Talk:Medical analysis of circumcision

Evidence of the sexual effects of circumcision

Robert has every right to correct things that are not true or inaccurate or distorted. However, that does not extend to suppressing information that doesn't fit his mindset. Let's look at one particularly bad example. I quoted Fink's findings and Fink's words:

Adult circumcision appears to result in worsened erectile function (p = 0.01), decreased penile sensitivity (p = 0.08), no change in sexual activity (p = 0.22) and improved satisfaction (p = 0.04). Of the men 50% reported benefits and 38% reported harm. Overall, 62% of men were satisfied with having been circumcised.

Robert mutilates this by cutting out the parts he doesn't like:

However, of the men 50% reported benefits, 38% reported harm and overall, 62% of men were satisfied with having been circumcised.

Is this honest? Isn't this "hiding something" by using just a snippet? Robert challenges the honesty of others. I challenge him to apply the same standards to his own contributions to Wikipedia.Michael Glass 23:35, 22 Oct 2004 (UTC)

Michael, thank you for your input. I shall use this as a check on your own standard of intellectual integrity (or the lack thereof). It is clear that you set different and higher standards for other than you or your fellow anti-circumcision activists are able to maintain yourselves. Like with that "sympathetic" admin around here who can be relied upon to support your cause you fail to keep your "own" honest and turn a blind eye when the head-bangers post the most off-the-wall stuff. Unfortunately most the people who feign neutrality fail the test of intellectual honesty as well so you are not alone (although you find yourself in very dubious company). Taken for example the pathetic desperation to neutralise the Foreskin restoration article by turning what is obviously an activity of base psychosexual motivations (by people the majority of whom appear to have serious mental illness) to one where if on these poor "victims" could regain a long juicy anteater of a foreskin they would feel whole again (in the mens room). So please Michael don't lecture me on what should or should not be done, what should or should not be quoted and importantly on how not to be selective in how one quotes from studies. - Robert the Bruce 03:19, 23 Oct 2004 (UTC)

Robert, Thank you for your comment. I understand that you don't like to be lectured. However, you had no answer to my point that your partial quote was a distortion of Fink's findings. I will restore the complete quote and I expect it to be left alone.Michael Glass 00:01, 24 Oct 2004 (UTC)

A second instance of selective quotation was in relation to Moses et al.

Here is how the article read:

Winklemann identified the foreskin as a "specific erogenous zone" with nerve endings arranged in rete ridges.[1] Taylor et al. further developed this information with the discovery of a heavily innervated "ridged band" area near the tip of the foreskin.[2] Circumcision invariably removes this ridged band. Moses et al. commented: +

There is indirect evidence suggesting that the foreskin may have an important sensory function, although aside from anecdotal reports, it has not been demonstrated that this is associated with increased male sexual pleasure. Some loss of sensory function may not be an important consideration, or may not even be felt to be disadvantageous by men and women more troubled by premature ejaculation than concerned with increased penile sensitivity. However, few studies have investigated the relation between male circumcision and sexual pleasure or satisfaction; more research is needed to clarify the role of the foreskin in sexual health. [3]

Here is how Robert edited it to read:

Winklemann identified the foreskin as a "specific erogenous zone" with nerve endings arranged in rete ridges.[4] Taylor et al. further developed this information with the discovery of a heavily innervated "ridged band" area near the tip of the foreskin.[5] Circumcision invariably removes this ridged band. However, as Moses et al. noted, "it has not been demonstrated that this is associated with increased male sexual pleasure."; [6]

Is that an honest edit? Are we given a fair picture of what Moses et al wrote? I think not.Michael Glass 14:05, 24 Oct 2004 (UTC)

As they say around here those interested can follow the link and read the detail for themselves. What say now? - Robert the Bruce 14:29, 24 Oct 2004 (UTC)

Quote fairly. Michael Glass 03:10, 25 Oct 2004 (UTC)

ditti - Robert the Bruce 04:47, 25 Oct 2004 (UTC)

In my opinion Robert's selective quote of Moses, et al is misleading. The whole sentence should be included, "There is indirect evidence suggesting that the foreskin may have an important sensory function, although aside from anecdotal reports, it has not been demonstrated that this is associated with increased male sexual pleasure." -- DanBlackham 07:52, 25 Oct 2004 (UTC)

There has been no response to Dan Blackham's comment. I have therefore put back the longer quotation because it more fairly reflects what Moses et al wrote. Michael Glass 05:48, 30 Oct 2004 (UTC)

"Despite evidence that circumcision does not lead to increased keratinization [72] (http://bmj.bmjjournals.com/cgi/content/full/320/7249/1592) or reduction in sensitivity of the glans [73] (http://health.groups.yahoo.com/group/independentreference/message/5) anti-circumcision activists continue to make such unsupported claims."

"However, despite the facts some men who undergo foreskin restoration claim that the procedure really does improve glans sensitivy."

Translation: "Despite the fact that it obviously doesn't affect sensitivity these morons still believe it anyway."

How exactly is that supposed to be NPOV?

It doesn't make sense to claim that being circumcised makes you last longer while simultaneously claiming that it has just the same sensitivity (as some pro-circ doctors had mentioned as a benefit). It also doesn't make sense to acknowledge that the glans has increased sensitivity after a circumcision when you're saying it doesn't change sensitivity ("Some men report unpleasant sensitivity of their glans after adult circumcision" from circumcision). I guess some doctors are a bit confused. Should doctors on the same side with contradicting statements be included in this?

-Nathan J. Yoder 07:31, 6 Nov 2004 (UTC)

The section on female partners was incomplete and unbalanced. This has been corrected with additional information to form a NPOV. Robert Blair 02:10, 16 Jan 2005 (UTC)

Actually what you tried to do there was to slip in the Bensley/Boyle junk science. See archive for discussion on this [7] - Robert the Bruce 05:22, 16 Jan 2005 (UTC)

Unrelated to medical analysis

The following paragraph is not relevant to a medical analysis of circumcision.

A 1988 study of new mothers found that 71% preferred a circumcised partner for sexual intercourse, and 83% for giving fellatio. When asked why, 92% responded that it stays cleaner and 90% that it looks sexier. Although 78% of the women had not had direct contact with an uncircumcised penis, those who did expressed the same preference[8]However, this study has been criticised for alleged pro-circumcision bias of the authors and the fact that the study was done in an area of the United States where circumcision was the norm.

The paragraph should be in an article on an ethical or cultural analysis of circumcision, not a medical analysis of circumcision. -- DanBlackham 04:21, 24 Oct 2004 (UTC)

Dan I welcome your sudden change of heart in that you have a new concern for keeping content focussed narrowly on the article subject on hand. Would I be naive to expect your total support when I get amongst the off topic anti-circ propaganda that has been insidiously inserted into numerous articles over a period of time? Ok then ... somehow I thought not. - Robert the Bruce 10:54, 24 Oct 2004 (UTC)

Robert, please explain how the sexual preference of women in Iowa, most of whom had no sexual experience with intact men, is related to the medical analysis of circumcision. -- DanBlackham 07:57, 25 Oct 2004 (UTC)

Loony Tunes Link

There were links to pictures of invasive penile cancer in the article:

Images of Invasive Penile Cancer in Uncircumcised Men (http://www.dermis.net/bilder/CD52/img0084.jpg) (http://www.dermis.net/bilder/CD55/img0066.jpg) (http://www.dermis.net/bilder/CD16/img0038.jpg) (http://www.dermis.net/bilder/CD14/img0092.jpg) (http://www.dermis.net/bilder/CD16/img0037.jpg)

I wrote: "When I clicked on the links provided, all I got was a page that said that dermis net, where the pictures were housed, had expired. (They were there only a few days ago!")

Robert replied:"(They're back! Now fancy that Michael - nice try though ;"

I have tried three times in the last 24 hours and got the following notice:

"This domain name expired on 10/16/2004 and is pending renewal or

deletion."

