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On the 27th of August, the Royal Australasian College of Physicians published on their website a single-page document entitled "Current College Position on Circumcision". The position is very similar to that expressed in the 2004 statement, and indeed much of the language is identical. The changes seem to be very subtle. For example, the original statement contained the sentence, "After extensive review of the literature the RACP reaffirms that there is no medical indication for routine neonatal circumcision", but this has now changed to "After extensive review of the literature the RACP does not recommend that routine circumcision in infancy be performed, but accepts that parents should be able to make this decision with their doctors." The document includes a note stating that, once complete, the full revised policy will be published on the RACP's website. However, it seems worth revising our "Policies of various national medical associations" to refer to this most up-to-date position. Any comments? Jakew (talk) 16:12, 31 August 2009 (UTC)

Ooh. Difficult decision. It's unclear whether this document supersedes the earlier one. If it leaves something out, are they more-or-less retracting it, or it this just a shorter summary document that doesn't state everything? OK, regardless: if it doesn't appear in this document, then perhaps they don't consider it part of a summary of important points, so it may be better for us to leave it out too. I suggest that we remove the reference and footnote to the 2004 statatement, and replace it with a reference to this document. I suggest the following wording (note "surgeon" instead of "operator"):

The Royal Australasian College of Physicians (RACP; 2009) state that "after extensive review of the literature" they "do[] not recommend that routine circumcision in infancy be performed". They also state that "if the operation is to be performed, the medical attendant should ensure this is done by a competent surgeon, using appropriate anaesthesia and in a safe child-friendly environment." Additionally, the RACP state that there is an obligation to provide parents who request a circumcision for their child with accurate, up-to-date and unbiased information about the risks and benefits of circumcision, adding that "in the absence of evidence of substantial harm, parental choice should be respected."^[1]

For comparison, here's the current wording in this article:

The Royal Australasian College of Physicians (RACP; 2004) state that "after extensive review of the literature" they "reaffirm that there is no medical indication for routine neonatal circumcision". They also state that "if the operation is to be performed, the medical attendant should ensure this is done by a competent operator, using appropriate anaesthesia and in a safe child-friendly environment." Additionally, the RACP state that there is an obligation to provide parents who request a circumcision for their child with accurate, up-to-date and unbiased information about the risks and benefits of circumcision, adding that "there is no evidence of benefit outweighing harm for circumcision as a routine procedure in the neonate."^[2]

Currently, the footnote contains an extensive quote. I have a mild preference for deleting these long quotes, but if such a quote is retained, I suggest that a quote of equal or lesser length from the new document be used instead. ☺Coppertwig (talk) 19:15, 5 September 2009 (UTC)

Yes, I think that's a reasonable edit. However, on aesthetic grounds (I dislike empty square bracket pairs) I would change 'they "do[] not recommend' to 'they do "not recommend' or 'they "[do] not recommend'. I suggest making this change within the next couple of days, assuming there are no objections. I may do so myself if need be. Jakew (talk) 15:55, 17 September 2009 (UTC)

Thanks for accepting the gist of my edit here, Jake, but it seems to me you've miscounted: your edit seems to me to leave only 3 points, not 4, so I suggest re-inserting the bit about being extremely painful. How about: "Opponents of circumcision argue, for example, that it interferes with normal sexual function,is extremely painful, is performed based on myths, and when performed on infants and children violates their human rights comparably to female genital cutting." Or, the last part (starting at "and when performed on") could be shortened to just "and is comparable to female genital cutting", and some of the earlier wording of the earlier part of the sentence restored; perhaps this would look to you more clearly like just a single point. ☺Coppertwig (talk) 13:35, 29 August 2009 (UTC)

I count four arguments, Coppertwig: i) interference with normal sexual function, ii) performance based on myths, iii) violation of human rights, and iv) analogy with FGC. I don't have strong feelings about which four points, though, so am happy about removal of "when performed on infants and children violates their human rights" as you suggest. Jakew (talk) 13:43, 29 August 2009 (UTC)

It looks like four to me. I consider "violates human rights the way FGC does" to be one point. How about this: we allow five (four-and-a-half?) points each, and count the current advocates' sentence as follows: "Advocates of circumcision argue, for example, that it provides important health advantages which outweigh the risks, has no substantial effects on sexual function, has a low complication rate when carried out by an experienced physician, and is best performed during the neonatal period" (1) provides health advantages; (2) outweighs the risks; (3) no effect on sexual function; (4) low complication rate; (5) best performed neonatally. In any case, I consider it important to include "extremely painful", as this is one of the key complaints of opponents, in my opinion. ☺Coppertwig (talk) 13:50, 29 August 2009 (UTC)

I'm quite happy to retain the "pain" point, as long as the total number of points on both sides is equal. We've had a consensus version of this paragraph for a long time, and it seems obvious to me that adding the FGC analogy changes this balance by adding a point (and if it doesn't, what's the point of adding it?). Again, I don't really mind how balance is achieved, as long as it is achieved. Jakew (talk) 14:05, 29 August 2009 (UTC)

I wouldn't say it adds a point; I would say it modifies an already existing point. Would you consider this to be a single point, Jake? "and in regard to the human rights of infants and children is comparable to female genital cutting". Or how about, "and is comparable in terms of human rights to female genital cutting"? Or "is morally comparable to female genital cutting" (although I prefer one of the others) 14:12, 29 August 2009 (UTC) Thanks for the discussion, Jake. This is much more fun than when we're agreeing all the time. Do I get to win this one? ☺Coppertwig (talk) 14:19, 29 August 2009 (UTC)

(ec) I think it modifies the point in such a way that it makes an additional point by implication, and I think the alternatives suffer from the same problem. The basic point is: "and is comparable to female genital cutting". Additional points are made by embellishing this argument. References to human rights (and, though perhaps to a lesser extent, morality) are not actually required in order to make the primary point; mentioning them serves to make a further point by implying that rights (etc) are violated. I think we need to choose between either the FGC analogy or another argument. Jakew (talk) 14:25, 29 August 2009 (UTC)

I don't see how "outweighs the risks" doesn't embellish the advocates' argument just as much. To me, arguing "comparable to FGC" isn't much of an argument at all unless it means in terms of human rights; in what other way would it mean?

Nevertheless, as a compromise, I propose: "Opponents of circumcision argue, for example, that it interferes with normal sexual function, is performed due to excuses and myths believed or conjured by parents and health providers, is extremely painful, and is comparable to female genital cutting." (Here, it seems to me that "human rights" is implied.) This is shorter, however, so optionally the earlier parts of the sentence can be expanded, e.g. "adversely affects normal sexual pleasure and performance" (from a version of the same sentence a year ago).

Or wait! An even earlier version of the sentence (2 years ago) included "and a genital mutilation like female genital cutting". How about "Opponents of circumcision argue, for example, that it interferes with normal sexual function, is performed due to excuses and myths believed or conjured by parents and health providers, is extremely painful, and is a genital mutilation like female genital cutting."? I prefer this one, I think. The source uses the term "mutilation" (or "mutilate", etc.) multiple times. ☺Coppertwig (talk) 14:47, 29 August 2009 (UTC)

In online debates I've seen FGC analogies made in relation to human rights, sexual function, complications, benefits, and bioethics (there may have been others, too, but those are the ones that spring to mind). I think your compromise proposal is acceptable. The version with "genital mutilation" is not, however, as that (once again) introduces an additional argument (well, "genital mutilation" is just name-calling rather than an argument, but it's still technically a point) that would cause an imbalance. Jakew (talk) 15:08, 29 August 2009 (UTC)

You haven't addressed my point about the advocates' sentence having a double point as well. However, I've put in one of the compromise versions discussed above. ☺Coppertwig (talk) 15:20, 29 August 2009 (UTC)

Okay, that looks acceptable. I don't think it's a double point, because one of the "points" is just a fact. It's difficult to dispute that there are health advantages; if you remove a body part you eliminate the possibility of diseases of that body part. What is controversial about health benefits includes a) the specific benefits gained (though these aren't named in the sentence, so this isn't much of an issue), and b) whether the benefits are of sufficient magnitude to outweigh the risks. I suppose the word "important" could be removed, but if we do so we'd better address the verbose mess of "excuses and myths believed or conjured by parents and health providers"... Jakew (talk) 15:34, 29 August 2009 (UTC)

OK, it's a truce. ☺Coppertwig (talk) 15:46, 29 August 2009 (UTC)

By the way, I'm not fond of the long version of the "myths" phrase. I only restored it because I presumed that whoever put it in in the first place wanted it there. ☺Coppertwig (talk) 13:18, 30 August 2009 (UTC)

(double ec) It's not about winning and losing arguments and debates Coppertwig. We just need to apply clear logic and represent all view points to be neutral. I agree you expanded a point and did not create an additional one. Garycompugeek (talk) 14:30, 29 August 2009 (UTC)

Thanks. Yes, I know. I was joking. If we find a version acceptable to all parties, we all win. ☺Coppertwig (talk) 14:49, 29 August 2009 (UTC)

Re tweak: [1] Sorry, Gary, but I prefer keeping the word "is". Removing it makes the sentence less grammatical in my opinion. Now to fix it, we would have to insert "and" before "is extremely painful". But that would then tend to imply that it's in terms of pain that it's similar to FGC, which is not what I intended and may not necessarily be verifiable. ☺Coppertwig (talk) 16:15, 29 August 2009 (UTC)

I disagree and feel adding "is" is bad grammar, does not change meaning in the slightest bit, and therefore not necessary. Garycompugeek (talk) 17:00, 29 August 2009 (UTC)

The current sentence, which I find ungrammatical and which you (if I understand correctly) find more grammatical than the version with "is", is: "Opponents of circumcision argue, for example, that it adversely affects normal sexual pleasure and performance, is performed due to excuses and myths believed or conjured by parents and health providers, is extremely painful, and comparable to female genital cutting." Please explain why you find the version with "is" ungrammatical. (Maybe we speak different dialects or something?) Here's why I find this one ungrammatical. The sentence uses a parallel construction. The first part, "Opponents of circumcision argue, for example, that it" is completed multiple times by the other parts. In other words, it's equivalent to several sentences with a repeating first part:

• "Opponents of circumcision argue, for example, that it adversely affects normal sexual pleasure and performance."
• "Opponents of circumcision argue, for example, that it is performed due to excuses and myths believed or conjured by parents and health providers."
• "Opponents of circumcision argue, for example, that it is extremely painful."

However, for the last part, it doesn't work; this isn't a proper sentence:

• "Opponents of circumcision argue, for example, that it comparable to female genital cutting."

Perhaps you mean that in the parallel construction, the two last parts both go into the same sentence:

• "Opponents of circumcision argue, for example, that it is extremely painful, and comparable to female genital cutting."

That is a proper sentence. However, to do it that way, you would need an "and" before this third item in the parallel construction, since there are now only three items. Otherwise it's like saying "He believes that God is all-powerful, knows everything, is forgiving." rather than "He believes that God is all-powerful, knows everything, and is forgiving." The first doesn't seem grammatical to me: a list usually has "and" before the last item in the list. Aside from grammar, I prefer not to combine the last two points, as I explained above. ☺Coppertwig (talk) 18:49, 29 August 2009 (UTC)

I have self reverted because I do not consider it a big deal either way. Garycompugeek (talk) 19:15, 29 August 2009 (UTC)

Thank you very much! ☺Coppertwig (talk) 19:27, 29 August 2009 (UTC)

I suggest changing "Opponents of circumcision" to "Advocates of the intact penis". (Here, the singular form is used to denote a class, as in "The lion is a carnivore.") I think this is a better description of the position: it wouldn't make sense to oppose circumcision while implying that any other random surgical modification to the penis is probably OK. This also seems to be wording used by such advocates. ☺Coppertwig (talk) 00:26, 5 September 2009 (UTC)

I would support you in that. 'Opposition to circumcision' is not NPOV, as it either implies activism against a norm (which circumcision is not, but has POV connotations), or a some 'bad' practice (which would be a POV). 'Advocates of the intact penis' gets around this, because it more closely reflects their position. Mish (talk) 01:21, 5 September 2009 (UTC)

