Talk:Circumcision/Archive 30

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Frenectomy in the intro paragraph

Jakew and the Cabal claim bias with inclusion. See their comments above.

I reiterate that because frenectomy in integral to circumcision ... required to complete ~25% of circs, only done along with circs, and potentially caused by circs ... the reader should have reference to the procedure in the intro. Again, it is a critical component of circumcision. See the intro that existed for years before the Cabal deleted...

Circumcision is the procedure that removes some or all of the foreskin (prepuce) from the penis. The frenulum may also be cut away at the same time, in a procedure called a frenectomy. The word "circumcision" comes from Latin circum (meaning "around") and caedere (meaning "to cut").TipPt 15:53, 23 July 2007 (UTC)

I agree. Based on my above discussion with Jakew, it is clear that a majority of the sources cited in the procedures section make reference to the frenelum as well as the foreskin. I would suggest fine tuning the above wording, perhaps by removing the word "away" since apparently the frenelum may also be cut through without being removed. Whatever the particular phrasing, I agree that the frenelum should be included in the definition of circumcision since it is clearly a part of the penis involved in the procedure. Zandrous 11:06, 24 July 2007 (UTC)

Given the discussion above, it sounds reasonable to me to include mention of the frenulum in the intro. --Coppertwig 22:20, 24 July 2007 (UTC)

It appears that there is sufficient evidence to include mention of the frenelum in the intro. Now the question becomes, do we have sufficient sources to mention frenectomy specifically, or just the frenelum as a part of the penis involved in the procedure? I could not find mention of frenectomy in the sources that TipPt provided links to in the above section entitles "Avi Reverts Away Frenectomy." TipPt, if I am missing something could you direct my attention to the mentions of frenectomy? Zandrous 12:52, 25 July 2007 (UTC)

Frenectomy has its own article, and, in my opinion, while it should be referenced somewhere in the section on methodology, it is inappropriate for the lead. -- Avi 14:38, 25 July 2007 (UTC)

I agree. However, I think mention of the frenelum belongs in the definition in the lead. Zandrous 17:08, 25 July 2007 (UTC)

This article is about circumcision in general. The frenulum is a detail that may or may not be involved. It doesn't belong in the lead. Jayjg ^(talk) 01:20, 27 July 2007 (UTC)

TipPt's continued lack of civility

For someone who “honestly apologized” for inappropriate remarks about other editors, espcially vis-a-vis use of the term “cabal,” on July 15, your further posts, Tip, are indicative of your insincerity, and perhaps duplicitousness, as can be seen from

• [1]
• [2]
• [3]
• [4]
• [5]
• [6]

-- Avi 14:46, 25 July 2007 (UTC)

Positions of National Medical Associations

I updated the positions of the national medical associations with careful citations and the updates were removed. For instance, the article incorrectly states that the Canadian Pediatric Society "does not recommend routine circumcision". That was their 2004 position. Since 2007, they recommend that routine circumcision "should not be performed". I quoted the new position and cited it and yet my update was removed. It is simply not honest to pretend that they still just do not recommend the procedure, when they now actively recommend against it. Similarly, I cited the position statements of the Royal Australasian College of Physicians and their New Zealand counterparts stating their position that routince circumcision should not be performed. These too were removed from the article. It is not honest to pretend that these organizations do not recommend against circumcision.

Edwardsville 16:09, 26 July 2007 (UTC)

First, the source you cited is dated 1996, not 2007. It notes that a revision is in progress as of May '07.

Second, your claim that "This is a significant change from earlier policy, which was simply not to recommend circumcision." was completely unsourced and violated WP:NOR.

Third, they do not state that they recommend against the procedure. They do, however, comment on the specific case of circumcision as a routine procedure: "The overall evidence of the benefits and harms of circumcision is so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns."

Finally, your "quote" from the RACP is not their recommendation but is itself a quote from a third party. Jakew 16:28, 26 July 2007 (UTC)

Yes, I cited the wrong page. Thank you for pointing out my mistake. I should have cited [7]

The claim that it is a strenghtening of the old policy is confirmed by the citation at the end of the paragraph, like everything else in the paragraph.

If you find the lack of the word "routine" misleading (and you shouldn't, since no medical association is against the prodedure when there is a medical reason) you could have just removed the word.

The correct place for the RACP quote is here. [8]

Edwardsville 16:52, 26 July 2007 (UTC)

Hey - you also removed citations showing that the American Medical Associations, and the other national medical associations in the west, say that circumcision is painful and anesthetic should be used.

Edwardsville 18:12, 26 July 2007 (UTC)

Seixas Family?!?

There is text beneath the picture on top of the article that says:

Seixas Family circumcision set and trunk, ca. eighteenth century Wooden box covered in cow hide with silver implements: silver trays, clip, pointer, silver flask, spice vessel.

Which "Seixas Family"? There is mention of some Seixas Family in this text without explaination (or helpful wikilink) about what or who this Seixas Family is. This should be fixed to avoid confusion.

Also, this picture of little wooden box looks creepy in its context. --antiXt 20:42, 26 July 2007 (UTC)

Uhm,... anybody!?! Please do not ignore - do something constructive instead of constant fighting. Both sides. --antiXt 17:56, 28 July 2007 (UTC)

Follow the image link, it is a library of congress picture. -- Avi 16:42, 31 July 2007 (UTC)

It doesn't say which "Seixas Family" is this about, so it would be good to either put an helpful wikilink or remove information (in this article) that this creepy wooden box belongs to/belonged to some "Seixas Family". And why is "Seixas Family" capitalized like that? --antiXt 13:55, 5 August 2007 (UTC)

Come on, please do something about it instead of constant fighting about petty details! --antiXt 16:42, 12 August 2007 (UTC)

I followed the image link, and did not find any useful information not already provided except that the image can also be viewed at the Library of Congress website; however, I didn't find any text page associated with it there. (I suppose there probably is, but I don't know how to find .t I tried "Search", for example.) I find that the information provided with images at Commons is usually woefully inadequate.

I suggest deleting the name "Seixas", since we don't know who they are, and beginning with just "Family ...". --Coppertwig 16:57, 12 August 2007 (UTC)

Dispute tag

The dispute tag is accurate. There's currently dispute as to whether circumcision is (always) surgery, and whether the strongest statements from medical association position statements can be quoted in the article. Also the large section on religion occurring before much (or any?) mention of any harm or risk has been pointed out as being non-neutral. Etc. --Coppertwig 22:36, 30 July 2007 (UTC)

Nevertheless, although what the dispute tag says is accurate, it was not appropriate to put it on this article at this time, at least not in the way it was done. See Template:dispute and Wikipedia:Accuracy disputes. To use the dispute tag properly, I think you have to have disputes about at least five parts of the article, and you have to state clearly what they are and have a link from the tag to a section of the talk page that lists them. The tag only had a link to the top of the talk page. There has to be a way to know whether the disputes which were the reason for the tag have been resolved. The disputes I'm aware of don't seem to me to be enough for the disputed tag, and especially not the totally-disputed tag. I apologize for having commented above without first reading the instructions for dispute tags. (There are, however, some ongoing disputes that still need to be resolved.)

When adding, removing or changing dispute tags or other tags at the top of the article, please say in the edit summary exactly what tags you're changing. The article is no longer semi-protected, so please don't put a semi-protected tag on it. --Coppertwig 17:06, 31 July 2007 (UTC)

Removed "Skin Bridge" Photo

I believe this photo was removed because it was obviously of an underaged child.71.198.175.226 22:42, 30 July 2007 (UTC)

I'm confused as to which image you mean. Does that explain this edit? [9] To reduce confusion, editors should state the reason in the edit summary. --Coppertwig 16:56, 31 July 2007 (UTC)

To clarify, the photo showing an example of the skin bridge was removed but it has since been put back up by another use. It clearly appears to be the photo of an underage male, and as far as I know this is not legal to post even in medical use. Please correct me if I am wrong.

Why would it be illegal; it is not pornographic? -- Avi 21:02, 31 July 2007 (UTC)

It's still not clarified. Someone didn't sign their post, but worse than that, they didn't specify which image they're talking about. --Coppertwig 21:23, 31 July 2007 (UTC)

Arbitration of content

The issue is content. The circumcision article is not factual in it's omission of highly pertinent facts, it's emphasis on relatively irrelevant information, and it's gross misrepresentations of fact.

I won't raise related issues again, and will have a concise list of topic problems in about a week.TipPt 19:21, 1 August 2007 (UTC)

Photos?

Any reason why the uncircumcised photo is poor-quality, dark, and features an unkempt hairy man, while the circumcised photo is well-lit and featurs a well-groomed man? Hmm... anyone care to fix this obvious bias? 65.94.108.200 17:46, 9 August 2007 (UTC)

Because wikipedia is evil and is engaged in a secret mission to emasculate all men through "circum-rays" emitted from your monitor as you innocently browse the project .

Seriously (and if you could not understand the above as tongue-in-cheek humor, Oy Vey!), those two pictures are excellent foils, because they depict the penis in almost the same exact style regarding angle towards the camera, relative image size, and, of course, flaccid vs. erect. Perhaps someone with Photoshop can brighten the uncircumcised one? -- Avi 18:06, 9 August 2007 (UTC)

There's nothing wrong with hair or with dark skin. --Coppertwig 21:46, 9 August 2007 (UTC)

Leading paragraph

1) Is cutting also not "customary" in Israel (which isn't on the list unless counted as "Muslim" or considered part of the United States; either of which POVs seem far fetched in either direction). 2) What is the "other" bit in "so it is not prescribed in other forms of Christianity." other to "some African churches you mean? Surely "is not prescribed by the major Christian denominations" makes less of a tail wagging a dog? --BozMo talk 16:48, 25 July 2007 (UTC)

Thanks for the suggestiions.Michael Glass 01:56, 26 July 2007 (UTC)

It is probably best not to try to list such countries. It may be perceived as an exhaustive list. The World Health Organization include the following (source):

...using published data from the DHS and other sources 13, 53, 54, we estimated the number of non-Muslim and non-Jewish men circumcised in countries with substantial prevalence of non-religious circumcision (Angola, Australia, Canada, Democratic Republic of Congo, Ethiopia, Ghana, Indonesia, Kenya, Madagascar, Nigeria, Philippines, the Republic of Korea, Uganda, United Kingdom, the United Republic of Tanzania, United States).

The information may also be subject to change. Another WHO document advises that Eastern and Southern African nations have elected to scale up male circumcision. Jakew 11:32, 26 July 2007 (UTC)

I approve of Reinis' edit [10] which moved the footnotes to after punctuation. I had thought it looked odd before, the way the footnote was placed right after a word, and had been intending to make a suggestion to change it if I got around to it. --Coppertwig 13:13, 13 August 2007 (UTC)

Edits and reverts

I support many of the edits that Edwardsville made today, and except for a few of them, I don't see explanations on the talk page as to why they were reverted. I hope to find time to comment in more detail later. --Coppertwig 22:56, 26 July 2007 (UTC)

Most of them are personal opinions. Jayjg ^(talk) 01:18, 27 July 2007 (UTC)

Circumcision is a painful operation and the American Medical Association, like other national medical associations in the west, state that it should only be performed with anesthesia . Doesn't sound like personal opinion.

While there is debate about whether penile sensitivity is lost, it is obvious that there is a loss of sensation from the foreskin. A case where something on which there is no debate is targetted? Verifiability over truth, I guess. We cannot verify whether a male gets sensation from his severed foreskin. Wow -- and you wonder why I make Orwellian references on this discussion page. In any case, Jayjg, maybe you could restrict your edits to what you consider opinion rather than wholesale reversion as is common here. Blackworm 09:12, 28 July 2007 (UTC)

I suggest that you contemplate, for a moment, the consequences for the article if it could include anything that is 'obvious' to at least one person. The article would be a mess of unverifiable, non-neutral, and perhaps self-contradictory nonsense. There is a very good reason why policy requires us to only include information that is explicitly stated by a reliable source. Unfortunately, the claims which you've quoted above do not come close. Jakew 11:03, 28 July 2007 (UTC)

It is not a question of "at least one person." No one I would judge to be sane would claim that the owner of the foreskin derives sensation from his severed foreskin after circumcision. The good reason behind using RS's should not allow us to take leave of our reason. This is clearly a case of WP:IAR if there ever was one: ultimately, the section is better with that sentence than without it. But there are so many better examples of totally disputed claims, incorrect and misleading summaries, POV-forks, and even a reference to something published by you, Jakew -- an active editor, in a laughably clear breach of conflict of interest. When presented with the evidence, you simply deny and revert without any logical explanation or even any denial of obvious logical contradictions. Four or five strong willed people, with two having administrative power, are enough to keep this charade going forever. Despite someone erasing the totally-disputed flag (without any consensus reached here), you can be sure this article is, in fact, totally disputed. Blackworm 08:21, 29 July 2007 (UTC)

Comments on some edits that were reverted: [11]

"Indeed, Galatians 5:2 appears to forbid the practice, though few Christian churches uphold this rule." This sounds like opinion: it might "appear" to some people to forbid it. An exact quote from Galatians might be OK (though is it sufficiently relevant for this article? Maybe in an article on circumcision and religion?) or your statement backed up by a reference to a source that gives that opinion about Galatians.