Robert, as I write this, they're not back. Why did you say that they were back when they weren't? Michael Glass 13:51, 25 Oct 2004 (UTC)

Dermis.net has often been intermittent. This should suit you agenda, no? I guess you can be glad that they are not always available ... truly horrific stuff. Enough to turn the stomach of even the most ardent foreskin admirer, yes? I have learned something though. I was told by someone that the fact that they are always visible to me is that my browser has them cached. So it is only when I refresh the page that I can establish that the site is in fact down. Don't worry though Michael, I will be sure to let you know exactly when the site is up again. - Robert the Bruce 18:21, 25 Oct 2004 (UTC)

Robert, you have admitted that you were wrong about the link and have explained why you made this mistake. However, you did not apologise for implying that I was dishonest. Instead you descended to making further baseless allegations about my supposed motivations. I have noted this abuse and will take the action that I feel is appropriate about it. Michael Glass 12:55, 26 Oct 2004 (UTC)

Michael I still don't know what you are on about. As of now the links are working. What exactly is your problem? The site is intermittent. Try it and see for yourself. PS: I understand exactly why you are so keen to have the links deleted. I sympathise. - Robert the Bruce 16:57, 26 Oct 2004 (UTC)

Robert, I can't comment on what you understand exactly and yet don't understand. That makes no sense to me. However, the links to Dermis.net still don't appear to be working right. From my computer they go to Dermis.net's main page. so there may still be a problem with the site. I recommend that you provide a link to web pages instead of jpg pictures. This would be more informative to the reader and may make the link more stable.Michael Glass 20:58, 26 Oct 2004 (UTC)

Anyway thank you for drawing attention to this "problem" Michael. I have found some alternative URL's which seem to work just fine. On the other matter michael, no. The links should go direct to the images and not to the home page where people will battle to find the right images. As you well know Michael ... a picture is worth a 1,000 words. ;-) - Robert the Bruce 03:34, 27 Oct 2004 (UTC)

Robert, I recommended that you provide a link to web pages instead of jpg pictures. You said you wouldn't do that, so I wondered why. I checked out one web page and I found the pictures on one page [9]. The difference: this page mentions the name of the organisation that posted the pictures. Was that a problem to you? If so, why? Michael Glass 06:24, 27 Oct 2004 (UTC)

I notice that the above question remains unanswered. It is Loony Tunes to have ten links to the pictures, five of which are unstable, when the same pictures can all be viewed with just one link. Michael Glass 05:45, 29 Oct 2004 (UTC)

Cervical Cancer Death Rates

I have provided information about death rates from cervical cancer but Robert contests this. I believe the figures are relevant because it puts into perspective the relative danger from cervical cancer. This is also relevant because of the claims that circumcision reduces the incidence of the virus that causes the cancer. I cannot understand why anyone would have a problem with this. Michael Glass 01:39, 27 Oct 2004 (UTC)

To focus purely on reported deaths covers only part of the story. The British research stated quite clearly:

"80% or more of these deaths (up to 5000 deaths per year) are likely to be prevented by screening, which means that about 100000 (one in 80) of the 8 million British women born between 1951 and 1970 will be saved from premature death by the cervical screening programme at a cost per life saved of about pound 36000." So effectively Michael once again you have been caught with your hand inthe cookie jar trying to sell a half truth to the unsuspecting readers. By universal pap smears they are treating the "symptom and not the cause". Think about it. - Robert the Bruce 03:42, 27 Oct 2004 (UTC)

Robert, once again you have resorted to personal attacks and abuse instead of concentrating on the issue. It was certainly not my intention to deceive, but to put the disease into perspective. Your concentration on subtracting information rather than adding it fits your description of trying to sell a half truth. If you are interested in telling the truth, the whole truth and nothing but the truth you should be concentrating on adding information instead of subtracting it. If you feel that the information was distorted or wrong, then work with me and others to get better information. But don't just cut out information. That is not fair dealing. Michael Glass 06:06, 27 Oct 2004 (UTC)

Michael it is very difficult to work with someone committed to inserting their POV in articles. If you have any idea how such alliance of truth would be possible given the history of POV insertions around here I would be keen to hear about it. - Robert the Bruce 17:14, 27 Oct 2004 (UTC)

Robert, could you explain to me what is POV about providing the death rate of a disease that is being discussed? How do you justify removing information about the death rate of a disease that is being discussed? What is your problem with the death rate? Could it be that there is not a big enough gap between the cervical cancer death rates of Great Britain and the United States to suit your purposes? Michael Glass 20:57, 27 Oct 2004 (UTC)

Simple Michael, because you are failing to include the influence screening has had on the incidence of related deaths in the UK. It is up to you to write an NPOV piece which will include the total picture and not to just slip in a half truth. Your source for this is:

The cervical cancer epidemic that screening has prevented in the UK

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15262102

- Robert the Bruce 04:00, 28 Oct 2004 (UTC)

Dear Robert, I "failed" to "include" the influence of screening on the death rates from cervical cancer, because it was already in the article! I quote:

...scientists from the London School of Hygiene and Tropical Medicine found that had it not been for effective cervical screening fully one in 65 of all British women born since 1950 would have died from cancer of the cervix.

What I did was to add the death rates from cervical cancer. The very thing you accused me of failing to include was in the article all that time.

So why is it important to include the information about death rates? The answer can be found in the abstract that Robert noted above. I quote:

BACKGROUND: Recent reports suggest that the reduction in mortality achieved by the UK national cervical screening programme is too small to justify its financial and psychosocial costs, except perhaps in a few high-risk women.

Clearly, this abstract has to be understood in the light of a controversy over funding the cervical cancer screening program. You see, the death rates from cervical cancer were small enough for some bean counters to argue that the screening program didn't make a great difference to overall death rates. The figures that I quoted help to explain why that argument might arise.

There is another reason for including the overall death rates from cervical cancer. The article implies that Great Britain has suffered an epidemic of cervical cancer because of a lack of circumcision. By including the cervical cancer death rates of Britain and the United States, readers can judge for themselves how much difference it might make:

In 2000, cervical cancer deaths in Great Britain were 3.9 per 100,000.(USA, 3.3; Canada, 2.8; Australia, 2.4.) [10]

Once again, I suggest that Robert has failed to demonstrate how adding this information to what was already in the article is telling a half-truth. I contend that deliberately removing this information is the action of someone who prefers to dodge part of the picture for narrow ideological reasons. Michael Glass 14:09, 28 Oct 2004 (UTC)

You have every right to suggest what you may but that does not change the situation one iota in that you are deliberately attempting to sell a half truth here. The death rate from cervical cancer has absolutely no bearing on the article as it is only the end result of a process which can largely be avoided through screening. Anyone who understands a jot about the great circumcision debate will know that your single intention is insinuate that "risk" to partners of both circumcised and uncircumcised men is about the same. This is clearly not so. Do the math as far as the UK is concerned and put a cost on the whole situation at GB pounds 36,000 per life saved. It is this pathological fear you and your ilk have of the foreskin being recognised as a public health risk that drives you to such extraordinary lengths. Very sad Michael, very sad. - Robert the Bruce 15:44, 28 Oct 2004 (UTC)

Robert, in one place you argue that the death rate from cervical cancer has absolutely no bearing on the article; then you turn round and ask me to do the maths on the cost of saving lives. How can you do that without knowing the death rates? Michael Glass 01:29, 29 Oct 2004 (UTC)

Limitations of the Laumann study

Robert has contested the following statement:

Laumann also found that circumcision was less prevalent in Black and Hispanic males and those whose mothers had less education. As health is worse amongst non-whites and the less well educated in America, this could have influenced the above findings.

Healthy men are likely to have fewer sexual dysfunctions than men who are less healthy. Some illnesses are known to affect sexual function, including circulatory diseases, diabetes and depression, and all these diseases are more prevalent in less advantaged communities. In Laumann's sample, the circumcised men were more likely to come from the wealthier and healthier sections of the American community. Hence it is perfectly legitimate to suggest that this may have had an effect on reported levels of sexual dysfunction. Michael Glass 12:40, 27 Oct 2004 (UTC)

This is uneducated speculation. It has no place in Wikipedia. Drop it Michael. - Robert the Bruce 17:09, 27 Oct 2004 (UTC)

I will drop that speculation on condition that you agree to drop all your speculative comments from the article. Michael Glass 21:01, 27 Oct 2004 (UTC)

Michael you seem very astute at findings limitations in studies which do not have foreskin friendly findings but I wonder why you seem to miss glaring aspects relating to those which seem to provide a means for the promotion of the foreskin. The next question should be considered as a test of your intellectual integrity. Using your "sharp eye" for such limitations would you provide us all with your take on the O'Hara survey? I would love to get your take as to any possible "limitations" or even a fatal flaw with it. - Robert the Bruce 03:50, 28 Oct 2004 (UTC)

Robert, the question at issue here is the Laumann study's findings, but let us say that you are right in saying that I'm good at finding flaws in one set of studies while you are good at finding flaws in another set. That sounds like a pretty good combination to me. It means that you will be a good check on me and I will be a good check on you. If we can do it that way we can both benefit from each other's insights. Michael Glass 06:51, 28 Oct 2004 (UTC)

Michael it would perhaps be good if you start and explain why you need to be "checked on". Share with us what floats your boat? Are you a foreskin restorer? Maybe that done you can turn your attention upon the O'Hara survey, yes? - Robert the Bruce 15:36, 28 Oct 2004 (UTC)

Robert, I see that you are not interested in discussing the Laumann study findings. As your interests lie elsewhere, please go somewhere else and discuss your preoccupations with someone else. Michael Glass 23:48, 28 Oct 2004 (UTC)

Sexual Effects

This section on analysis appears to be pure the presentation of psycho sexual speculation from anti-circumcision zealots which have been conclusively rebutted. This section therefore no longer serves any purpose. It should be deleted. I suggest we start a count down here on the basis of seeking out those who believe there is anymerit in its retention. Lets work on a seven day count down. - Robert the Bruce 08:16, 30 Oct 2004 (UTC)

Information about the findings of Winklemann and Taylor must stay. If people are to argue about removing the foreskin they should at least know what the foreskin consists of. Michael Glass 23:05, 30 Oct 2004 (UTC)

Michael I have responded to you on this (below) in some detail. The problem is that the use of Winkelmann as a source of foreskin friendly information is somewhat less tha honest because he did not state what you want to present him as having stated. (Does this sort of detail bother you?) And secondly that Taylor stuff is pure speculation. I suggest it is prudent to delete all reference to Taylor until there has been some independent finding which support the conclusions he leapt to after looking at some skins form cadavers under a microscope. We need to remember we are working on an encyclopaedia here and not a publicity brochure for the anti-circumcision movement. The need for honesty and accuracy is clearly much higher here at Wikipedia. Please respect that. - Robert the Bruce 03:02, 31 Oct 2004 (UTC)

Robert, please don’t lecture me on honesty. I have not found your words particularly honest or reliable. You just said "Taylor’s stuff is pure speculation." However, you disprove this when you reveal that he examined cadavers! A link to one of Taylor’s articles, e.g., The Prepuce [11] would enable readers to check what he wrote and make up their own minds. Michael Glass 13:15, 31 Oct 2004 (UTC)

Misleading Description of Edits

I described my edit thus:

(cur) (last) 06:04, 30 Oct 2004 Michael Glass (Sexual Effects - Robert, the snippet distorts what Moses et al wrote. A distorted quote is not good enough.r.)

