Wikipedia talk:Requests for mediation/Medical analysis of circumcision

message: :The following discussion is preserved as an archive. Please do not modify it.  Subsequent comments should be made on the appropriate discussion page.  No further edits should be made to this page. 
Hi, I shall be mediating your case. In the next few days I shall put some questions on here which it would be great to get all your views on. We can then use this as the starting point for the mediation. If you need to contact me at any stage please either e-mail me or drop a message on my talk-page. --Wisden17 18:50, 19 May 2006 (UTC)

message: Initially I have some questions which I would like all parties opinion on, if possible, or if you feel that your view has been expressed already you need not answer, or you may simply want to indicate your support for it.
#There appears to be two quite distinct sides to this issue, and much reference has been made to WP:NOR. This does appear to be a central part of this argument, and so I would ask those that feel that the article should mention a risk of CA-MRSA infection being associated with circumcision to state quite clearly and concisely what they feel their evidence is.
#Secondly, what are all parties' views on the suggestion of creating an article which specifically is to do with Criticism of Circumcision, and perhaps link to this page from the Medical Analysis page?
Now if we take thess two questions to start with. We can then address the issue of whether there is a real faction of editors trying to impose their POV, and use RFAs to do this. 
I think from looking at your debate so far it has been generally civil, but there have been occasional lapses. I would urge all parties to be Civil whilst the mediation is taking place. 
The discussion on this pages needs to be as clear and concise as possible, as most of the issues and evidence and reasoning will have been raised before. --Wisden17 20:16, 23 May 2006 (UTC)
thread_title:  Initial Questions 

message: === Superdix's view ===
# Bratu et. al. list "invasive or surgical procedures" as a risk factor in CA-MRSA infections for the pediatric population . To call the inclusion of this information original research implies that the Bratu and his colleagues forgot to add the words "excluding circumcision" in their list of risk factors. To explain this generalization in medicine, I quote Alberts et. al: "Wounds in barrier epithelia, including the skin, allow pathogens direct access to the interior of the host. This avenue of entry requires little in the way of specialization on the part of the pathogen" (Alberts et. al., Molecular Biology of the Cell, 4th. ed., New York: Garland Science, pp. 1434-1435). This is basic medical knowledge, which one has to acknowledge when reading the article in question, or any other article on the subject of infections for that matter.
# While covering this issue over several articles may be a quick solution to this debate (and countless others), I think ultimately the quality of the articles will suffer, and the public will have a harder time navigating the issue as a whole. Superdix 22:40, 23 May 2006 (UTC)
thread_title:  Answers to Initial Questions 

message: # Bratu et. al. list "invasive or surgical procedures" as a risk factor in CA-MRSA infections for the pediatric population . To call the inclusion of this information original research implies that the Bratu and his colleagues forgot to add the words "excluding circumcision" in their list of risk factors. To explain this generalization in medicine, I quote Alberts et. al: "Wounds in barrier epithelia, including the skin, allow pathogens direct access to the interior of the host. This avenue of entry requires little in the way of specialization on the part of the pathogen" (Alberts et. al., Molecular Biology of the Cell, 4th. ed., New York: Garland Science, pp. 1434-1435). This is basic medical knowledge, which one has to acknowledge when reading the article in question, or any other article on the subject of infections for that matter.
# While covering this issue over several articles may be a quick solution to this debate (and countless others), I think ultimately the quality of the articles will suffer, and the public will have a harder time navigating the issue as a whole. Superdix 22:40, 23 May 2006 (UTC)
thread_title:  Superdix's view 

message: I'd like to add that the link between CA-MRSA and circumcision is not something we came up here on Wikipedia as original research.  As it turns out, a group known Doctors Opposing Circumcision (DOC) put out a widely-distributed press release on this topic.
One instance can be found here, although Googling turns up more.  On their own site, they've put up a Special Statement on the issue.  Before clicking on this link, please note that it contains some disturbing medical photographs.  I mention this fact to avoid surprises, not because I suggest the inclusion of shock pictures in the article.
Based on prior experience, I'm going to anticipate that Jakew, Nandesuka and Jayjg will all deny that DOC qualifies as a reliable source, on the basis that it is a partisan group.  Nonetheless, as Superdix shows, the medical community has ascertained that CA-MRSA is a risk for any procedure that cuts the skin, including circumcision.  To the best of my knowledge, there is no verifiable basis upon which circumcision could be excluded from this.
As for a "Criticism of Circumcision" article, I think this would constitute a POV fork, which is not generally considered good Wikipedia practice. Al 04:33, 24 May 2006 (UTC)
thread_title:  Alienus's View 