"Indeed, in Galatians 5:2, he goes so far as to say "behold, I Paul say unto you, that if ye be circumcised, Christ shall profit you nothing" . " This is verifiable. Again, I'm not sure whether it's needed. I think the whole religion section should be shorter in this article, and most stuff like this moved to an article about circumcision and religion.

"Some organizations have been formed as support groups for men who are resentful about being circumcised" (changed "upset with" to "resentful about") I support the "resentful about". It sounds more specific and accurate to me. "Upset" sounds undignified, like a general loss of control over one's feelings rather than a specific feeling about a specific thing. Alternatives include: "who wish they had not been circumcised", "who feel regretful about..." etc.

"Circumcision is a painful operation and the American Medical Association, like all western national medical associations, recommends the use of anaesthesia . Despite this, Stang, 1998, found only 45% ..." I support this edit. References are given to support the assertions. Jayjg said in an edit summary while reverting, "rv POV and/or OR edits to last by michael glass". Please support your statement that these assertions are POV. Please find references stating that circumcision is not painful. The reference given clearly states that neonates show signs of pain (reaction to noxious stimuli).

Re Taddio 1997. I'm not sure I can immediately see this study online. Could someone fix the link and/or provide a quote here on the talk page from that article to support the statement that they say the results are speculative? (I might be able to do this later.)

"While penile sensitivity may or may not be reduced by circumcision, it goes without saying that all sensation is lost from the foreskin." I support including this sentence. It's a good summary of the next couple of sentences, and is much easier to quickly understand what is being said. It's not unverifiable: it's supported by the reference(s) described in the sentences that follow it.

"As of 2007, the Canadian Pediatric Society recommends that "circumcision of newborns should not be routinely performed" . This is a significant change from earlier policy, which was simply not to recommend circumcision. " I support including this information. It's important and relevant, and supported with a reference.

". It states that circumcision "should not be routinely performed" , It recommends, " I support this edit. It's supported by a reference. It looks like an accurate representation of the position of that association. It's quite relevant to this article.

"This is also the policy of the Paediatric Society of New Zealand " Do they really have exactly the same words? Someone should check. Whether or not, the policy of this organization also deserves to be mentioned in this article.

I hope to have time to comment on some other edits later. Feel free to discuss the above. Please put your comments here: [i.e. below rather than interspersed in mine; thanks for having done that.] --Coppertwig 17:06, 28 July 2007 (UTC)

(unindenting) Let me reply in turn:

• "Indeed, Galatians 5:2 appears..." agree: opinion.
• "Indeed, in Galatians 5:2, he goes so far as to say..." -- Need to eliminate "goes so far" and "indeed", but the quote itself is not a problem.
• "Some organizations have been formed as support groups..." -- ok, agree with you.
• "Circumcision is a painful operation" -- reference does not explicitly make this claim. Furthermore, "like all western national medical associations" appears to be OR.
• Re Taddio 1997, see here. The final paragraph reads: "The post-hoc nature of our analyses and the small sample sizes make our conclusions speculative. Nevertheless, we suggest that analgesia should be routine for circumcision to avoid possible long-term effects in infant boys' pain responses." (emph added)
• "While penile sensitivity may or may not be reduced by circumcision, it goes without saying that all sensation is lost from the foreskin" -- personal opinion. It is unverifiable. It may be a verifiable fact that such an argument has been made, however.
• "As of 2007, the Canadian Pediatric Society recommends that "circumcision of newborns should not be routinely performed" -- wrong. The source cited, as noted above, is dated 1996, not 2007. It is already summarised in the text. The comment that "This is a significant change from earlier policy, which was simply not to recommend circumcision" appears to be pure original research.
• "It states that circumcision" -- as noted above, this is not the recommendation of the cited source, but is in fact a quote from a different document. Thus it severely misrepresents the source.
• "This is also the policy of the Paediatric Society of New Zealand..." The RACP policy is a policy of several sub-organisations, including the NZ society. There's no particular reason to name each of these individually. Jakew 18:57, 28 July 2007 (UTC)

Thank you very much for taking the time to reply in detail. I edited in "resentful about". More later. --Coppertwig 21:05, 28 July 2007 (UTC)

• Re Galatians 5:2, I agree that "goes so far" and "indeed" are implying a particular point of view and that the quote itself might be OK without them.
• Re pain: Here's another reference: [12]

OK, this and the other reference may not state explicitly that there is pain. They indicate that newborns undergoing circumcision have higher-pitched cries, changes in heart rate and other reactions usually associated with noxious stimuli. How about if we say something like "Newborns undergoing circumcision without anesthesia show higher-pitched cries, changes in heart rate and other reactions often associated with pain." However, please answer this question: do you doubt that circumcision is painful? Are you actually challenging the assertion that circumcision is painful, and are you not personally convinced that it is? If no one is seriously challenging the assertion, then I would prefer to keep a shorter, simpler statement such as "circumcision is a painful procedure", to avoid unnecessarily complicating the article and taking up the reader's time. I think that given these references, the statement that circumcision is painful is not likely to be challenged.

• Re the link to the Taddio article: Thanks for providing a link. I think the references section in the article needs to be fixed up a bit. We now have two articles: Taddio 1995 and Taddio 1997. The first seems to be a preliminary study and the second a similar but more complete study. For the first one, the link you provided gives the full text available without registration. I think it would be a good idea to put this in the references list for the benefit of readers who would like easy online access to the text. The second, better study apparently requires registration at The Lancet to view it. The link given in the references section goes to a page saying something like "page not found" (if you're not logged in). I think we need to fix this to go to a useful link, such as a page at The Lancet that displays at least the title of the study to people who are not logged in. Although registration is free, it takes time and requires providing personal information and agreeing to terms and conditions, which is why I think it would be useful to list both studies in the reference list.

The 1995 study says the results are "speculative". The 1997 study includes a somewhat larger sample size and is "prospective", and does not contain the word "speculative".

Here's a quote from the 1997 study. I suggest that we include these words or something very similar in the article: "Despite evidence that circumcision causes intense pain and short-term alterations in infant feeding, sleeping, and crying behaviours,1–3 analgesia is rarely given."

• Re "like all western national medical assocations": good point. I think it would be unwise to make a generalization like this in the article: it could turn out to be wrong, (it's hard to even define the list of which countries this means). Better to list the particular medical associations being referred to. Unless maybe there's a good quote from a reliable source making this claim.
• Re sensation in the foreskin: please answer: do you seriously believe that people with their foreskin removed do not necessarily lose all sensation in their foreskin? The paragraph in a version of the article you reverted was:

"While penile sensitivity may or may not be reduced by circumcision, it goes without saying that all sensation is lost from the foreskin. Boyle et al. (2002) argued that circumcision and frenectomy remove tissues with "heightened erogenous sensitivity," stating "the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings—many of which are lost to circumcision." They concluded, "Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well.""

If you're seriously challenging the statement that all sensation is lost from the foreskin, how about a statement like "the circumcised male has lost the ability to feel sensation with the part of the body that was removed." I think this is an important point, obvious once pointed out but that might not occur to a mother considering having an infant circumcised, so it's important to include it in the article. Maybe you could suggest a different wording?

• Re Canadian Paediatric Society [http:www.cps.ca] The 1996 statement says "Circumcision of newborns should not be routinely performed." The website says this statement is under revision. I agree that (without more information, anyway) we shouldn't say there's a significant change in policy.
• You're right: New Zealand is covered by the RACP. The RACP statement (Australasia) says "The CPS recommended 'Circumcision of newborns should not be routinely performed'... . ... the RACP concurs with these statements and endorses ... that 'Neonatal male circumcision has no medical indication'". I think these statements should be mentioned in the article. --Coppertwig 16:04, 29 July 2007 (UTC)
• Re pain control: The CPS statement says "The evidence of the need for pain control is strong,". The RACP statement says "Circumcision is now generally performed with local or general anaesthesia". Edwardsville, I don't see statements that anaesthesia "should" be used. If I missed them, perhaps you can supply them to support your statement. --Coppertwig 16:30, 29 July 2007 (UTC)

Jakew, please explain in more detail why you deleted this part: " and endorses statements by other medical societies that "circumcision of newborns should not be routinely performed" and that "neonatal male circumcision has no medical indication"." How is that a "mispresentation"? Rather than simply deleting it, would you please put it back in and edit it so that in your opinion it's no longer a misrepresentation? Would it be OK with you if I put into the article the following exact words from the position statement: "The CPS recommended 'Circumcision of newborns should not be routinely performed' ... the RACP concurs with these statements and endorses ... that 'Neonatal male circumcision has no medical indication'"." That's wordier than what I originally put in and I think the increased wordiness is unnecessary, but if you think it's necessary to avoid a misunderstanding it's OK with me. Do you think even more words are needed to fill in the parts where I put three dots? --Coppertwig 16:38, 29 July 2007 (UTC)

The first problem is that the source is slightly unclear: it does not specify whether they mean that they concur with the policy statements cited ("statements"), or with the specific sentences ("statements"). The second problem is that the CPS and AAP statements belong in the relevant sections, not under Australasia. The third problem is that the RACP are already quoted as saying that "there is no medical indication for routine neonatal circumcision", and we do not need to introduce repetition. A final problem is that to include quotes with which the source agrees is a poor reflection of their own policy, and appears to be an example of cherry-picking words in order to present circumcision in the most negative light possible, rather than to fairly represent the sources. Jakew 17:06, 29 July 2007 (UTC)

• Re pain, you ask "Are you actually challenging the assertion that circumcision is painful, and are you not personally convinced that it is?" My main concern is with the fact that we should not make a claim that is not explicitly stated by a source. My personal view, since you ask, is that circumcision without anaesthesia is likely painful, but that circumcision with appropriate anaesthesia is not.
• Re the Taddio study, we must always link to the text at the publisher's site in preference to CIRP. Please see Wikipedia:Convenience links#Reliability.
• Re your suggestion that "Here's a quote from the 1997 study. I suggest that we include these words or something very similar in the article", I think this is a poor idea. The purpose of that study was not to assess how frequently anaesthesia is given, so it can only be considered an opinion.
• Re sensation in the foreskin, I'm more concerned with accurate sourcing and the absence of original research than with my own view. Incidentally, our purpose is not to convince mothers to circumcise or not to circumcise, but only to summarise reliable sources. Please see WP:NOT. Jakew 16:39, 29 July 2007 (UTC)

• Thanks for your replies. Re pain: Oh, I see what you mean: we can't just say that circumcision is painful, because it isn't when anaesthesia is used. You're right about that.
• Re the Taddio studies: It's strange. The 1995 study is listed as a reference in the 1997 study, referring to it as another Lancet article, but I can't seem to find it on the Lance website. Maybe just linking to the 1997 article is fine, but at least the link should be fixed so it doesn't say something like "page not found" to people who are not logged in. I might attempt to do this later.
• Re the quote from the 1997 study: perhaps you're right.
• Re sensation in the foreskin: no comment for now.
• Note my comment above asking you to explain what you meant by "misrepresentation" -- you might have missed that due to the edit conflict. --Coppertwig 17:13, 29 July 2007 (UTC)

• Re the RACP statement. I don't see how any of that adds up to "misrepresenation". The statement with "...should not be..." seems to me to be a stronger statement than "no medical indication"; anyway they don't mean quite the same thing. Therefore I would like to see both or at least the "should not be" one included. (The "neonatal male..." one is pretty much just a repetition of "no medical indication" and not needed, as you point out.) Since they state in their position statement that they "concur" with this, I think it's quite fair to state that that is their position. As to being unclear: whether they mean that they concur with those sentences or with the whole position statement containing those sentences, either way they do concur with those sentences since they're contained in those position statements, so any such lack of clarity if present is irrelevant for our purposes here. --Coppertwig 17:50, 29 July 2007 (UTC)

That a statement appears to be more strongly against circumcision is a very poor reason for inclusion. We are not an anti-circumcision website, and we have a non-negotiable policy of neutral point of view. That means that we can't collect the most anti- (or pro-) circumcision comments in a source and present them together. Instead, we must ensure that we fairly summarise the most representative points.