Robert described his edit thus:

(cur) (last) 08:19, 30 Oct 2004 Robert the Bruce (OK Michael lets get rid of the whole paragraph then - no problems either way with that I hope?)

So what does he do? He cuts out a second paragraph, removing the findings of Winlelmann and Taylor as well. Could Robert explain whether this was carelessness or deceit? Either way, a misleading description of an edit is unacceptable. Michael Glass 23:05, 30 Oct 2004 (UTC)

The problem is your selective approach to this subject. You want to closely examine what Moses stated but you just want to keep a sound bite from Winkelmann. By introducing such information you kind of open a "Pandora's box" where if is difficult to know where to begin and where to end. That is where the POV comes in. For example you want to include a soundbite that a person named Winkelmann included the foreskin in his study of erogenous zones you need to explain the differences in function between Meissner and Vater-Pacini corpuscles and explain that Winkelmann also included the oral cavity, conjunctival region, the perianal region and the lip. And then we need to explain that the enervation of the foreskin is closer to that of the oral cavity than the clitoris or the glans penis. I mean how far do you want to go with this Michael? The one thing for certain is that it will lead to your anti-circumcision deceit about the sexual function be debunked once and for all and all that will remain will be the psychosexual aspects (such as foreskin fetishism) but no scientific or anatomical evidence to prove your case. So if you want to include something along the lines in the now "suspended" (rather than deleted) paragraph why not work it out here before trying to reinsert nonsense into the body of the article. BTW, have you noticed how nicely the Foreskin fetish article is starting to take shape? But boy has it touched some nerves in the process. Would you like to bring your expertise to that party? - Robert the Bruce 02:53, 31 Oct 2004 (UTC)

Robert, if you want to object to the Winkelmann and Taylor studies so be it. I will be interested to consider why you feel these references are a problem. In fairness to the reader, there should be links to the relevant studies such as Cold & McGrath's paper [12] so that the readers can easily go to these studies and judge for themselves. What I objected to is your misleading description of your edit.

You described your move as ‘suspending’ these words. This is mendacious. You deleted them. You deleted them and you described your edit as deleting something else. This is not an honest description of what you did. "Deceitful" could be a word to describe it.

As for the question of a foreskin fetish, I believe that you may know something about this. Someone who would write about the "long juicy anteater of a foreskin" may well have something to say about this subject. However, there is also the evidence of a sexual involvement in circumcision that also has to be considered, such as Williamson and Williamson’s "the circumcised penis exists in exposed beauty whether flaccid or erect." [13] Circumcision Fetishism could also be a suitable topic for Wikipedia. Michael Glass 13:09, 31 Oct 2004 (UTC)

Take a look at robert's "A general clean up" edit. He deleted quite a bit of information in his "general clean up." His blatant lies in edits are a violation of Wikipedia policy. Whenever he responds to comments of this type with very legitimate criticism he just evades the entire point and engages in ad hominem. Nathan J. Yoder 17:09, 3 Nov 2004 (UTC)

Introduction dispute

The following sentence from the introduction is disputed by contributors with a pro-circumcision POV.

Currently neonatal circumcision is not considered medically necessary according to professional medical organizations in Australia, Canada, the United Kingdom, and the United States. In their view the benefits of neonatal circumcision (including a lower rate of urinary tract infection in infants, a lower rate of penile cancer in adults, and a lower rate of infection of some sexually transmitted diseases, particularly HIV) do not significantly outweigh the risks (including bleeding, infection, surgical mishap, and rarely death).

In my opinion the sentence accurately summarized the policy statements of the professional medical organizations.

Also the introduction includes a short quote from the policy statements of the College of Physicians and Surgeons of British Columbia and the American Academy of Pediatrics. In my opinion these two statements accurately represent the range of opinions of professional medical organizations. The BC statement is the strongest in terms of saying infant circumcision is not medically necessary and the AAP statement is the weakest. However a contributor with a pro-circumcision POV repeatedly deletes the statement by the College of Physicians and Surgeons of British Columbia. -- DanBlackham 10:51, 30 Oct 2004 (UTC)

What dispute? You are pushing your POV and I am attempting to maintain a NPOV approach to this subject. The title of the article is Medical analysis of circumcision of which policy statements by medical bodies are but a component and not the be all and end all. If one were to include such a statement in the introduction (which I reluctantly agree with) one will do from the most influencial of such bodies. Where on earth does the BC statement suddenly deserve centre stage treatment? (unless of course it is closest to your POV). Why don't you insert links to such statements? Please try to restrain yourself. There is no dispute, there is only a problem where you are not being allowed to get away with your standard POV pushing and are the verge of throwing a tantrum. Chill out. - Robert the Bruce 11:06, 30 Oct 2004 (UTC)

No, Robert, you are the one who is pushing your pro-circumcision POV. The statements by professional medical organizations are the best neutral point of view summaries of the medical analysis of circumcision. They all say there is no medical indication for infant circumcision. Not one of the professional medical organizations says the small potential medical benefits of infant circumcision far outweigh the medical risks and harms, not one, not even the American Academy of Pediatrics. The Royal Australasian College of Physicians statement says, "Review of the literature in relation to risks and benefits shows there is no evidence of benefit outweighing harm for circumcision as a routine procedure." -- DanBlackham 11:55, 30 Oct 2004 (UTC)

I disagree with the wording of the above. While a few (one?) medical organisations have explicitly stated that benefits do not outweigh harms, I don't think it's appropriate for us to speak for those that haven't stated a policy on that matter. The AAP's statement also merely says that there are benefits and risks, and parents should make the decision (implicitly disagreeing with your wording). I propose the following milder (and thus more generally true) statement (emphasis added):

In their view the benefits of neonatal circumcision (including a lower rate of urinary tract infection in infants, a lower rate of penile cancer in adults, and a lower rate of infection of some sexually transmitted diseases, particularly HIV) do not sufficiently outweigh the risks (including bleeding, infection, surgical mishap, and rarely death) to recommend that all males be circumcised. - Jakew 12:45, 30 Oct 2004 (UTC)

Some of the medical organizations have taken a much stronger stand, for example:

"The possibility that routine circumcision may contravene human rights has been raised because circumcision is performed on a minor and is without proven medical benefit." -- The Royal Australasian College of Physicians. Policy Statement On Circumcision. Sep 2002. [14]
"Unnecessarily invasive procedures should not be used where alternative, less invasive techniques, are equally efficient and available. ... Therefore, to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate." -- British Medical Association. The Law & Ethics of Male Circumcision - Guidance for Doctors. March 2003. [15]

Please note the Royal Australasian College of Physicians statement says routine or non-therapeutic circumcision is "without proven medical benefit". -- DanBlackham 13:43, 30 Oct 2004 (UTC)

Well add a section a the bottom then where you can list all the statements. One word of caution though the order in which they are listed should be in accordance with the population size represented by the organisation and not according to how much they suit your anti-circumcision/pro foreskin POV. NB: Leave the introduction alone. - Robert the Bruce 15:28, 30 Oct 2004 (UTC)

Introduction Cultural Bias

The current introduction says that a number of national medical organizations have placed circumcision under scrutiny. However, only the American Pediatric Society's policy is cited. This causes the article to lead off with a US-centric viewpoint, affecting the POV. Other medical associations should be cited (whether neutral, pro or con). I say this not to make the article pro- or anti-circumcision, but to curb the US focus that so often emerges in Wiki articles. I recognize, of course, that the article is slated for clean-up.--Westendgirl 18:20, 2 Dec 2004 (UTC)

Winkelmann and Taylor

The findings of Winkelmann and Taylor are important and relevant to this article. Robert, please stop deleting them. Dr. Taylor found the ridged band of the foreskin has a high concentration of specialized nerves. In my opinion that is probably it single most important fact that needs to be included in the section on sexual effects of circumcision. -- DanBlackham 11:03, 1 Nov 2004 (UTC)

Dan I understand just how you feel and I sympathise. But you do realise that your point of view (POV) does not deserve centre stage attention unless it is backed up by credible fact. Sadly this piece misrepresents Winkelmann and Taylor's two-page excuse for a study is an outstanding example of irresponsible speculation being taken for serious science by desperate people. Hammond showed us that at least half of foreskin restorers have a mental pathology of sorts, 30% are serious substance abusers and these sad and desperate people are being exploited by an anti-circumcision movement for their own purposes. Disgraceful actually. If you are desperate to include Winkelmann then you need to point out the difference between the Meissner and Vater Pacini corpusles both in terms of location and function. So please try to keep your eye on the ball here. Because "in your POV" you believe that something should be included in the article does not necessarily mean it has the required merit. Try your best to strive for NPOV and not just recklessly push your anti-circumcision agenda. It is not helpful. - Robert the Bruce 17:44, 1 Nov 2004 (UTC)