message: Wisden17, thanks for taking the step of contacting DOC.  My take on this is that there should be some mention of CA-MRSA, since it's clear that actual doctors have considered this risk, so it doesn't run afoul of WP:RS, WP:NOR or WP:V.  However, Jake is right in that there has not been an epidemic of CA-MRSA infections in circumcized boys, so we shoud be careful to say that this is a potential risk, not a plague.  In short, I think it all comes down to how we explain this, not whether we do.  Given what we know, to omit it would be a clear violation of WP:NPOV. Al 04:35, 27 May 2006 (UTC)
thread_title:  Alienus replies 

message: This mediation has clearly got started. We have now got input from a number of parties.
Let me take the issues raised so far, and offer ways forward in discussing them.
#
#I'll take DOC to start. I've contacted Dr. Denniston again to find out about membership numbers and the number of qualified doctors it has in that membership, as this seems to be an issue which can easily be resolved with a few simply facts (whatever they may show).
#
#Next, there has been mention of the removal of the POV tag from the Circumcision page, and I would ask that any further edits to clearly relevant pages are left until after this mediation. I can understand the logic behind the removal, with regard to the inteniton and design of POV tags. However, I think that common-sense may have suggested that the timing of such a removal was not brilliant. And so I ask that all involved parties do not edit relevant pages to this mediation (which the Circumcision page clearly is) until the resolution of this RfM. 
#
#Turning to the issue of debate and elaborating on points above. The main area of contention seems to be regarding how to apply Wikipedia's policies to this situation. Now there are several ways of looking at ways forward. Option 1: mention a possible link, but without any source. Option 2: mention a possible link and use DOC as a source. Option 3: mention a possible link, and use DOC and  Bratu's research as supporting material.
Looking at the three options it would appear none is ideal. There may well be a link but there does not at the present time appear to be a reliable source which shows that link. 
Saying that, if DOC get back to me with membership figures that represent a large number of doctors then this view may need to be revised slightly. 
I suggest that we await DOC's response, and also that we continue further discussion on the issue here. I would be interested to know on what basis you would argue that you can add the views of DOC to this article, when even they admit that warning is prospective, rather than retrospective, meaning that any evidence will be purely 'guesswork' (for want of a better word).
Also  I would welcome people's views on the suggestion of adding a link to the DOC's page under external links section, in order that people can look at all sides of the debate for themselves (without having to bear in mind Wikipedia's policies).
My next suggestion is that some of you may like to look at debating the content of Wikipedia's policies, in the relevant places, as some of you clearly seem a bit disillusioned by them. All of Wikipedia's policies are open to change and debate, indeed they may well need it. Wikipedia is run by the community and so the community have a say in its policies. If you feel that they need chaning then propose revisions to them and let the community comment on them.
Another point is that you may wish to look at this pageand try to get evidence to support a claim via that route.
Essentially we need to discuss what the best way to include a reference to a view that there is a link would be. So should it be a mention in the artilce, or link?
Two other points need to be considered, as the mediation was not only about a possible link being mentioned in the article.
Additionally the RfM mentioned:
* An RFA has been used to remove one anti-circ user already and a new one is on the way to remove another. Is this in good faith or a sign of abuse?
* In general, is there a group of people acting as a unit so as to intimidate new editors, impose their POV and own the article?
I don't really wish to discuss RfA's as I feel that the specific arbitration hearing is the place to do such a thing.
The second point, though, may be worth discussing. I think the problem boils down to how to implement Wikipedia's policies, but also do so in a manner which does not insult or offend other people. From looking at the evidence I cannot see that there is a group that seem to 'own' the article, but that there is a group that seem keen to ensure that the article is as accurate as pssible and conforms to Wikipedia policies and guidelines.
A common problem with Wikipedia is to do with its policies and not with its editors. The issue in this case may well be to do with WP:NOR. If this is indeed the case, I have said above that you may wish to look at proposing changes to that policy and awaiting the community's view.
I look forward to reading you views to the questions presented above. --Wisden17 16:36, 28 May 2006 (UTC)
thread_title:  A review of the thoughts - so far 

message: :: I've told you before that I find your description of me as a "pro-circ activist" to be not merely untrue, but incivil.  That you would repeat this baseless charge in mediation speaks volumes.  Nandesuka 21:48, 28 May 2006 (UTC)
thread_title:  Response by Nandesuka 