I agree that they concur, and that this is part of their policy statement; however it is far from a key point and as such a rather poor choice of quote to use in summarising their statement.

Finally, the ambiguity presents us a problem. If they meant that they agree only with those sentences in the statements, then such a quote does not misrepresent them. If, however, they meant that they agree with the entire statements from the AAP and CPS, then it would misrepresent their position if we cherry-picked only certain phrases. Jakew 18:46, 29 July 2007 (UTC)

It doesn't misrepresent their position to quote the very sentences they chose to quote when they were saying that they concurred. The strongest sentences are the most interesting. If they have a strongest pro-circumcision sentence perhaps we should quote it too. --Coppertwig 19:11, 29 July 2007 (UTC)

I can only suggest that you write an essay on the subject of 'interesting quotations about circumcision'. The article, however, is part of an NPOV encyclopaedia. Hence, the priority is to present sources in a fair and representative manner. Jakew 10:13, 31 July 2007 (UTC)

(<<<outdent) The strongest sentences in a position statement are the most representative of that position statement. --Coppertwig 17:08, 31 July 2007 (UTC)

What's your basis for making such an assertion? Jakew 18:02, 31 July 2007 (UTC)

Please give your opinion about how to select the most representative statement(s) from a position statement, if you don't agree with mine. --Coppertwig 21:32, 31 July 2007 (UTC)

I acknowledge that it is a hard problem. In general, I would say that 1) such statements are to be found in the organisation's own 'conclusions/summary/overview/recommendations' section, 2) that they should be their own words, rather than a third-party quote, 3) that they should be relatively self-contained and qualifiers should not be excluded, and 4) that they should cover the policy regarding both routine and elective (including religious) circumcisions. That's not an exhaustive list, but it is at least a start.

I should note that, in the footnotes, we have fairly complete quotations from the organisations already. Jakew 10:35, 1 August 2007 (UTC)

I'm impressed, really. You've managed to find an objective way to choose one sentence rather than another from a position statement -- though I wouldn't necessarily want to be restricted always to the summaries of things. I guess when the position statement has something in bold type, that's sort-of a clue, too. --Coppertwig 01:31, 2 August 2007 (UTC)

There is no valid reason for "4) that they should cover the policy regarding both routine and elective (including religious) circumcisions" unless you insist that the strong societal stigma against saying anything negative against religious circumcision carry over into watered-down, non-medical, PR statements about all circumcision. Statements about circumcision which are freed from the stigma of offending those who circumcise for religious reasons, are the most fair, balanced, and in a medical context, accurate statements. That's why we don't have any in the article (Jakew reverts them). And by the way "routine" circumcision *is* "elective." Blackworm 20:32, 4 August 2007 (UTC)

I mean that their policies regarding both routine circumcision and elective circumcision should be included, Blackworm. If, for example, the AAP were to release a statement in which they stated that no circumcisions should be performed for any reasons, then that could certainly be included. As it stands, however, few (if any) major medical organisations are opposed to elective circumcision.

As for elective vs routine, I am using routine to mean "for all infant boys" and elective to mean the parents choosing/electing the procedure, as in:

• "Scientific studies show some medical benefits of circumcision. However, these benefits are not sufficient for the American Academy of Pediatrics (AAP) to recommend that all infant boys be circumcised. Parents may want their sons circumcised for religious, social and cultural reasons. Since circumcision is not essential to a child’s health, parents should choose what is best for their child by looking at the benefits and risks." [13]
• "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child."[14]

Hope that helps. Jakew 20:48, 4 August 2007 (UTC)

The word you are looking for to describe "for all infant boys" is "universal," not "routine." No one is discussing universal circumcision. Routine infant circumcision is a reality today. Circumcision happens routinely. Elective circumcision essentially means "circumcision not performed for a health reason, but at the request of the parents," which is exactly why most (if not all) medical associations "do not recommend" elective circumcision. Your response is confused and illogical. Blackworm 06:03, 6 August 2007 (UTC)

Perhaps you need to read through the above two quotations more carefully, Blackworm. Jakew 10:12, 6 August 2007 (UTC)

Perhaps you should read Blackworm's comments and the quotations more carefully, Jakew.

Edwardsville 12:19, 12 August 2007 (UTC)

Definition of "vandalism"

In Jayjg's most recent edit, in which his edit description reads: "cleaning up the rest of some old vandalism," the following content is removed:

", though it is not prescribed by the major Christian denominations. It is not requirement of the other great world religions."

Wikipedia's official policy on vandalism states: "Apparent bad-faith edits that do not make their bad-faith nature inarguably explicit are not considered vandalism at Wikipedia."

Since none of the other definitions of vandalism in the policy seem to match this deleted material, then Jayjg, could you support your apparent claim that this material is both in bad faith, and that its "bad-faith nature" is "inarguably explicit? Blackworm 09:03, 2 August 2007 (UTC)

Good point. Please use accurate, useful edit summaries, everyone. I await Jayjg's response. --Coppertwig 12:59, 2 August 2007 (UTC)

Is this going to be resolved? I'm still waiting to hear the response.

Edwardsville 12:21, 12 August 2007 (UTC)

Yes -- Coppertwig, why do you no longer await Jayjg's response? I do too. I hope that as a Wikipedia administrator, Jayjg at least addresses his apparent mischaracterization of an edit, which comes dangerous close to his (again) violating WP:AGF? He has said in the past that he is right in violating that particular guideline at his will; perhaps that is still his firm stance. Then again, a simple "sorry, I just think everything negative against circumcision is vandalism, I won't do it again" would have done nicely and closed this issue. Blackworm 08:18, 6 September 2007 (UTC)

Pain

(The subject now seems to have changed from article length. In order to facilitate discussion of both subjects, I'm therefore creating a new section for the following. Other than changing the indentation I'm not making any changes to the text, which was formerly a part of "Article too long?". Jakew 10:48, 5 August 2007 (UTC))

I guess at this point I'm wondering what purpose this entire discussion page serves, when the boldest editors simply edit and revert to their liking, and make horrible, illogical arguments as to why such edits/reverts should remain in place. Eventually, when a topic has been "debated" enough, they ignore the discussion which by then passes into "Archive xx" and is lost forever (i.e. ignored). The net effect is, the article stays wildly biased. It's August 2007 and Jakew, you are arguing against inclusion of the phrase "circumcision is a painful procedure" when it is found verbatim is several of the exact same references you use to make pro-circumcision claims. I know you've read them, you know you've read them, so why not help the article by fixing the reference instead of reverting the claim? Your user page gives us the answer: your goal is not to improve the article, but to eliminate anti-circumcision POV from the article. When you add three or four others who seem to have the same goal, two of whom being administrators making threats exclusively against those who seem to want to include anti-circ material or exclude pro-circ material, while policy breaks by others go ignored, then you don't have a working, dynamic, growing article, you have what we have here -- a farce. I realize I'm "not contributing," but as far as this article is concerned I think whether you're seen as "helping" or "hurting" just depends on which side of the circumcision debate you are on. (And yes, there is a debate, it's not just "anti-circumcision zealotry" like our administrator Jayjg claims.) Again, show me once that you are willing to end this charade and *really* practice what you preach, and I'll be right there working as hard as I can to help. But continue to oppose or support all edits based on their content, while claiming it's based on policy or guideline and making weak arguments that don't support your claim, and I will continue to see this for the game it currently is. Blackworm 20:53, 4 August 2007 (UTC)

Blackworm: Will you please list the references that say "circumcision is a painful procedure" (and perhaps give the page number and where on the page they say it)? I was looking for references like that. --Coppertwig 00:04, 5 August 2007 (UTC)

• "Newborns experience pain during circumcision." Circumcision: Position Paper on Neonatal Circumcision. American Academy of Family Physicians (2007). http://www.aafp.org/online/en/home/clinical/clinicalrecs/circumcision.html
• "Circumcision is a painful operation." http://cks.library.nhs.uk/patient_information_leaflet/circumcision
• "ASPMN recognizes that neonatal circumcision is a painful procedure." ASPMN Position Statement on Neonatal Circumcision Pain Relief http://www.aspmn.org/pdfs/Pediatric%20Circumcision.pdf
• "Neonatal circumcision is a painful surgical procedure often performed without analgesia." New England Journal of Medicine Volume 336:1197-1201, April 24, 1997, Number 17 -- Efficacy and Safety of Lidocaine–Prilocaine Cream for Pain during Circumcision, http://content.nejm.org/cgi/content/abstract/336/17/1197

It's true, it's verifiable, and gosh darn it, it will never find its way into the Wikipedia article on circumcision except presented as speculation, conjecture, something to be ignored, from a few of the anti-circumcision zealots, like the crazy so-called "New England Journal of Medicine," or those kooks over at the "American Academy of Family Physicians," which is really just a front for a bunch of anti-Semites. Blackworm 05:52, 5 August 2007 (UTC)

You forgot the official policy statement of the American Academy of Pediatrics, which states “there is considerable evidence that newborns who are circumcised without analgesia experience pain and psychological stress”. "Circumcision Policy Statement", Pediatrics, Volume 103, Number 3, Pages 686-693, March 1, 1999. I put that citation in the article. Naturally, it was immediately removed. This article is indeed a joke. The positions and conclusions of the world's major medical organizations are ignored and are consistently removed when it doesn't support circumcision, while individuals who are in favor of circumcision get quoted. Oh, of course, the AAP gets quoted when people like what it says - but as soon as it says that circumcision is painful, it gets ignored. Edwardsville 18:43, 5 August 2007 (UTC)

The policy section already contains the words "Analgesia is safe and effective in reducing the procedural pain associated with circumcision; therefore, if a decision for circumcision is made, procedural analgesia should be provided." Jakew 19:09, 5 August 2007 (UTC)

Oh, and I note yet again that all reference has been removed to the joint policy statement of the Paediatrics & Child Health Division of The Royal Australasian College of Physicians, the Australasian Association of Paediatric Surgeons, the New Zealand Society of Paediatric Surgeons, the Urological Society of Australasia, the Royal Australasian College of Surgeons, Paediatric Society of New Zealand. In this statement, they clearly say that "circumcision of newborns ought not to be routinely performed". The quote is cited directly to the home page of the Royal Australasian College of Physicians (http://www.racp.edu.au/download.cfm?DownloadFile=A453CFA1-2A57-5487-DF36DF59A1BAF527), yet it immediately vanishes as soon as it appears. Edwardsville 18:51, 5 August 2007 (UTC)

I'm afraid you're incorrect. This RACP document is referenced in several places in the article, and is discussed in the section Circumcision#Australasia. It does not contain the phrase you quote above, but it does contain the phrase 'The CPS recommended "Circumcision of newborns should not be routinely performed"'. Note that this quote is not their own policy, but is attributed to another organisation. It is misleading to claim otherwise. Also, it is a single statement, and it should not be misrepresented as two separate statements. Jakew 19:09, 5 August 2007 (UTC)

Nonsense. It says clearly that it is their own position, agreeing with the other groups. It says:

The CPS recommended "Circumcision of newborns should not be routinely performed" (reaffirmed February 2001: (www.cps.ca/english//statements/FN) and the AAP concluded "we can not recommend a policy of routine newborn circumcision". (www.aap.org/mrt/factscir.htm). Following the present review of the evidence, the RACP concurs with these statements.