Robert, please stop your ad hominem attacks. Dr. Taylor's article is an accurate description of the cellular anatomy of the foreskin.[16] He found that an intact male's foreskin has a high concentration of specialized nerve cells. That is a scientific fact and it should be included in the article, even though it does not agree with your pro-circumcision agenda. -- DanBlackham 08:41, 3 Nov 2004 (UTC)

Actually, describing them as specialised is deceptive. What he found was that a certain part of the foreskin (the ridged band of mucosa) was comparatively rich in Meissner corpuscles. They're no more specialised than any other nerve cell. It's true that later Taylor did speculate that these were specialised tissue, but this was pure speculation with no basis in fact. Saying that the ridged band of the foreskin is comparatively rich in superficial touch receptors is apparently factual, but I'm afraid that any poetic essays about specialised receptors inducing sexual ecstacy (etc.) must be considered junk and treated accordingly. - Jakew 11:54, 3 Nov 2004 (UTC)

Describing Meissner's corpuscles as specialized nerve cells is not deceptive; it is an accurate statement. Meissner's corpuscles are especially effective in detecting light touch. As you said Dr. Taylor found that there is a high concentration of Meissner's corpuscles in the ridged band of the foreskin. There is also a high concentration of Meissner's corpuscles in the fingertips, lips, and nipples. Most people know from their own personal experience that their fingertips, lips, and nipples are more sensitive to light touch than most other parts of their body. Robert's attempt to delete Dr. Taylor's findings that the foreskin contains a high concentration of specialized nerves, called Meissner's corpuscles, which are effective in detecting light touch is deceptive and is an unacceptable attempt to insert his own pro-circumcision POV in the article. -- DanBlackham 23:54, 5 Nov 2004 (UTC)

Sorry DanB but the deception comes in through the suggestion that the because of the presence of "specialised nerves" the foreskin therefore has a sexual function. Meissner corpuscles are indeed "specialised nerves" and are found in such places as the oral cavity, the lips, the finger tips, the palms and the soles of the feet ... and the foreskin (and not the nipple as you suggest - see the Areola and Nipple section of Winkelmann - was this deliberate or just a slip?). I suggest we keep working on this DanB and together we will be able to unravel the deceit about an anatomical sexual function of the foreskin ... you do want the truth to prevail don't you Dan? - Robert the Bruce 01:02, 6 Nov 2004 (UTC)

Deleting relevant information

The following is relevant information that should be included in the article:

Van Howe (2004) examined male neonatal circumcision both from a cost perspective and a medical perspective.[17] His analysis found that male neonatal circumcision is poor health policy and cannot be justified financially or medically.

In June of 2004 the College of Physicians and Surgeons of British Columbia stated that neonatal circumcision is medically unnecessary.

"Infant male circumcision was once considered a preventive health measure and was therefore adopted extensively in Western countries. Current understanding of the benefits, risks and potential harm of this procedure, however, no longer supports this practice for prophylactic health benefit. Routine infant male circumcision performed on a healthy infant is now considered a non-therapeutic and medically unnecessary intervention." [18]

If you do not agree that this information should be included in the article, please explain why before deleting it. -- DanBlackham 00:54, 23 Nov 2004 (UTC)

The anti-circumcision activist Van Howe once again introduced a "study" in which he expressed his views. Again, he used deceptive tactics including selective - and dishonest - inclusion of figures and faulty methodology. O'Farrell and Moses gave an enlightening analysis of his previous work on HIV, and the same basic approach seems to be used by him today. It is not appropriate to include his propaganda in this article. Nor is it appropriate to include partial quotations from organisations, though a link is perfectly ok. - Jakew 01:11, 23 Nov 2004 (UTC)

Jake, please cite the Wikipedia guidelines that say it is not "appropriate to include partial quotations from organizations". The quote is from the section "Medical Perspectives" of the College of Physicians and Surgeons of British Columbia Policy Manual. The quote is relevant to the article. -- DanBlackham 02:42, 23 Nov 2004 (UTC)

Cost-benefit, medical utility, and cost-utility are completely relevant to the "medical analysis of circumcision". Arguments against the author are simply "ad hominem" attacks that are recognized as fallacious arguments. Ad hominem attacks are the last defence of someone who has nothing to say. Please refrain from ad hominem attacks on the author of cited papers.

Also, this file is overlong. Removing sections that are duplicated elsewhere in discrete articles is appropriate and requested. Robert Blair 12:58, 24 Nov 2004 (UTC)

Who says the file is overlong? For someone who has been here since 18 November you are being aren't you pushing your luck just a little? BTW you came here in response to the call to arms on the foreskin restoration list I suppose? - Robert the Bruce 16:35, 24 Nov 2004 (UTC)

Revert War - Request + Information

If you choose to revert changes on this page, please do not revert changes to fix syntaxes, for example my change of "Long NPOV}}" to "{{Long NPOV}}". If you would refrain from using words such as "Vandal" when referring to another user's edit, it will go a long way towards creating NPOV pages

Also, there is a ban against reverting a page more than 3 times a day. (Thus I, and Robert Blair, may not revert this page until tommorrow starts for wikipedia's timezone) Effective today, violation of that policy will be enforced with 24-hour period bans. See Wikipedia:Three revert rule and Wikipedia:Three revert rule enforcement--Josiah 04:56, 28 Nov 2004 (UTC)

Protection

I requested this article be protected, because of the Revert war that was happening. In order for this article to be unprotected, we ought to discuss our differing viewpoints so that we can come to a NPOV article. --Josiah 02:59, Nov 29, 2004 (UTC)

Well as it turns out the timing of the protection comes at the worst possible moment as it freezes the article immediately after the edit of the person who made the call-to-arms to disrupt Wikipedia [19] Read up on it.
- Interesting. Life sucks sometimes. Hopefully we can work out a consensus version that incorporates both sides of this issue.--Josiah 06:56, Nov 29, 2004 (UTC)
Now seeing you have been the cause of this protection I suggest that you take responsibility for sorting the issues out. First, is that those (who came in response to the call-to-arms) from the anti-circumcision and foreskin restoration lists want the phimosis and balanitis sections removed from this article and replaced by links to the separate articles. Any ideas why they would want to do this? - Robert the Bruce 04:56, 29 Nov 2004 (UTC)
- I'm pretty sure that you meant the last as a Rhetorical question. I completely agree with you that those should be included in this article.--Josiah 06:56, Nov 29, 2004 (UTC)
  - Well sadly you protected a version that specifically excluded them. What to do now? - Robert the Bruce 17:38, 29 Nov 2004 (UTC)
    - I din't protection anything Robert. I requested a page protection. Please, let's try to work on a consensus version. For the most part, I am on your side of this issue.--Josiah 05:01, Nov 30, 2004 (UTC)
    - What I suggest is done then is to reinstate the sections on Phimosis and Balanitis. Then you idea of putting the proposed "Complications of Circumcision" and "Weighing the Benefits and the Costs" up in a sandbox or whatever to be workshopped by the community before allowing insertion into the main article. - Robert the Bruce 05:29, 30 Nov 2004 (UTC)

This article, medical analysis of circumcision is about a surgical operation. The article is overlong and two sections, phimosis and balanitis, have been moved to separate discrete files.

In analyzing a surgical operation one must discuss the possible benefits and the known risks and complications of the operation. That was missing from this analysis. I created a careful discussion of the risks and complications, but that was deleted without discussion.

Also, one must consider the ethics of the operation. The ethics are controversial, and a NPOV article was created to discuss that and a link was inserted into the medical analysis of circumcision file. That was also deleted by reversion. These reversions are tantamount to vandalism because they destroy good work.

Wikipedia says:

A revert is the advised action to deal with vandalism. Where you think an older version of a page is better than the current version, a revert is sometimes appropriate. Sometimes, though, it is better to write a third version that takes the best bits of the other two, and combines them to get the best of both worlds.

With regard to wholesale deletions, Wikipedia says:

Try to avoid deleting things as a matter of principle. Amend and edit, then it is remarkable how you might see something useful in what was said. Most people have something useful to say. That includes you. Deletion upsets people and makes them feel they have wasted their time: consider moving their text to a sub-directory of their user pages instead (e.g. saying not quite the right place for it but so they can still use it): much less provocative.

Jakew and Robert the Bruce have not followed the rules. They simply delete whatever does not fit their POV. I urge that they be banned.

