic? Secondly, to what change in content without attribution are you referring? The talk pages history is there for everyone to see, Tip. -- Avi (talk) 18:16, 31 August 2008 (UTC)

Avi provided a wiki link to Yoreh Deah, which DID NOT mention technique (minor or radical removal of tissue). Your claim (that the current was the original technique) needs to be supported for consideration.

In the links you added after the fact without attribution (see 30) I find several editors agreeing that frenectomy should be included in the lead. The opposers do not cite facts to base their claims.TipPt (talk) 18:44, 31 August 2008 (UTC)

Avi, re "Your ... utmost of confidence": please comment on content, not on the contributor. TipPt, I added the "sidebox" at the top of this thread with links to some prior discussions. One of the editors agreeing in one of those previous discussions was I, who have changed my mind. In order to include mention of frenectomy in this article rather than in a subarticle, or even more so in the lead rather than in the body of the article, we would have to establish its weight in the reliable sources related to this topic. You've supplied only an article from 1990 and a letter to the editor, and my search didn't turn up much if anything, so my impression is that with the sources we have, it doesn't have the weight to be mentioned in the lead, and likely not in this article either, but could go in one of the subarticles. Note that in the time since you had previously been editing this article, it was shortened considerably and material was moved into subarticles per WP:SUMMARY; I'd like to keep it short. ☺ Coppertwig (talk) 18:58, 31 August 2008 (UTC)

We have two reliable published sources Coppertwig. How many does Wiki require? (one)

Frenectomy was included in the lead until Blackworm removed it ~recently because of the word "away". It's a short sentence, so it isn't an issue of length. 20 - 33% is very relevant to the topic. Again, I have shown (two qualified cites) that frenectomy is intergral to many circumcisions for logical reasons.—Preceding unsigned comment added by TipPt (talk • contribs) 15:20, August 31, 2008

(<-)TipPT, the wikilink to Yoreh Deah was just to educate you as to what it is. I provided the direct citation above, and for your benfit, will bring it here again for you:
יורה דעה ס' רס"ד סע' ג-ו. -- Avi (talk) 19:19, 31 August 2008 (UTC)

I forgot, you cannot read Hebrew. The citation is Yoreh Deah (264:3-6) -- Avi (talk) 19:21, 31 August 2008 (UTC)

The historian and court researchers probably didn't read Hebrew either, but they were able to reference to prove this historical fact. I don't see how one rabbi (thus possibly biased) 600 years ago can become the basis of scholarly research for Wiki.

Again, your source DOES NOT address the original technique, which helps prove my point. I rely on recent (an unbiased encyclopedia, and court records) to state facts.TipPt (talk) 19:46, 31 August 2008 (UTC)

TipPt, there are a huge number of publications about circumcision. Not every one of these deserves to be cited in the lead of this article: there isn't room!! For the second link you provided (which goes to a page of letters to the editor) please tell me which letter you're citing. WP:MEDRS says "In general, Wikipedia's medical articles should be based upon published, reliable secondary sources whenever possible." One study from 1990 of 75 subjects, a primary source, just doesn't have the weight to deserve mention in the lead. Thanks for providing an interpretation of what the full study says; however, perhaps it only applies to the U.S., and procedures may well have changed since 1990. ☺ Coppertwig (talk) 20:52, 31 August 2008 (UTC)

Complications from traditional circumcision

I pulled the following sentence from the "complications" section:

A 1999 study of 48 boys seen between January 1981 and December 1995 found that haemorrhage occured in 52% of boys, infection in 21% and one child had his penis amputated.reference

Rationale: The study examines boys who had undergone "traditional" circumcision (presumably in Africa). However, "traditional" circumcision is not defined in the abstract or the Wikipedia article. It is also unclear if the 48 boys examined in the study were selected because they were experiencing complications, or if they were randomly selected from a pool of boys who had undergone traditional circumcision. This important distinction should be made if we include this study in the article.

I'm going to try to access the full article to clear up these details, but it may take a while since the IngentaConnect link on PubMed says "Page Not Found." If someone has library access to Annals of Tropical Paediatrics: International Child Health, please see if you can elucidate these issues. Thanks, AlphaEta 18:36, 31 August 2008 (UTC)

Thank you for checking facts, AlphaEta. By the way, that sentence was added in this edit on Aug. 18 by Tremello22. ☺ Coppertwig (talk) 01:07, 1 September 2008 (UTC)

I think for now, that AlphaEta's concerns would be addressed by writing, "A 1999 study of 48 boys who had complications from traditional male circumcision in Nigeria found that..." From the abstract, it seems clear to me that these boys were brought to the hospital because of their complications. I agree that it's misleading without noting this, and given this fact I'm not sure what the value of the information to this article is. Blackworm (talk) 20:25, 1 September 2008 (UTC)

Excellent suggestion. I've re-added it, for now. Do you feel the study is too specific for inclusion in the main article? We can always move it over to one of the sub-articles (I believe there are at least 20 to choose from). AlphaEta 21:13, 1 September 2008 (UTC)

I don't know, perhaps the best place to put it would be in the "circumcision procedures" section, in the same paragraph as In poor African countries, male circumcision is often performed by non-medical personnel under unsterile conditions. Then again, some may argue that this is synthesis, since we may be unduly implying without a source that there is a relation between the poorness and Africa-ness of the circumcisions and the kinds of complications encountered. What do you think? Blackworm (talk) 00:29, 2 September 2008 (UTC)

Yeah, I actually had the exact same idea. It's also associated with this little gem that I added earlier today. I suppose we could use all three refs to make a new paragraph about the potential problems of inexpertly performed/non-sterile/"traditional" circumcision. I know the status quo around here is to just throw quotes into the article (thinking is tough!), but I figure between the two of us (and anyone else who wants to join in), we may actually be able to make some new words. Thoughts on the new words idea? (If we don't overstate the relationship between these three stories, we can probably avoid most WP:SYN concerns.) AlphaEta 01:19, 2 September 2008 (UTC)

Misleading the reader

The current version of Circumcision leads the reader to believe that the covenant made with Abraham was radical (and VERY dangerous at the time without antibiotics), in that it removed the all covering of the glans instead of just the foreskin ... the SKIN extends beyond (fore-skin) the glans.

