Talk:Circumcision: Difference between revisions

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			:Instead of being helpful, Jake is being deliberately difficult trying to stop this information being put in. A quick google search shows that the MGM bill is real: . It is obviously relevant to the topic of male circumcision. ] (]) 10:54, 7 April 2009 (UTC)

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Problematic addition to lead

A problematic addition has been made to the lead. A similar edit was made previously; I edited it at the time to correct some of the most severe problems.

Let's consider the two versions:

"Most circumcisions occur during adolescence for cultural reasons."
"Most circumcisions occur without anesthesia during adolescence for cultural reasons, and in these circumstances there is an increased chance of adverse effects."

For comparison, it may help to examine the source. It states:

"Globally, 30–34% of men are circumcised.3 Most of these circumcisions are performed for cultural or religious reasons during adolescence, outside formal health-care settings, without anaesthesia and in challenging traditional settings."

If we examine the first of these, we can see that it fits well in the context of the paragraph. If we examine the second version, we see that there are some serious problems:

The edits involve the second paragraph of the lead. The subject of this paragraph is the prevalence of and reasons for circumcision: in short, "how many?" and "why?". The relevance of the particular method of circumcision (ie whether anaesthesia is or isn't used) and the consequences (if any) in terms of adverse effects is unclear. I don't mean to suggest that these issues don't matter, but it is unclear why they belong in this paragraph. Their only apparent function seems to be to say "look how awful most circumcisions are." And because it is unclear why they belong, the effect is that the paragraph seems to act as a soapbox.
There are verifiability problems. On the plus side, the source does suggest that most circumcisions are performed without anaesthesia, and it does suggest that they occur during adolescence. However, from there it is downhill. It does suggest that most circumcisions are performed for cultural or religious reasons, but this is different from saying (as in both versions) that they're performed for cultural reasons. Worryingly, it doesn't directly support the claim that the items mentioned (adolescence, lack of anaesthesia, and cultural reasons) increase the probability of adverse effects.

For these reasons, I'm reverting to the shorter version. I am also changing "cultural reasons" to "cultural or religious reasons". Jakew (talk) 10:27, 4 March 2009 (UTC)

I disagree with your edit. I believe the fact that most circumcisions are committed without anaesthesia to be extremely relevant, and much more relevant than much other information in the lead, especially the WP:SOAP paragraph that emphasizes its antiquity and the religions that encourage the act, while omitting mention of religions that discourage it or have discouraged it. We should at the very least cite this source in "circumcision procedures," and specifically mention that most circumcisions are done in adolescence, without anaesthesia. Blackworm (talk) 16:11, 4 March 2009 (UTC)

Sorry, Blackworm. When I said "I don't mean to suggest that these issues don't matter, but it is unclear why they belong in this paragraph", I was trying to stress that I was discussing relevance to that particular paragraph rather than, say, relevance to circumcision. I guess that wasn't as clear as I intended.

I think it would be reasonable to include something in "Modern circumcision procedures". Jakew (talk) 19:46, 4 March 2009 (UTC)

If you think so, why don't you add it? Removing something wholesale, rather than moving it, is discouraged on Misplaced Pages. If you think it doesn't belong in that particular paragraph, move it to another (in the lead). Don't remove it. The third paragraph, which discusses pros and cons, is so focused on neonatal circumcision that I feel it would be misleading to put it there, although if nothing else I will put it there. I don't understand how cultural cannot be used to summarize "cultural and religious" -- a religious reason is a cultural reason. Please restore the language or at least move it elsewhere. As far as adverse effects, I guess you didn't see this sentence:

That the adverse event rate of 35.2% in traditional settings was twice the rate of 17.7% in medical settings is scarcely comforting.1

Or can adverse event not be summarized as adverse effects? Also, why is there no mention of possible complications of the lead, when there is a good summary in the body? The lead looks pretty soapboxy to me, in the positive vein -- coming from someone who really doesn't have a strong opinion about neonatal circumcision. II | (t - c) 20:26, 4 March 2009 (UTC)

Regarding "cultural and religious", if you examine the previous sentence ("The prevalence of circumcision varies mostly with religious affiliation, and sometimes culture"), you'll see that it makes a distinction between religion and culture. Having made such a distinction, we cannot reasonably use "culture" in a very broad sense, and expect that the reader will understand that this more inclusive sense is intended. In another context it might be more acceptable to use less precise language, though personally I would prefer to be precise.

