Talk:Circumcision/Archive 15

message: Here's new content for the last parts of that text, which starts out ..."Prior to 1989, the American Academy of Pediatrics had a long-standing opinion that medical indications for routine circumcision were lacking. This stance, according to the AMA, was reversed in 1989, following new evidence of reduction in risk of urinary tract infection." 
Added is the text:
They also state that incidence of UTI’s is “small (0.4%-1%)” in uncircumcised infants, and “depending on the model employed, approximately 100 to 200 circumcisions would need to be performed to prevent 1 UTI...One model of decision analysis concluded that the incidence of UTI would have to be substantially higher in uncircumcised males to justify circumcision as a preventive measure against this condition.”
And again later existing text, which states...
"The major medical societies in Britain, Canada, Australia and New Zealand do not support routine non-therapeutic infant circumcision. Major medical organizations in the United States state that parents should decide what is in their child's best interests, explicitly not recommending the procedure for medical reasons."
Added is the sentence:
Physicians in "nearly half" of neonatal circumcisions "did not discuss the potential medical risks and benefits of elective circumcision prior to delivery of the infant son.  Deferral of discussion until after birth, combined with the fact that many parents' decisions about circumcision are preconceived, contribute to the high rate of elective circumcision."  Neonatal circumcision remains the most common pediatric operation carried out in the U.S. today.TipPt 23:43, 16 July 2006 (UTC)
replies: text: The first addition completely disturbs the flow of the section, which is about the policy of the AAP, not the views of the AMA on UTIs. The second introduces original research. I'd have to evaluate the third in context, but it seems to be excessive detail. Jakew 09:13, 17 July 2006 (UTC)
thread_title:  Circumcision since 1950 changes 

message: The last sentence in the second paragraph should be:
A 2002 peer reviewed journal of the AAFP reported on research finding “participants reported significantly reduced erectile function, decreased penile sensitivity, no significant change in sexual activity, and significantly improved satisfaction after circumcision. This improved satisfaction represented a more satisfactory appearance of the penis and less pain during sexual activity.”TipPt 23:59, 16 July 2006 (UTC)
replies: text: I haven't gotten to reviewing the citations in this section yet, but if it says that, OK. However, what does it add? It just proves that there is no data that it affects one way or the other, b/c everything and the kitchen sink was agreed to in that study. It hurts performance, it enhances performance, it has nothing to do with performance, all were responses? -- Avi 01:31, 17 July 2006 (UTC)

text: It's a second-hand report of Fink's study. There's no indication that it's AAFP policy, so no reason to include it in preference to the primary source. The primary source is already cited, along with other studies, in the main article (sexual effects of circumcision), and to include it and others here would just add clutter. Jakew 09:10, 17 July 2006 (UTC)
thread_title:  Added text to "Sexual" 

message: The existing text...
A survey in 1987 found that the prominent reasons for parents choosing circumcision were "concerns about the attitudes of peers and their sons' self concept in the future," rather than medical concerns. A 1999 survey reported that reasons for circumcision included "ease of hygiene (67 percent), ease of infant circumcision compared with adult circumcision (63 percent), medical benefit (41 percent), and father circumcised (37 percent)." The authors commented that "Medical benefits were cited more frequently in this study than in past studies, although medical issues remain secondary to hygience and convenience."  
Added text as the next sentence:
They also concluded “Most parents have made a decision on circumcision before physicians discuss it, and physician discussions appear to have little impact on the decision. Ease of cleanliness is still the most common reason parents choose circumcision.” 
And existing text again...
A 2001 survey reported that "The most important reason to circumcise or not circumcise the child was health reasons."  A 2005 study suggested that increased recognition of the potential benefits may be responsible for an observed increase in the rate of neonatal circumcision in the USA between 1988 and 2000.  
Adding the text:
“However, the increase may also result in a higher incidence of surgical complications of circumcision.”
And existing ending...
In a 2001 survey, 86.6% of parents felt respected by their medical provider, and parents who did not circumcise "felt less respected by their medical provider".
That's all one paragraph.  
Please look at the methodology in the Adler  survey ... it's really horrible.  We should not quote that survey without specifying the limited context (to the selections on the multiple choice questionnaire).TipPt 00:23, 17 July 2006 (UTC)
replies: text: I'm not up to that section yet. Anything I have converted to ref format, I have looked up, tried to drill down to earlier sources, and at times, had to make some changes b/c the text and the reference did not match. Also, when we have later studies, do we really need to refer to earlier ones? I guess that once we are done, the meat-and-potatoes of this section will be moved to "History of Circumcision" and we'll just have an overview here with a  tag. When I get up to this section, I'll keep your suggestions in mind as I try and review the sources. But you shoul dknow, some of your links seem to be dead, so I reverted them for the time being. -- Avi 01:34, 17 July 2006 (UTC)

