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Lead structure

There's a problem with the lead in its layout. Shouldn't the argument for circumcision and the arguments against circucmsision have seperate paragraphs like it did in May?

Also, one complication thats missing from this article is the problem of excessive skin removal which results in hair growing halfway down the penis because it is borrowing skin from the pubic hair area. See: Pass a Method talk 22:34, 5 July 2011 (UTC)

Why should they have separate paragraphs? Jayjg 02:11, 6 July 2011 (UTC)

According to several sources, paragraphs are supposed to be divided and devoted to new ideas., , , . The pro-circumcision arguments and anti-circumcision arguments should thus be seperate. I'm gonna seperate the two now. Pass a Method talk 10:23, 6 July 2011 (UTC)

There's no doubt that paragraphs should cover separate subjects, but the mistake that you appear to be making is to presume that the subjects are actually separate. The division that you propose (between "pro-circumcision" and "anti-circumcision") is not necessarily adequate grounds for a paragraph break, as it is frequently appropriate to combine positive and negative things about something: for example, one would not ordinarily insert a paragraph break between "I really like the icing on this chocolate cake" and "but I think there are a few too many nuts in it". The problem is that your division is imposed post hoc upon the actual structure, which isn't about pro- or anti-circumcision arguments as such, but rather an overview of the interesting facts about circumcision. Indeed, the flaws in this division are even evident in the text under discussion, because the sentence before the paragraph break which you inserted could be described as "anti-circumcision".

The problem with splitting the paragraph at this point is that the sentences actually are related, and splitting the paragraph fails to make this clear. Consider the sentence immediately after the paragraph break that you inserted. The "ethical concerns" regarding the implementation of campaigns to promote circumcision are strongly related to HIV, as is clear from the title of the cited source. Indeed, these campaigns to promote circumcision exist because of the protection against HIV.

Given these problems, I suggest that you self-revert. Jakew (talk) 11:38, 6 July 2011 (UTC)

Fair point. What about the last sentence which reads "Medical associations of some developed countries ...." Does that sentence deserve its own paragraph? I think it does deserve its own paragraph because (a) it would look more organized, (b) it might facilitate additions/revisions in the future, (c) structuring an anti-view before a pro-view (or vice versa) in the same sentence or paragraph usually tends to give prominence to the initial viewpoint over the latter. So do you agree to a compromise to separate the final sentence? Pass a Method talk 13:20, 6 July 2011 (UTC)

Conceptually it fits in with the material in the paragraph it is currently in, and in any event a single sentence cannot be a paragraph. Jayjg 22:12, 6 July 2011 (UTC)

I just reverted the double conflicting intro that Doc did. Doc I appreciate you trying to compromise by leaving the old intro in while adding your new intro however it sure makes for a messy intro that seems to contradict itself here and there. The last paragraph deals with HIV Doc. Why not just add your Krieger ref into that paragraph or the HIV section? Garycompugeek (talk) 20:15, 11 July 2011 (UTC)

I have restored the current info on HIV per MEDRS, and left in the paragraph about the controversy. There is clearly no reason to use old, out-of-date reviews except to push a POV here. Yobol (talk) 20:27, 11 July 2011 (UTC)

MEDRS has nothing to do with policy statements, its about science. I'm sure the AMA could care less about MEDRS and if asked about their current policy on circumcision they would say see our last statement. I'm also sure they would issue a new statement if their policy has changed. Therefore if you wish to hide their statement it would be you pushing a POV, not I. Garycompugeek (talk) 19:22, 12 July 2011 (UTC)

I'm quite certain that the AMA does not care about MEDRS, as they are not Misplaced Pages editors. As we are, we should follow our guidelines, with due weight to the best sources, as our guidelines suggest. Yobol (talk) 19:26, 12 July 2011 (UTC)

So you are saying we should remove any policy statements that are over 3-5 years old based on WP:MEDRS? I'm quite cetain that MEDRS guidelines are in place to keep science up to date and has nothing to do organizational policies. Garycompugeek (talk) 12:55, 13 July 2011 (UTC)

I'm saying old and out of date statements should get less weight. The AMA position is already covered in the lead, just not with the weight you feel is warranted. Yobol (talk) 15:36, 13 July 2011 (UTC)

First you removed the AMA quote based on MEDRS now its UNDUE weight, how many cards do you have up your sleave? Considering no one but WHO recommends routine neonatal circumcision why do you feel the AMA quote is inappropriate? Garycompugeek (talk) 20:24, 13 July 2011 (UTC)