Regarding adverse effects, the sentence you quote compares the adverse event rate in traditional settings with that in medical settings. It might support a statement such as: "circumcisions performed in traditional settings are associated with a greater risk of adverse effects than those in medical settings." However, the claim attributed to the source was that circumcisions performed a) without anesthesia, b) during adolescence, and c) for cultural reasons were associated with increased risk of adverse events. That claim is not made by the source, and should not be attributed to it.

I agree it would be inappropriate to include this material in the third paragraph. It doesn't seem to belong in any paragraph in the lead. Jakew (talk) 21:50, 4 March 2009 (UTC)

Ah, yes. Circumcisions performed in adolescence without anesthesia for cultural reasons is not equivalent to circumcisions performed in traditional. I apologize for not picking that up. Since you seem to be heavily-invested in this article, why not summarize the medical effects in the lead? II | (t - c) 00:33, 5 March 2009 (UTC)

Because we don't want to acknowledge any negative effects associated with circumcision. This is the purpose of the article, didn't you know? Tremello22 (talk) 12:20, 11 March 2009 (UTC)

Effect of circumcision on HIV infection & other STD's

There's a large new randomized prospective trial that was published in the latest New England Journal of Medicine on male circumcision and its effects on prevention of HSV-2, HPV and syphilis in Uganda. I'll post the link as soon as the site posts what's already been printed on paper.

Also, I was looking at the intro paragraph to the HIV:

"The origin of the theory that circumcision can lower the risk of a man contracting HIV is disputed. Since the idea was first mooted, over 40 epidemiological studies have been conducted to investigate the relationship between circumcision and HIV infection. Reviews of these studies have reached differing conclusions about whether circumcision could be used as a prevention method against HIV."

At this point, with several well-designed experimental studies published, the epidemiologic data seem less relevant. Any objections to condensing the paragraph to the following?

"Over 40 epidemiological studies, with contradictory conclusions, have been conducted to investigate the relationship between circumcision and HIV infection." Wawot1 (talk) 19:44, 24 March 2009 (UTC)

I agree with the basic idea, Wawot1, but not with the proposed edit. I think it would be misleading to say that these studies have had "contradictory conclusions", which might be interpreted as meaning that the results of these studies were highly inconsistent. Observational studies generally find a negative association between circumcision and HIV infection. With the exception of Van Howe, authors of meta-analyses were generally in agreement on this, but disagreed about whether observational data alone were sufficient to support a recommendation of circumcision as intervention.

How about this instead: "Over 40 epidemiological studies have been conducted to investigate the relationship between circumcision and HIV infection; reviews have reached differing conclusions about whether circumcision could be used as a prevention method against HIV." Jakew (talk) 19:57, 24 March 2009 (UTC)

Fair enough. Wawot1 (talk) 20:04, 24 March 2009 (UTC)

In at least 7 African countries circumcised males have higher AIDS rates than uncircumcised males. The U.S. has the highest AIDS rate and highest STD rates of any indutrailized country in the world, although in most industrailized countries near 0% of males are circumcised. Dozens of studies show that circumcisions do not reduce the risk of males getting AIDS. So especially outside of the U.S. many medical organizations state that there are conflicting evidences if circumcisions help protect against AIDS and STD's or not. I think it is very misleading to cherry-pick evidences and claim that circumcisions help protect against AIDS and STD's when there are so many conflicting evidences. You guys are doing a good jobJew1000x (talk) 14:04, 26 March 2009 (UTC)

Can you please cite some reliable sources for your claims?Wawot1 (talk) 21:14, 26 March 2009 (UTC)

Gladly, Rwandan men are more likely to have HIV if they've been circumcised: 3.5% of intact Rwandan men have HIV 2.1% of circumcised Rwandan men have HIV (figures from http://www.measuredhs.com/hivdata/reports/start.cfm) Other countries where circumcised men are *more* likely to be HIV+ are Cameroon, Ghana, Lesotho, Malawi, Swaziland, and Tanzania. That's at least seven African countries where men are more likely to be HIV+ if they've been circumcised, and yet we see health organizations promoting circumcision to prevent HIV. What will it take to stop this madness? I'm mot an epidemiologist, but I am a doctor and incomplete justifications are nothing more than guessing and often lead to misdiagnoses. I don't know why this bias exists, but for once there are a lot of those of the Judaic faith in medicine, especially in the U.S. As a member of the Judaic faith myself, I can attest bias may be at hand. Ambiguity is the only safe argument Jew1000x (talk) 00:11, 27 March 2009 (UTC)