Please note that it is not just the RACP, because this is the joint policy of all the groups I mentioned above. I provided the link and anyone who follows it can see perfeclty what is written there. http://www.racp.edu.au/download.cfm?DownloadFile=A453CFA1-2A57-5487-DF36DF59A1BAF527 Follow it and read it again

Edwardsville 19:40, 5 August 2007 (UTC)

Oh, and while we are at it, I notice that the two links to anti-circumcision groups that I provided in the "opposition" section were taken out. Do you disagree that these groups oppose circumcision?

And while you are here, are you going to stop removing quotes from national medical associations stating that circumcision is painful?

Edwardsville 19:40, 5 August 2007 (UTC)

Hey, here's another quote from the American Medical Association that I put in and that got taken out again. It was in the section on the policy statements of medical organizations and was cited directly to the AMA's website. The American Medical Association states that "virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice."

Now why was that taken out of the article? Because it isn't relevant to a section on the policies of major medical organizations regarding circumcision? Because it isn't an important fact? Because the American Medical Association isn't a sufficiently important authority?

Edwardsville 20:52, 5 August 2007 (UTC)

Thank you very much for providing those references, Blackworm and Edwardsville. I think I understand a point that I think Jakew was making earlier: that it would be misleading to say something like "circumcision is painful" because of course, when it's performed with anesthetic, it might not be. Therefore I think rather than saying "circumcision is painful" or words to that effect, that we say something along the lines of "circumcision without anesthetic is painful." (I think we don't know whether it's painful (always or sometimes or never) when anesthetic is used. I think at least sometimes there's still some pain. (This is not a proposal to say that so in the article.)) Therefore I think the quote Edwardsville gave above is a good one.

Jakew also made the point that it already says "Analgesia is safe and effective in reducing the procedural pain associated with circumcision; therefore, if a decision for circumcision is made, procedural analgesia should be provided." I would like to reply here that this is not at all the same thing. This quote does not state that there is pain. This quote strongly implies that there is pain at least sometimes; i.e. it does not rule out the possibility that some circumcisions without anesthetic are painless. The other quotes state that there is pain (something that is merely implied here) and strongly imply that there is pain in every such procedure if anesthetic is not used (something that is not even implied by the quote Jakew mentions). Therefore I think we do need to say something along the lines that "circumcision is painful...". I think it would be OK to take one of the other quotes and insert, inside square brackets, something like "when performed without anesthetic", since that is obviously (to me) what is meant. But, as I say, I propose adding the quote Edwardsville gave above (i.e. the AAP quote, "there is considerable evidence that newborns who are circumcised without analgesia experience pain and psychological stress".) --Coppertwig 22:00, 6 August 2007 (UTC)

I don't see the harm in including the "there is considerable evidence" quote in the 'pain' section (if it isn't already - I haven't checked), but I don't think it would be appropriate to include it in the main policies section. Firstly, as I've noted, we already have a quote referring to pain & pain management, and while you (correctly) note that it doesn't discuss exactly the same issue, one seems enough. Secondly, of the two quotes, the "Analgesia is safe and effective" quote is arguably more 'policy-ish' (pardon my lousy English) than the other, since it explicitly states what should be done.

Regarding pain, Lagarde et al (Acceptability of male circumcision as a tool for preventing HIV infection in a highly infected community in South Africa. AIDS, 17(1), 89–95) reported on traditional circumcision procedures in South Africa. 42.6% described the traditional procedure as "very painful", 34.4% as "mildly painful", and 18.5% as "not painful". There are also other studies, in which local anaesthetic was used, in which participants described the procedure as "painless". Clearly, then, we cannot make a blanket statement that circumcision is painful. More cautious wording is warranted. Jakew 22:30, 6 August 2007 (UTC)

I see what you mean about "policy-ish". I put the "there is considerable evidence..." quote into the Pain section, and rearranged things a bit so it would flow smoothly. --Coppertwig 01:07, 7 August 2007 (UTC)

Edwardsville, the AAP quote says "physiologic", not "physiological" as you quote them above. Please be careful when you use quotation marks. Thanks for finding the quote, though! --Coppertwig 01:19, 7 August 2007 (UTC)

If the reliable source says "circumcision is painful" that is good enough to warrant inclusion. It is not our job to decide that they are wrong because of our own thoughts and feelings about the matter. To do so would be original research. I notice Jakew has not argued my point about this directly -- he has done exactly what I said he would. Obfuscate, deny, stall, "discuss." The sources say "circumcision is painful." It will not be allowed into the article because it casts circumcision in a negative light. It's plain and simple for everyone to see. Blackworm 03:09, 7 August 2007 (UTC)

A more accurate summary would be that some reliable sources describe circumcision as painful, while others do not. You are correct in noting that it is not our job to decide that they are wrong; however it is our job to summarise and present them in a way that conforms to WP:NPOV and WP:V. Jakew 09:55, 7 August 2007 (UTC)

I disagree. If we have a consensus here that something is false, I believe we should leave it out of the article. WP:V does not require including everything that normally-reliable sources say. We need to use our judgement as to what is interesting and important. Things that are false are less likely to be important to report in this type of article. --Coppertwig 00:59, 8 August 2007 (UTC)

But, it is not false. It is true. And it is in enough reliable sources that it should be stated as fact. Unlike what Jakew is implying, NO reliable sources say circumcision is not painful. NONE. This isn't a debate, anywhere except here, where anything casting circumcision in a negative light is "wrong" and to be omitted. Blackworm 01:32, 8 August 2007 (UTC)

Here are a few of these 'non-existent' sources...

• Kirya C, Werthmann MW Jr. Neonatal circumcision and penile dorsal nerve block--a painless procedure. J Pediatr 1978 Jun;92(6):998-1000.
• Poma PA. Painless neonatal circumcision. Int J Gynaecol Obstet 1980;18(4):308-9.
• "Since circumcision can now be done under local anesthesia, the newborn infant can have a painless prophylactic operation that will prevent urinary tract infections, pyelonephritis, and end-stage renal disease." Roberts JA. Neonatal circumcision: an end to the controversy? South Med J 1996 Feb;89(2):167-71.
• "A "sugar tit" consisting of a small amount of sugar wrapped in gauze and soaked in wine is given to the infant to suck upon before the actual procedure. This mild sedative is often so effective that the prepuce excision is painless, and no harm has ever been caused by using this form of sedation." Weiss GN. Neonatal circumcision. Southern Medical Journal 1985: 78(10)
• "[circumcision] patients in group 2 were practically pain-free" Stav A, et al. Modification of the penile block. World J Urol 1995 ;13 (4):251-3
• "We strongly recommend subcutaneous ring block technique using lidocaine (1%) for children below one year of age undergoing circumcision. It is a fast, easy and painless procedure with no significant complications." Ahmed A, et al. Circumcision in Infants and Neonates with or without Local Anesthesia. Kuwait Medical Journal 2004: 36(4); 275-7
• "In infants under the age of 7 months, 99.0% fed immediately, 96.0% settled rapidly and remained settled, 96.5% had no disturbance of sleep pattern, 92.5% had little or no pain and 96.0% had no pain or difficulty when urinating. None required stronger analgesia than paracetamol. ... CONCLUSION: EMLA anaesthetic cream, properly applied, is a safe and effective method of anaesthesia for circumcision of neonates to 7 months of age. It reduces or eliminates pain, restlessness, agitation and interference with parent bonding." Russell CT, Chaseling J. Topical anaesthesia in neonatal circumcision: a study of 208 consecutive cases. Aust Fam Physician 1996 Jan;Suppl 1:S30-4.

Jakew 13:45, 8 August 2007 (UTC)

None of those sources say circumcision is not painful. To you, a truism like "getting your eyes gouged out is painful" is debatable because it's not true if you're unconscious (from anaesthesia or otherwise). It's a ridiculous line of argument. The correct and balanced way to proceed is as follows: Say, without qualifier, that circumcision is painful. Then, include information that shows that anaestheic can be effective in reducing pain. Then, note clearly that most neonatal circumcision in the West (and practically all elsewhere) still takes place with no anaesthetic. The problem is, the reality is horrifying to most people, just like a video would be, or balanced, objective information would be. I can totally understand why you wish to keep this information muddled, ambiguous, and confusing, given your admitted quest to rid the article of any anti-circumcision POV and defend the article from "the onslaught from anti-circumcision activists" (the quote you proudly display on your user page). Blackworm 01:37, 9 August 2007 (UTC)

Blackworm, what exactly are you claiming to be true? The trouble is, the statement "circumcision is painful" is ambiguous. It could mean that some circumcisions without anesthetic are painful. It could mean that all circumcisions without anesthetic are painful. Or, it could mean that all circumcisions are painful, even if anesthetic is used. Maybe some of these interpretations are true and some are not. To move this discussion forward, we need to be clear about precisely what we're claiming. I think it would be misleading to put "circumcision is painful" in the article because as far as I know, a major interpretation of that (that all circumcisions are painful, even with anesthetic) is not true. However, something about circumcision being painful should appear in the article. We just need to figure out how to word it. --Coppertwig 21:35, 8 August 2007 (UTC)

The burden is to show verifiability, not truth. That burden has been met. I could further argue the truth, but it is irrelevant to Wikipedia. Circumcision is painful. True. Anaesthetic tends to reduce the pain. True. Most circumcision is performed without anaesthetic. True. You'll only ever see the second "truth" mentioned in this article. Blackworm 01:37, 9 August 2007 (UTC)

Verifiability is merely a condition of inclusion in an article; it's not a ticket conveying a right to inclusion. I agree with you that truth is not obsolete but deserves to be talked about. I'm not convinced that you're able to predict the future. Is "circumcision is painful" the only wording you're willing to suggest on this topic? When you claim that it's "true", which meanings do you mean? --Coppertwig 01:55, 9 August 2007 (UTC)

"Circumcision is painful" sounds perfectly clear to me. If people would rather say that circumcision without anesthesia is painful, that may be alright, but only if we have direct research showing that there is no pain after the operation. My understanding is that there is pain after the operation and that adults feel pain and use pain relief. There is problem with the article as it stands, though, in that only the AAP quote is being cited. Scientific opinion is very clear that circumcision withouth anesthesia is painful (some other cited quotes to support that have been listed above, but they are only the tip of the iceberg). As far as I know, there isn't any doctor's group that disputed it, whereas they all seem to talk about the importance of pain relief during circumcision.

146.163.162.184 17:51, 9 August 2007 (UTC)

Also, I must agree with Blackworm that the article must stress that most circumcision is performed without anesthesia, despite the fact that doing so causes pain to the infant.

146.163.162.184 17:52, 9 August 2007 (UTC)

I see the problem. We can't say "circumcision is painful" because that would imply that it's always painful, which it probably isn't in at least some cases with anesthetic. We can't say "circumcision can be painful" because that would imply that it's only occasionally painful even with no anesthetic. We can't say "circumcision without anesthetic is painful", because that would imply that all circumcision with anesthetic is painfree, which it probably isn't. It's really not easy to find the right words.

How about something along these lines (immediately before the current beginning of the first paragraph of the Pain section): Several medical associations and scientific articles have stated that circumcision is painful. Other scientific articles point out that circumcision can be painfree if certain types of anesthetic are used. --Coppertwig 21:56, 9 August 2007 (UTC)

Could someone please explain what is the problem with the AAP quote already present in the article: "There is considerable evidence that newborns who are circumcised without analgesia experience pain and psychologic stress." Jakew 22:02, 9 August 2007 (UTC)

It would be OK with me if it were presented as true, i.e. if the article itself said "there is considerable evidence..." etc., rather than "the AAP says that...". The way it's presented now, it gives the impression that the AAP may be the only people who believe that circumcision is painful; I agree with 146.163.162.184 that something more needs to be said; i.e. the article needs to accurately reflect the fact that there are numerous reliable sources stating that circumcision is painful. There are several ways to do that, but only saying "the AAP says..." and nothing else doesn't convey it.

Here's another idea. How about The American Academy of Pediatrics, among other medical associations and scientific reports, point to evidence that circumcision without anesthetic is painful... or something. It's a bit tricky to get the wording right because they don't all use the same words. --Coppertwig 22:25, 9 August 2007 (UTC)

I agree that it should be made clear that this isn't just the AAP's position, since this is the position of every respectable body that has made a statement on the issue. "Point to evidence" is too weak, because it doesn't mention the strength of the evidence. It suggests that the AAP might just be concerned about the possibility, rather than having concluded that there is good reason to conclude that the operation is painful. I suggest that the issue is important enough (most circumcision is done without anesthesia!) that a list of quotes be presented from the major medical oranizations. Failing that, there should at least be the statement that circumcision is painful followed by a stack of citations to different medical organizations.