I'd strongly oppose that description. Once again, we have the problematic word "intact". Depending on the definition one uses, a circumcised penis may be described as "intact" (in the "not damaged" sense), so it fails to properly distinguish. Moreover, if the reader interprets it as meaning "not damaged", it implies that a circumcised penis is damaged. That's acceptable in a quote, since the POV is attributed, but we should be careful to avoid expressing such a POV ourselves. Also, it's insufficiently precise: I've known someone who was wholly opposed to circumcision, but who was in favour (albeit not as passionately) of genital piercings. If one uses the "unaltered" sense of "intact", I'm not sure whether he would be described as an advocate of an intact penis. But he could be described as an opponent of circumcision. As far as this article is concerned, the only thing that matters is their view regarding circumcision, and it doesn't make sense to try to hide that. Finally, even if we changed it to "Advocates of the uncircumcised penis", though, I still think it would be problematic, because what we're trying to capture is not "the uncircumcised penis is good" but "circumcision is wrong". Plenty of people (including myself, for that matter) would agree with the former statement, but would disagree with the latter; it is those who believe the latter that we wish to describe. Jakew (talk) 08:40, 5 September 2009 (UTC)

"Advocates of the intact penis" is a very good, NPOV phrase. We have already discussed how "uncircumcised" and "non-circumcised" are not a valid terms. Because of this, those activists coined and defined the phrase to deal with the very problem this discussion is dealing with: How to describe a natural state when the 'unnatural' state is the norm (since then, the term has been used in the media and academic articles). For a similar reason, they do not use the phrase "normal penis" since in circumcising populations, the circumcised penis is 'normal', however, it is not 'intact.' Also, said activists are NOT oppossed to circumcision when it is medically indicated, or when an adult choses it for himself, so calling them "Opponents of circumcision" is not only a biased POV, but inaccurate, too. Frank Koehler (talk) 17:16, 24 September 2009 (UTC)

The important thing is how they describe themselves, if we are talking about their views, so, how do they describe themselves in their literature? Anecdotes about friends who have genital piercings hold no weight here. If some describe themselves in opposition, and others in advocacy, then we need to reflect both - but if it is exclusively one or the other, then we need to reflect that. Mish (talk) 01:55, 7 September 2009 (UTC)

How they describe themselves is important if we say something like "those who describe themselves as ...", but it is of limited relevance otherwise, since we have no obligation to describe them using the same language that they would use to describe themselves. As a (somewhat extreme) example, it is not uncommon for mass murderers to describe themselves as "God's avenging angel" (or something similar), but we would generally avoid using such language. Please remember that our role is to describe views, not to express them ourselves. Often people will deliberately use non-neutral language to describe themselves, in order to "sell" their position. Our role is to find neutral, descriptive, precise language for describing the views. Jakew (talk) 09:12, 7 September 2009 (UTC)

That is your POV, not policy or guideline - and backed up by a bogus example. We are not discussing serial killers, we are discussing people who advocate that a child retains an intact penis until they are of an age they consent to these sorts of procedures. You object to terms and phrases you don't like (such as 'genital cutting', 'intact') - and wheel out all sorts of stats and sources to back you up - and then when we are discussing how people actually refer to themselves, that is 'irrelevant'. Of course it is not irrelevant, it is highly relevant to ensure that we describe such people or groups accurately. In the case of a terrorist group, even if they describe themselves as freedom fighters rather than terrorists we can legitimately describe them as terrorists if they are listed as such by government agencies or there are reliable sources that report on their terrorist activities. However, when we describe animal rights activists, we refer to them as animal rights activists, not people opposed to hunting or experimenting on animals. 'Opposition to circumcision' is not neutral, and is also inaccurate (because nobody opposes such genital surgery when it is either medically necessary, or consented to by an adult); the correct description would be 'Opposition to unnecessary infant circumcision', (but while being more accurate, I suspect that would raise more because of the use of 'unnecessary'. 'Advocates of the intact penis' conveys more of what people are arguing for - and advocating that such surgery be deferred until a child is of an age they can make their own informed consent over a procedure that is not driven out of immediate medical necessity. I can see why you might be confused that this is compatible compatible with advancing consenting adults' liberty to pierce their own genitals - but the two are very different, one involves the subject's consent, and one doesn't, one is about what adults do to themselves, the other about what adults do to children. Perhaps a better phrase would be 'Advocates of penile autonomy' (or 'advocates of genital autonomy'), as that covers unnecessary infant circumcision, medical necessity, and people's own consented genital modification, and seems pretty accurate and NPOV. Mish (talk) 09:46, 7 September 2009 (UTC)

It doesn't really matter whether you personally approve of their POV, Mish, the same principle applies to both serial killers and opponents of circumcision: they must be described in neutral, accurate terms, which are not necessarily the terms which they would themselves choose (although, having said that, Milos chose to name her organisation "NOCIRC", so there is little apparent difference in this particular case).

Now, to consider your specific suggestions:

"Opposition to unnecessary infant circumcision" would be problematic, as you say, because of the term "unnecessary". There is, of course, considerable debate over whether infant circumcision is necessary for prophylaxis, and even in cases of therapeutic circumcision controversy may occur over whether it is necessary.

"Opposition to infant circumcision", which you do not mention, would be somewhat better, but is actually overly precise. It fails to include, for example, those who oppose circumcision of children or indeed adults. Of the arguments actually listed in the lead ("that it adversely affects normal sexual pleasure and performance, is performed due to excuses and myths believed or conjured by parents and health providers, is extremely painful, and is comparable to female genital cutting"), the first two are independent of age, and the last two are arguably so.

"Advocates of the intact penis" I've discussed above (in my comment dated 08:40, 5 September 2009).

"Advocates of penile autonomy" or "advocates of genital autonomy" are splendid examples of marketing: choosing a description of a position with which people would not want to disagree. As such, they're incompatible with NPOV, and also have accuracy problems for similar reasons to "advocates of the intact penis". Jakew (talk) 10:35, 7 September 2009 (UTC)

If a penis is described as "intact" in the context of an injury in an automobile collision, it wouldn't be taken as implying the penis wasn't circumcised. However, in the context of this article I think it's clear to the reader that it means uncircumcised; and it's terminology used by opponents of circumcision. Nevertheless, you have a good point, Jake, that what we mean is not "advocates of the intact penis" (which may exclude those who accept piercings; although piercings don't actually remove parts so the penis could still be considered "intact") but "opponents of circumcision", which means something different, so we have to say what we mean. It's tricky to get the wording right in terms of whether they're opposing all circumcision or only non-therapeutic infant circumcision. We could say "Opponents of non-therapeutic infant circumcision"; but I think what we mean is "people who oppose circumcision in one way or another, including those who oppose non-therapeutic infant circumcision, as well as those who would advise adults not to get circumcised," and that "opponents of circumcision" is a reasonably good wording to represent this. MishMich, the NPOV policy requires that we use an "impartial tone" (see WP:NPOV#Impartial tone), which means that the language we use doesn't sound as if it's coming from one POV or another. People may disagree about what impression various language gives. One way to resolve this is to do literature searches to find out what terminology is used with what frequency in reliable sources on the topic. Jake has a good point that if an organization is called "NOCIRC", then "opponents of circumcision" sounds like a description such opponents would accept or even use. Another possibility might be "Opponents of circumcision, who tend to use the word 'intact', ..." while shortening the "myths" phrase to stabilize the length of the sentence; however, I guess that would be OR and probably not universally true, so never mind. I would oppose putting "intact" in scare quotes, though, as I feel it would distance us too far from that POV; we don't put "uncircumcised" in scare quotes. ☺Coppertwig (talk) 12:59, 7 September 2009 (UTC)

We don't put "circumcised" in quotes either. Mish (talk) 16:19, 7 September 2009 (UTC)

Multiple studies have made use of existing data to predict the effect of circumcision programmes at a national level. Most of these studies are positive about the cost-effectiveness of circumcision programmes, but a few are not. Recently, Zodon added one of these studies to this article, as well as circumcision and HIV. Because the viewpoint expressed in this study was not representative, doing so created an undue weight problem in both articles. I addressed these problems by expanding coverage in the HIV article (see here) and — due to limited space — reverting the addition here. I am concerned that Garycompugeek has now restored the addition here: Gary, how do you propose to resolve the undue weight problem? Jakew (talk) 17:45, 16 September 2009 (UTC)

Jake I would not have reverted you if I agreed it was undue weight. I find the addition well sourced, interesting and notable. Garycompugeek (talk) 18:21, 16 September 2009 (UTC)

I'd be interested to know why you think the weight is appropriate, Gary. Can you explain why, of all the studies cited here, this and only this should be cited? Jakew (talk) 18:35, 16 September 2009 (UTC)

(sigh) Jake... unlike you, I encourage volunteers to edit the wiki. Zodon is not a new user, seems to have a firm grasp on policy, and was placing an edit in relevent articles to topic. You have severe gatekeeper tendancies that tend to drive off editors quite quickly with a battery of well rehearsed wiki lawyering. Sit back. Relax and see if others support your edit. Avi usually reverts me after I revert you to keep the status quo. Garycompugeek (talk) 19:08, 16 September 2009 (UTC)

I support Gary, simply because I think Jake is wrong - studies relating to HIV are cited in the section, and they leave the section unbalanced, there is nothing wrong in citing a study which questions the cogency of the assertion about cost-effectiveness (which incorporates cost-effectiveness). That is what NPOV is also about. (Also, I would like to see Jake learn a bit of humility in not getting his own way at least once). Mish (talk) 20:30, 16 September 2009 (UTC)

What "assertion about cost-effectiveness" are you referring to, Mish? There is only a single mention of cost-effectiveness in the entire section at present, and that is in the problematic addition that we're discussing. That, in essence, is the problem. If we are to discuss cost-effectiveness then we ought to do so properly, citing a representative selection of the literature, as WP:NPOV requires. There's space to do that in the detailed article. However, if we cite a single, non-representative study, then we have failed to give a representative picture of cost-effectiveness as it is discussed in the literature. How can that be justified? I submit that it can't: it is clearly undue weight. Jakew (talk) 21:46, 16 September 2009 (UTC)

My apologies, I didn't make myself clear enough. I have amended my text accordingly. This source, for example, incorporates cost-effectiveness as one aspect of efficacy: [2]. If you have omitted this aspect of these sources, and that has been challenged, then maybe you need to think about including it. Mish (talk) 22:06, 16 September 2009 (UTC)

Well, it wasn't terribly clear that you were referring to references to cost-effectiveness that we didn't actually mention. If you're proposing to incorporate additional material re cost-effectiveness as well as the McAllister paper, that's another matter. Undue weight can be resolved that way, too (as I mentioned, I added material to circumcision and HIV for that very purpose). I'm not sure that there's sufficient space to go into much detail about the projected effect of circumcision, but am open-minded. What, exactly, do you propose? Jakew (talk) 08:12, 17 September 2009 (UTC)

I have said before, I have no intention of editing this article again. I am pointing out something, and it is up to those editors who are overseeing the editing it to implement such changes themselves. Mish (talk) 10:00, 17 September 2009 (UTC)

Apparently Jake would rather edit war than gain support for his revert. Jake... 3 editors have shown favor.. please gain consensus to revert addition. Garycompugeek (talk) 15:20, 17 September 2009 (UTC)

You appear to misunderstand consensus, Gary. One does not require consensus to revert an edit, since there is already an effective consensus on the stable state of an article. One does require a consensus to change that state; where an edit is made and reverted, that is evidence that no consensus exists. Rather than repeatedly reverting, it is advisable to discuss the proposed change and obtain agreement. For more information, please see WP:CONSENSUS, WP:BRD, and the {{controversial}} at the top of this talk page. Jakew (talk) 15:32, 17 September 2009 (UTC)

You appear as an iron fisted gatekeeper who refuses to listen to other editors opinions and concerns. Gain more support for your opinion or standown. Garycompugeek (talk) 17:21, 17 September 2009 (UTC)

Gary, I asked you why you felt that the weight was appropriate in my comment of 18:35, 16 September 2009. You didn't even answer that question, and indeed you appeared uninterested in discussing the edit at all, apparently preferring to have some kind of meta-discussion about editors and approaches to editing (as seems to be the case again now). If you want to discuss the edit, fine, let's do so. But complaining that I refuse to listen when you avoid questions is ... bizarre, to say the least. Jakew (talk) 18:17, 17 September 2009 (UTC)

I answered your question Jake. Bizarre is your deaf ears. Let me repeat myself "Jake I would not have reverted you if I agreed it was undue weight. I find the addition well sourced, interesting and notable." Your assertion of UNDUE is OR. Garycompugeek (talk) 19:06, 17 September 2009 (UTC)

Gary, you're quoting your post dated 18:21, 16 September 2009. It tells me that you believe it is not undue weight, but it doesn't tell me why. That's why, in my response (dated 18:35, 16 September 2009), I asked you why you believed that the weight was appropriate. Jakew (talk) 19:21, 17 September 2009 (UTC)

You say its give undue emphasis because it contradicts other studies. Mish and I disagree and feel it is required per NPOV to show other views. Is it impossible for you to agree to disagree or something? Garycompugeek (talk) 20:24, 17 September 2009 (UTC)