text: I must agree with this revert. Given that the findings of various studies were different, you can only quote Tiemstra's work in its own context. And once again, in adding "However, the increase may also result in a higher incidence of surgical complications of circumcision" you harm the flow of the text, which is about reasons for circumcision. Finally, as I've explained many, many times, we do not make original criticism of study methodologies. We can, however, quote criticism that others have made. Jakew 09:17, 17 July 2006 (UTC)
thread_title:  A couple more added sentences to Circ since 1950 

message: Penn and Teller did an excellent show (Bullshit) regarding circumcision.  Although they are clearly bias, could anyone that has access to the episode look into their sources?  Perhaps it would be a good addition to the article... —Preceding unsigned comment added by Sugarskane (talk • contribs) 
:I must admit that it was quite a while ago that I watched their show, but as I recall they only mentioned a couple of sources. The only one that I can identify from memory was Van Howe's discredited 'meta-analysis' of circumcision and HIV, which is mentioned in the medical analysis article. Jakew 15:18, 20 July 2006 (UTC)
thread_title:  Penn and Teller 

message: Anyone have any objection to a historical and logical re-ordering of the religions references to (1) Judaism; (2) Christianity; (3) Islam; (4) Sikhism; (5) Hinduism?Masalai 20:50, 21 July 2006 (UTC)
replies: text: I agree.  Also, "Aesthetic" and "Secular tradition" should be placed last (2.7 and 2.6, respectively) under "2 Cultures and religions."... which should become "2 Religions and Cultures."TipPt 14:17, 22 July 2006 (UTC)
thread_title: Religious implications

message: The current text implies that the uti evidence has changed parents opinions about circ's...which is misleading (we don't know if it's changed, or if so, why):
Prior to 1989, the American Academy of Pediatrics had a long-standing opinion that medical indications for routine circumcision were lacking. This stance, according to the AMA, was reversed in 1989, following new evidence of reduction in risk of urinary tract infection. A study in 1987 found that the prominent reasons for parents choosing circumcision were "concerns about the attitudes of peers and their sons' self concept in the future," rather than medical concerns. A 1999 study reported that reasons for circumcision included "ease of hygiene (67 percent), ease of infant circumcision compared with adult circumcision (63 percent), medical benefit (41 percent), and father circumcised (37 percent)." The authors commented that "Medical benefits were cited more frequently in this study than in past studies, although medical issues remain secondary to hygience and convenience." A 2001 survey reported that "The most important reason to circumcise or not circumcise the child was health reasons."A 2005 study suggested that increased recognition of the potential benefits may be responsible for an observed increase in the rate of neonatal circumcision in the USA between 1988 and 2000.
In a 2001 survey, 86.6% of parents felt respected by their medical provider, and parents who did not circumcise "felt less respected by their medical provider".
Note that the increase in the circ rate between 1988 and 2000 was mostly more blacks in the South.TipPt 14:48, 22 July 2006 (UTC)
thread_title:  Circ since 1950 

message: I trust there will be no objection to this minor editorial re-organisation. Sikhism makes rather a point of eschewing what it regards as the excesses of both Islam and Hinduism -- hence the otherwise somewhat puzzling requirement that one wear underpants. Possibly Sikhism should come between Islam and Hinduism.Masalai 22:27, 27 July 2006 (UTC)
thread_title: Re-ordering