Robert Blair 04:50, 29 Nov 2004 (UTC)

I have attempted to make changes to this page which incorporate both their edits and yours, however, you instantly reverted them. After examining the recent edits (68% of your edits have been exclusively on this page, none are related to other topics) made by you and your sockpuppet IP, it appears to me that you have created this account for the sole reason of turning this into an anti-circumcision article. I'd be glad to have you prove me wrong. Preventions of Phimosis and Balanitis are examples of possible benefits from circumcision. So here's my proposal: I'll accept the removal of the paragraphs that covered them if you either do the same to possible disadvantages of being circumcized, or replace the removed material with quality articles that cover other possible benefits of circumcision. I propose this because we cannot cover only the bad, and skip the good, or only the good, and skip the bad, on such a controversial topic as this.--Josiah 06:56, Nov 29, 2004 (UTC)

Hi Josiah:

Prevention of balanitis and phimosis are indeed possible benefits of circumcision. However, they now have separate discrete files that cover that. Links were placed to those files. It is not my intention to ignore those possible benefits. But the article is way overlong and this had the effect of shortening the article and eliminating the redundancy of having duplicate discussions. We can check those files to see if they adequately mention that circumcision could prevent those conditions.

I forgot to mention in my post above that in an article on the "medical analysis of circumcision", the cost-benefits studies are a relevant and essential part of the discussion. That section had also been deleted arbitraily deleted without discussion. That is improper. Robert Blair

I disagree on the first part. Those parts ought to be covered, but they don't need to be convered as in depth. For example, the Jew page and the Karaite Judaism both cover Karaite Judaism, but the former has a brief summary of it, whilst the latter details it fairly in depth. Perhaps we could work out something like that here. I agree with you on the second part, I initially tried to include those parts. Perhaps we can make a sandbox with each of the contested areas, and work from there?--Josiah 15:53, Nov 29, 2004 (UTC)

Hi Yoshiah:

I think your proposal is reasonable. Please start the sandbox and inform me of its location.

I am quite busy at the moment so I would like you to do the inital editing.

Robert Blair

With respect Josiah you need to understand how these people work. The principle is two steps forward, one step back. Here you find yourself contemplating a trade off where in order to reinstate deletions of whole sections they get to insert whole paragraphs of POV. The first issue which should be not negotiable is the inclusion of the Phimosis and Balanitis sections. Thereafter they should motivate their POV insertions on the talk apge before just plain inserting that stuff directly into the article. - Robert the Bruce 03:55, 30 Nov 2004 (UTC)
- Robert, that may or may not be true. However, we must always Assume Good Faith.--Josiah 05:01, Nov 30, 2004 (UTC)
- Been there done that. A wiser person now. - Robert the Bruce 05:16, 30 Nov 2004 (UTC)

Proposal

In interests of ending this edit war, I suggest the following proposal. Keep the cost-benefit section, as well as the phimosis and balanitis sections. Please vote "aye" (yes) or "nay" (no) below.

Wouldn't it be better to address each section by itself (phimosis, balanitis, complications, and cost-benefit)? If there is only one proposal, I think the proposal should include keeping the section on complications too. -- DanBlackham 07:11, 2 Dec 2004 (UTC)

Aye

--Josiah 06:07, Dec 2, 2004 (UTC)

Nay

Introduction

The following section from the introduction has been repeatedly deleted from the article. In my opinion this section is accurate, has neutral POV, and should be included in the article.

Currently neonatal circumcision is not considered medically necessary according to professional medical organizations in Australia, Canada, the United Kingdom, and the United States. In their view the potential medical benefits of neonatal circumcision (including a lower rate of urinary tract infection in infants, a lower rate of penile cancer in adults, and a lower rate of infection of some sexually transmitted diseases, particularly HIV) do not significantly outweigh the potential medical risks (including bleeding, infection, surgical mishap, and rarely death).

Every medical analysis of circumcision by professional medical organizations has concluded that neo-natal circumcision is NOT medically necessary. -- DanBlackham 08:03, 2 Dec 2004 (UTC)

Hi Dan: Yes, I agree, the section on complications and the cost-benefit section are essential. I accept the introduction you propose. The present quotation from the AAP statemen should be deleted because that statement is outmoded, inaccurate, does not agree with current bioethics thought, and is not in agreement with statements from the Canadian Paediatric Society and the Royal Australasian College of Physicians and Surgeons. The present AAP statement is likely to be revised soon. We have to remember that the Internet is international in nature so we should not focus on a national view. Robert Blair 16:00, 2 Dec 2004 (UTC)

I believe that would do better with the cost-benefit analysis. On a side-note, does anyone actually say that it is medically neccessary?--Josiah 03:26, Dec 3, 2004 (UTC)

No national or international professional medical organization says neonatal circumcision is medically necessary. There has been a broad consensus in the medical community since the 1970's that there is no medical indication for circumcising baby boys. The American Academy of Pediatrics said in 1971, "There are no valid medical indications for circumcision in the neonatal period." The Canadian Paediatric Society reached the same conclusion in 1975. Currently every national and international professional medical organization that has an official policy on circumcision says that neonatal circumcision is not medically necessary. For example the Royal Australasian College of Physicians says, "After extensive review of the literature the RACP reaffirms that there is no medical indication for routine male circumcision." -- DanBlackham 09:22, 3 Dec 2004 (UTC)

I do not believe anyone -religous or secular - says otherwise. --Josiah 21:53, Dec 7, 2004 (UTC)

Robert Blair, in my opinion it would be okay to included the quote from the American Academy of Pediatrics (AAP) if a quote from another professional medical organization like the Royal Australasian College of Physicians (RACP) were also included. The AAP position on non-therapeutic circumcision is the weakest of all the major national medical organizations. Even the American Medical Association has taken a stronger stand against non-therapeutic circumcision than the AAP. In my opinion quotes from the AAP and RACP would be a good representation of the range of positions taken by professional medical organizations. -- DanBlackham 09:53, 3 Dec 2004 (UTC)

Unprotected

Now that this page is unprotected, Robert the Bruce restored the article to my last version, and I have just restored the Cost/Benefits section as well as the complications section. I believe this is the best compromise for both sides, as both have the issues they want covered on the page. For future edits, I request that everyone (including myself ;) ) cite a specific source when adding information. This will help alleviate any possible future "edit wars".--Josiah 21:56, Dec 7, 2004 (UTC)

"anti-circumcision activist(s)" - POV

I believe that, while accurate, this title is inflammatory. It would be better replaced with "critic" (of circumcision).--Josiah 23:45, Dec 7, 2004 (UTC)

Inflammatory or not, the title is descriptive. Van Howe has displayed his lack of objectivity by saying (from memory) "the true horror of the procedure [of circumcision] is better expressed by the term male genital mutilation." - Jakew 00:29, 8 Dec 2004 (UTC)

The article by Dr. Van Howe was published in Medical Decision Making. Obviously the editors thought Dr. Van Howe's article was worthy of publication in their journal. Referring to him as "the anti-circumcision activist" is inflammatory and represents a strong pro-circumcision POV. If a qualifier is needed, Yoshiah's suggestion "Robert Van Howe, a critic of circumcision" has a more neutral POV. -- DanBlackham 11:09, 9 Dec 2004 (UTC)

Bob Van Howe is undoubtedly an anti-circumcision activist. There can be little doubt about that. While it's true that - astonishingly - Med. Decis. Making published it, calling attention to it should not be done unless we want to list the journal publishing every single other journal (which, I'm sure you'll agree, would be silly). To do otherwise is to lend false credibility to Van Howe's creation. Would you be content with "Robert Van Howe, a lifelong opponent of circumcision..." - Jakew 21:10, 9 Dec 2004 (UTC)

Oh the war of the edits: "Dr Van Howe" the critic of circumcision vs "Bob Van Howe" the anti-circumcision activist! When it comes to medical references it would be good to list the author, the name of the article and when and where it was published. This would require a lot of tedious work in editing the articles but I think it would be well worthwhile.Michael Glass 00:37, 10 Dec 2004 (UTC)

That adds unnecessary bulk to the articles. It's also as ridiculous as listing the publisher of a book (who cares if Addison-Wesley published it?) The conventional way to cite an article is to name the author (and sometimes year), and provide a full citation in the references. Since we're on the net, I'd say that the references can be replaced with inline links. - Jakew 13:59, 10 Dec 2004 (UTC)

If an article is published in a peer reviewed journal such as Medical Decision Making, in my opinion a qualifier is not needed to describe the author. Labeling Robert Van Howe as "a lifelong opponent of circumcision" in an attempt to discredit him is not neutral POV. -- DanBlackham 12:06, 10 Dec 2004 (UTC)

Bob Van Howe discredits himself with his appalling scholarship and biased approach. His publications invariably oppose circumcision, and his data has a suspicious tendency to be the opposite of that obtained by serious researchers. - Jakew 13:59, 10 Dec 2004 (UTC)

True or not, that does not change the fact that Wikipedia considers pro and anti to be loaded words. Many critics of circumcision only hold objections when the subject is never given a choice. That's not total opposition, but contingent on voluntary involvement. We don't call every sex act rape -- only the involuntary kind. Same goes here, and pro-mutilation attitudes do not magically change the definitions of words so that anti-circumcision means every kind of objection under the sun. DanP 23:46, 10 Dec 2004 (UTC)

Dan one understands exactly where you are coming from on this. It is quite clear that you understand fully who is or isn't an anti-circumcision activist. From the message of your below (and your obvious membership of anti-circumcision groups and lists) it is quite obvious what your agenda is around here and how you wish for Wikipedia to be misused for propaganda purposes by your fringe group. From now on you will deceive no one. One is of course left wondering why some of these "eager beavers" around here have not had you up for banning due to the deliberate and coordinated attempts to misuse Wikipedia for narrow propaganda purposes. But you know who you can rely on around here don't you ;-) - Robert the Bruce 07:04, 12 Dec 2004 (UTC)

Need some help on Wikipedia
Subject: Need some help on Wikipedia
Date: Mon, 20 Sep 2004 15:27:55 -0700 (PDT)

Dear group,

I have been battling the pro-circumcision folks on
Wikipedia again, hoping to list "circumciser" as a
valid article entry.  I have tried to keep the article
as factual as possible and related to world cultures.