Gary, your summary of my position is not quite accurate. I'm saying that our coverage of cost-effectiveness must conform to WP:NPOV. That is, if we discuss the cost-effectiveness of circumcision as an HIV prevention measure, then that discussion should reflect a representative sample of the literature: not necessarily every viewpoint, but at least the major ones, and in rough proportion to the frequency with which they're found in sources. What we cannot do is to take what appears to be a minority viewpoint (that of McAllister et al) and present only that viewpoint. I understand that you disagree, but you still haven't explained why. This seems to be a basic application of policy; would you like to explain why you disagree? With what part of my analysis do you find fault? Jakew (talk) 20:51, 17 September 2009 (UTC)

It strikes me that in the discussion about effectiveness in places like Africa, one of the factors is cost-effectiveness, and so circumcision is put forward as a cost-effective solution to prevent HIV, against the costs of retrovirals, hospice care, and all the social costs associated with young deaths. That is omitted in the article as being of any relevance, yet cost-effectiveness is a significant factor in dealing with any epidemic, more than the trauma of individual deaths and sickness - these are not factors in epidemiology, but the national or international cost is. Here is a paper which deals with the matter on that basis, and shows that use of prophylactics is more cost effective. But it is ineligible because we have failed to include one of the most significant factors in measuring effectiveness - that it is economically more effective to provide condoms rather than circumcise people, when those reports promoting circumcision also point out that even with circumcision it is still advisable to use condoms? If that little omission isn't OR I'm not sure what is. It begs the question why, if condoms are more cost effective and are still advised despite circumcision, we are putting so much weight on circumcision as a preventative treatment for HIV infection. The WHO has a section devoted to cost-effectiveness, and here is a paper which challenges this, but it is inadmissable because we have ignored that section in the WHO report. Makes me wonder what else has been ignored in cited sources so that contradictory material becomes inadmissible. Mish (talk) 20:59, 17 September 2009 (UTC)

This isn't the place to debate the merits of circumcision programmes (you're welcome to contact me by email if you wish), or even whether McAllister's claim is correct, so I won't respond to those points here. Nevertheless you are correct that we should consider whether to include mention of cost-effectiveness. That is indeed a factor that is considered by policy-makers when planning intervention strategies. It is certainly important, though I'm not sure that it's necessarily more important than any other aspect of circumcision and HIV. I think we need to remember that, in this article, space is limited, and so we cannot as a practical matter include every piece of information. We have to be selective, and I'm not sure whether this issue is sufficiently urgent to warrant further expansion of the HIV section.

I would also question your characterisation of this material as "inadmissable because we have ignored [the cost-effectiveness] section in the WHO report". If we decided to discuss cost-effectiveness then there is no reason why we could not cite McAllister's claims about cost-effectiveness as well as those in other sources, including the WHO report. The undue weight problem comes from discussing only McAllister's claims. Jakew (talk) 21:43, 17 September 2009 (UTC)

Fine, I look forward to seeing how you intend to incorporate the cost-effectiveness discussion for circumcision, which will then allow for this new material to go in unchallenged. Mish (talk) 10:01, 18 September 2009 (UTC)

Mish, Jake is just one editor with one opinion. It is not necessary to please him for every change that goes into the article. Garycompugeek (talk) 13:01, 18 September 2009 (UTC)

Absolutely, Gary. There's no need to please any editors. However, Wikipedia works by discussion and consensus, and so, while tempting at times, we cannot simply declare that editors can be ignored (you have yourself asserted the importance of "listen[ing] to other editors opinions and concerns", I note). Moreover, it is of course of vital importance to pay attention to and discuss appropriate policy. Since you still haven't responded to my request that you explain where the fault lies with my undue weight analysis, may I assume that you're unable to do so?

Mish, this section contains a version of the contested sentence (corrected so that it accurately represents what McAllister et al actually claim), plus material that I added in order to make the weight given to that source more appropriate. I consider this section too long and too detailed for this article, though I am not altogether sure how best to cut it down. As I thought I'd made clear above, my preference is not to cover cost-effectiveness in this article, but I am open-minded and happy to consider an addition, as long as it conforms to NPOV. Jakew (talk) 15:09, 18 September 2009 (UTC)

I dunno, something like 'one of the factors advocates of circumcision in HIV prevention cite is cost-effectiveness [sources], this is countered by one analysis which suggests that using condoms is more cost-effective [source]', as a rough sentence which I'm sure could be honed to cover the cracks in my own limited understanding. But, NPOV, and brief. Mish (talk) 16:11, 18 September 2009 (UTC)

I'm concerned about describing authors as "advocates of circumcision" - I'm not sure if it's the case that every author who concluded that circumcision is cost-effective is also an advocate, and even if it is, we'd need a source describing them as such. I think it's also important to say what other authors have said about cost-effectiveness (saying that they say something about cost-effectiveness isn't really enough), and I think we should avoid constructions suggesting that one author is "countering" claims made by another, as there is rarely a literal claim-response pattern in the literature - it is usually more complicated than that.

I think something like the following might be more suitable. However, I would be the first to admit that it is much longer than would be ideal. Too long, but it is at least NPOV.

• Comparing the cost-effectiveness of circumcision with that of other interventions, the World Health Organisation found that circumcision is "highly cost-effective" when data from the South African trial are used, but less cost-effective when data from the Ugandan trial are used. McAllister et al., however, estimated that condom use is 95 times as cost effective. Other researchers have considered the cost-effectiveness of circumcision alongside other interventions. For example, Kahn et al. studied sub-Saharan African settings with a high or moderate HIV prevalence, reporting that adult circumcision is "likely to be a cost-effective HIV prevention strategy" even when deployed among only a small fraction of the population, concluding that circumcision "generates large net savings after adjustment for averted HIV medical costs". The UNAIDS/WHO/SACEMA Expert Group on Modelling the Impact and Cost of Male Circumcision for HIV Prevention found "large benefits" of circumcision in settings with high HIV prevalence and low circumcision prevalence. The Group estimated "one HIV infection being averted for every five to 15 male circumcisions performed, and costs to avert one HIV infection ranging from US$150 to US$900 using a 10-y time horizon".

Comments? (Refs can be found in the detailed article.) Jakew (talk) 16:37, 18 September 2009 (UTC)

This seems to be more than is necessary when the section links to its own article, although I agree with what you said about advocacy. I'd suggest:

* Comparing the cost-effectiveness of circumcision with that of other interventions, the World Health Organisation found that circumcision is "highly cost-effective" when considering the South African trial data, but less cost-effective according to data from the Ugandan trial. McAllister et al., however, estimated that condom use is 95 times as cost effective than treating HIV. Other researchers considered the likelihood of the cost-effectiveness of circumcision compared to treating HIV. Kahn et al. postulated that circumcision was "likely to be a cost-effective HIV prevention strategy" in relation to "averted HIV medical costs". The UNAIDS/WHO/SACEMA Expert Group proposed that in settings with high HIV prevalence and low circumcision prevalence, there would be cost-benefits: "one HIV infection being averted for every five to 15 male circumcisions performed, and costs to avert one HIV infection ranging from US$150 to US$900 using a 10-y time horizon".

Mish (talk) 17:03, 18 September 2009 (UTC)

I appreciate your concern about the level of detail; unfortunately, though, the only way to present a minority viewpoint without giving it undue weight is to present it with sufficient context to inform the reader about majority viewpoints as well. I agree with some, but not all, of your modifications. Hopefully most the following will be self-explanatory. If not, do ask. One thing that may not be obvious is the title of the UNAIDS expert group. Their name is actually "UNAIDS/WHO/SACEMA Expert Group on Modelling the Impact and Cost of Male Circumcision for HIV Prevention", and I don't think that we can properly include just part of this. I can understand why you've shortened it, however - it is a bit much! I've transformed it to a description instead.

• Comparing the cost-effectiveness of circumcision with that of other interventions, the World Health Organisation found that circumcision is "highly cost-effective" when considering South African data, but less cost-effective according to data from Uganda. McAllister et al., however, estimated that condom use is 95 times as cost effective as circumcision. Other researchers considered the cost of circumcision compared to treating HIV. Kahn et al. reported that, in sub-Saharan Africa, circumcision was "likely to be a cost-effective HIV prevention strategy", generating "large net savings after adjustment for averted HIV medical costs". A UNAIDS/WHO/SACEMA expert group proposed that in settings with high HIV prevalence and low circumcision prevalence, there would be cost-benefits: "one HIV infection being averted for every five to 15 male circumcisions performed, and costs to avert one HIV infection ranging from US$150 to US$900 using a 10-y time horizon".

Comments? Jakew (talk) 17:53, 18 September 2009 (UTC)

Looks OK to me, but would like to hear from others. Mish (talk) 21:34, 18 September 2009 (UTC)

Okay. Jakew (talk) 08:02, 19 September 2009 (UTC)

Based on the draft paragraphs above, here are some attempts at short versions:

• "Researchers and organizations such as the WHO have estimated that circumcision is a cost-effective strategy for controlling the spread of HIV, although McAlllister et al. argue that it is less cost-effective than condom use."
• "Circumcision has been deemed to be a cost-effective method to reduce the spread of HIV in a population, though not necessarily more cost-effective than condoms."
• "The WHO and other researchers and organizations describe circumcision as a cost-effective or highly cost-effective method of preventing HIV transmission, while McAllister et al. calculate that condoms are 95 times as cost-effective in sub-Saharan Africa."

With appropriate footnotes to the references (also found in the Circumcision and HIV article) e.g. WHO, .. McAllister ☺Coppertwig (talk) 21:31, 20 September 2009 (UTC)

I oppose this edit by Gary. I agree that it's undue weight, because the only information in the article about cost-effectiveness of circumcision for HIV prevention would be from that one study, and that it should therefore, if included, be balanced with other POVs about the cost-effectiveness. Gary, what are your reasons for including that material? ☺Coppertwig (talk) 21:53, 20 September 2009 (UTC)

I started a stub article on UNAIDS/WHO/SACEMA Expert Group on Modelling the Impact and Cost of Male Circumcision for HIV Prevention. ☺Coppertwig (talk) 22:10, 20 September 2009 (UTC)

I'd go for No.3 of the above. Not sure it needs its own article, or does anything problematic within this article have to have its own article? Mish (talk) 22:14, 20 September 2009 (UTC)

My concern about #1 and #3 is that they give the impression that WHO and other authors have considered cost-effectiveness in an absolute context (that is, "is it cost-effective or not"), while only McAllister et al. have considered cost-effectiveless in a relative context (that is, "is it more or less cost-effective than alternative interventions"). That's not the case: WHO have compared circumcision to other interventions, too, and their conclusions were not the same as those of McAllister et al. For that reason, I prefer #2. Jakew (talk) 08:13, 21 September 2009 (UTC)

If I had to make a choice I would choose number #3 as most informative. Zodon has added the material Coppertwig. Mish and I have simply supported its addition. Why? It seems obvious. It is relavent to topic, interesting, and notable. If you feel one study makes it undue weight feel free to add other studies. I agree with Mish and don't believe the information merits its own article. Yes Mish it seems a common practice to hide negative controversial information about circumcision into stub articles. Garycompugeek (talk) 09:30, 21 September 2009 (UTC)

Sigh. Pity, it seemed for a short while as though we were approaching consensus, now we seem unable to agree on a shortened version. Let's back up a moment: is anyone opposed to including the longer version in my comment dated 17:53, 18 September 2009? I'm not keen on the length, personally, but it is accurate.

Incidentally, it is clear from both the title and content of the article that Coppertwig created that it is about the UNAIDS etc. "Expert Group" that authored one of the studies cited, not about the cost-effectiveness of circumcision in general. And since the study in question was positive about circumcision, it is nonsensical to describe this as "hid[ing] negative information about circumcision into stub articles" — if it was "hiding" anything, wouldn't it be positive information? If you can't AGF, please at least check facts before accusing. Okay? Jakew (talk) 17:41, 21 September 2009 (UTC)

No Jake, your proposition from 17:53 9/18 is an acceptable compromise. I have struck out and modified my original comment but still feel a lot of criticism gets regulated to stubs. Garycompugeek (talk) 09:30, 22 September 2009 (UTC)

Gary, the reason that the insertion was inappropriate was that it was undue weight on a single study. In this article we're trying to summarize the medical and scientific consensus, rather than cherry-picking individual studies that happen to support one's personal POV. Jayjg ^(talk) 23:07, 22 September 2009 (UTC)

My position on whether to add (balanced, etc.) material on cost-effectiveness or not is neutral; I'm sorry I didn't make that clear. However, I oppose adding unbalanced information on cost-effectiveness. I was only suggesting shortened versions in an attempt to be helpful, not because I necessarily even supported any of my own suggestions: they may need tweaking in one way or another. In the interests of reaching consensus it's OK with me to put the version suggested by Jake into the article, but I think it's too long and that we should keep trying to find a shorter version. ☺Coppertwig (talk) 23:28, 25 September 2009 (UTC)

Some of the facts in this article I question their accuracy. Some of the sources in this article are junk sources.