message: Here is a 13.9% rate in 2003.TipPt 00:25, 28 July 2006 (UTC)
replies: text: Unfortunately it's just a news article. Presumably the journalist got the statistic from somewhere, but sadly no source is cited. Jakew 10:39, 28 July 2006 (UTC)
replies: text: Although this is a secondary source, isn't that still acceptable under the Reliable Source guidelines?  It's not like the National Review of Medicine is a minor publication put out by some fringe activist group, is it?  Based on my understanding of the RS guidelines, I think this is perfectly acceptable for our purposes.Zandrous 15:03, 28 July 2006 (UTC)
replies: text: My feeling is that we need to treat it as an ordinary news article, and apply the usual distrust of journalists' ability to check their facts. :) Jakew 10:00, 30 July 2006 (UTC)
replies: text: I'm not sure I understand; are you saying that this is not a reliable source?  It appears to me to be perfectly encyclopedic to cite a medical trade journal for this kind of information.Zandrous 14:46, 30 July 2006 (UTC)
thread_title:  Canada rate 

message: Needs to include this review:
The paragraph should make it clear that "medical" indications are lacking or inadequate to recommend neonatal circumcision.
Note that the "bias" is toward finding "benefits" to circumcision.
We should add this paragraph:
Daily washing with water, and washing after sex improves penile health.  According to the American Academy of Pediatrics 1975 statement "A program of education leading to continuing good personal hygiene would offer all the advantages of circumcision without the attendant surgical risk."   Studies in Denmark indirectly suggest that "good hygiene with regular washing may be just as effective at preventing the diseases treated by circumcision."TipPt 23:37, 29 July 2006 (UTC)
replies: text: The 'evidence' is mere opinion, which is inadequate to support the statement. Jakew 09:52, 30 July 2006 (UTC)
thread_title:  Medical Aspects 

message: "The best protection from UTIs comes not from cutting off a small piece of the baby's skin, but from the mother herself. Jan Winberg et al (the Lancet, March 1989) concludes that the number of UTIs in newborn males could be reduced by strict rooming in of mother and baby or by active colonization of the baby with his mother's anaerobic gut flora. In this research, UTIs in newborn males were caused by Escherichia coli, bacteria not of maternal origin; therefore, infants had no passive resistance to these pathogens.
During delivery in a natural setting, the infant acquires aerobic and anaerobic intestinal flora from the mother, together with the necessary immunoglobins to resist infections from these agents through the placenta and breastmilk. When an infant is born in a sterile hospital setting, he is carefully protected from the possible contamination caused by his mother's body fluids, and then isolated in a nursery. His first contact with the E. coli strain is from the hospital environment itself, against which the infant has no resistance.
During the first few days of the infant's life, he should be handled by the mother and other members of his immediate family as exclusively as possible, whether circumcised or intact. The mother's resistance to the pathogenic effects of her own gut flora and that of the other family members should protect the infant from early UTIs. Once the infant has established his own gut bacteria colony, this will help protect him from colonization by stray pathogens.
The baby born in a typical hospital labor setting who is then removed to the nursery is at much greater risk for UTIs from stray bacteria than the infant born at home. Circumcision is no guarantee of health; contact with the mother and her breastmilk are an infant's first and foremost protection from infections."TipPt 23:35, 29 July 2006 (UTC)
replies: text: Tip, we need to support credible sources from peer-reviewed journals. This dubious publication requests of the interested reader: "You are enthusiastically invited to write articles, make comments, tell stories, send techniques, ask questions, write letters or news items related to...". Jakew 09:56, 30 July 2006 (UTC)
thread_title:  We need to include this info: (And another reason the UTI studies are biased) 

message: I smiled reading that it is only in recent decades that unnecessary circumcision has become contraversial. Even in 1930 in the UK the rate was 35%, when there was no free medical care and it was something doctors could charge for (as in the US today). I have made a couple of corrections about the UK, and cited the most recent BMJ paper  which again re-iterates the prevailing view in the UK: 3.8% of boys are circumcised here by age 15 and that is far too many. In some regions it is below 1.5%.
:Do you have any evidence that this is the prevailing view? Jakew 12:52, 3 August 2006 (UTC)
replies: text: About four or five years ago (I can only date BMJ article by where I was living when I first read them) the BMJ invited views on it, with one invited US doctor writing in favour. There was no consensus for making unnecessary circumcision illegal (which was a significant view) but there was for effort to reduce it. I will look it up when I have some time, but the grouped articles etc are hard to put together on the online version.  --BozMo talk 13:19, 3 August 2006 (UTC)
replies: text: Actually there is a lot more recent stuff. Both the British Association of Paediatric Surgeons and the BMA cited this paper in their position documents on circumcision (the BMA's was updated June 2006) not as an opinion but as accepted fact see: [] which expresses concern in their policy statement on circumcision that unnecessary circumcisions are taking place citing only the paper. I guess a literature review would be ideal but these two organisations are collective groups of doctors who represent their members, and I see no signs at all of voices of dissent (except invited US ones). --BozMo talk 13:36, 3 August 2006 (UTC)
thread_title:  Still strong US and pro-circumcision bias 