If you are active on Wikipedia, please go to that
article and give me a hand.  So far, the pro-MGM side
has been voting to delete, and I could use some
assistance.

Thanks,

Dan

Libel

Wikipedia policy:

Similarly, slander, libel, or defamation of character is not to be tolerated on Wikipedia; true instances of such writing, that might legitimately expose Wikipedia to legal sanction, should immediately be called to the attention of an administrator and/or the community at large. Disagreements as to the identity of a person, their motivations for a given action, opinions of third parties about them, etc. do not fall under slander, however, and you should not use legal threats as a bludgeon to get your POV enshrined in an article.

References to Robert S. Van Howe, M.D., M.S., F.A.A.P. impugn his scientific credibility and are libelous statements that are likely to get Wikipedia in trouble if he see them. Such characterizations violate Wikipedia policy. Robert Blair 01:11, 13 Dec 2004 (UTC)

Would you care to explain how describing Van Howe as an anti-circumcision activist is libellous? Libel is defined as a false statement intended to attack a person's credibility. Howe all but describes himself as such here [20]. He has been described as such in print on several occasions, such as this letter to Pediatrics [21]. Please don't be so silly. - Jakew 07:48, 13 Dec 2004 (UTC)

Jake, I would just sit back and watch how things develop from here on. I read into Robert Blair's (or whoever's) statement the implied threat of legal action. Lets see how quickly the self-styled "guardians of the wiki" act to deal with this breach of rules/policy. Jake, should I hold my breath on this one? - Robert the Bruce 15:26, 13 Dec 2004 (UTC)

Such statements cast aspersions on a professional's integrity and are clearly libelous. They imply that the science has deliberately been skewed to produce a given result. They expose Wikipedia to the possibility of legal action. No one wants that. The statements must be removed. In any event they are not germane to the discussion of the medical analysis of circumcision.

4.230.234.187 16:33, 13 Dec 2004 (UTC)

A true and accurate statement cannot by definition be libellous. As demonstrated, Van Howe is an anti-circumcision activist. I would further say without hesitation that the data has indeed been deliberately skewed, and I will take full responsibility for that statement. However, the article does not say that. It only says that he is an anti-circumcision activist - a true statement that has been made repeatedly in the medical literature, with no apparent objection from Van Howe. I would suggest that your objection to the accurate description of him stems from your own nagging doubts about his work, doubts that you would rather not consider. Am I right? - Jakew 17:00, 13 Dec 2004 (UTC)

Jake: I have no doubts about the merit of Van Howe's work. If you have doubts, then you should criticize the work, not the man. Van Howe may have green hair and red eyes but that is not relevant to his work. He is very knowledgable on circumcision issues, because that is a field he has chosen. Your continued posting of this non-relevant defamatory material is exposing Wikipedia to possible legal action. They may ban you if you persist.

Robert Blair 01:54, 14 Dec 2004 (UTC)

Robert: You may be confident in Van Howe's work, but I know this subject extremely well, and I am only too familiar with his repeated attempts at deception. I care not what he looks like. No legal action can be taken against Wiki or myself for making true statements. If you seriously believe otherwise, then I suggest that you make a "request for comment" about me.

Since you ask, here are some comments on his work that I recently posted elsewhere:

For HIV, he uses his flawed meta-analysis. The many faults in this were pointed out by Moses et al., and O'Farrell and Egger. These points were addressed in a proper meta-analysis by Weiss et al. Although Van Howe claims to give preference to the most recent studies, he ignores this later meta-analysis altogether.

For complications, he inappropriately combines rates for neonatal circumcisions with those for later circumcisions. It has been demonstrated that newborn circumcision is much safer (one study found 0% complication rate in the neonatal group vs 30% later on).

For deaths, he inappropriately takes the LFS value from Gairdner. As I discussed recently [see below], this is inappropriate. Neonatal circumcision (which, after all, is the title of Van Howe's analysis) does not use general anaesthesia.

For UTIs, he strangely relies on To's study alone, completely ignoring all other studies (both before and after). While he (not unfairly) criticises some of the early US Army studies, his criticisms do not apply to much of the other data.

For penile cancer, he ignores Kochen and McCurdy's work, preferring to take his figures from Europe (strange, but tolerable), then takes figures only from Maden's study. More recent data is also available.

For balanitis, he ignores the overwhelming evidence that circumcised males are at reduced risk. (see Fakjian N, Hunter S, Cole GW, Miller J. An argument for circumcision: prevention of balanitis in the adult. Arch Dermatol. 1990 Aug; 126: 1046-1047; Herzog LW, Alvarez SR. The frequency of foreskin problems in uncircumcised children. Am J Dis Child. 1986; 140: 254-256; Fergusson DM, Lawton JM, Shannon FT. Neonatal circumcision and penile problems: an 8-year longitudinal study. Pediatrics. 1988;81(4):537-41; Mallon E, Hawkins D, Dinneen M, Francics N, Fearfield L, Newson R, Bunker C. Circumcision and genital dermatoses. Arch Dermatol. 2000 Mar;136(3):350-4 for some examples)

Bizarrely, he claims that 0.1% of men will indulge in foreskin restoration (an improbably high and unjustified figure). Since this is entirely an elective endeavour, it isn't appropriate. If it were, then elective circumcision should be considered a cost of not circumcision. Van Howe fails to do this.

My recent discussion of deaths: Baker´s[1] estimate of 229 circumcision-related deaths per year in the US is based on Gairdner´s[2] value of 16 deaths in 90,000 circumcisions.

This is inappropriate. Gairdner´s deaths were mostly caused by complications of general anaesthesia, which is much more dangerous than local anaesthesia. General anaesthesia is not used for neonatal circumcision.

Wiswell and Geschke[3] reviewed the records of 136,086 boys. 100,157 of these were circumcised. No circumcised boy died, but two uncircumcised boys died of complications of UTIs. They also report that no deaths occur in a larger group of 300,000 boys.

Speert[4] reviewed the records of 566,483 circumcised infants, and found one death.

Gee and Ansell[5] reviewed the records of 5,521 circumcised infants, and found no deaths.

King[6] reported on 500,000 neonatal circumcisions, with no fatalities.

Trevino[7] reports that no deaths occurred in 650,000 circumcised boys.

1 http://www.cirp.org/library/general/baker1/

2 http://www.cirp.org/library/general/gairdner/

3 Wiswell TE, Geschke DW. Risks from circumcision during the first month of life compared with those for uncircumcised boys. Pediatrics. 1989 Jun;83 (6):1011-5.

4 Speert H. Circumcision of the newborn: an appraisal of its present status. Obstet Gynecol. 1953; 2: 164-172

5 Gee WF, Ansell JS. Neonatal circumcision: a ten-year overview: with comparison of the Gomco clamp and the Plastibell device. Pediatrics. 1976 Dec;5(6):824-7.

6 King LR. Neonatal circumcision in the US in 1982. J Urol. 1982; 128: 1135-36

7 Trevino S. Personal communication to Wiswell T. 1987

- Jakew 14:14, 14 Dec 2004 (UTC)

I see. So he is wrong because his numbers disagree with those who advocate or actually perform circumcisions. That is quite a convenient, and almost categorical form of denial. Seems that no other body part is subjected to this style of analysis: cut a bunch of people first -- do the numbers change? -- oh, well that was the right thing to do! That proves very little, as there is no control group, and no real science. Opposing this methology is not insanity, and a medical analysis is not just a numbers game. We are all involved, like it or not. We would be missing more than our foreskins if certain doctors made decisions about what to take off. Even the pro-genital-mutilation studies that are spread throughout Wikipedia do not disclam "Warning about Van Howe, this guy is a raving circumcision proponent, don't believe a word of it". That has little to do with fact, and more to do with defamation and bias (they are probably public figures in this context). Anti-circumcision folks do not even try to sneak into articles "Wiswell: flaming circumcision advocate wants to cut all boys". That has little merit or purpose except to unbalance the article. DanP 00:38, 17 Dec 2004 (UTC)

DanP, Van Howe's paper falls into the general class of papers known as reviews, or surveys. These introduce no new data, but instead attempt to perform some analysis using the existing medical literature. In this case, it's a cost-utility analysis. In these days of evidence-based medicine, articles should be obtained and selected via a well-defined process that is not inherently biased. For example, one might say "I'll search Medline (a well-known database of medical papers) for circumcision, from 1980 onwards". The search strategy is usually stated, so that it can be repeated and thus verified. If one makes arbitrary selections (as Van Howe does), then one can justifiably be criticised. - Jakew 01:13, 17 Dec 2004 (UTC)