The neutrality and bias of this article is questionable. --Alin0Steglinski (talk) 23:39, 23 October 2009 (UTC)

It is difficult to imagine a more vague description of a problem. As stated, your complaint cannot be resolved. We need to know:

• Which statements do you question the accuracy of?
• Which sources are "junk sources"? (And, by reference to applicable policy and guideline, what is meant by "junk sources"?)
• In what specific ways are the neutrality and bias questionable?

For each of these points, you need to state the problem in a way that is sufficiently clear to allow your claims to be evaluated, and — assuming that they are valid — also to know whether they have been resolved.

For these reasons, I've reverted your addition of the tags. I have also reverted your inexplicable addition of the "unreferenced" tag on the penile cancer section; since this section cites 5 sources, so the addition of a tag reading "This section does not cite any references or sources" seems ill-considered at best.

For future reference, I'd like to point to this guidance from WP:DRIVEBY:

The editor who adds the tag must address the issues on the talk page, pointing to specific issues that are actionable within the content policies, namely Wikipedia:Neutral point of view, Wikipedia:Verifiability, Wikipedia:No original research and Wikipedia:Biographies of living persons. Simply being of the opinion that a page is not neutral is not sufficient to justify the addition of the tag. Tags should be added as a last resort.

Jakew (talk) 08:37, 24 October 2009 (UTC)

I use fewer words, and provice a more understandable and accurate characterization of the reference:

Opponents of circumcision argue, for example, that it adversely affects normal sexual sensation, pleasure, and performance, is based on medical myths, is extremely painful, and is comparable to female genital cutting.

Jakew reverts to: Opponents of circumcision argue, for example, that it adversely affects normal sexual pleasure and performance, is performed due to excuses and myths believed or conjured by parents and health providers, is extremely painful, and is comparable to female genital cutting.

Please explain your position. It is certainly not balance.Zinbarg (talk) 17:19, 10 November 2009 (UTC)

It's quite straightforward. This and the preceding sentence describe two opposing points of view, and we must be careful not to give one more weight than the other. That means that we should use approximately the same number of words for each, and we should cover the same number of points. Strictly speaking, we already have an imbalance in that we give four points to advocates, but five to opponents. Your edit increased the number of opponents claims to six (there are three claims in "adversely affects normal sexual sensation, pleasure, and performance").

I also reverted your edit because you changed the URL for a citation such that the URL was for an entirely different document from that which was cited. In some circumstances it might have been acceptable to change the citation as well as the URL, but in this instance the URL you supplied was for a self-published source that would not meet appropriate WP policy. Jakew (talk) 17:39, 10 November 2009 (UTC)

Sorry about the URL mistake. I started off by thinking that the doctors url would be more representative, and then forgot I only made that one change to the cite. I will match the number of points of views in the two when I get time.Zinbarg (talk) 19:19, 10 November 2009 (UTC)

If you can't find a scientific reference to refute this study [[3]] you must make it advocate.Zinbarg (talk) 17:24, 10 November 2009 (UTC)

Sorry, that doesn't make any sense whatsoever. Care to explain? Jakew (talk) 17:41, 10 November 2009 (UTC)

The Schoen article lacks proper cites, and is neither factual nor representative of pro-circ advocates. Specifically, his statement about neonatal being the best time is not factual. 8 days, or 5 months is better. Advocates are frequently for religious purpose, and that's completely ignored. Because he is not representative or accurate, his contribution must be considered from AN advocate, not "advocates."Zinbarg (talk) 19:26, 10 November 2009 (UTC)

Whether claims are factual or not is a can of worms that we cannot and should not open here. To exclude positions that we think are inaccurate would potentially introduce bias into the article. Fortunately, we don't need to do so, since we're saying only that certain people claim that something is the case, not that it actually is the case.

A more relevant issue is whether Schoen's statement is representative of circumcision advocates. You've stated that it isn't, but you haven't offered any evidence in support of your position. Do you have any? Jakew (talk) 19:37, 10 November 2009 (UTC)

I object to your not caring about wikipedia being factual. I provided the research link above, and Schoen provides no references. The Schoen article is unsubstanciated and not factual, thus it's often the simple opinion of a doctor. Cancer?!!! To call him representative of "advocates" is wrong. Note that in the anti-circ sentence, she reviews many many fully researched positions. Schoen misses religious purpose completely, which is certainly an advocacy position. Many advocates promote circumcision around the age of 7, or at 8 days, Schoen is wrongly claiming otherwise. Many advocates focus on cultural rites. All I did was correct the sentence to say "an advocate," which he is, instead of "advocates." At a min, we have to remove the statement that it's done best as a neonate.Zinbarg (talk) 23:11, 10 November 2009 (UTC)

Zinbarg, I think you misunderstood about whether Jake cares about Wikipedia being factual. In any case, Jake's approach is very much in line with Wikipedia's policies such as WP:V, ("verifiability, not truth", a longstanding bit of policy I helped retain).

Jake, Zinbarg's point is that Schoen is only one person. Can you come up with good arguments that the citation given supports the plural "advocates"? Maybe the citations Schoen gives can be considered to indicate other advocates.

Zinbarg, I don't know what you mean when you say Schoen's citations aren't proper. I haven't looked at them, but maybe you could explain in more detail what you mean so I would know what to look for.

Zinbarg, now that you've deleted the bit about the neonatal period being best (and shortened the awkward phrase about myths, to retain the balance in length of the sentences) do you think it's OK to keep the word "advocates"? I think it's probably OK. Just changing to the singular doesn't look good to me: it spoils the balance between the two sentences. It would be better to find a different reference to justify using "advocates", changing the arguments if necessary. ☺Coppertwig (talk) 00:56, 16 November 2009 (UTC)

It's true that Schoen is only one person, Coppertwig. However, it's also true that Milos and Macris are two people, so if we said "an advocate" then shouldn't we also say "two opponents"? I think that both the "advocate" and "opponent" arguments are sufficiently representative that we can generalise; especially given that they are being included in the lead for the specific purpose of giving an overview of the controversy. Jakew (talk) 10:03, 16 November 2009 (UTC)

Two opponents can correctly be called "two opponents" or alternatively just "opponents", but one advocate cannot be correctly called "advocates", so no, there would not necessarily be an obligation to insert "two". You say you think the arguments are representative, but I don't see any arguments based on reliable sources to support this. I'm not disagreeing with you, but it looks like merely a statement of your opinion, which is not sufficient on Wikipedia. Another idea would be to say something like "Arguments that have been given in favour of circumcision have included ... . Arguments that have been given against circumcision have included ... ." This sidesteps completely the question of how many advocates or opponents are involved. This formula would have the additional advantage of avoiding implying that all advocates (or all opponents) support the particular arguments listed. (I keep forgetting whether this article uses American or British spelling; couldn't we have a template at the top of the talk page specifying?) ☺Coppertwig (talk) 01:25, 18 November 2009 (UTC)

If we refer to two opponents as just "opponents", then aren't we implying that the arguments are typical of those of opponents in general? To my mind, the most important thing here is to be consistent. If we refer to opponents as "opponents", implying that their arguments are representative of the class, then we should do the same with advocates. On the other hand, if we say "an advocate" then we should be equally precise in saying "two opponents", to avoid implying that one is representative of a class but the other statement is not. I can't think of any justification for selective precision.

Regarding whether the arguments are representative, you're right: we don't have any reliable sources showing that they are. But if they aren't representative, then why are we including them in the lead at all? If they are not representative, why do random opinions of three arbitrary people deserve to occupy one of the four paragraphs that appear in the first (and probably most read) section of the article?

I'm not opposed to rewording the sentences as you suggest, but if there's serious doubt about whether the arguments are representative, then I think that ought to be addressed. Jakew (talk) 10:38, 18 November 2009 (UTC)

I "say Schoen's citations aren't proper" because he provides no cites for his circ right after birth recommendation, and he cites his own work in two other areas (papers that also read like the opinion of a practitioner). It's OK to keep the word "advocates" and then use Schoen. He's probably representative of medical advocacy, save his circ soon after birth recommendation. That's only a US hospital thing.Zinbarg (talk) 17:41, 20 November 2009 (UTC)

OK, I guess the current version is OK, then, now that the part about neonatal has been removed. "Advocates of circumcision argue, for example, that it provides important health advantages which outweigh the risks, has no substantial effects on sexual function, and has a low complication rate when carried out by an experienced physician.^[3] Opponents of circumcision argue, for example, that it adversely affects normal sexual pleasure and performance, is justified by medical myths, and is effectively comparable to female genital cutting.^[4]" ☺Coppertwig (talk) 20:23, 21 November 2009 (UTC)

Please watch the three "Professional Education," "Neonatal Circumcision: An Audiovisual Primer procedure instruction clips found here[[4]]. See how the gomco, mogen, and plastibell instruction clips discuss breaking adhesions or crushing and cutting the band sometimes found on the ventral side of the penis from the corona. The "Modern circumcision procedures" section in wiki lacks mention of this common (I see 20 - 30% of the time elsewhere in wiki) technique. I found it in a surgical manual. I'm working on adding something to that section.Zinbarg (talk) 18:00, 20 November 2009 (UTC)

I think this might be a little complicated, and would therefore ask that you propose any change here, on the talk page, so that we can agree on what needs to be done before changing the article itself. Jakew (talk) 18:42, 20 November 2009 (UTC)

Modern circumcision procedures

For infant circumcision, modern devices such as the Gomco clamp, Plastibell, and Mogen clamp are available commonly used.^[5]

With all modern these devices the same basic procedure is followed. First, the amount of foreskin to be removed is estimated. The inner lining of the foreskin (preputial epithelium) is then bluntly separated from its attachment to the glans, and the foreskin is retracted to ensure that the glans can be freely and completely exposed. The frenulum band may need to be broken or crushed and cut from the corona near the urethra to free the foreskin. The device is then placed (this sometimes requires a dorsal slit) and remains there until blood flow has stopped. Finally, the foreskin is amputated[[5]].^[6]Zinbarg (talk) 00:45, 21 November 2009 (UTC)

I hope you don't mind, Zinbarg, but I've added highlighting to the above to show changes from the current version. I'll comment in a moment. Jakew (talk) 10:09, 21 November 2009 (UTC)

I oppose these changes, for the following reasons:

• Change of "With all modern devices the same basic procedure is followed" to "With all devices..." — we don't know that this procedure is used for all devices. We only know that it's used for the modern devices mentioned in the previous paragraph.
• Addition of "The foreskin is retracted to ensure that the glans can be freely and completely exposed." — this sentence is partly redundant, since we've already stated "The foreskin is then opened via the preputial orifice to reveal the glans underneath and ensure it is normal."
• Addition of "The frenulum band may need to be broken or crushed and cut from the corona near the urethra to free the foreskin." — this is not supported by the cited source (the AAP's 1999 policy, see section "Methods of circumcision"). Jakew (talk) 10:19, 21 November 2009 (UTC)

Thank you for highlighting the changes, which make things much easier to follow. I agree with your criticisms. I simply objected to the word modern when we're talking about medical devices that have been used for so very long. I added "these" above. I also changed the order of the sentences, and got rid of the redundancy. We could use the stanford instructional material as citation (short version added above) to support the statement about basically properly dealing with frenular breeve and chordee as they become apparent during circumcision. We could cite good cosmetic and functional result? Do you want to include those medical conditions in the text? There is still redundancy, in that much of the common procedure above is repeated in the descriptions of using the specific devices. I'll probably work on those sentences next, but it will just be taking stuff out.Zinbarg (talk) 05:41, 22 November 2009 (UTC)

Thanks for changing the above, but I'm still uneasy about the frenulum sentence. The problem is, if we cite two sources at the end of a claim then the implication is that both sources support that statement. But here, it's a synthesis of the two sources that, together, support the statement. We ought to avoid that.