message: BozMo, I'm reverting your recent changes to the introduction. The problems were:
Inclusion of: "By contrast, less than 4% of male children in the UK are circumcised in total, of which circumcisions about half are regarded as unnecessary. About 2% of boys in Denmark are circumcised , a level targeted by the UK."
It's not entirely clear that this belongs in the introduction. If it does, it's phrased too broadly. We can't say that less than 4% are circumcised, but we can say that Rickwood et al estimate this percentage. Nor can we say that they're regarded as unnecessary or that a lower level is targeted by the UK - these views are merely those of the authors of that paper.
:See above--BozMo talk 13:42, 3 August 2006 (UTC)
replies: text: In a scientific paper this would be correct but the other references are not treated this way, and it is not usual for Wikipedia imply the uncontested numbers in a serious paper are not reliable. --BozMo talk 13:13, 3 August 2006 (UTC)

text: On the Scandinavia report of course I went back to the paper that they cited in turn to check. It said Denmark which is why I correct this. --BozMo talk 13:09, 3 August 2006 (UTC)

text: I am relaxed about this, although the sentence did not seem source related to me (e.g. futher down the article is a full quotation from all these countries). However you also reverted the removal of the UK from the sentence justified by "Report 10 of the Council on Scientific Affairs (I-99):Neonatal Circumcision." I looked through that source (or rather word searched it) and couldn't find anything about the UK at all. Did I miss it or do you have quite a lot more cleaning up to do? --BozMo talk 13:08, 3 August 2006 (UTC)

text: In general though this article is not well researched. A lot of the problem is the assumption that everyone everywhere always circumcised and it was normal. It is hard work finding stats but I cannot find any figure for the UK which ever went above 35% (the article describes it as "routine"), and this seems to be an interwar blip. --BozMo talk 13:13, 3 August 2006 (UTC)
thread_title: Recent changes by BozMo

message: the "before-next" images should be of the same person or people of the same skin color and similar hair. not for any "racial" reason, no, only to make it better distinguisable.
:Gee, maybe we can get someone to have pictures taken, then go get circumcised, and get a new set of pictures. Care to volunteer? Fan-1967 19:44, 8 August 2006 (UTC)
thread_title:  "before-next" images 

message: So far: there are none.
45 days of homelessness, without showering, revealed absolutely no infection despite being uncircumcized. Doctor Octagon 11:39, 18 August 2006 (UTC)
replies: text: So, a sample size of one and with no controls. Good luck publishing this finding. Jakew 12:02, 18 August 2006 (UTC)

text: Doctor Octagon seems to have edits that match the pattern of a certain vandal in Philadelphia who creates a new persona and array of sockpuppets every time his current one becomes a laughingstock.  Then again, I've been wrong before. --Atari2600tim (talk • contribs) 12:33, 18 August 2006 (UTC)
thread_title:  Self-examination of medical benefits of circumcision 

message: I was just homeless for 45 days and found no ill effects on my uncircumcized penis.  Obviously, it has no medical benefit.
Doctor Octagon 18:25, 20 August 2006 (UTC)
replies: text: And your point is?? -- Avi 18:38, 20 August 2006 (UTC)

text: 45 days of being homeless certainly does not prove this issue one way or the other.  Consider allowing drug companies to only have to do their clinical drug studies on a single person for 45 days.  Your username has the word 'Doctor' in it, but it is certainly clear that you are not a medical doctor. --71.77.22.100 19:04, 20 August 2006 (UTC)
thread_title:  45 on unwashed uncircumcized