If you search any medical database on breast cancer, it's always aimed toward preserving the breast, instead of amputating as a cautionary matter of statistics or risks. If your view that "evidence-based" medicine is appropriate, where is the evidence of foreskin disease in a newborn? It is almost always absent. That isn't bias, that is fact. You've struggled to delete that fact over and over using a probabilistic and interpretation-based approach toward this matter, and now you say a well-defined process should exclude one that will perform some analysis using the existing medical literature. If that is the case, we should immediately purge Wikipedia of all claims of both benefit and harm from circumcision, since Wikipedia is now such a repository of re-analysis. Isn't that correct, or did I misread the title of this article? My only suggestion is that we mention Van Howe's work without judgement, of him or his work, except to say that the paper asserts such things. These accusations work both ways, and numerous "circumcision benefit" links in this article are mentioned without hinting that the author is a single-issue lunatic. DanP 18:50, 17 Dec 2004 (UTC)

Dan, I most certainly do not say that Van Howe's work should be excluded because it "perform(s) some analysis using the existing medical literature", and I'm sorry if I gave that impression. It is entirely valid to analyse using the existing literature, and indeed beneficial. When doing this, one has to use a well-defined approach. One can't just be arbitrary. The problem with his work is that instead of being systematic in his review of the literature, he has been selective and arbitrary (see my notes above). In itself, that would be alright (though it would make his paper appear as cranky as it really is), but the trouble is that Van Howe lies, and claims to have used a systematic approach. That's readily disproven by repeating his claimed method, and seeing the papers he chose to omit. - Jakew 00:14, 18 Dec 2004 (UTC)

It is easy enough to say Van Howe's perspective is a lie. Even that judgement is somewhat arbitrary in what you are willing to accept, and what you reject. Many systematic refutations of pro-mutilation junk science are available online. But that has never been sufficient to exclude them from Wikipedia. Why not let the reader decide on their own? I'm sure plenty of research is out there explaining how to save money and avoid surgery, and how to seek alternative treatment for many diseases or disorders involving non-vital organs. Yet that same candle of truth must in no way go near the male genitals? I have difficulty seeing the non-arbitrary systematic approach there, or how Van Howe work differs from any other less-blatantly mutilating fields of medicine. Perhaps you can explain why this is so? DanP 01:36, 29 Dec 2004 (UTC)

Dan, would you please realise that we're not talking about whether to delete Van Howe - we're just discussing whether to include commentary. You say that systematic refutations are available online - so where are they? - Jakew 12:21, 29 Dec 2004 (UTC)

Commentary or not, the same standards should apply to the circumcision advocates as to genital integrity. Do you dispute this, or should commentary only be valid from your side? As to systematic refutation, every time CIRP article are linked, or commentary as to failures of pro-mutilation arguments are detailed, you oppose them as selective or biased. Yet your wild rampage against Van Howe is warranted? Why? DanP 23:24, 29 Dec 2004 (UTC)

DanP, my "wild rampage against Van Howe" consists merely of noting that he's an anti-circumcision activist. Please keep a sense of proportion here. It's unclear what you mean by "CIRP articles" - do you mean a paper that happens to be hosted at CIRP, or do you mean one of CIRP's own discussion pages? While the latter are absurdly biased, I don't object too much to the former. My main gripes with CIRP's pages are a) their little "explanatory notes", designed to guide the reader towards their way of thinking, and b) their highlighting of passages that they like, and c) their habit of linking to only the references that support their position. If they just presented the paper as it was in the journal, I'd have no objection. -Jakew 12:32, 30 Dec 2004 (UTC)

A sense of proportion

To keep a sense of proportion here one needs to remember that there is no medical indication for neonatal circumcision, in other words neonatal circumcision is not medically necessary. There is no other part of a child's body that doctors will cut off without a valid medical indication. The College of Physicians and Surgeons of British Columbia policy statement says:

"Infant male circumcision was once considered a preventive health measure and was therefore adopted extensively in Western countries. Current understanding of the benefits, risks and potential harm of this procedure, however, no longer supports this practice for prophylactic health benefit. Routine infant male circumcision performed on a healthy infant is now considered a non-therapeutic and medically unnecessary intervention."

--DanBlackham 18:27, 30 Dec 2004 (UTC)

Thanks for that Dan. It is always nice to know that we can get an up-to-date anti-circumcision view from you. BTW don't you think it is time to retract the "call-to-arms" posts on various anti-circumcision lists (which you are a member of) for activists to rally and force your POV into Wikipedia articles? - Robert the Bruce 00:33, 5 Jan 2005 (UTC)

Robert, while your contributions are valuable, why would you criticise someone for having a viewpoint. Are you saying you do not? NPOV does not say eliminate POV. In fact it welcomes both sides, which apparently is something you hate. Go read NPOV and come back and tell us whether your POV is missing from the article. Then let's discuss it. DanP 01:14, 5 Jan 2005 (UTC)

I don't think we need to indulge in smoke and mirrors to apply some spin to the NPOV definition. There is about to be a ruling made by the AC which will confirm that "Wikipedia is not a vehicle for propaganda or advocacy." This then read in conjunction with the following emails [22][23][24] will effectively bring the activities of targeting Wikipedia by one particular fringe group to an end. Wonderful. - Robert the Bruce 04:44, 5 Jan 2005 (UTC)

Whenever the microscope looks at your circumcision advocacy efforts, you would not be happy either. Like it or not, your viewpoint is in the minority worldwide. But I do not promote giving it less prominence in Wikipedia. Both sides of many ethical debates are presented in Wikipedia, the pros and the cons. Saying "no propaganda" is fair enough. But I believe you have tossed the first stone in nearly every instance, and our rules must apply to both sides. By your logic Wikipedia should delete pro-choice or pro-life and declare one "the truth" and the other propaganda. Is this what you are saying? Please clarify what you mean so we can all understand. DanP 18:49, 5 Jan 2005 (UTC)

Yes I thought you would take the news badly. But all is not lost yet, however, you can rely on a rearguard action of 5th Cloumnist sympathisers around here to provided an imaginative "interpretation" to help your cause. Again sadly you misrepresent the "worldwide" view. Where is your evidence that any more than a pathetic "worldwide" minority share the level of activism towards male circumcision issues as do you and your "friends"? My point is simple. Just as with Bin Laden there is no possiblity of reaching compromise or achieving consensus. Finally, please don't speak for me, I am happy to be judged my owm words and not those that others put in my mouth. - Robert the Bruce 03:28, 6 Jan 2005 (UTC)

Sorry

I am new to Wikipedia. The IP address 24.184.199.202 is me, Mrfunkygenius. I had set my account to “remember me” but it hasn’t worked. Sorry.

The Rural Uganda Study [25]

The article that I found read as follows:

where circumcision was carried out before the age of 12 it results in a reduction to 0.39 of the odds of an uncircumcised man. The degree of protection changed according to the age at which circumcision was performed, however, with those circumcised at between 13 and 20 years at an odds ratio of 0.46, and those circumcised after the age of 20 at an odds ratio of 0.78. The researchers concluded that "Prepubertal circumcision is associated with reduced HIV risk, whereas circumcision after age 20 years is not significantly protective against HIV-1 infection."

However, a closer reading of the source reveals that those who were circumcised at the age of 21 or more had a higher rate of infection than those who remained uncircumcised. It said:

"HIV-1 prevalence was 14.1% in uncircumcised men, compared with 16.2% for men circumcised at age > or = 21 years."

I believe it is important to state this if only to show that circumcision alone is not a sure protection against HIV. Michael Glass 04:14, 6 Jan 2005 (UTC)

Sorry Michael but once again you misrepresent the findings of the study. I posted this paragraph to clarify the position in the main article.

"It is noted that the researchers' found among those circumcised after the age of 21 years: 
"HIV-1 prevalence was 14.1% in uncircumcised men, compared with 16.2% for men circumcised at age
> or = 21 years. While anti-circumcision activists emphasize this fact it should be noted that in
this community, where circumcision when carried out is during adolescence, circumcision after the 
age of twenty-one is most as a result of medical conditions of the foreskin and/or repetitive and/
or persistent sexually transmitted disease (STD). It is therefore likely that a significant number
of these men actually became infected with HIV while still uncircumcised."

So sadly Micheal the anti-circ line has been exposed for what it is. Now a question. If circumcision can actually reduce the number of HIV infections by millions world wide why are anti-circumcision activists, who incidentally claim to be concerned with child and human rights, so desperate to counter such findings? Is it a case that the mindset of the average anti-circumcision activist places the foreskin as more important than millions of human lives and the accompanying human tragedy that is part of the HIV/AIDS pandemic. It makes one think. - Robert the Bruce 04:37, 6 Jan 2005 (UTC)

Robert, this is a fine piece of invective, but it is without substance. I left the quotation that I found but added another quote to point out that those circumcised after the age of 21 had a higher rate of infection than those who remained uncircumcised. The last two sentences of your paragraph are simply speculation. That is why I removed them. However, if you have solid evidence for them, by all means post it for everyone's consideration.211.31.53.27 06:56, 6 Jan 2005 (UTC)

Hi, welcome to Wikipedia. Your first two posts and seem to know your way around here pretty well. Some may even be forgiven thinking that you may be a sockpuppet. Perhaps one of the more unbiased sysops may check out that possibility. Which list are you from BTW? - Robert the Bruce 17:08, 6 Jan 2005 (UTC)

Since we know that the difference is not statistically significant, and that after adjusting for confounding variables, males circ'd after 20 are still at more risk, it seems rather pointless to include all this discussion. It's a non-point. Forget it. - Jakew 15:31, 8 Jan 2005 (UTC)

'Doctor' Van Howe

Michael, nobody disputes that Van Howe is a doctor. However, if you read the rest of the article, you'll see that in accordance with academic tradition, authors are introduced by surname only. In no other cases do we introduce titles or first names - why should we make a special exception? If you decide to change it to "Dr Robert Van Howe" again, I hope that you'll be consistent and change every other author, too. - Jakew 14:22, 8 Jan 2005 (UTC)

Is it in accordance with academic tradition to brand people as being pro or anti-circumcision? If not, then perhaps we should also remove the comment about him being an anti-circumcision activist. Michael Glass 15:17, 8 Jan 2005 (UTC)

Yes, if you look through the literature, you'll find plenty of references to people's stance in published articles. For example, see Fleiss and Hodges or Schoen. - Jakew 15:27, 8 Jan 2005 (UTC)

NPOV

NPOV requires that opposing viewpoints are equally acceptable and both should be presented without bias. This means that pro-circumcision and anti-circumcision viewpoints must be allowed. Robert the Bruce simply cannot delete material that does not conform to his mind-set.