Edwardsville 12:27, 12 August 2007 (UTC)

Your first suggestion would be a clear case of soapboxing a point. Your second would be a violation of WP:NPOV, since there are reliable sources describing circumcision as painless. Jakew 12:53, 12 August 2007 (UTC)

Why would Edwardsville's first suggestion be soapboxing a point? It doesn't look like it to me. What are the reliable sources describing circumcision as painless? As far as I know, all the big medical organizations say that it is painful. I don't even know of any experiments that found otherwise.

Just David 17:16, 14 August 2007 (UTC)

My first suggestion would not be soapboxing a point. It would be presenting the reader with the facts about what medical science has to say on this issue. The major medical organizations of the world are not neutral on the topic of whether circumcision is painful and it would be misleading for the article to suggest otherwise. As to the authorities Jawew talks about who say that circumcision is painless, just who are these authorities, what are the experiments they performed, and what are the citations to the articles they published? Do any medical bodies accept their views?

The citations you give above are all useless, since they deal with whether circumcision under anesthesia is painful, and anything done with sufficient anesthesia is not painful. If you want the article to read "circumcision without anesthesia is painful" instead of "circumcision is painful", that would be acceptable.

Edwardsville 13:15, 15 August 2007 (UTC)

I think I've found a better wording of a sentence I'd proposed earlier. I suggest adding this to the end of the first paragraph of the pain section: Other medical associations also mention evidence that circumcision without anesthetic is painful. <ref name="AAFP"/> <ref name="CPSIFP2"/> . (The references are to the American Academy of Family Physicians position paper and to the Canadian Paediatric Society 2004 advice to parents.) --Coppertwig 22:47, 16 August 2007 (UTC)

"Mention evidence" is not strong enough. It is compatible with the organizations in question mentioning just as much evidence, of just as great a strength, for circumcision being painless (or even more such evidence on the other side). In fact, I am not aware of any of these organizations refering to any evidence that circumcision is painless, whereas they say a great deal about evidence that it is painful and recommend that anesthesia be used. Statements and recommendations from the organizations in question would be appropriate.

Just David 17:29, 17 August 2007 (UTC)

How about we replace the word "mention" with the word "point to" with some citations? "Point to" makes it clear that they are treating this evidence as significant, not just one piece of evidence among others.

Edwardsville 13:56, 21 August 2007 (UTC)

I put in the sentence, with "point to".

Here I'm collecting quotes from medical associations recommending use of anesthetic:

• "If a decision for circumcision is made, procedural analgesia should be provided." (American Academy of Pediatrics 1999 position statement. )
• "Your baby will need a local anesthetic (dorsal penile nerve block or subpubic block technique),..." (Canadian Paediatric Society information for parents )
• "As with all medical procedures, doctors must act in accordance with good clinical practice and provide adequate pain control and aftercare." (British Medical Association guidance for doctors )

Re the paragraph with quotes from Glass, Tannenbaum and Shechet: this paragraph should be shortened a lot, because the sources are merely expressing opinions; they should not have as much space/weight in the article as they do in comparison to the other material which is from published results of scientific studies and position statements of medical associations. We have many sources stating that circumcision is painful and several calling circumcision with anesthetic painfree, but only those two sources calling circumcision without anesthetic painfree and they're not scientific studies. The material about circumcision without anesthetic being painfree should be reduced to about half a sentence in my opinion. --Coppertwig 22:41, 21 August 2007 (UTC)

Perhaps rather than "mention" or "point to", the verb "cite" would be more neutral. --Coppertwig 16:48, 22 August 2007 (UTC)

Completely agree: much better. Jakew 16:52, 22 August 2007 (UTC)

Problematic edits

Once again, certain problematic edits have been made to the article (eg. [15]).

There are countless problems with them, including:

1. Dramatic changes (restructuring) of the policies section with neither explanation or consensus.
2. Cherry-picking of the most negative quotations, rather than the most representative. As WP:NPOV cautions: "In these types of disputes, it is important to note that verifiability lives alongside neutrality, it does not override it. A matter that is both verifiable and supported by reliable sources might nonetheless be proposed to make a point or cited selectively"
3. Misrepresentation of sources (for example, still attributing "circumcision of newborns should not be routinely performed" to the RACP, in spite of the fact that this was a quote from a third party). I've already explained this problem above; there is a distinction between Bob quoting Alice as saying X and Bob himself saying X.
4. Misleading repetition: the edits includes the same policy (RACP) under two different sections, creating the misleading impression that these are two different statements.
5. Inclusion of the American Cancer Society text. The same quotes (albeit a fuller, more representative version of the first) are included elsewhere in the article - they should only be included once. Since the ACS identifies itself as a volunteer organisation, and is not itself a professional medical body, it is inappropriate for inclusion in this section.

Jakew 12:29, 6 August 2007 (UTC)

1. Consensus doesn't mean that you agree. Check out some of the opinions that people have been posting about your edits. Your personal opinions do not override those of the American Medical Association, the American Academy of Pediatrics and so forth.

2. If you think the most negative quotations have been cherry-picked, stick in some positive ones that you find for balance. So far, the article has ignored and misrepresented the opinions of the major medical organizations. But if you think you can balance things, post away. It is not my habit to remove something from the article just because I disagree with it, so your comments will be safe Just make sure that you cite your sources carefully. It is about time that we paid attention to what they are actually saying, not what people wish were being said.

By the way, it is ludicrous to suggest that it is cherry-picking to point out, as the article did not before, such things as that the American Medical Association states that "virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice" or that the American Medical Association and American Pediatric Society say that circumcision is painful. Not including these facts is simply biased. It is pretending that medical opinion is something other than what it is.

3. Read that RACP policy statement. It very clearly states, and I very clearly quoted, that the RACP policy agrees with the quoted policy of the Canadian Paediatric Society. They say "here is what the Canadian Paediatric Society said and we agree with that". For goodness sake, read the policy statement.

4. It doesn't say that they are two different statements because it gives the same attribution. The policy is relevant to both sections.

5. If the opinion of the American Cancer Society, which is run by doctors, is not relevant, then the opinions of no researcher on the subject of cancer is relevant to the article. But hey, if you want to make a truthful and well-cited comment about the ACS after the quote from them, go right ahead. This article is supposed to be about the truth after all.

Edwardsville 19:14, 6 August 2007 (UTC)

1. WP:CONSENSUS does not mean that I, specifically, agree, but it does imply (loosely speaking) that most editors (of which I am one) do. Neither the AMA nor the AAP have attempted to edit Wikipedia, as far as I know, and unless and until they do, it is pointless to speculate about what they would want to do with this article.
2. In terms of the 'policies' section, the article already represents a fair and balanced selection of quotations, with fuller quotations in footnotes, in accordance with consensus at a former AfD. The attempt to imbalance is itself a problem, and a summary is often made worse, not better, by adding text.
3. I have read the RACP article, as should be quite obvious from the fact that I not only corrected your misquote, but observed the fact that you incorrectly attributed these words to the wrong source. Hypothetically, I might agree with, say, your point 5 above, but it would be completely erroneous to claim that I had stated those words myself. Even if this misattribution were fixed, there is still a problem remaining: given that we obviously cannot quote the entire policy statement, we must select the most represent parts, and a quote from a third party with which the source happens to agree is a very poor choice. It contributes to the distinct impression of cherry-picking anti-circumcision quotes from the documents, rather than taking representative quotes.
4. Quoting the same policy statement under two different sections gives a very strong (and misleading) impression that they are two different statements. There is absolutely no need to do so, moreover, since the statement was cited, perfectly adequately, under 'Australasia' - a term that includes both Australia and New Zealand.
5. What evidence do you have that the ACS is 'run by doctors', as you claim? Furthermore, please note that I have not objected to citing the ACS in the cancer section, only to duplicating the content and representing it as a medical association policy statement. Jakew 19:35, 6 August 2007 (UTC)

Edwardsville, re your edit that Jakew cites at the beginning of this section: Please don't make any extensive changes to the article, or any changes however small which include matters that have recently been under discussion here, without first quoting your proposed changes here, discussing and reaching consensus. Please don't make changes that move whole paragraphs unless that is the only change you make in that one edit and you use a word like "moving" in the edit summary to explain what you're doing (otherwise at first glance in the diff link it looks as if you've added or removed large parts of the article; see the diff link Jakew gives above.) You can make other edits immediately before or afterwards if it's OK to make such edits for other reasons. (Maybe you weren't moving paragraphs and it's just the way the diff link is that makes it look that way. I can't figure out what's going on in that diff link -- too many changes. Maybe you could just make fewer changes per edit to help make things easier.)

I agree with Jakew that the statement "circumcision of newborns should not be routinely performed" should not be presented as if the RACP said it. Note also that this statement, and the RACP's agreement with it, already appear under Canada in the policy section; it would be too repetitive to say it again elsewhere in the article. I didn't see the wording Edwardsville used. Here's an idea: in the Australasian section, very briefly point out that they concur with a Canadian statement and refer the reader to the Canadian section, without repeating the statement itself.

Edwardsville, you said: ' They say "here is what the Canadian Paediatric Society said and we agree with that". ' I feel that it's very important, especially in a discussion of this nature, that when you say "they say" and then use quotation marks, that you give only the exact, unedited words -- which is not at all what you've done here, I believe. --Coppertwig 21:45, 6 August 2007 (UTC)

Coppertwig, the RACP say very clearly in their position statement that they endorse the following statement "circumcision of newborns should not be routinely performed". Thus, I say in their article that their policy is "circumcision of newborns should not be routinely performed" and I give the appropraite citation. If you state "X is true" you have stated "X".

Regarding moving the paragraphs around, the countries were listed out of alphabetical order.

Edwardsville 02:53, 7 August 2007 (UTC)

Jakew,

1. It is not pointless to speculate what the national medical organizations would want in this article. They would want their conclusions and recommendations stated in this article. The old article misrepresented these.

2. The policies article did not include a fair and balanced selection of quoations. It contained gross misrepresentation by leaving out key parts of the policies of national medical organizations, in particular, key parts of their conclusions and recommendations regarding circumcision. You have been removing the statement by the AMA that "virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice." . Is that really not an extremely important piece of information for the section on the policy statements of medical organization? Or is the AMA not an authority worth quoting in this article? Why are you so keen that it be left out? Similarly, the article did not even mention the medical associations who hold that routine circumcision should not be performed, even when giving the policies of those organizations. Isn't it relevent when discussing their policy on circumcision to mention that they say it should not be routinely performed. This is not remotely balanced.

3. No, it is not obvious that you read the article, because you seem to have missed that the RACP was endorsing the Canadian policy. The wording used is in the policy for which I have given the citation. They say that they endorse the following claim "circumcision of newborns should not be routinely performed". I say in their article that their policy is "circumcision of newborns should not be routinely performed" and I give the appropraite citation. If you state "X is true" you have stated "X". Please read it again.

Yeah, there is a difference between Bob saying "X" and Bob quoting Alice as saying "X". There is also a difference between Bob quoting Alice as saying "X" and Bob saying "Alice said X and I agree".

4. Australia and New Zealand are two separate countries with two different sets of medical organzitions who do not have to have the same policies. They is no such country as Australasia, no such thing as a national Australasian medical organization and no such thing as the policy of a national Australasian medical association. Do you want to lump the US and Canada together under North American statements?