Here's an alternative suggestion: why don't we add the following sentence after the main material (and after the AAP citation). "Sometimes, the frenulum may need to be broken or crushed and cut from the corona near the urethra to free the foreskin.^[7]" Jakew (talk) 10:51, 22 November 2009 (UTC)

Circumcision Decision-Maker [6] I found this refreshingly different approach to circumcision information for parents. Let's face it, the most frequent visitor to these pages are people researching the circumcision decision, as opposed to say, students, doctors, lawyers or academics. It isn't pro or con on the circumcision issue, but rather pro-parent as it looks at the reasons parents might chose circumcision and then explores them individually. I suggest a new "External Link" section be created for this, something like "Circumcision Information for Parents. Frank Koehler (talk) 02:00, 21 November 2009 (UTC)

As far as I can tell, this is just another anti-circumcision website: having spent some time browsing through the various issues, every single page seemed designed to persuade people not to circumcise. I can't see that it offers anything that isn't already provided.

Actually, looking at their "Panel of experts" page leaves little doubt as to the anti-circumcision nature of the site: "The panel’s consensus is that the foreskin is a vital, functional part of the male genital anatomy—is not a birth defect—and, if there is not a strong, valid, and immediate medical reason for removing it, for ethical reasons, it should remain intact. The owner of the penis should decide how it looks and works, when he is old enough to do so." Jakew (talk) 10:22, 21 November 2009 (UTC)

Granted, they tend to advise against it more than recommend it, but that doesn't make them anti-circ any more than it makes them pro-circ. The other links tend to be more adamant about being pro-circ or anti-circ than this one. At least they strive for balance. Regardless, I think it is more important that it be provided to readers than some of the other links, some of which are personal opinion websites, not organizations. And, this group lists all the names of their editorial panel, not something that some of the other websites do. No one has suggested it not being listed. Frank Koehler (talk) 12:57, 26 November 2009 (UTC)

The page I cited clearly states that, except for special circumstances, the "foreskin ... should remain intact", in other words circumcision should not be performed. If that isn't an anti-circumcision sentiment, I'd like to know what is. If it is included, it should be listed under "Circumcision opposition". To do otherwise would, in my view, be misleading. Also, if it is included, it should replace one of the existing links, since we're trying to preserve balance between links representing each point of view. So I guess the question is, what link would you propose to delete? Jakew (talk) 13:24, 26 November 2009 (UTC)

I think it is important to include because parents want quick, online answers. I understand the need to keep balance in this article. Konig mentions this below in keeping the same number of links. I would replace the link to the Circumcision Information Resource Pages (CIRP). CIRP is not an organization, it is a ersatz library. To me, it is redundant since many of the CIRP articles important to this discussion are already referenced here. And, these articles are easily found using any search engine, plus the medical libraries like MedScape and PubMed. If no one objects, I'll make that change in a day or two. Frank Koehler (talk) 14:59, 26 November 2009 (UTC)

I strongly oppose that proposal. Per WP:ELYES item #3, CIRP is suitable for inclusion, precisely because it is a large library of (mostly) neutral, accurate, peer-reviewed papers. As such, in my opinion, it is the most encyclopaedic of all the opposition links. Organisations are probably suitable per the apparent intent of WP:ELYES item #1. I would suggest removing circumstitions.com, as that site is neither encyclopaedic information nor an organisation, but is basically just one man ranting about circumcision. Jakew (talk) 15:37, 26 November 2009 (UTC)

I hear what you are saying, and still CIRP is redundant. And, Circumcstitions was my second choice. I think we can go with that. I'll make the change if no one objects in the next day or two. Frank Koehler (talk) 16:41, 26 November 2009 (UTC)

Agree, I think a mix of encyclopaedic information, as well as resources for prospective parents, are key for a balanced approach to this issue. Jkonig (talk) 14:41, 1 December 2009 (UTC)

My name is Jennifer Konig, and I am the Senior Project Manager at IntactAmerica.org. I am writing to ask that our website be added to your list of Circumcision Opposition links. Our organization, headed by Georganne Chapin, has grown exponentially this last year, and has become the leading national voice in the movement to stop infant circumcision in the United States. We are well positioned to replace smaller grassroots efforts, as we have received national media attention: MSNBC, The Today Show, and several nationally syndicated radio programs, as well as articles in The New York Times, The Chicago Tribune, and other publications. Given our national prominence, we ask that you add Intact America to your list, and in an effort to keep things balanced, perhaps remove the SexAsNatureIntendedIt site, as it's not an organization, but more of a sales site. Please visit [7] as well as [8] for more information. Thank you for your consideration.Jkonig (talk) 18:49, 24 November 2009 (UTC)

This seems a reasonable request to me. Unless there are any objections in the next 24hrs or so, I intend to replace sexasnatureintendedit.com with intactamerica.org. Jakew (talk) 18:55, 24 November 2009 (UTC)

Its a reasonable addition, to me, too. Frank Koehler (talk) 22:34, 24 November 2009 (UTC)

Agreed as well. -- Avi (talk) 23:20, 24 November 2009 (UTC)

Thank you for making this change. It's very much appreciated. Jkonig (talk) 14:41, 1 December 2009 (UTC)

Please see this text from the cited reference[[9]]:

Conclusion 7: Programmes should be targeted to maximize the public health benefit

The population level impact of male circumcision will be greatest in settings (countries or districts) where the prevalence of heterosexually transmitted HIV infection is high, the levels of male circumcision are low, and populations at risk of HIV are large. A population level impact of male circumcision on HIV transmission in such settings is not likely until a large proportion of men are circumcised, although benefit to the individual is expected in the short term. Modelling studies suggest that universal male circumcision in sub-Saharan Africa could prevent 5.7 million new cases of HIV infection and 3 million deaths over 20 years.

The greatest potential public health impact will be in settings where HIV is hyperendemic (HIV prevalence in the general population exceeds 15%), spread predominantly through heterosexual transmission, and where a substantial proportion of men (e.g. greater than 80%) are not circumcised.

Other settings where public health impact will be considerable include those with generalized HIV epidemics where prevalence in the general population is between 3% and 15%, HIV is spread predominantly through heterosexual transmission and where relatively few men are circumcised.

In settings with lower HIV prevalence in the general population, including where HIV infection is concentrated in specific populations at higher risk of HIV exposure, such as sex workers, injecting drug users or men who have sex with men, limited public health benefit would result from promoting male circumcision in the general population. However, there may be individual benefit for men at higher risk of heterosexually acquired HIV infection such as men in sero-discordant partnerships and clients presenting at clinics for the management of sexually transmitted infections. There is insufficient evidence to suggest that circumcision reduces HIV transmission among men who have sex with men.

The US (and all other English speaking and Western countries; added 12.6.09)) meets none (less than 1% prevalence, and spread primarily by homosexuals) of the above criteria for inclusion in the UN programe. Therefore, the last sentence in the introduction is misleading because this information is not relevant to most readers. But it's in the introduction! Why is this minor medical info in the introduction at all?.

At a min, we could "add public health benefits are minimal where prevalence is below 3%" to that last sentence. But again, as I think about it, the whole sentence should be deleted.Zinbarg (talk) 00:18, 2 December 2009 (UTC)

If this were USPedia, you might have a point, but since it isn't, you don't. Wikipedia is global in scope, and is about circumcision in general. The population of the US is 308 million, that of the globe is 6,800 million. To imply, as you do, that 95% of the world's population don't matter, is frankly offensive.

The second mistake you've made is to conflate two issues. The first, which is mentioned in the introduction, is whether circumcision reduces the risk of female-to-male transmission of HIV. A secondary issue is whether circumcision programmes should be introduced as a result, and if so, where. Jakew (talk) 09:51, 2 December 2009 (UTC)

You're smarter than that Jakew. The same statement (using the 3% threshold for "consideration" of circ as a health measure) can be said for nearly all the countries in the world. Rates in Muslim countries are all far far less than 3%. HIV/circ info is not relevant to the vast majority of the world's population.

The introduction has already treated medical issues fully in the pro/con, and in the medical assiciation sentences. Medical associations have considered HIV protection benefits when making their recommendations. Your forcing minor hiv prevention benefits into the introduction after the medical association position statement is biased pro circ, and POV unacceptable.

"Consideration" is a strong word, because for example in Africa spending on circ's would crowd out spending on vaccinations which return 100x the cost equivalent longevity benefit. Your "frankly offensive" is therefore grossly misplaced.Zinbarg (talk) 15:30, 2 December 2009 (UTC)

I've placed a POV tag on Circumcision until this issue is resolved.Zinbarg (talk) 15:54, 2 December 2009 (UTC)

Zinbarg, first if you mean "the US and other countries" then you need to say that. If you say "the US" then you can't blame me for assuming that you actually mean "the US".

Second, I'm not sure where you've found the word "consideration". The source you cited above uses the term "considerable". Is that what you mean?

Third, the source you've cited does not present 3% as a reversible "threshold". It states that "settings where public health impact will be considerable include those with generalized HIV epidemics where prevalence in the general population is between 3% and 15%..." (emph. added). Note the use of the word "include", which indicates that this is not an exhaustive list of criteria, and it is not therefore a reversible statement.

Fourth, even if ignore my previous point for the sake of argument and assume that public health impact is not "considerable" in a particular country, that does not mean that circumcision or information about it is irrelevant. It just means that the expected public health impact of circumcision programmes is less than considerable.

Fifth, most of the other medical association sentences, and certainly the 1999 AMA statement quoted in the lead predate the three randomised controlled trials that led the WHO and CDC to issue their statements. In order to give a more complete picture, therefore, it is necessary to cite these medical associations as well. Also, doing so helps to "explain why the subject is interesting or notable" and "summarize the most important points" (WP:LEAD). Jakew (talk) 15:59, 2 December 2009 (UTC)

The vast majority of readers of this wiki article are english speaking Americans. I see other languages have their own wikis, which implies a focus of this version on US readers. Regardless, it's only relevant to a few countries or a minority of global readers but you have it in the introduction as though its a VERY important part of the article. You make it much more important than other medical considerations and costs. That's POV bias.

Yes, consideration is from "considerable." If it's not considerable, it's left out of consideration (out of the range of high enough significance).

The sentence states that under 3% will have less than considerable impact on public health. "Include" means that other issues may not be considered here. For example, positive impact (of circs) requirements would "include" availability of hygenic procedure settings and methods. We already covered medical issues in the introduction in the two prior paragraphs.

We use the AMA only because we can quote them thus covering ~all other associations. Most individual association statements are recent enough to have considered hiv benefits found in studies (cited by WHO and CDC), most conducted between 2000 and 2005. For example, the AAP is 2005, CPS 2004, BMA 2006, and the AAFP reaffirmed in late 2007. Don't just look at the dates of the WHO and CDC statements (look to the underlying research).

Again, it is a benefit already covered in the introduction as a medical issue. Without bias. Placement after the AMA paragraph, and placement in the introduction puts undue weight on the information and is pro circ bias.Zinbarg (talk) 17:24, 2 December 2009 (UTC)

First, Zinbarg, there is little doubt that HIV/AIDS is an important aspect of circumcision, as can be seen from the attention given to the subject by reliable sources. A considerable fraction of papers about circumcision have focused HIV, and this fraction is increased further if you consider papers published in the past few years.

Second, you've misunderstood the sentence. As I explained, the word "include" indicates that prevalence of >3% is one of several factors leading to considerable public health impact. Consequently, as I stated, although a prevalence >3% may indicate considerable public health impact, that's not reversible: considerable public health impact does not require a prevalence >3%.

Third, the AMA discusses other associations at the time. However, the randomised controlled trials cited by the CDC and WHO were published in 2005 and 2006. Very few statements have been published since then; the AUA's statement is the only one that springs to mind. Jakew (talk) 17:55, 2 December 2009 (UTC)

"Attention given" is subjective. Recent attention doesn't mean it belongs in the lead. It's a known health benefit, but you present the information so that it subjugates the prior pro/con (includes medical) advocacy and the medical association paragraphs. You overweight the importance of HIV benefits relative to religious and cultural reasons, which are the primary reasons for almost all circumcisions.

We won't agree on "reversible." You know statistics; it's actually reversible. Instead look to the next paragraph in the WHO statement: "In settings with lower HIV prevalence in the general population, including where HIV infection is concentrated in specific populations at higher risk of HIV exposure, such as sex workers, injecting drug users or men who have sex with men, limited public health benefit would result from promoting male circumcision in the general population." In other words, VERY limited benefit for the vast majority of our readers, or of those who circumcise. But you force it into the lead, apart from the prior medical related paragraphs. VERY few circumcisions are done for medical reasons. This presentation in the lead is POV.