"As a member of the Judaic faith myself"? LOL! Nice try. Jayjg 02:22, 27 March 2009 (UTC)

Great website. I couldn't find your statistics about circumcision on it though. Regardless, all of the data there are from sample surveys and are observational. Those kind of data can only demonstrate correlation, but not causality. The three randomized studies showing that circumcision reduces HIV incidence were randomized prospective trials and this type of study can say something about causality. Wawot1 (talk) 21:34, 27 March 2009 (UTC)

Navbox discussion

Readers of this page may be interested in an ongoing discussion about the navigation box that was recently added. Jakew (talk) 10:21, 26 March 2009 (UTC)

New African study conclusive, unless we turn against science itself

The new African study is so conclusive that people who questioned circumcision can take pride in having demanded scientific data in support of circumcision's health benefits. That data has been supplied. At this point, the only way to deny circumcision's health benefits is to deny the scientific method, or to impute deceit by our most respected news organizations. "When reason is against a man, a man will soon be against reason." Well, let's hope not.Profhum (talk) 02:58, 27 March 2009 (UTC)

"March 25, 2009 — Male circumcision significantly reduced the incidence of HIV and herpes simplex virus type 2 (HSV-2) infection and the prevalence of human papillomavirus (HPV) infection, suggesting potential public health benefits, according to the results of a randomized controlled trial reported in the March 26 issue of the New England Journal of Medicine."

"Male circumcision significantly reduced the incidence of...HIV infection among men in three clinical trials," write Aaron A.R. Tobian, MD, PhD, from Bloomberg School of Public Health, Johns Hopkins University in Baltimore, Maryland, and colleagues. "We assessed the efficacy of male circumcision for the prevention of...HSV-2 and...HPV infections and syphilis in HIV-negative adolescent boys and men." ...

"Male circumcision has now been shown to decrease the rates of HIV, HSV-2, and HPV infections in men and of trichomoniasis and bacterial vaginosis in their female partners," the study authors conclude. "Circumcision also reduces symptomatic ulceration in HIV-negative men and women and HIV-positive men. Thus, male circumcision reduces the risk of several sexually transmitted infections in both sexes, and these benefits should guide public health policies for neonatal, adolescent, and adult male circumcision programs."

Circumcision May Reduce Incidence of HIV, HSV-2, HPV Infection CME

News Author: Laurie Barclay, MD

CME Author: Charles Vega, MD, FAAFP

Disclosures

Release Date: March 25, 2009; Valid for credit through March 25, 2010

http://cme.medscape.com/viewarticle/590110?src=cmemp

-- Fyslee (talk) 06:44, 7 April 2009 (UTC)

Who's the one turning against science?

Your claims regarding the scientific method and reason are classically mistaken. First, the countries with the lowest HIV rates in the world do not practice circumcision. This alone is scientific proof (a la scientific method) that circumcision is entirely unnecessary to achieve the lowest rates of HIV infection. It would thus be completely folly to suggest that men in countries with low HIV rates (European countries, for example) should cut the tips off their penises based on the evidence you've presented. Further, the studies you cite could actually lead young people towards the FALSE belief that they could avoid HIV infection by circumcision with the result being that young circumcised males might not use condoms. Or perhaps an HIV positive man who is circumcised would be less likely to tell a partner with the FALSE hope that there is a low(er) risk of spreading infection. This could lead to an increase in HIV. Again, the lowest HIV rates in the world are in countries that do not circumcise.

Having said that, I'm curious why the issue of cleanliness and access to fresh water is not discussed in this article. The nations that circumcise all arise from relatively arid cultures (israel and Palestine, arab countries, and sub-saharan africa) where regular bathing was not always possible in ancient times. This may explain the historic practice. After all, the scientific consensus appears to be that circumcision is unnecessary and thus not recommended so long as you practice good basic hygiene (and have access to the fresh water that is necessary).