I have provided two independent unbiased sources stating the tearing back and removal of the prepuce was added later for logical political reasons.[25][26]. No editor has shown otherwise.

The original covenant technique rarely involved the frenulum (not so tight as to cause chordee) and thus frenectomy!TipPt (talk) 20:27, 31 August 2008 (UTC)

Cultures and religions

The opening words of the second paragraph really should state:

“Under Jewish religious law circumcision is a mitzva aseh”

As it stands at the moment, without “religious”, it overlooks the fact that you can be a 'cultural Jew', without being of the Jewish faith and bound by religious law, yet still claimed as a Jew by Jewish religious law .. and that, irrespective of whether or not you are of the faith and circumcised, the halakhic rules - which all branches of both Orthodox and Conservative Judaism maintain are binding – irrevocably make you a Jew if you are Jewish born of matrilineal descent (your mother is a Jew). It is therefore, both in my opinion and according to the halakhic rules, nonsense to simply state that circumcision “is obligatory for Jewish-born males“.

As it stands, it effectively states that Jewish Law says that you aren't a Jew if you aren't circumcised – and that, being complete nonsense, doesn't really do the article any great favours in the credibility stakes.

Unless anyone has a convincing argument as to why the word “religious” shouldn't be inserted, I will make the change (I would normally just go ahead and make the change, but not in this particular snipers alley).

The other alternative would be to change the section heading, but that would then involve a more substantial rewrite.Finn (talk) 14:32, 1 September 2008 (UTC)

I have changed the sentence to read:

In Judaism, the Halakha states that circumcision is a mitzva aseh ("positive commandment" to perform an act) and is obligatory for Jewish-born males, and some Jewish male converts.

That sentence is completely accurate (as an aside, the wikilink of Jewish Law went to halakha). Under halakha, Jewish males need to be circumcised, and Jewish males who are not circumcised are in violation of the halakha--not that they are not-Jewish. For cultural Jews who do not hold themselves responsible for halakha, their violation of the halakha is irrelevant to them. Thoughts? -- Avi (talk) 17:10, 1 September 2008 (UTC)

I think your change is an improvement, Avi. The previous version began "Under Jewish law circumcision is a mitzva aseh ... " You've changed it to "In Judaism, the Halakha states that circumcision is a mitzva aseh ... " If the reader clicks the wikilink for "Halakha" it's made clear there that it's religious law being referred to. I agree with your analysis that violation of religious law is irrelevant to people not of that religion. ☺ Coppertwig (talk) 17:47, 1 September 2008 (UTC)

Changed to read 'Judasim' it is indeed correct; because it is now clearly a statement about religion only - not religion and culture. Thanks. Finn (talk) 19:27, 1 September 2008 (UTC)

You know you would think that in 4,000 years more people would learn something. The website http://www.circumcision.org/ whose directors are a majority Jewish, states "Based on a review of medical and psychological literature and our own research and experience, we conclude that circumcision causes serious, generally unrecognized harm and is not advisable." So I think that Jewish law that is thousands of years old is pretty archaic today. There are also laws about stoning people in Jewish law, no? Aren't all of these considered barbaric and archaic today? RasterB (talk) 16:07, 2 September 2008 (UTC)

As an Orthodox Jew I actually find what you say somewhat insulting. Besides the fact that the directors of circumcision.org are likely not Orthodox, and perhaps not even observant, they are not reliable for the purposes of traditional Jewish law. As for the irrelevant discussion about stoning, when was the last time there was a capital case tried by a theocratic Jewish tribunal? It was close to 2,000 years ago. Circumcision still occurs today; your analogy is completely flawed, and, in my opinion, indicative of a fundamental lack of understanding of Jewish law and tradition. Lastly, please try to phrase your comments in a less insulting manner. While you may personally believe that ancient traditions are bunk and hokum, there are many other people who do not; wikipedia requires cordial and respectful collaboration. Thank you. -- Avi (talk) 16:39, 2 September 2008 (UTC)

RasterB, whilst I might be tempted to agree with some of the underlying arguments in that; your comments are wholly inappropriate and totally irrelevant. Even as an atheist Jew who abhors ritual circumcision, I find your comments quite offensive. Finn (talk) 17:07, 2 September 2008 (UTC)

I certainly did not intend to offend anyone, but it seems that if the article is going to bring up Jewish law, it is appropriate to put that law into proper context. RasterB (talk) 04:48, 3 September 2008 (UTC)

Being that hundreds of thousands of people still view the laws as binding and authoritative, I believe the context you mentioned is flawed and incorrect. While what you wrote above may be your opinion, it remains inappropriate for wikipedia. -- Avi (talk) 05:21, 3 September 2008 (UTC)

RasterB, the fundamental arguments about the (in)flexibility of Jewish religious law are already covered by the Halakha article, so they don't need to be covered again in here. Explore out from there and you will discover why those same "archaic" rules dictated that stoning must stop - yes, even for abominable homosexuals, like me - well over a thousand years before any 'civilised' western culture even began to think about it (the site you mention, being largely about propaganda, conveniently overlooks such inconvenient details)Finn (talk) 07:29, 3 September 2008 (UTC)