The HIV preventive benefits from circumcision were known well before 1999 (pre AMA statement) with the first meta in 2000. Looks like the WHO cited studies are 2000, 2007, 2005 and 2007. The CDC cited studies from 1999 to 2007 (2000, 2006, 2000, 2003, 2000, 1999, 2005, 2007, 2007, 2006). The RACP statement came out in 2009, the CPS in 2004, the AAP reaffirmed (not recommend) in 2005, and the BMA in 2006, so all would have considered HIV benefits. Note the CDC doesn't recommend circumcision in the US, and the WHO recommends conditionally.Zinbarg (talk) 00:50, 3 December 2009 (UTC)

Zinbarg, the present arrangement, consisting of the sentence about the WHO, etc., as well as the AMA sentence, has been the subject of long-standing consensus for a long time. It represents an attempt to represent the views of most medical associations via the 1999 AMA statement (admittedly outdated, but the best we have), and also documents another, more up-to-date statement from a globally influential medical organisation - the WHO. The two serve to balance each other: citing the AMA but not the WHO would give an outdated view skewed against circumcision, whereas citing the WHO but not the AMA would, perhaps, suggest stronger support for circumcision than is the case.

To an extent, the attention given to HIV is objectively verifiable. By checking Google Scholar, for example, we can confirm that there are 87,300 articles referring to circumcision, of which 14,800 (17%, roughly 1 in 5) discuss HIV. If we consider papers published in the last decade (since 1999), 14,400 and (55%, roughly 1 in 2) respectively. The conclusion is difficult to escape: as a fraction of the text in the lead, the single sentence given to HIV is about the same as even the lowest of those percentages, let alone the more recent papers that represent more current scholarship on the subject. To remind you, Wikipedia articles are supposed to reflect the weight given to various aspects of the subject in reliable sources.

As I've stated several times now, the randomised controlled trials that led the CDC and WHO to publish their statements were published in 2005 and 2007 (Sorry, I erroneously said 2006 before; that was the date of the press release announcing the results of the latter two, the respective papers were not published until early 2007). It is true that papers have been published on the subject dating back to 1986, but due to the design of other studies, they were not considered sufficiently strong evidence (see, for example, the 2003 Cochrane Review and compare with the current Review. Also see this August 2006 press release from WHO stating that "WHO, UNFPA, UNICEF and the UNAIDS Secretariat emphasize that their current policy position has not changed and that they do not currently recommend the promotion of male circumcision for HIV prevention purposes. However, the UN recognizes the importance of anticipating and preparing for possible increased demand for circumcision if the current trials confirm the protective effect of the practice."). You might find Circumcision and HIV helpful.

So, if we consider the policies that you mention: the 2009 RACP update appears to have been withdrawn (at any rate it doesn't seem to be on their site any more), and in any case was a preliminary document lacking a detailed discussion of the evidence. The 2004 CPS statement and 2005 AAP reaffirmation predated the trials. Only the BMA post-dates the publication of one trial, and that document specifically avoids discussion of the medical harms or benefits, stating "The Association has no policy on these issues", so it can't meaningfully be included.

Since the sentence is about an effect of circumcision, rather than asserting a reason for it to be performed, I don't see the relevance of your comments about reasons. Jakew (talk) 11:02, 3 December 2009 (UTC)

Doing away with the indentation, you're correct in that HIV/circumcision is a hot topic recently in research. I guess I don't mind mention of the WHO and CDC statements in the lead, but that should be in the AMA (ie medical) paragraph and carefully written. It should be clear to the reader that the CDC does not recommend circumcision in the US, and the WHO effectively recommends only several countries in Africa (see[[10]]). Those conditions mean they don't recommend in English speaking countries, or in countries where almost all circumcisions currently take place.

I have very limited experience with "consensus." Please focus on verifiable fact without propaganda. Putting the HIV info in it's own paragraph in the lead is propaganda, made worse by its' placement at the end of the introduction, placement away and after the medical and pro/con paragraphs and, and by not noting the WHO conditions for relevant public benefit.

I understand the gold standard studies in 2005 and 2007. Regardless, the RACP, BMA, and AAP statements came after at least the 2005 study (confirmation). Lets not speculate on the RACP. The relevant BMA quote is: "The medical benefits previously claimed, however, have not been convincingly proven, and it is now widely accepted, including by the BMA, that this surgical procedure has medical and psychological risks. It is essential that doctors perform male circumcision only where this is demonstrably in the best interests of the child." The BMA has no opinion about religious circumcisions. The AAP came out in April 2005, but one of the gold standard studies came out in Feb 2005, so it would have been considered. If you believe the WHO, the primary basis for Assoc. decisions (cost/benefit) isn't changed where the incidence low and the disease in small (homosexual) demographic clusters. They all do not recommend routine "medical" neonatal circs.Zinbarg (talk) 16:04, 3 December 2009 (UTC)

It's difficult to imagine how the information you propose including could be expressed concisely, accurately, and with appropriate sourcing. However, I'm willing to consider a concrete proposal. What specific changes do you have in mind? Jakew (talk) 16:25, 3 December 2009 (UTC)

I agree with Zimberg in wondering why that statement is in the introduction. It isn't a primary or defining point about what circumcision is, it is controversial (the African studies researcher bias has been debated in their journals), and the effect and application is limited in a number of ways. This is a biased statement. At best, it goes down in the HIV section where its scope can be properly qualified. Because this topic has been in the news doesn't mean it deserves 'top billing' here. That would negate the factual, NPOV goals of WP. This isn't a news column or a blog, its an encyclopedia. My opinion is for deletion. Frank Koehler (talk) 16:23, 5 December 2009 (UTC)

I haven't been able to add the gist (removing mucosa reduces m/f intercourse infection) without undue emphasis. The only way I could think of making it relevant was to say it was a hot item in research recently. It's well covered in the HIV section. The lead is much more professional without the HIV paragraph/information.Zinbarg (talk) 19:30, 5 December 2009 (UTC)

(ec) I'm not convinced of Zinbarg's statement that the vast majority of readers of this article are English-speaking Americans, and suspect that's probably mistaken. Even if it were true, I would still oppose writing this article with a pro-US bias or favouring US readers; it should be NPOV, treating all countries of the world equally.

The weight placed on various subtopics should reflect the weight on those subtopics in reliable sources; this should determine the weight in the lead as well as in the body of the article. To get a feel for the weight of the circumcision-and-HIV subtopic, I looked at the first 10 Google Scholar hits in a search for "circumcision" for each of the following years. The number of hits mentioning "HIV" in the title (for the years I happened to check, if I counted right; I worked backwards from 2009, so found myself doing mostly odd years and filled in 2006 and 2008 afterwards) was:

year		1981	1991	2001	2003	2005	2006	2007	2008	2009
Google scholar hits mentioning HIV in title among first 10 hits		0	0	4	3	5	3	8	4	3

While the large amount of attention to HIV might be called "recent", since it seems to pretty well span at least the past 10 years, it's not just a brief spate of media attention, but a significant subtopic in the overall reliable sources. So the paragraph in the lead looks reasonable to me as a reflection of this amount of weight. If some of you feel that the paragraph leaves out some significant points of view about HIV, you can suggest different or additional wording to add to the paragraph, along with arguments that those points of view to be added are given a significant amount of weight in reliable sources. However, I think that the last part of the sentence ("minimal protection", etc.) already gives balance by presenting an alternative point of view, although from the same source.

Your Google hit table is novel, but all you've really done is show that HIV research began when AIDS was first discovered and named. In the grand timeline of circumcision going back millenia, the HIV aspect is just a blip, and it hasn't been proven that circumcision stops AIDS, which also makes the statement misleading. Frank Koehler (talk) 14:17, 6 December 2009 (UTC)

"Intervention" can mean something done to an individual, not necessarily a population-wide program. It's still a fact that these organizations have made these statements, regardless of what country one is in when one reads it or whether that information is relevant to decisions about programs in those countries. I think readers are smart enough to realize that reduction of risk of HIV transmission is relevant only in cases where there is an infected partner. ☺Coppertwig (talk) 20:09, 5 December 2009 (UTC)

I don't have the same confidence you do, Coppertwig. People still believe that smegma is carcinogenic, and that babies don't feel pain during circumcision. Let's not assume any more than we have to. Frank Koehler (talk) 14:17, 6 December 2009 (UTC)

Wait: I thought of a possible wording: appending at the end of the last sentence of the lead "... and also discuss how the health impact of circumcision programmes may vary with setting." (based on the same two references.)

I'm suggesting this to try to address the concerns raised by Zinbarg and Frank Koehler, but I myself don't think it's necessary. I note that the WHO/UNAIDS report also says "9.1 Countries should estimate the resources needed, develop costed national plans and allocate resources for male circumcision services without taking away resources from other essential health programmes." In other words, it seems to be recommending circumcision programmes in all countries. ☺Coppertwig (talk) 23:52, 5 December 2009 (UTC)

I think you are falling into the pitfall of trying to put everything in the introduction. There's an HIV section. Let it do its job. Circumcision is defined as the removal of the foreskin. It is not defined as a proposed AIDS prophylactic. If that were true, then circumcision would not have existed prior to 2001, according to the table above. Frank Koehler (talk) 14:17, 6 December 2009 (UTC)

Recommending only where there will be considerable public health benefit, as discussed above; Copper please read. That's true in no English speaking country. Our audience. It's not relevant to our audience because it's not a considerable health measure. There just isn't enough HIV in the English speaking countries. Medical associations considered the issue, and do not change their recommendations; as discussed above. Being in the news/research is not basis for introduction level relevance in a proper encyclopedia. This is not a blog.Zinbarg (talk) 00:12, 6 December 2009 (UTC)

Hi, Zinbarg. Thanks for your reply. Sorry: could you specify the particular sentence so I don't have to re-read this whole thread? Is it a different sentence from the one Jake explained uses 3% as a minimum but not as a maximum threshold? Perhaps they contradict themselves; the sentence I just quoted seems to recommend public health measures in all countries.

Our audience is not only English speaking countries, but people who read English regardless of whether they're native English speakers or not and regardless of whether they live in a country of predominantly English speakers. Even if the audience were only people in English speaking countries, we cannot assume these readers are uninterested in what happens in other parts of the world.

It's not only in news/research, but is also in secondary sources such as the cited documents, which is what makes it very relevant for this encyclopedia.

I'm not convinced that medical organizations didn't change their recommendations; I thought I remembered an updated set of recommendations from a medical organization that had subtly different nuances. Even if some medical organizations considered the information and didn't change their recommendations, that doesn't change the fact that the WHO and CDC made the statements quoted. If you can find a source that states that medical organizations didn't change their recommendations, possibly some wording could be added based on that.

If medical organizations didn't change their recommendations, that in no way erases the fact that there is extensive coverage of this subtopic in reliable sources. ☺Coppertwig (talk) 01:55, 6 December 2009 (UTC)

Pasted from the top of this discussion, from the UNAIDS citation: "In settings with lower HIV prevalence in the general population, including where HIV infection is concentrated in specific populations at higher risk of HIV exposure, such as sex workers, injecting drug users or men who have sex with men, limited public health benefit would result from promoting male circumcision in the general population."

Also from above from me: The US (and all other English speaking and Western countries; line added 12.6.09) meet none (less than 1% prevalence, and spread primarily by homosexuals) of the above criteria for inclusion in the UN programe. Therefore, the last sentence in the introduction is misleading because this information is not relevant to most readers. But it's in the introduction of this article!

Copper you seem to suggest, and Jakew's purpose is to sow doubt on the current recommendations of medical associations; 1999 AMA, versus 2007 and 2008 for the UNAIDS and CDC statements. That's propaganda and without factual basis. We discussed above the fact that the RACP 2009, CPS 2004, AAP 2005 (3 months after the 2005 gold standard study was published) and BMA 2006 statements all came after strong ie gold standard, HIV studies (even by 2004, when the CPS came out with their update, a strong effect was well known). Pasted from above and tweeked: "The HIV preventive benefits from circumcision were known well before 1999 (pre AMA statement) with the first meta in 2000. Looks like the WHO cited studies are 2000, 2007, 2005 and 2007. The CDC cited studies from 1999 to 2007 (2000, 2006, 2000, 2003, 2000, 1999, 2005, 2007, 2007, 2006). Note the CDC doesn't recommend circumcision, and the WHO recommends conditionally." Again, it's logical that Assoc policy wouldn't change, given the low incidence and demographics of HIV in those (English speaking) respective countries.

Relevant to the article yes, but not in the lead because it's no more relevant (very minor in English speaking countries) than any other medical benefit. It's well covered in the body of the article, and in it's own article.