Factual material may be presented also.

HIV

Van Howe's point of view is offset by O'Farrell. Likewise, Kebaatetswe's viewpoint is offset by Hill-Denniston and by Boyle. These are opposing viewpoints and are entitled to be represented.

Robert Blair 12:09, 9 Jan 2005 (UTC)

HIV/AIDS

I've corrected a typo and removed the "Dr Robert" from Van Howe, for reasons discussed above. I've also made some stylistic changes.

I've removed the paragraph about the finer points of the Uganda study. What on earth is the point of discussing something that we already know is not statistically significant (as noted in the quoted conclusion in the previous paragraph)?

I've shortened the quote from Kiwanuka so that we just include the conclusions. After all, we're providing a link to the study itself, so it seems overkill (and from a copyright perspective is also dubious) to quote the entire abstract.

I've incorporated Robert Blair's version of the RCT paragraph, but have removed the sentence about researcher bias (citations?).

Describing Kebaatetswe as an opinion piece is false, since it is based upon surveys. And I'm adding the fact that the criticisms are from anti-circumcision activists.

I've also made some stylistic changes to Lagarde. - Jakew 12:18, 9 Jan 2005 (UTC)

I have grouped all the overviews (USAIDS, Cochrane, RACP) together. This is helpful in showing where the different bodies agree and disagree about their assessment of the relationship between HIV and circumcision. Michael Glass 07:40, 10 Jan 2005 (UTC)

Jake has questioned why I think it is important to include the following passage from O'Farrell and Egger in the article:

There is debate on the role of male circumcision in HIV transmission. Most case-control and cohort studies from Africa have shown an association between a lack of circumcision and an increased risk of HIV infection in men. The evidence is conflicting, however, with cross-sectional surveys from Tanzania and Rwanda either showing no relationship or an association in the opposite direction.

I believe it is important to point out that there is conflicting evidence about the relationship between circumcision status and incidence of HIV. This backs up what the Cochrane Library said and helps to explain where Van Howe got his raw data. In turn, this puts the reader in a better position to understand and assess the comments of Moses et al in criticising Van Howe's meta-analysis. I originally broke the quotation into two parts: one that dealt with the conflict in the evidence and the other that dealt with the criticism of Van Howe. I think this is clearer than having one long quotation. However, I can quite understand if others felt the passage should be quoted in one block.Michael Glass 13:51, 12 Jan 2005 (UTC)

Michael you certainly must get an "A" effort for the way that you tirelessly work towards supporting the unsupportable. Why even foreskin guru Geoffrey T. Falk (the "org" behind cirp) has reported that Van Howe himself admits that his findings are weak. I quote:

"I spoke with Bob Van Howe recently, and he agreed that there was some merit in Moses' criticism of
his meta-analysis. Some of the statistics were not as refined as they could have been. Bob is now
working on a revised analysis using the numbers from these studies. However, one must remember that
the data from these studies themselves is subject to numerous confounding factors. There is also
publication bias, which means that studies with negative results (no correlation) are less likely
to be published." - Geoffrey T. Falk
http://groups-beta.google.com/group/alt.circumcision/msg/07775bd5d88833c3

So Michael, give one good reason why the Van Howe trash should not be deleted in toto from Wikipedia? - Robert the Bruce 17:50, 12 Jan 2005 (UTC)

I disagree, Robert. I think it important that people should be aware of the flaws in Van Howe's work, and for that reason alone, we should discuss it. I'd have a great deal more respect for CIRP if they had the decency to include one of their little notes, directing readers to the relevant letters, but unfortunately they don't appear to have that much integrity. The burden of exposing the facts about circumcision - and about Van Howe - thus falls to us. - Jakew 22:41, 12 Jan 2005 (UTC)

The fact that CIRP continues to display the trash on its website says all that needs to be said about the lack of integrity of that organisation ... but it goes further ... what does it say about the integrity of those POV warriors that continue to relentlessly present this Van Howe trash as being a scientific counter to the ever mounting evidence of the relationship between the lack of circumcision and a higher risk of HIV infection among the uncircumcised and their partners? Here it is called a Wikicrime ... but don't hold your breath for any sysop to take action in this regard. - Robert the Bruce 04:23, 14 Jan 2005 (UTC)

Robert Brookes, I have no particular brief for Van Howe. If his meat-analysis is flawed, then there are two ways of dealing with this issue. One is to discuss it and the criticisms; another is to remove all discussion of that particular study. It would all depend on the influence that the Van Howe article has had. If it was particularly well-known and influential, then it is better to include information about it, including the flaws that people have detected in it.

However, I have a great problem with your latest edit to the section on HIV/AIDS. Under the excuse of removing clutter you have suppressed evidence that is not to your liking and skewed the whole section towards your own point of view. The version that you mutilated was something that both Jake Waskett and I felt reasonably comfortable with. Now you have turned it into a propaganda piece once more. This is not a positive contribution to the article. Michael Glass 09:10, 14 Jan 2005 (UTC)

Michael, of course you will not be in agreement with much that is written on this subject. Walabio has identified you as a "full time intactivist" [26] and as such you are totally anti-circumcision POV. Now we (who follow the circumcision debate) know just how desperately anti-circumcision activists are to break or discredit the link between the lack of circumcision and a higher risk of HIV infection for the uncircumcised and their wives partners. We also know how apoplectic they are at the thought of the RCT's confirming this protective effect. Michael, I know all this is bad for the foreskin but it does not mean that you or other foreskin promoters should be allowed to fill such articles with anti-circumcision propaganda. As to Van Howe, it is now clear that you are aware of Van Howe himself admitting that his research was fatally flawed. The fact that anti-circumcision websites continue to present it as credible is an absolute disgrace. As far as Wikipedia is concerned any attempt to reinsert this trash should be treated as a wikicrime. (I thought you should know this). Now onto your final point. I can sympathise that the current state of the article is not in agreement of your POV but that of course does not mean that the content is wrong, inaccurate or a lie. What would you like me to add? Would you like me to add the fact as to just how desperate anti-circumcision activists are to discredit the foreskin/HIV link. That we can agree on but to push propaganda, is something I cannot support. Sorry.- Robert the Bruce 12:35, 15 Jan 2005 (UTC)

Robert Brookes, thank you for confirming the fact that 'Robert the Bruce' is your sock puppet.

You still have not answered my point about the censoring of the article. No-one could accuse Jake Waskett of being anti-circumcision, and yet we were both able to come to some consensus about the HIV/AIDS section of this article. The reason was that both of us were striving to give a fair and accurate account of the state of medical opinion at the moment. This has been sabotaged by your removal of relevant material.Michael Glass 13:59, 15 Jan 2005 (UTC)

Michael you really need to understand the meaning of consensus. Any agreement between you and i would not be binding on anyone else. I would have thought that it would have been obvious. Michael as one of (as Walabio calls) the full-time intactivists what real possibility is there that you will accept any version other than that equivalent to what is found on CIRP and other anti-circumcision sites? (other than as a temporary tactical concession). Using words like "censored" and "sabotaged" is counter productive to your image. - Robert the Bruce 18:07, 15 Jan 2005 (UTC)

Split

This article's getting big. Perhaps we should spin off sections as "Sexual consequences of circumcision", "Risks of circumcision surgery", and perhaps "Circumcision and HIV" to reduce article length. —Ashley Y 23:58, 2005 Jan 14 (UTC)

Ashley, give yourself three months before making such suggestions. - Robert the Bruce 12:20, 15 Jan 2005 (UTC)

Just to extend the logic of the mutilationists... I bet you could find medical benefits to having all your nails surgically extracted. You'd never have to deal with that nasty-smelling gunk that collects underneath them ever again. And then you could have your lips surgically removed so there was only just enough to cover your mouth when closed. There's no actual evidence that you need them, right? Or that they are specifically sexually sensitive when it comes to kissing. And it would make your teeth easier to brush. Of course, the anti-lipectomy activists might disagree, but they're probably all paraphiliac lip-fetishists anyway... —Ashley Y 06:17, 2005 Jan 16 (UTC)