message: That's fascinating, but fails to address any of the issues I brought up, so it's hardly productive.  Speaking of issues, I was amused by some text recently added to Talk:Medical_analysis_of_circumcision (search for "Did we read the same article? ") by a guy calling himself User:Tzaddik.  A quick google confirmed the meaning of his nick, which pretty much told me in advance what his view was.
Anyhow, the text was trying to praise the neutrality of the article, but managed to do quite the opposite, with such unintentional humor as: "It left me a slanted conclusion... pro circumcision; which seems to be the correct one, given my understanding of the different studies and data quoted. In fact, although my mind was made up from the start, the article kept me guessing throughout the read, as to where the data would lead."  I don't know whether to laugh or cry. Al 00:34, 29 May 2006 (UTC)
thread_title:  Response by Alienus 

message: :The issues you bring up are the result of misunderstanding Wikipedia policies, or perhaps thinking that they say what you think they ought to say. Policy does not state that something may be included if at least one doctor has stated it, it requires that the statement has been made in reliable sources. If has not, it should not be included. You argue that we're not free to remove all mention, but WP:RS states: "bear in mind that edits for which no reliable references are provided may be removed by any editor."
:We cannot build a credible encyclopaedia by including anything and everything that someone, somewhere has stated on a web page. We must select the wheat from the chaff. That is our role, our decision, and contrary to your claim that it is not up to us, WP:RS actually requires us to do it. 
:The issue of credibility only comes into play (and then only minimally) when a reliable source has been provided.
:Finally, I must agree with Nandesuka. Please concentrate on the issues rather than slinging insults about. Jakew 09:55, 29 May 2006 (UTC)
thread_title:  Response by Jakew 

message: First of all, your consistent assumption of bad faith does not constitute an insult on my part.  Second, your beliefs about Wikipedia policies do not have much bearing on the truth. Third, if you have nothing to say about the matters brought up in this RfM, please do not fill up this page with irrelevancies.  I urge you to put aside your squabbling and personal attacks so that you can be productive. Al 17:49, 29 May 2006 (UTC)
thread_title:  Response by Alienus 

message: Unfortunately, Wisden, it seems that DOC's policy prevents them from giving any verifiable information about their membership:
:We do not disclose our membership list in order to protect our members from economic pressure by those in the medical community who want to preserve an entrenched but outmoded surgical procedure. We speak for those members.
I would not be opposed to including an 'external link' to DOC's hypothesis, as long as the wording is suitable (something like "statement proposing a possible link between circumcision and MRSA, from Doctors Opposing Circumcision"). However, until such time as mention is made in a reliable source, I can't see any way of including it in the article itself in a way that conforms to policy.
While I personally feel that policy is working well on the whole, I would certainly endorse your suggestion of raising objections to policy at the relevant pages. Jakew 17:53, 28 May 2006 (UTC)
thread_title:  Response by Jakew 

message: How Wikipedia policy is interpreted seems to be influenced at least in part by the desired result.
In the Breastfeeding article Jake argued that two letters written by International Board Certified Lactation Consultants published in the Journal of Human Lactation are not a reliable source.  Jake also said The Womanly Art of Breastfeeding and The Breastfeeding Answer Book published by La Leche League International are just "opinion pieces".  Two editors familiar with breastfeeding verified that The Breastfeeding Answer Book is an "authoritative reference" in the field of breastfeeding. 
Later Jake argued that Otto Verdoner's rather strange letter to the editor published in a weekly newspaper in Boulder, Colorado is a reliable source for the National Organization of Circumcision Information Resource Centers article.   -- DanBlackham 10:51, 1 June 2006 (UTC)
replies: text: Uh, yeah, I've been saying all along that the mediator is mistaken to accept Jake's interpretation of policy.  Al 16:38, 1 June 2006 (UTC)

text: I agree in that this information is irrelevant to the mediation. It does, however, shed some light on what is a major obstacle in this mediation, namely that some users constantly push their own interpretation of a policy or guideline without even discussing the issue at hand. Superdix 20:39, 1 June 2006 (UTC)
thread_title: Interpretation of policy

message: It's so simple...
CA-MRSA exists, and raises the risks of all surgical procedures.  It has reduced the frequency of elective procedures.
Informed consent now requires inclusion of infections risks, specifically MRSA, and Wiki should reflect practice.
It's easy to find research quotes (non DOC) citing general surgical MRSA risks.  The risks/complications section should also review this relatively new risk.TipPt 04:53, 6 June 2006 (UTC)
thread_title:  Circumcision is usually an "elective" procedure.