You said we should add something like "health impact of circumcision programmes may vary with setting." And I want the medical stuff in one paragraph without all those irrelevant dates and fluff. Not that I'm happy about it, but how about:

The Joint United Nations Programme on HIV/AIDS, and the Centers for Disease Control and Prevention state that evidence indicates male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, but also state that circumcision only provides minimal protection and that limited public health benefit would result from promoting male circumcision in the general population.^[8][9] The American Medical Association states: "Virtually all current all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice."^[10]Zinbarg (talk) 16:30, 6 December 2009 (UTC)

We got bogged down in "English speaking" stuff. The point is that there are very few countries in the world where there is enough HIV in the population having heterosexual relations to make circumcision a relevant health issue. It could have great impact in some African nations, but that's it. And some African nations are not our audience Copper. So why is HIV in the lead at all? An attempt at propaganda.Zinbarg (talk) 16:43, 6 December 2009 (UTC)

I see several obvious problems with your proposal, Zinbarg:

• It's erroneous. Neither the CDC nor the WHO state that "limited public health benefit would result from promoting male circumcision in the general population".
• Because the AMA sentence appears in the same paragraph, it appears as though the AMA are commenting on the same issue.
• No dates are provided. This actually makes the problem noted above worse, because it appears as though the AMA is a response to the WHO's statement. Jakew (talk) 16:59, 6 December 2009 (UTC)

It's a direct quote (fourth paragraph in Conclusion 7) from the WHO and directly implied by the CDC statement, and it pertains to our audience.

The AMA is in a seperate sentence with it's own citation. The AMA sentence does not read as a response to the WHO statement; it's an associations do not recommend statement. You just feel that way because it doesn't meet your purpose (sow doubt on the current recommendations). No dates are needed because they all are very current.Zinbarg (talk) 17:15, 6 December 2009 (UTC)

It may be a direct quote, but you've stripped away all of the context that acts as a qualifier. The WHO state that in certain settings, limited public health benefit would result, but by removing the context you've made it seem as though they're saying that limited public health benefit would result in any setting.

As noted, dates are needed, and the information should be presented in different paragraphs since the subject of the two sentences is different. Jakew (talk) 17:20, 6 December 2009 (UTC)

This version helps the two sentences be more seperate:

The Joint United Nations Programme on HIV/AIDS, and the Centers for Disease Control and Prevention reviews research finding male circumcision significantly reduces the risk of HIV, but also state that circumcision only provides minimal protection, and that limited public health benefit would result from promoting male circumcision in the general population.^[8][9] The American Medical Association in it’s circumcision policy statement concludes: "Virtually all current all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice."^[10]

• I left setting out, because the recommended setting is so very limited. It's certainly not our audience (english speaking, western, those who circumcise for religious purpose). How would you qualify the setting?
• Given the limited setting, how can you give it it's own paragraph in the lead?
• You're the one insisting on nearly irrelevant (to our audience, or to the transmission of HIV outside africa) information forced into the lead. The subject is the same, which is introduction to medical aspects of circumcision, so it can be in the same paragraph.Zinbarg (talk) 17:47, 6 December 2009 (UTC)

Lets jump here to save downloads

How about:

The WHO/Joint United Nations Programme on HIV/AIDS, and the Centers for Disease Control and Prevention conclude from recent research that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, but also state that circumcision only provides minimal protection and should not replace other interventions to prevent transmission of HIV. Limited public health benefit would result from promoting circumcision in settings with lower HIV prevalence.^[8][9] The American Medical Association, in it’s circumcision policy statement, concludes: "Virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice."^[10]Zinbarg (talk) 18:01, 6 December 2009 (UTC)

Several problems:

• "reviews research finding" is absurdly vague, and avoids saying what they conclude. They state that it significantly reduces the risk.
• The quote "In settings..." needs an introduction.
• There are grammatical errors in "American Medical Association in it’s circumcision policy statement concludes". Should be: "American Medical Association, in its circumcision policy statement, concludes".
• Why has WHO changed to UNAIDS?
• Dates are still missing. Jakew (talk) 18:53, 6 December 2009 (UTC)

Thanks for the gramatical fixes. Please changes you need above. You had it as three (WHO, UNAIDS, CDC); it's WHO/UNAIDS and CDC. Is the above OK? For me to accept dates for the WHO/UNAIDS and CDC publications we will have to put in a bunch of dates citing all the various medical association statements and their respective dates. Just saying AMA 1999 is misleading and deceptive. I guess I would prefer citing each of the associations linked to their statement and the dates. Is that OK?Zinbarg (talk) 21:31, 6 December 2009 (UTC)

I've reverted this change because it should have been clear that there is no consensus for the change at the present time. Specifically, dates are still missing, the information is still presented as one paragraph despite covering two different issues, and grammatical errors remain.

Regarding your question, I think it would be very difficult to cite individual medical association statements without either a) being too long, or b) constituting original synthesis. Jakew (talk) 10:17, 7 December 2009 (UTC)

Wait a second! There are English-speaking countries in Africa. For example, (according to the Wikipedia articles, at least), English is one of the official languages of South Africa, which has the largest HIV population in the world.

Sorry, Zinbarg, I oppose your edit. [11] Please get consensus on the talk page before making changes like that. As Jake explained, we can't state that " Limited public health benefit would result from promoting circumcision in settings with lower HIV prevalence", because we don't know that! Nobody can predict the future, and we can't even state that the WHO stated that because they didn't: they stated a longer sentence with some ifs ands and buts in it, which doesn't mean the same thing. As Jake explains, putting the AMA statement after the WHO statement (not in chronological order), removing the date and saying "concludes" each has the effect of implying that the AMA was commenting on or commenting after the WHO statement, which is misleading and unacceptable.

I suggested on your talk page moving the "1999" to inside square brackets immediately after the word "current", within the quote. I think that would address the problem you raised. Alternatively, I think it's OK to state one more year in the lead (or two, if the WHO and CDC statements were in different years), but I think it would be too cumbersome to put a lot of years everywhere: it would take up space and bore the reader. I don't understand your reason for wanting to add more medical association statements.

How about removing the date, but immediately after the AMA statement saying "Later, after results of randomized controlled trials were reported, ..." and continuing with the WHO and CDC statements. I'd prefer not to do it that way, as it could still be misleading to someone who reads only the first sentence of the paragraph, but it seems to me to be a way to remove the date, which I think you want to do. ☺Coppertwig (talk) 15:13, 7 December 2009 (UTC)

In fairness, it doesn't seem like it should be Jakew who decides to revert away the consolidated sentences. But also, thanks for putting in the POV tag.

It doesn't read as cleanly with all the dates, but it's not long. It's certainly not original synthesis; we have the AMA noticing a fact, and we can present a list of the the underlying assoc statements involved and their respective dates. It would make the lead more of an introduction.

Here's with dates, hopefully grammatically correct:

The WHO/UNAIDS;2007, and the CDC;2008 state that evidence indicates male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, but also state that circumcision only provides minimal protection and should not replace other interventions to prevent transmission of HIV. Limited public health benefit would result from promoting circumcision in settings with lower HIV prevalence.^[8][9] The AMA;1999, in it’s circumcision policy statement, concludes: "Virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice."^[10] Current policy statements include the RACP;2009, CPS;2004, BMA 2006, AAP;2005, AAFP;2007, and the AMA;1999.

And without dates, hopefully grammatically correct:

The WHO/UNAIDS, and the CDC state that evidence indicates male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, but also state that circumcision only provides minimal protection and should not replace other interventions to prevent transmission of HIV. Limited public health benefit would result from promoting circumcision in settings with lower HIV prevalence.^[8][9] The AMA, in it’s circumcision policy statement, concludes: "Virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice."^[10]Zinbarg (talk) 17:03, 7 December 2009 (UTC)

Good point on South Africa; 10% incidence is in the 3% to 15% range where interventions would be considered. I already agreed to the sentence about HIV in the lead. Mostly, I think readers will have seen the information in the media recently.

The sentence "Limited public health benefit would result from promoting circumcision in settings with lower HIV prevalence" is from this cited sentence in WHO/UNAIDS "Conclusion 7: Programmes should be targeted to maximize the public health benefit"..."In settings with lower HIV prevalence in the general population, including where HIV infection is concentrated in specific populations at higher risk of HIV exposure, such as sex workers, injecting drug users or men who have sex with men, limited public health benefit would result from promoting male circumcision in the general population." The paragraph goes on with "However, there may be individual benefit for men at higher risk of heterosexually acquired HIV infection such as men in sero-discordant partnerships and clients presenting at clinics for the management of sexually transmitted infections. There is insufficient evidence to suggest that circumcision reduces HIV transmission among men who have sex with men." The WHO/UNAIDS is recommending conditionally. The sentence in the lead currently reads like a blanket health issue and implicit recommendation. How would you like to qualify that sentence, but still keep it introduction short?

The way it is (dates wise), the reader is mislead thinking the AMA 1999 date is the most current Assoc statement to say do not recommend. The reader is mislead that the 1999 statement pre-dates significant HIV findings, and that those findings were possibly not considered when making their recommendation. Again, thanks for putting back the POV tag.Zinbarg (talk) 18:03, 7 December 2009 (UTC)

Coppertwig and Jakew, I was looking for a response to questions and points:

• The WHO/UNAIDS/CDC state that conditions for public benefit are limited, and their statements sentence must include something similar. The current text is misleading. Coppertwig is incorrect saying it's not a valid quote.
• Using all the dates looks and reads fine. Is there any problem with the dated version above?
• The only problem I see is it leaves the reader to look at the WHO/UNAIDS/CDC publications to see the underlying study dates. I wrote above, the HIV preventive benefits from circumcision were known well before 1999 (pre AMA statement) with the first meta in 2000. Looks like the WHO cited studies are 2000, 2007, 2005 and 2007. The CDC cited studies from 1999 to 2007 (2000, 2006, 2000, 2003, 2000, 1999, 2005, 2007, 2007, 2006). The RACP statement came out in 2009, the CPS in 2004, the AAP reaffirmed (not recommend) in 2005 (3 months after one of the gold standard studies), and the BMA in 2006, so all would have considered HIV benefits. But it's too subjective to just use Jakew's opinion about which studies/dates are valuable; see the list of studies and note that there's nothing special about 2005 and 2007; many studies/dates were (esp CDC) referenced.Zinbarg (talk) 18:46, 8 December 2009 (UTC)

I just read Coppertwig's last entry, and I had missed his statement that the AMA (1999) must go after the WHO/CDC (2007 2008) because of dates (chronological). The AMA sentence is about the current recommendation of medical associations worldwide. It's those statement dates that are relevant to the reader. One of those association recommentations has a later date than the WHO/CDC. Regardless, it's the underlying research dates (references) that are important. Please show me Wiki policy that publication date is more important that underlying research date. Actually, show me Wiki anything that says chronological over importance.Zinbarg (talk) 19:08, 8 December 2009 (UTC)

Actually, Zinbarg, I think that the version you present in your post dated 17:03, 7 December 2009 is still unacceptable. Problems include:

• The sentence "Current policy statements include the RACP;2009, CPS;2004, BMA 2006, AAP;2005, AAFP;2007, and the AMA;1999." is either pointless or nonsensical synthesis. If the intent is just to say that policy statements exist, what's the point? What does it tell the reader about circumcision? If, on the other hand, the intent is to tie these statements into the "current policy statements [that] do not recommend routine neonatal circumcision", it's synthesis, and nonsensical synthesis at that, since the AMA could not possibly have meant any statements published after their own.
• As Coppertwig points out, the "Limited public health benefit would result from promoting circumcision in settings with lower HIV prevalence." sentence is oversimplified and misses some of the finer points of the original. It's also rather confusing, because it jumps straight into where public health impact might be limited without first saying where it would be expected to be considerable.
• There is still a grammatical error in "in it’s circumcision" — this should be "its".
• Although relatively minor, "WHO/UNAIDS;2007" is not the correct way to introduce a term. Where it is the first use of an acronym in an article, we should present the full expansion, typically with the expanded version followed by the acronym in parentheses.
• As Coppertwig pointed out, the order is also wrong. Since the AMA and WHO/CDC sentences refer to different subjects, it would make more sense to present them in different paragraphs. However, if they're presented in the same paragraph then it makes much more sense to do so in chronological order.

I suggest that it might be more productive to consider adding a sentence to the WHO/CDC paragraph, something like "WHO expect the public health impact of circumcision programmes to vary according to the characteristics of the setting." Jakew (talk) 21:17, 8 December 2009 (UTC)

Your sentence suggestion is vague, but conclusions are specific. It needs to be short for the lead. Here's "Conclusion 7: Programmes should be targeted to maximize the public health benefit" again:

The population level impact of male circumcision will be greatest in settings (countries or districts) where the prevalence of heterosexually transmitted HIV infection is high, the levels of male circumcision are low, and populations at risk of HIV are large. A population level impact of male circumcision on HIV transmission in such settings is not likely until a large proportion of men are circumcised, although benefit to the individual is expected in the short term. Modelling studies suggest that universal male circumcision in sub-Saharan Africa could prevent 5.7 million new cases of HIV infection and 3 million deaths over 20 years.