5. The American Cancer Society is a national medical organization. Look it up.

Edwardsville 03:00, 7 August 2007 (UTC)

1. If you believe that the article misrepresents the conclusions of the sources, then I suggest that you explain why.
2. As far as I can tell here, your main concern is that the article does not cherry-pick negative quotes. That is almost a non-argument.
3. I am aware that the RACP agrees with the AAP and CPS statements (and I have noted some concern over the wording about this above). However, as I commented previously, even if I agree with something you have said, it is misleading to claim that I myself said it. This is called misattribution.
4. Actually, there is such a thing as an Australasian medical organisation, and one happens to be called the Royal Australasian College of Physicians. They describe themselves as "The RACP is a diverse and energetic organisation responsible for training, educating and representing over 9,000 physicians and paediatricians in Australia and New Zealand."[16] If, at some future time, the US and Canada issue a joint statement under an umbrella organisation (North American Pediatric Association or something) then yes I shall want to 'lump them together' because that is precisely what the source has chosen to do.
5. Is not an answer to my question. Jakew 10:13, 7 August 2007 (UTC)

Jakew, you continue to ask questions while ignoring mine. Are you ever going to say why you refuse to let the article note that

The American Academy of Pediatrics Circumcision Policy Statement states that “there is considerable evidence that newborns who are circumcised without analgesia experience pain and psychological stress” and recommends that anesthesia be provided

Do you really think that the American Academy of Pediatric's position is not extremely relevant to the article? Do you think that the American Academy of Pediatrics is not an important body or that their opinion does not matter?

Why do you keep removing the fact that the American Medical Association states that "virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice."

Do you really not find that relevant to the section on the policy statements of medical organizations? Do you really not think that it is an important fact? Do you not think that the American Medical Association is important enough for their opinion to matter?

Why do you keep removing reference to organizations whose policy is that routine circumcision should not be performed? You don't like the word "states" but you don't change "states" to "It is X's policy that". You just remove reference altogether? Why is that, Jakew? Do you really think that their position that the operation should not be routinely performed is not relevant to the section on their policy on circumcision? If an association said that circumcision should be routinely performed, would you leave that out of the article, or would you consider that relevant? Would you really stop removing reference to their policy if the article said "It is X's policy that" rather than "X states"? "X states" is accurate, but it really doesn't matter which we use in the great scheme of things. Or would you remove reference to their policy too, despite the fact that the organizations in question directly endorse the statement in their policy statement?

Are you ever going to answer my questions?

You ask why I say that the article misrepresents the conclusions why, despite the fact that I have explained time and again with direct quotes from the policy statements in question. Do you really think that the policy statement misrepresent themselves in what they say? Conversely, when I ask for evidence as to why you say that these recommendations are "cherry-picked", you can come up with no evidence of your own, not a single quote. The policy statements are right there, Jakew, usually with their conclusions and recommendations highlighted. You can go right ahead and read them and find whatever you find. You are free to find evidence just like anyone else instead of erasing evidence that you don't like. The organizations said what they said. If you don't like it, that's irrelevant - I'm reporting what they said and you are offering no evidence at all that I am twisting their words. The major medical organziations of the world deserve to be heard, Jakew. Their opinions are an awful lot more important than yours or mine.

Speaking of "cherry-picking", you are defending a section on "Australasia" on the grounds that there is one medical organization that uses that term. What about the rest? The document in question lists many of them. Yet you just picked one and ignored the fact that the others are entirely national. Why is that?

Are you ever going to answer my questions?

Edwardsville 12:59, 7 August 2007 (UTC)

Edwardsville, please pay attention to what others are saying on this talk page. If you had done so (see [17]), you would have realised that I don't 'refuse' to let the article note the AAP's comment.

You would have realised that two editors have asked you to explain your proposed restructuring and gain consensus. Yet you've made no effort to do so.

You would have realised that both Coppertwig and I have noted that it is incorrect to claim that the RACP stated words which were in fact attributed in the source to the CPS. As Coppertwig has commented, "Note also that this statement, and the RACP's agreement with it, already appear under Canada in the policy section; it would be too repetitive to say it again elsewhere in the article."

Finally, the word 'Australasia' means, according to the American Heritage Dictionary of the English Language, "The islands of the southern Pacific Ocean, including Australia, New Zealand, and New Guinea." The source cited in it is titled: "Paediatrics & Child Health Division/The Royal Australasian College of Physicians/Policy Statement On Circumcision". Four of the six sub-organisations listed include 'Australasia' in their names. Jakew 13:43, 7 August 2007 (UTC)

Jakew, you are being ridiculous. Removing important cited policy statements of national medical associations is neither fair nor balanced. It is biased in the extreme. You are simply preventing the truth from being told. Please contribute constructively to the article or leave it alone.

It is obviously not repetitive to say that medical organizations in Australia and New Zealand state that circumcision should not be routinely performed because people should know what is being said by the medical organizations in Australia and New Zealand say on the matter, not just medical organizations in Canada. The idea that Australia and New Zealand should not get separate headings even though there are medical organizations that they do not share is likewise ridiculous.

As for restructuring, Edwardsville clearly said it was done to put nations in alphabetical order.

Please read what is being said to you. Please address the questions that are being put to you. Please stop removing important cited policy statements of national medical associations. Your blatant bias in censoring important facts is inappropriate in the extreme. It is just wrong. 74.230.142.124 20:52, 7 August 2007 (UTC)

You keep ignoring my questions Jakew, yet you expect me to answer yours?

I am happy to talk to Coppertwig, since he is actually talking to me. I am actually becoming heartened by the idea of building consensus here for changes to be made on the page, since I see that there have been some positive changes recently made to the article. My previous experence of this article has involved only people arbitrarily removing facts they didn't want aired, regardless of what was being said on the talk page. But will Jakew abide by consensus here, or will he just remove whatever he doesn't like?

Edwardsville 22:00, 7 August 2007 (UTC)

User 74.230.142.124, when you say "Jakew, you are being ridiculous," I think that may be a violation of WP:NPA. Some of the rest of the paragraph may also be. Please talk about article content, not about other editors. If something someone says really is ridiculous, it should be easy to put together a calm, logical argument against it without resorting to labelling. Please log in with a unique username -- it's easy to register if you haven't already and makes it easier to keep track of who is talking. --Coppertwig 00:43, 8 August 2007 (UTC)

Edwardsville, in your message above "Coppertwig, the RACP say very clearly ... routinely performed" If you had been paying attention to this talk page and the editing history of the article, you would realize that I know that already: I had already made the article contain that information in the Canada section. Re later in that paragraph "If you state "X is true" you have stated "X"." If you see no distinction between the meanings of two different ways of saying something, and Jakew does see a distinction, then since it's all the same to you why don't you just make a suggestion (on this talk page) for an edit that conforms to the way Jakew thinks is more accurate?

Edwardsville, after I reminded you twice on this talk page to be careful with quotation marks, you've misquoted the AAP again, I believe. You quoted them as saying something with the word "psychological" in it when I think the word they used was "physiologic". If you're going to help edit an encyclopedia, please learn to be careful with quotes. You can double-check them or even triple-check if necessary before posting. --Coppertwig 00:54, 8 August 2007 (UTC)

And by the way, Jakew has already answered at least one of the questions you're saying he didn't answer. I don't have time to look for it right now -- you can look in the talk page above. You might not agree with the answer and it might look to you as if it's not really answering the question, but it is an answer and if the discussion is to move forward rather than going in circles you have to address your comments to that answer rather than claiming that he hasn't given an answer. --Coppertwig 02:00, 8 August 2007 (UTC)

One more thing: one reason your edits are being reverted is that you've been asked to suggest edits here and discuss them, and I don't think you're doing that, at least not thoroughly. I don't really understand what you're doing in that edit you keep repeating. I said I didn't understand it, yet you keep doing it again without telling us here what you're doing (e.g. is it moving paragraphs? or not? What is it doing? What section of the talk page does it relate to?) If you discuss edits here first you may get a better reception. --Coppertwig 02:17, 8 August 2007 (UTC)

Edwardsville, I asked you to divide your edit up so that if you're moving paragraphs around (e.g. putting sections into alphabetical order) then that is the only thing you're doing in that edit. You replied to another part of my comment (above) so you must have seen it, yet after that you again repeated the same edit without dividing it up, and I don't see any explanation from you as to why you shouldn't divide the edit up as I asked. I really can't see what's happening in that edit. If you do two separate edits (one to move things around, and a separate one to add and delete material) then I will be able to see much better. If you're putting things into alphabetical order, please don't add or delete anything in the same edit. Please don't repeat that same edit again. Also, please provide edit summaries. (When you edit, there's a little box at the bottom of the screen marked "edit summary". Fill it in with a helpful explanation of your edit.) If you put something into alphabetical order, say so in the edit summary. Please spend more time reading and understanding what other people are saying on this talk page. Thanks. --Coppertwig 02:41, 8 August 2007 (UTC)

It may not have been "Edwardsville" who was responsible for that last revert. He has been writing to people (including myself) showing them both versions of the text, telling them what has been going on here, and urging them to get involved. I hope that we see a lot more people getting involved, although not necessarily performing reverts.

146.163.162.184 17:54, 9 August 2007 (UTC)

I agree with what Edwardsville said about the unscientific bias in favor of circumcision in the article. If it is him that is reverting, I hope he stops, but I urge him to keep pointing out the gross flaws in what we have now. The public deserves a fair discussion of circumcision with the important facts presented impartially - what we have now does not reflect the state of play in science at all.

Just David 18:09, 9 August 2007 (UTC)

You're both welcome to get involved yourself if you're here on your own behalf, not editing as a favour for another editor here. (See meatpuppets.) You can help improve the article. A good way to start would be to get involved in the ongoing discussions, or else to find better wording for some part of the article and propose that change here, to be discussed, maybe modified by others, and maybe edited into the article. Or maybe even be bold and go ahead and edit the article -- but don't be surprised if your edits are reverted. A certain amount of reverting is normal wiki behaviour, and often edits require a lot of discussion on this page before they're accepted by everyone. Do please avoid repeated reverts of the same material: see WP:3RR. --Coppertwig 22:06, 9 August 2007 (UTC) (This message had been intended to be welcoming to very new user(s) but was poorly thought out and does not seem to have had the intended effect.)

I never asked anyone to do anything for me as a favor. I have told a number of people about what has been going on here and have encouraged them to get involved. While quite a lot of people from child abuse advocacy groups and sexual freedom groups have expressed shock and concern, the general consensus has been that it isn't worth trying to get truth into a Wikipedia article. I will continue to encourage others to get involved.

Edwardsville 12:32, 12 August 2007 (UTC)

Just what am I being accused of? I do not express any opinions other than my own and I certainly don't express opinions as a favor to anyone. "Edwardsville" knows that I am more than eager to disagree with him when I disagree with him.

Just David 17:14, 14 August 2007 (UTC)

I think they are accusing me, not you. First, the unfounded accusation was sockpuppetry. When I showed that I could prove I was innocent by pointing out the ISP addresses (although the onus should have been on them to show evidence that I was guilty before they made a charge), they shifted it to "meatpuppetry". I hope that you keep posting.

Edwardsville 13:10, 15 August 2007 (UTC)

Taddio 1997

The article now says "This statement referred to a study by Taddio, 1997, who found a correlation between circumcision and intensity of pain response during vaccination months later, but stated that "[f]actors other than circumcision may account for the observed differences in pain response."[77]" The full paragraph in the Taddio study is:

"Factors other than circumcision may account for the observed differences in pain response. For example, there may be differences in genetic attributes, socioeconomic status, and parent-infant interactions between people who have their sons circumcised and those who do not. However, race and socioeconomic status did not differ between groups in this study and there were no observable qualitative differences in the way parents interacted with their infants during the vaccination."

I think it's misleading to quote the first sentence of this paragraph without providing the qualifying information given later in the paragraph. I suggest either deleting the "factors other than circumcision..." quote (preferred), or adding However, race and socioeconomic status did not differ and no qualitiative differences were observed in the way parents interacted with their infants. (Note: what I'm suggesting to add is not the exact words of the study; it's rearranged a bit for brevity (summarizing) but is intended to mean the same thing. The exact words are given above.) --Coppertwig 01:29, 7 August 2007 (UTC) Clarification: I didn't mean that any editor here was intentionally misleading. I only meant that if the first sentence of the paragraph is given, then for balance the part after "However" also needs to be represented. I had meant to avoid using the word "misleading" because the word itself can be misleading, but I forgot. --Coppertwig 01:50, 7 August 2007 (UTC)

I agree that it is misleading to quote the first sentence and not the qualifying information given later in the paragraph. (Like you, I am not suggesting an intention to mislead).

Edwardsville 04:17, 7 August 2007 (UTC)

I'm not sure that I understand your concern, Coppertwig. Taddio et al first tell us that "Factors other than circumcision" may account for differences. Then they give three "example" differences, and comment on these specific examples. I cannot understand why you would want to justify deleting the first sentence on these grounds. Jakew 11:13, 7 August 2007 (UTC)

The section as it stands is misleading because he specifically talks about the three differences that might be present, and then states that they did not appear to be present in this case.