Catholic Church view on circumcision

Reading the section on the Catholic's view on circumcision, I checked the source material for the cited sentence. However, from what I can understand from the source, what is said on the Wiki page is not the same as what is said in the source. The page currently states that anyone who observes the act of circumcision commits mortal sin, yet the source says that anyone who observes it as necessary for salvation and as if faith in Christ without them could not save, sins mortally.. I believe the two sentences are worded differently and should be changed to reflect the intent in the source. Big Samus (talk) 04:58, 31 March 2009 (UTC)

No this is not a correct reading of the cited text, "Therefore it strictly orders all who glory in the name of Christian, not to practise circumcision either before or after baptism, since whether or not they place their hope in it, it cannot possibly be observed without loss of eternal salvation.". This is a clear prohibition on circumcision for those who hope for (Catholic) salvation.

However a source more recent than the fifteeth century would be desirable! Circumcision is currently requested by many Catholics for their children for the secular reasons of health, tradition and culture and it would be desirable to include this point with a reference. I will see if I can find one. Dr-zt (talk) 09:25, 6 April 2009 (UTC)

As is so often the case, multiple interpretations exist; for a couple of sources see History of circumcision#Male circumcision in the Renaissance. Jakew (talk) 09:34, 6 April 2009 (UTC)

Circumcision is also currently rejected by many Catholics on the grounds that it is an unnecessary infliction of great pain and mutilation upon a helpless infant. It would be desirable to include this point with a reference. I will see if I can find one. Blackworm (talk) 19:35, 6 April 2009 (UTC)

MgmBill etc

I'm reverting this edit, which has several problems:

A bill known as the Genital Mutilation Prohibition Act seeks to amend the Female Genital Mutilation Act of 1996 so that boys, intersex individuals, and nonconsenting adults may also be protected from genital mutilation.<ref>{{cite web |url = http://mgmbill.org/usmgmbill2009.pdf |format=PDF|title = Genital Mutilation Prohibition Act}}</ref>

Several problems here:

unreliable sources. MgmBill.org is a self-published source, and hence is unsuitable for use as a source.
Accuracy. It's questionable whether the word "bill" can accurately be used. Until adopted and sponsored by a legislator, it is merely something that a private individual would like to see as a bill.
Questionable notability. The existence of a pdf file, purporting to be a "bill", on a privately held website is not a good reason for it to be mentioned in Misplaced Pages. We would need evidence that this bill is notable, and sufficiently so to warrant inclusion.
Lack of neutrality. The phrase "may also be protected from genital mutilation" implies that circumcision is a form of mutilation. Some hold this opinion. Others do not.

The US Federal Law states that whoever knowingly circumcises any part of a female who has not attained the age of 18 years shall be fined or imprisoned. No such law exists pertaining to male circumcision.<ref>{{cite web |url = http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=browse_usc&docid=Cite:+18USC116 |format=HTML|title = U.S. Code Laws}}</ref>

Again, some problems here:

This article is about circumcision of males, which the source does not even mention. This violates WP:NOR, which requires that "To demonstrate that you are not presenting original research, you must cite reliable sources that are directly related to the topic of the article, and that directly support the information as it is presented." (emph in original)
Since the source doesn't mention circumcision of males, it should be blatantly obvious that the source does not support the claim that "No such law exists pertaining to male circumcision". Again, this is original research.

Jakew (talk) 09:48, 7 April 2009 (UTC)

MGM Bill

As the rules state, it must been previously published by reliable third-party publications. It has been re-published on the following reliable third-party publications.
The bill has been adopted by numerous legislators as you can easily find here
See responses to one and two.
That is a direct quote from the bill itself. We can edit it, or you can censor what you don't want others to see. It appears you have chosen the later. Let's set bias aside please.

US LAW

The law is regarding the bill, which pertains to male circumcision. Regardless of the fact that it was probably the most relevant entry under the section of Consent, and the most balanced and neutral of all views under this section by nature of it's inclusion of both sexes, unlike what is there now (which is besides the point, because it was pertaining to the bill which is about male circumcision).
We could edit it, or you can censor what you don't want others to see. It appears you have chosen the later. Let's set bias aside please.

--201dan (talk) 10:22, 7 April 2009 (UTC)

Instead of being helpful, Jake is being deliberately difficult trying to stop this information being put in. A quick google search shows that the MGM bill is real: CNN, A proposed bill to ban male circumcision. It is obviously relevant to the topic of male circumcision. Tremello22 (talk) 10:54, 7 April 2009 (UTC)

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