The greatest potential public health impact will be in settings where HIV is hyperendemic (HIV prevalence in the general population exceeds 15%), spread predominantly through heterosexual transmission, and where a substantial proportion of men (e.g. greater than 80%) are not circumcised.

Other settings where public health impact will be considerable include those with generalized HIV epidemics where prevalence in the general population is between 3% and 15%, HIV is spread predominantly through heterosexual transmission and where relatively few men are circumcised.

In settings with lower HIV prevalence in the general population, including where HIV infection is concentrated in specific populations at higher risk of HIV exposure, such as sex workers, injecting drug users or men who have sex with men, limited public health benefit would result from promoting male circumcision in the general population. However, there may be individual benefit for men at higher risk of heterosexually acquired HIV infection such as men in sero-discordant partnerships and clients presenting at clinics for the management of sexually transmitted infections. There is insufficient evidence to suggest that circumcision reduces HIV transmission among men who have sex with men.

• I guess this works "WHO expect the public health impact of circumcision programmes to vary according to the characteristics of the setting where infection prevalence exceeds 3%."
• It's not original synthesis because the AMA pointed out the fact. What the AMA did needs updating. Remember, its an introduction, where you usually introduce stuff covered in the body. The intent is also to show not recommend for medical reasons is timely, pervasive, and qualified.
• Thanks, I have a hard time with grammatical problems spell check doesn't catch.
• I worried about the formal way to introduce. Note that the curser displays the full name anyway. Also, I think nearly everyone knows who the WHO is CDC, AMA ect. The point is to introduce. It's currently (the current lead) so detailed it's misleading (its two, not three, publications).
• If we could ever agree, a proper introduction is like an outline for the body. This paragraph might be the outline section for medical research and related associations statements. "Circumcision is usually performed as a religious duty or covenant, but preventative medical benefits are known including bla bla. The WHO bla bla high prevalance. The CDC bla bla certain populations. The AMA ect do not recommend routine non-therapeutic, provide information to parents.Zinbarg (talk) 02:14, 9 December 2009 (UTC)

Zinbarg, you don't have to quote the WHO's conclusions multiple times. I can manage to scroll up.

You're right that my proposed sentence is a little vague, but it seems to me that the alternative is trying to capture a large amount of detail, which would probably require a lot more words. Your suggestion doesn't work, because they expect the impact to vary according to the characteristics in all settings, not just those with prevalence >3%. The prevalence is one of several characteristics of the setting that cause the expected impact to vary.

The AMA summarised statements that had been published as of 1999. They did not summarise statements published after theirs — come on, they couldn't do so without a crystal ball! Consequently, it's original synthesis, as I said.

I suspect that most readers will probably be aware of the existence of the World Health Organisation, but they may not be familiar with the acronym "WHO". If you think the current sentence implies three publications, we could reword it to read "World Health Organization and Joint United Nations Programme on HIV/AIDS (WHO/UNAIDS; 2007)". Jakew (talk) 10:40, 9 December 2009 (UTC)

The key words are public health impact. Under 3% you will have "limited public health benefit would result from promoting male circumcision in the general population." They do not expect the impact to vary. The current sentence is very misleading.

Look to the definition of original synthesis again. The AMA noted a fact; it can, and should be be, updated.

OK, we just put in the full names of all the groups and associations.Zinbarg (talk) 22:18, 10 December 2009 (UTC)

Nothing in Wikipedia policy states that facts noted by secondary sources are candidates for being "updated" by Wikipedia editors. That is contrary to the letter and intent of WP:NOR, which implies that we should instead wait for the publication of new, updated reliable sources. Jakew (talk) 14:06, 11 December 2009 (UTC)

I've read that policy stuff. You are wrong. We can, and should provide the reader with the current Associations statements under the format provided by the AMA, ie those that do not recommend. They all don't. In fact the CDC and the UNAIDS don't (routine neonatal) recommend. That is the point of the paragraph that makes it worthy of being in the lead. The current two paragraphs are very misleading. Being misleading is certainly not Wiki policy.Zinbarg (talk) 02:19, 16 December 2009 (UTC)

The two paragraphs in the lead are misleading. We need a single paragraph in the lead that introduces medical facts. Here's cron (per coppertwig requirement), and neutral but factually qualified (WHO/UNAIDS), with the list of "do not recommend" per the AMA:

The American Medical Association (AMA;1999), in its circumcision policy statement, concludes: "Virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice."^[10] Medical associations that “do not recommend” routine neonatal circumcision include the Royal Australasian College of Physicians (RACP;2009)^[11], the Canadian Paediatric Society (CPS;2004)[[12]], the British Medical Association (BMA;2006)^[12], the American Academy of Pediatrics (AAP;2005)[[13]], the American Academy of Family Physicians (AAFP;2007) [[14]], and the American Medical Association (AMA;1999)^[10]. The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (WHO/UNAIDS; 2007), and the Centers for Disease Control and Prevention (CDC; 2008) state that evidence indicates male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, but also state that circumcision only provides minimal protection and should not replace other interventions to prevent transmission of HIV. Limited public health benefit would result from promoting circumcision in settings where infection prevalence in a population is less than 3%.^[8][9]Zinbarg (talk) 17:17, 16 December 2009 (UTC)

We've already discussed this above. Original synthesis is forbidden by WP:NOR. Jakew (talk) 17:19, 16 December 2009 (UTC)

You misstated Wiki policy, that's all that was discussed above. It is certainly not "original" because the AMA noted the fact. There is no "synthesis" of the AMA statement. An encyclopedia needs to list medical associations (and agencies like the WHO) in the lead, using the format set by the AMA.Zinbarg (talk) 17:34, 16 December 2009 (UTC)

Did the AMA remark on any policy statements published after 1999? Yes or no?

If your answer is 'yes', please provide evidence.

If your answer is 'no', then the synthesis of these articles is original to Wikipedia and hence disallowed by WP:NOR. The synthesis of statements dated 1999 or earlier, however, has been published previously (by the AMA) and hence is not original research. Jakew (talk) 17:41, 16 December 2009 (UTC)

You misstate Wiki policy. The synthesis of "do not recommend" is not original to Wiki, the AMA did it in their statement. We are encouraged (by Wiki) to list current "do not recommend" in the lead.Zinbarg (talk) 17:58, 16 December 2009 (UTC)

Incorrect, Zinbarg. Unless you can point to a specific sentence in a source that justifies the claim, that is WP:SYNTHesis and is not allowed, even if it is logically valid. Please list the specific sources and sentences that support the claims; otherwise, the change would not be allowed per WP:OR/WP:SYNTH. Thank you. -- Avi (talk) 18:50, 16 December 2009 (UTC)

The AMA identifies a fact, and makes a claim. We elaborate within that framework. That's not a problem in Wiki; it's encouraged.

Your writing is not clear. Please explain "point to a specific sentence in a source that justifies the claim."Zinbarg (talk) 20:22, 16 December 2009 (UTC)

I've consulted other editors, and an admin. They all say the above is OK. If you want, we could do away with the AMA "virtually all" sentence, and just say the following a,b,c,d,e,f do not recommend.Zinbarg (talk) 15:00, 17 December 2009 (UTC)

Medical associations that “do not recommend” routine neonatal circumcision include the Royal Australasian College of Physicians (RACP;2009)^[13], the Canadian Paediatric Society (CPS;2004)[[15]], the British Medical Association (BMA;2006)^[12], the American Academy of Pediatrics (AAP;2005)[[16]], the American Academy of Family Physicians (AAFP;2007) [[17]], and the American Medical Association (AMA;1999)^[10]. The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (WHO/UNAIDS; 2007), and the Centers for Disease Control and Prevention (CDC; 2008) state that evidence indicates male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex, but also state that circumcision only provides minimal protection and should not replace other interventions to prevent transmission of HIV. Limited public health benefit would result from promoting circumcision in settings where infection prevalence in a population is less than 3%.^[8][9]Zinbarg (talk) 16:55, 17 December 2009 (UTC)

As far as I can tell, this is exactly the same as your proposal above (dated 17:17, 16 December 2009), but with the exception that the properly sourced sentence (attributed to the AMA) has been removed, and the original research remains. Jakew (talk) 16:45, 17 December 2009 (UTC)

There no problem with the above paragraph re original research. It simply lists the do not recommend associations without qualification (virtually all). We often list in Wiki. Do you want me to plaster this discussion with examples taken from hundreds of articles as proof? This behavior is silly.Zinbarg (talk) 16:55, 17 December 2009 (UTC)

Yes, Zinbarg, there is a problem, as Avi and myself have already explained, and I see little point in repeating. It is original synthesis of multiple sources to advance a position. The position that is advanced is that many/most medical associations "do not recommend" circumcision (it is unclear, incidentally, why these words are presented as a quote). That is one summary, and I am not saying that it is invalid, but it is the result of a) selective choice of sources (there may well be organisations that do recommend circumcision), and b) selective summarisation of sources (many could be equally summarised by saying "do not recommend against infant circumcision", for example). When the synthesis has been performed by a third party (in this case the AMA, of sources then available), this isn't a problem, as the statement can be attributed. However, Wikipedia editors cannot perform this kind of synthesis. Jakew (talk) 17:33, 17 December 2009 (UTC)

Avi didn't explain anything, and you repeat. I've read original research. I put the do not recommend in quotes because those listed can be quoted, but it's not necessary. There is neither a "position advanced," nor "many/most," which would certainly be NOR. It's just a list. It's comprehensive (not selective). You are free (encouraged by Wiki) to list other ("do not recommend against," or "recommend" for example) associations. Again, I'll be glad to show you many examples of lists in Wiki.Zinbarg (talk) 17:56, 17 December 2009 (UTC)

No, Zinbarg, it is not comprehensive, but selective, as I said. It is easy to identify policy statements that are excluded (that of the AUA, for example). And I could not make a list of "do not recommend against" for exactly the same reason that one cannot list "do not recommend" - it's original synthesis. Jakew (talk) 18:35, 17 December 2009 (UTC)

It's funny, I just realized if you tried to say X,Y, and Z do not recommend against (note it's not in quotes) it would be NOR because they do not expressly state do not recommend against (it may be implied). The listed "do not recommend."Zinbarg (talk) 18:03, 17 December 2009 (UTC)

How about we list every association and their respective conclusions.Zinbarg (talk) 19:49, 17 December 2009 (UTC)

It's an introduction: there isn't space. We go into more detail in the policies section. We just need a short summary. Jakew (talk) 21:00, 17 December 2009 (UTC)

Not true. Almost all assoc are listed above, and that takes very little space. Adding a few more only takes up another three lines max.

The few that do not recommend that are not listed above are the Australian Association of Paediatric Surgeons, New Zealand Society of Paediatric Surgeons, Urological Society of Australasia, and the Paediatric Society of New Zealand. The only one left (not listed, I think) is The American Urological Association, which "believes that neonatal circumcision has potential medical benefits and advantages as well as disadvantages and risks," which sounds neutral (neither rec, nor do not, and should be listed thus).

Most of the article body is taken up with medical issues ie beneifts and risks, so that thrust should be introduced. Routine neonatal circumcision is usually a medical procedure, and these associations provide concensus judgements for medical benefits and risks. Taking a short paragraph to summarise assoc positions, and WHO/UNAIDS and CDC publications, is a good use of "summary" lead space and very encyclopedic. Compare that to what's in place right now, which is a grossly misleading presentation of a very limited, possibly dated, selection of medical information.Zinbarg (talk) 23:00, 17 December 2009 (UTC)

Listing every association and their respective conclusions takes a lot of space if done in an NPOV fashion without performing original research. It requires giving a balanced summary of their specific conclusions, and that takes at least a sentence or so. It may well be possible to write something shorter if one is able to perform original synthesis to advance a position, but we can't do that. Jakew (talk) 11:14, 18 December 2009 (UTC)

Not true. The positions are almost all so very similar it (general position) would be easily summarized, and those applicable assoc listed. I'm sure you and I could agree on the ones like the AUA. That format would take even less space. It would be clear that the issue is routine neonatal only.Zinbarg (talk) 23:22, 19 December 2009 (UTC)

The reason for the tag continues; the last two sentences in the lead are grossly misleading. The first makes the concensus of Associations sound dated, and updating with current members is blocked for some reason by editors. The last sentence lacks necessary qualification (public benefit limited to regions where prevalence exceeds 3% among heterosexual men, basically only parts of Africa). This article is pro-circ propaganda; the sub articles are frequently worse.Zinbarg (talk) 23:29, 19 December 2009 (UTC)