Edwardsville 12:38, 7 August 2007 (UTC)

Of course, the section in general needs an awful lot of revision. There was a significant discussion of circumcision and pain above yet nothing seems to have changed, despite citations. There is an awful lot of literature on this, yet it is not even mentioned. Furthermore, and most importantly, what the scientific community has made of the literature has not been touched. Nothing has been said about recommendations from the American Academy of Pediatrics, the American Medical Association, and the various other medical associations regarding pain and pain relief. The quotes are all easy to find (a number of them are in the section above).

This section doesn't reflect the evidence that the operation is painful. It needs significant change before it is balanced. There is no indication of the weight of scientific opinion. 74.230.142.124 20:56, 7 August 2007 (UTC)

I see that just recently some positive changes were made to the section on pain. That is great. Much more needs to be done, of course. As things stand, it looks like the American Academy of Pediatrics might be the only authority who says that circumcision is painful. The article should reflect the fact that this is the consensus view in science - statements from other bodies would be appropriate, as would a more thorough survey of the scientific literature.

Edwardsville 22:02, 7 August 2007 (UTC)

Here's my concern. The quote "but stated that "[f]actors other than circumcision may account for the observed differences in pain response" could be a perfectly good summary of an article which goes on to say something like (made-up quote) There is evidence from other studies that socioeconomic status is correlated with circumcision and that socioeconomic status is correlated with infant behaviour at vaccination, and the results given here do not rule out the possibility that the correlation found here could be fully explained in that way. (end made-up quote) In other words, it could be a summary of an article where there is good evidence or a plausible, fleshed-out theory that some other factors might explain the correlation. Therefore, a reader seeing that summary might easily jump to the conclusion that this is that type of study, which it is not. The well-educated reader, on seeing the word "correlation", will immediately already know that some other factors might explain the correlation. Maybe some readers need some help -- but it has to be given carefully to correctly convey the type of result the study gives. Possible fixes include: deleting the "but stated that...pain response" quote; replacing the "but stated that ... pain response" quote with "although it was not a randomized study."; or keeping that quote and appending something like "although no difference between the two groups was observed in race, socioeconomic status or parental interaction." (as a summary of the "However..." part of the Taddio et al. paragraph.) And actually I think any of these three fixes would be fine. There may be other good ways to do it, too. --Coppertwig 01:12, 8 August 2007 (UTC)

I still don't regard it as necessary (or indeed an improvement to the article), but for the sake of consensus I'm happy to go along with your third suggestion, Coppertwig. Jakew 15:21, 8 August 2007 (UTC)

Thanks. I edited it in. --Coppertwig 21:29, 8 August 2007 (UTC)

The current revision still misrepresents Taddio's 1997 article because it gives undue weight to a relatively minor paragraph in the article and it ignores the significant findings and the significant recommendations of the article. I am sure it was not the intent of other editors to misrepresent Taddio's article. -- DanBlackham 23:54, 8 August 2007 (UTC)

You have a good point. Could you suggest a specific edit that would improve it? --Coppertwig 01:08, 9 August 2007 (UTC)

User:Avraham has edited the beginning of the Pain section to look like this: According to the American Academy of Pediatrics' 1999 Circumcision Policy Statement, “There is considerable evidence that newborns who are circumcised without analgesia experience pain and psychologic stress.”[67] In the statement, the Academy recommends the use of pain relief for circumcision.[67] One of the supporting studies, Taddio 1997, found a correlation between circumcision and intensity of pain response during vaccination months later. They acknowledge that there may be other factors besides circumcision that account for different levels of pain response, but felt that such differences were not present in their study. Mostly I think that's an improvement because it flows more smoothly than the previous version, but I don't think we can say "felt that such differences were not present in their study" -- I don't think that's verifiable (or maybe you could quote here on the talk page words from the study that support this statement?). I suggest changing those last few words to "but they found no evidence for specific factors." --Coppertwig 02:08, 9 August 2007 (UTC)

I agree that the paragraph flows better now. However I would change the last sentence in the paragraph to, "They recommended pretreatment and postoperative management of neonatal circumcision pain based on the results of their study." That was the significant recommendation of Taddio's 1997 article and it should be included in the paragraph. The current last sentence gives undue weight to unfounded speculation. Taddio's article clearly states that there was no evidence that other factors account for the observed differences in pain response. My recommendation for the paragraph is:

According to the American Academy of Pediatrics' 1999 Circumcision Policy Statement, “There is considerable evidence that newborns who are circumcised without analgesia experience pain and psychologic stress.” In the statement, the Academy recommends the use of pain relief for circumcision. One of the supporting studies, Taddio 1997, found a correlation between circumcision and intensity of pain response during vaccination months later. They recommended pretreatment and postoperative management of neonatal circumcision pain based on the results of their study.

DanBlackham 07:12, 9 August 2007 (UTC)

The problem with your proposal is that it omits Taddio's acknowledgement of the study's weaknesses. I realise that you believe this is "unfounded speculation", but that, of course, is WP:OR. I also realise that you believe that there was "no evidence" that other factors accounted for these differences; you misrepresent Taddio et al, however, who discuss only "example" (their word) factors. Jakew 10:58, 9 August 2007 (UTC)

No Jake, Taddio did not acknowledge the study's weaknesses. The paragraphs in question highlight the strength of the study's methodology and results.

It is good practice in articles reporting scientific research to list possible confounding factors. The article lists several possible confounding factors and then says there is no indication that any of those factors influenced the results.

"However, race and socioeconomic status did not differ between groups in this study and there were no observable qualitative differences in the way parents interacted with their infants during the vaccination." and "However, the revised infant temperament questionnaire did not show any differences in infant behaviour among the groups." (emphasis added)

To mention possible confounding factors when the article clearly says that there is no evidence those confounding factors influenced the results gives undue weight to a minor and relatively unimportant part of the article.

I do not misrepresent Taddio's article. Taddio lists several possible confounding factors and then explains why in their judgment each one did not influence the results. Your suggestion that there are other possible confounding factors that are not even mentioned in Taddio's article is original research. -- DanBlackham 23:11, 9 August 2007 (UTC)

I disagree. Taddio et al explicitly state that "Factors other than circumcision may account for the observed differences in pain response". Nowhere do they contradict this statement. They do list specific "example" factors that did not, but neither state nor imply that this list is exhaustive. It is not original research to take a statement to mean precisely what it says, nor is it original research to include a literal quote of that statement in the text. Sorry. Jakew 23:19, 9 August 2007 (UTC)

No Jake, they do contradict the statement: "However, race and socioeconomic status did not differ between groups in this study and there were no observable qualitative differences in the way parents interacted with their infants during the vaccination." and "However, the revised infant temperament questionnaire did not show any differences in infant behaviour among the groups." (emphasis added) -- DanBlackham 23:32, 9 August 2007 (UTC)

Coppertwig, the basis for "felt not present in study" is the bolded text below:

Factors other than circumcision may account for the observed differences in pain response. For example, there may be differences in genetic attributes, socioeconomic status, and parent-infant interactions between people who have their sons circumcised and those who do not. However, race and socioeconomic status did not differ between groups in this study and there were no observable qualitative differences in the way parents interacted with their infants during the vaccination.

— Taddio 1997, http://www.thelancet.com/journals/lancet/article/PIIS0140673696103160/fulltext#section18

-- Avi 11:53, 9 August 2007 (UTC)

I like DanBlackham's proposed version of the paragraph above, and agree that presenting their actual recommendations is more representative of their study than their discussion of the possibility of confounding factors, a possibility that is present in any non-randomized trial of that type; I think those recommendations should be presented. Although I prefer DanBlackham's proposal as-is, for the sake of consensus I suggest inserting in it at the beginning of the last sentence, "They acknowledge that there may be other factors besides circumcision that account for different levels of pain response, but they recommend..." or better, "They acknowledge that there may be other factors besides circumcision that account for these results, but they recommend..." Although in my opinion presenting the first sentence of the Taddio paragraph about confounding factors without also representing the "however" section of the paragraph would convey the wrong impression to many readers, nevertheless I now notice that when it's reworded to Avraham's wording including "there may be...", that ambiguity is not there in my opinion and there is not the urgent need to include Taddio's "however" clause. Avi/Avraham, in my opinion the quote you give does not support the "felt that..." statement. They present some carefully-worded results; they don't say how they feel about them, nor do they state that there are no confounding factors in their study -- on the contrary, they acknowledge the possibility that there may be. --Coppertwig 13:02, 9 August 2007 (UTC)

How about (changes underlined):

According to the American Academy of Pediatrics' 1999 Circumcision Policy Statement, “There is considerable evidence that newborns who are circumcised without analgesia experience pain and psychologic stress.”[67] In the statement, the Academy recommends the use of pain relief for circumcision.[67] One of studies supporting the use of pain relief, Taddio 1997, found a correlation between circumcision and intensity of pain response during vaccination months later. They acknowledge that there may be other factors besides circumcision that account for different levels of pain response, but stated that they did not observe the presence of such differences in their study.[77]

-- Avi 13:50, 9 August 2007 (UTC)

Seems reasonable to me. We should also note that the correlation observed was with circumcision performed using EMLA or no pain relief. The researchers commented: "Study of the vaccination pain response of infants who had received more effective circumcision pain management (ie, dorsal penile nerve block and adequate postoperative pain management) would be interesting." Jakew 14:01, 9 August 2007 (UTC)

To clarify, I'm proposing the following changes to Avi's text (changes in bold):

• According to the American Academy of Pediatrics' 1999 Circumcision Policy Statement, “There is considerable evidence that newborns who are circumcised without analgesia experience pain and psychologic stress.”[67] In the statement, the Academy recommends the use of pain relief for circumcision.[67] One of the studies supporting the use of pain relief, (Taddio 1997), found a correlation between circumcision using topical or no anaesthesia and intensity of pain response during vaccination months later. They acknowledge that there may be other factors besides circumcision that account for different levels of pain response, but stated that they did not observe the presence of such differences in their study.

Jakew 14:28, 9 August 2007 (UTC)

"Circumcision is painful" seems clear enough to me. If people would rather say that circumcision without anesthesia is painful, that may be alright, but only if we have direct research showing that there is no pain after the operation. My understanding is that there is pain after the operation and that adults feel pain and use pain relief. There is problem with the article as it stands, though, in that only the AAP quote is being cited. Scientific opinion is very clear that circumcision without anesthesia is painful (some other cited quotes to support that have been listed above, but they are only the tip of the iceberg). As far as I know, there isn't any doctor's group that disputed it, whereas they all seem to talk about the importance of pain relief during circumcision.

146.163.162.184 17:48, 9 August 2007 (UTC)

I'll let it pass if everyone else agrees on it, but I don't think it's accurate to say "but stated that they did not observe the presence of such differences in their study". I don't think they stated that. How about "but did not observe specific examples of such differences in their study," or "but did not find evidence of such differences in their study," or "but did not observe the presence of such differences in their study" (which is also shorter; just deleting the "stated that".) --Coppertwig 22:51, 9 August 2007 (UTC)

Any mention of possible confounding factors gives undue weight to a relatively minor part of Taddio's article. -- DanBlackham 23:20, 9 August 2007 (UTC)

I agree. I think it's better to leave out any mention of confounding factors, and either leave it to be implied by the word "correlation", or at most put something like "in a non-randomized trial". I'm trying to compromise. I'm willing to accept "They acknowledge that there may be other factors besides circumcision that account for different levels of pain response. without a clause about finding no evidence for such factors; would you be willing to express a preference one way or the other: i.e. is this better because it's shorter and therefore puts less undue weight, or do you think we need the counterbalancing clause if that is put in? I realize you would, like me, rather not see it mentioned at all. --Coppertwig 23:29, 9 August 2007 (UTC)

Any mention of possible confounding factors should not be included because it gives undue weight to a minor part of Taddio's article. I fear there will never be a consensus without a request for comment, mediation, and / or arbitration. -- DanBlackham 23:39, 9 August 2007 (UTC)

I do not think that mention should be made of possible counfounding factors, because evidence of such factors was looked for and not found, so it isn't a significant part of the study's conclusions. If the "confounding factors" sentence is to be included, then there should definately be mention of the fact that no evidence was found of such factors.