As has been explained many times, the AMA statement is 11 years old, published long before the main findings regarding HIV/AIDS came out. Please don't waste any more of our time on this. Jayjg 22:00, 14 July 2011 (UTC)

Isn't it sort of original research to assert that these AIDS studies could/should affect the AMA's position? I mean, it certainly doesn't seem like we should debate whether or not that's sufficient grounds for the AMA to change its position. And I don't think it is. So please stop asserting that the AIDS studies make the AMA statement less valid. Unless you can find a reliable source that does so. _Wizard @ 06:58, 15 July 2011 (UTC)

I agree with Lizard. Most major medical organizations have maintanied their original positions on circumcision despite the African findings. This suggests that they consider these findings to be unimportant. Also, there are more cases of aids in USA than Europe, despite the European circumcision rates being very low and USA cricumcision rates being higher. I live in Britain and the largest medical organization NHS has maintained their original position: Namely that the "the majority of healthcare professionals now agree that the risks associated with routine circumcision, such as infection and excessive bleeding, far outweigh any potential benefits." Pass a Method talk 09:01, 15 July 2011 (UTC)

The findings in Africa are considered extremely unreliable. One of the problems is that it takes at least 3 months after infection for HIV antibodies to be detectable. The test required a few months of self-monitored abstinence after the procedure date. Many of the uncircumcised people may have been infected early in this period and many of the other infections, could have been before the trials even began. For example if someone was infected early before the trial up to 3 months prior. It's hard to find any research placing circumcision's effectiveness above good hygiene. The trials are worth mentioning but should not be presented as completely factual. 68.188.128.14 (talk) 03:20, 23 July 2011 (UTC)

I think we can be reasonably confident that organisations will not base their assumptions on such between-country comparisons, since that would demonstrate ignorance of basic epidemiology. Jakew (talk) 09:18, 15 July 2011 (UTC)

Wait, are you both asserting that significant new findings on the prophylactic effects of surgical procedure – supported by the world's leading international authority on international public health – would have no impact on the positions of medical associations regarding that procedure? If you're going to make that kind of prima facie absurd claim, you'd probably need some strong evidence to back it up. Jayjg 02:27, 17 July 2011 (UTC)

I'm a little bit dissatisfied with the current intro. It seems to emphasize HIV-prevention benefits with several lines in the paragraph. But seems to minimize the opposing POV which only gets one insignificant vague line. For WP:NPOV i think we should give both perspectives an equal amount of lines; i.e. we could have 3 lines for each. Thoughts? Pass a Method talk 15:31, 13 July 2011 (UTC)

If you have other high quality recent reviews, please bring them up. Again, we go by what our sources say, not by some arbitrary standard, per WP:WEIGHT. If other high quality reviews have a different POV, then bring them forward. Per WP:WEIGHT, we explicitly should not give equal weight to sides of a POV just to make things "equal". We let our sources drive the weight. Yobol (talk) 15:36, 13 July 2011 (UTC)

Summary of policy statements

According to the current version of the lead:

• Many medical associations from developed countries do not recommend routine circumcision.

I previously changed this to "several", but LizardWizard substituted "many", arguing "The Australian source alone lists 7 medical associations not recommending routine neonatal circ (appendix 2). 9 orgs = all of them = Many, at least."

This argument is problematic for several reasons:

• Miscounting. Two sources were cited both in the article and by the RACP, meaning that the correct total is 7 (8 including the RACP), not 9. (I've since removed these additional sources from the article, as they were redundant.)
• Unknown selection principles. The policies listed are obviously not an exhaustive list (the AMA, for example, is not included), and no assurance is provided that it is a representative selection. I do not wish to suggest bias in this particular case, but as a general rule one should be careful when drawing conclusions based on potentially non-representative data supplied by another party, as such data may be biased in the direction of their position. In any case this is a moot point because it's all...
• Original research. Is it true to say that all 8 sources do not recommend routine circumcision? In Appendix 2 of the cited source, only two of the quoted policies actually refer to "routine" or "routinely performed" circumcision (three if the RACP's policy itself is included). To say that the others do not recommend routine circumcision, then, seems to be original research.
• Small sample. The statements represent five distinct countries or geographical regions: Canada, USA, UK, Holland, and Australasia. According to Developed country, there are 42 developed countries, so this represents 12% of the total. That is to say, even if it is accurate to summarise the positions in this way, we only have a sample of 12% of developed countries. Can this really be said to be "many"?

I have some concerns about the focus on routine circumcision (at the expense of elective, which most medical associations also discuss) anyway, but if we do discuss associations that don't recommend routine circumcision, then I think we should avoid overstating the case, and it seems clear that "many" is excessive. Are there any serious objections to "several"? Jakew (talk) 19:43, 12 July 2011 (UTC)

I think "several" is better than "many", but don't feel strongly enough to edit war over it. I do think that we should probably insert a blurb discussing the position of the societies regarding "non-routine" circumcision as well, for contextual purposes. Yobol (talk) 19:47, 12 July 2011 (UTC)

I'm confused. What medical organizations besides WHO recommends routine infant circumcision? Garycompugeek (talk) 12:43, 13 July 2011 (UTC)

I don't even understand why you're asking that question, Gary. Why is it relevant? Jakew (talk) 15:14, 13 July 2011 (UTC)

Because if you persist in avoiding strong-ish language like "many", I'm going to suggest that it be changed to something like:

The following medical organizations do not recommend routine neonatal circumcision: AMA, AAP, RACP, BMA, AUA, <...>. The following medical organizations do: (none known).

I think that's an unnecessarily verbose way of getting the point across, but at least it's not original research. _Wizard @ 16:29, 13 July 2011 (UTC)

Actually, that would be original research, as explained above. Jakew (talk) 17:27, 13 July 2011 (UTC)

I was going to just reply snarkily about how it could be made even longer, but never mind, I've just hit the jackpot. According to the 2010 RDMA (KNMG) piece, "There is currently not a single doctors’ organisation that recommends routine circumcision for medical reasons." Argument settled, I'll put that in the article. _Wizard @ 03:46, 14 July 2011 (UTC)

I've added attribution for the claim, as I think a stronger source (such as a systematic review) would be needed to make such a strong claim by itself. But the source is adequate. Jakew (talk) 08:14, 14 July 2011 (UTC)

The lede should at least make it clear that the statement was made in 2010. Jayjg 02:22, 17 July 2011 (UTC)

Fair point. Done. Jakew (talk) 08:01, 17 July 2011 (UTC)

POVing the intro again

PassaMethod has apparently decided to POV the intro, by unilaterally adding this paragraph:

The risks that accompany routine circumcision (such as excessive bleeding and infection) outweighs any possible medical benefits of circumcision. Loss of the foreskin can result in scarring and abrasion, because the foreskin functions as a protection of the glans.

As is fairly obvious, this is merely a selection of sources that speak against circumcision, not (as claimed) an attempt at neutrality. The last source used was particularly ridiculous; a book on "Better Birth", by Denise Spatafora, an "Executive Leadership Coach - Professional Life Coach". PassaMethod, please do not make any more edits to the lede without getting consensus here first. Jayjg 03:19, 17 July 2011 (UTC)

Agreed, there are serious problems with reliability, neutrality, and even original research here. See also: User talk:Jmh649#reliable sources, NHS BBC. Jakew (talk) 08:00, 17 July 2011 (UTC)

Tweak intro

I have split the 2nd paragraph in two to better represent their topics and readability. I have also removed two HIV paragraphs that are covered in the HIV section for weight concerns plus no need to go into more HIV detail in the intro. The reader can find out more in that section or entire article. Garycompugeek (talk) 19:55, 22 July 2011 (UTC)

That was hardly a "tweak", and there was no consensus to remove the HIV information, which is highly relevant and significant, and clearly belongs in the lead. Please get consensus for this change. Jayjg 22:29, 22 July 2011 (UTC)

Your response does not address my concerns Jayjg. We mention the link between circumcision and HIV in the lead with the WHO supporting campaigns in high risk areas. Why do you feel we need to go into more detail in the lead? What do you find wrong with splitting the paragraph? Garycompugeek (talk) 23:47, 22 July 2011 (UTC)

Broadly speaking, Gary, the weight is supposed to reflect that in the available sources. HIV is a "hot topic" in recent years, and there is a great deal of research into circumcision and HIV. Using some rough numbers from Google Scholar, for example, 660 of 2260 (29%) of articles published in 2011 relating to circumcision discuss HIV. Searching for "circumcision" and limiting the results to reviews or meta-analyses reveals an even more striking result: 8 of the 20 (40% of) items on the first page of results refer to HIV in the title. It's probably safe to say that more sources have investigated the HIV aspect of circumcision than any other sub-topic. So I don't quite understand why "weight concerns" would necessitate this edit. Jakew (talk) 10:31, 23 July 2011 (UTC)

1. circumcision NHS coices retrieved 15 july 2011
2. Foreskin functions retrieved 15 July 2011
3. Better Birth: The Ultimate Guide to Childbirth from Home Births to Hospitals (2009) Denise Spatafora

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