Edwardsville 17:50, 10 August 2007 (UTC)

I apologize, DanBlackham, for being too dismissive of the point you raised. Let's see if we can find a wording that everyone can accept. It seems clear that we won't get consensus for anything that includes wording such as They acknowledge that there may be other factors besides circumcision that account for different levels of pain response, for the reason DanBlackham raised and with which Edwardsville and I concur. I would appreciate it if Jake or Avi or someone would explain the reasons for wanting to include that wording, so that we can think about how to proceed. I'm wondering whether we might succeed by wording the original mention of the Taddio study differently; maybe something like "found a correlation in a non-randomized trial" or "found evidence suggesting a possible link". Perhaps Jake or Avi or someone could suggest other wording.

Jakew: usually, quoting an entire sentence accurately represents what's being said in the original (as opposed to quoting part of a sentence, which can result in leaving out the word "not", for example). But occasionally, as in this case, quoting an entire sentence out of context conveys a different meaning from the sentence in context. The word "may" in scientific articles is often used in the following way: saying "X may be Y" means or strongly implies that the authors have evidence supporting the hypothesis that X is Y. (A reviewer might ask that the sentence "X may be Y" be removed from an article if they have no such evidence.) Apparently in the Taddio study they were not using the word "may" in that way. However, when the sentence is taken out of context without the following "however", the impression is given (to some readers, at least; to those familiar with this way that "may" is often used in scientific papers, perhaps) that that is the usage: that is, that they do have some evidence supporting the hypothesis that some (particular) other factors account for the correlation; while if you read the whole paragraph you get the strong impression that they have no such evidence; if they had it, scientific convention would have required that they mention it in their article. --Coppertwig 19:01, 10 August 2007 (UTC)

Coppertwig, I'm generally reluctant to speculate about what authors may or may not have meant, since original research should generally be avoided. That said, my personal view is that Taddio et al probably made that statement as an acknowledgement of a fundamental limitation of their study design (as you note, it was not a randomised trial, and was thus inherently limited by possible confounding).

Whatever their reasons, the fact cannot be denied that they chose to make this statement. Incidentally, Wikipedia articles should generally avoid assuming specialist knowledge in the audience, and since 'hinting' through words such as 'non-randomised', even ignoring OR concerns, would be less clear than the researchers' own words, the latter should be preferred.

As I've said above, I do not object to adding the words "but stated that they did not observe the presence of such differences in their study", and I'm happy to work towards fine-tuning those words. Jakew 20:50, 10 August 2007 (UTC)

Jake, your concerns are unfounded. Taddio's study was a randomized trial well designed prospective cohort study.

"The participants in this study included uncircumcised boys, who served as controls (n=32), and circumcised boys who had been randomly assigned to treatment with Emla (n=29) or placebo (n=26) during circumcision. ... We recruited uncircumcised infants from the same study by the same inclusion criteria as for the circumcised infants, the difference being that their parents had chosen not to have their infants circumcised." (emphasis added)

"Infant pain response was scored from the videotape by a research assistant who was unaware of the purpose of the study and the treatment group status of the infants."

The following sentence from Taddio's article is just as important and just as relevant to this article as the paragraph on possible confounding factors.

"It is, therefore, possible that the greater vaccination response in the infants circumcised without anaesthesia may represent an infant analogue of a post-traumatic stress disorder triggered by a traumatic and painful event and re-experienced under similar circumstances of pain during vaccination."

The significant results and recommendation of Taddio's 1997 article were.

"The results of this study are consistent with studies of pain response in animals and behavioural studies in humans showing that injury and tissue damage sustained in infancy can cause sustained changes in central neural function, which persist after the wound has healed and influence behavioural responses to painful events months later. Pretreatment and postoperative management of neonatal circumcision pain is recommended based on these results. Investigation of the neurological basis of these effects is warranted."

The information in this paragraph is the most important information from Taddio's article. -- DanBlackham 22:02, 10 August 2007 (UTC)

Good point, DanBlackham! I apologize for referring to it as a "non-randomized" trial. The study presents results from both randomized and non-randomized comparisons. Significant results were found in both types of comparison. Results from randomized comparison: "In addition, visual analogue scale pain scores were significantly higher in infants circumcised with placebo than in those circumcised with Emla (5.1 vs. 3.3 cm; P < 0.05)". (p. 601, Taddio 1997.)

I agree with DanBlackham that the results of the study are worth mentioning, while the possibility of confounding factors, present in every nonrandomized trial, is not. Sorry, Jakew, maybe I'm just tired, but I don't recognize in your comment anything that looks to me like an argument intended to explain why that one sentence should be selected out of all sentences in the study. Anyway, here's a more objective criterion: I would like to point out that when the AAP mention the Taddio study, they don't say anything about possible confounding factors, so presumably they agree with DanBlackham and me that that isn't a highly interesting part of the report.

Here's a possible solution that I hope may be acceptable to everyone: to refer to the Taddio study with the same words or very similar words that the AAP uses. I might suggest changing a few words at the beginning of the sentence to make it flow smoothly into the paragraph without significantly changing the meaning. They say "One report has noted that circumcised infants exhibit a stronger pain response to subsequent routine immunization than do uncircumcised infants." --Coppertwig 22:22, 10 August 2007 (UTC)

You are mistaken, Dan. The design was a prospective cohort study; though circumcised patients were drawn from those previously randomised for a separate study (I'm surprised that you claim otherwise - the words "their parents had chosen not to have their infants circumcised" are a substantial clue): "Methods We used a prospective cohort design to study 87 infants. The infants formed 3 groups -- uncircumcised infants, and infants who had been randomly assigned Emla or placebo in a previous clinical trial to assess the efficacy of Emla cream as pretreatment for pain in neonatal circumcision."

Furthermore, your assessment of what is and what is not important seems questionable to say the least. Speculation about what a result may mean is perhaps interesting, but ultimately there are an infinite number of opinions, and only a finite number of facts. The results of the study, together with its strengths and weaknesses, are more fundamental. It seems reasonable enough, however, to mention their recommendation for "pretreatment and postoperative management of neonatal circumcision pain". Jakew 22:23, 10 August 2007 (UTC)

Although the design was prospective, when they analysed the data they also found results based on comparing the two randomized groups to each other. Since there are an infinite number of opinions, why not go with the AAP's choice of not mentioning the (relatively unimportant) confounding factors? Anyone who wants to know the details of the study can read the whole study themselves. --Coppertwig 22:28, 10 August 2007 (UTC) (I'm not sure what happened, but I'm guessing we had an edit conflict and that the new software handles it differently now and fit my comment in behind yours.) --Coppertwig 22:32, 10 August 2007 (UTC)

We seem to have moved beyond discussing the meaning of the researchers' words and into our own analysis of the methodology. I must accept part of the blame for that. But let's stop there (at least on-Wiki) and return to reliable sources. As I've stated above, one source to have commented on the methodology (Taddio) stated that such factors may "account for the observed differences". Does anyone know of any others?

Also, can I remind you that Wikipedia has certain policies that the AAP do not have. One of these, for example, is NPOV. It arguably violates NPOV to selectively quote some parts of a source while excluding other parts of that same source that serve to moderate and qualify the viewpoint. To take a (somewhat silly) example, if a scientist states that "I believe that I have found a cure for cancer, but I cannot be absolutely certain and I shall have definitive results when I have repeated my experiment", then both are part of her opinion, and to quote one but not the other is neither neutral nor fair to the source. Jakew 23:23, 10 August 2007 (UTC)

That's the very principle I was invoking when insisting that if confounding variables are mentioned, then the "however" clause also has to be represented. I've thought of another possible (though unlikely) way to get consensus: if the quotes and descriptions of the Taddio study are made much longer overall, then the confounding variable discussion can be briefly included without putting undue weight on it in comparison to the rest of the article. For example, if the entire Taddio article were to be quoted, then certainly it would be appropriate to include that sentence. Possibly it might also be appropriate to include it in a somewhat shorter representation of the Taddio article, perhaps as one long paragraph. I'm not sure that doing so would be consistent with the plans to shorten the article; perhaps it could be mentioned on the "main article" page.

You mention Taddio writing about the study: do you mean in the study report itself, i.e. Taddio et al. (1997) as cited on this page? I note that Taddio et al., in their summary of their own article which appears at the beginning of the article, saw fit to omit any reference to confounding variables in that summary. A good summary of a scientific article usually omits the nitty-gritty details of the tables and figures, minor details of the methodology and discussion of factors affecting large classes of scientific studies. The fact that Taddio et al. themselves omit discussion of possible confounding variables in their summary, which is considerably longer than the summary of the article on this page, suggests that if we follow the principle of due weight and fairly representing the source, it makes sense for us to omit it too. As the AAP also did. --Coppertwig 14:53, 11 August 2007 (UTC)

Yes, I mean the study cited. Qualifiers and discussion of limitations are often left out of abstracts, or implied through short descriptions of the methodology that require understanding of specialist terminology. As I've noted above, though, they are a moderating part of the viewpoint expressed in the study itself, and we would fail in our duty to represent this viewpoint "fairly and without bias" (WP:NPOV) if we did not include it.

As I've indicated earlier, I haven't any major problems with the "however" clause (I think it unnecessary, as "may account" is fairly clear English, distinct from "do account", "probably account", or for that matter, "do not account". Nevertheless, I'm happy to go along with it). Another option, which would also serve to reduce the article length, is to omit the study from this article, and instead include a slightly lengthier treatment of the study in the medical analysis article.

So far, it has been claimed (to paraphrase heavily) that 1) they didn't mean it, 2) that it was unfounded speculation, 3) that they then contradicted themselves, 4) that it would constitute undue weight (to quote what is part of the same viewpoint), 5) that this was a randomised trial (they must have been wrong), and now 6) that they didn't mention it in the abstract. I have to say that I find these an extraordinary set of arguments against accepting a compromise. Jakew 17:38, 11 August 2007 (UTC)

Given that both Taddio and the AAP ommited reference to these factors confirms that they are not particularly important parts of their conclusions. Citing them in our article gives undue weight, suggesting that there is a significant possibilities that these factors interfered with the results. It suggests that these are significant worries for Taddio and for the scientific community in general, when our evidence suggests just the opposite.

Edwardsville 12:36, 12 August 2007 (UTC)

Your concerns are adequately addressed by the proposed compromise of the 'however' clause. Jakew 12:50, 12 August 2007 (UTC)

I disagree. An element is being included in our summary that neither Taddio nor the AAP included in theirs, thus giving it undue weight. If neither Taddio nor the AAP felt that this was a significant concern worth mentioning in a summary, then we should agree with them.

Edwardsville 13:58, 13 August 2007 (UTC)

Are you seriously suggesting that Wikipedia should exclude all material that is not in the abstract of a paper? Or are you suggesting that this should be a special case? Jakew 14:13, 13 August 2007 (UTC)

I think Edwardsville is suggesting that we follow Wikipedia policy and not give undue weight to a relatively unimportant part of Taddio's 1997 article. I agree with Edwardsville and Coppertwig that including information from the paragraph on hypothetical confounding factors would give undue weight to that paragraph. -- DanBlackham 19:41, 13 August 2007 (UTC)

Actually, that was argument no. 4, Dan. We've largely moved to argument no. 6 now. :-)

Since you express concern about policy, I'm sure you are equally concerned about the need for balance, and will therefore accept the 'however' clause. Jakew 19:52, 13 August 2007 (UTC)

Jakew, I understand that you want to include mention of the possibility of confounding variables because you see it as important moderating information that puts the results of the study in context in a balanced way. I imagine it may be difficult for you to see why anyone would want to exclude that quote if the "however" clause is also represented; however, that is the position of two or three editors. I could go into more detail about the arguments. However, first I would like to see whether we can save time by setting aside that whole argument. I don't think anyone has replied to a suggestion I made earlier: to change the way the Taddio study is mentioned in the first place, so that mention of confounding variables becomes unnecessary. I gave two suggested wordings above (in the first paragraph of my message of 19:01, 10 August 2007 (UTC)), and here's another suggested wording: somehow mentioning the other studies the AAP mentions, and saying something like the AAP mentions a study which compares the reactions of circumcised and uncircumcised infants to the pain of vaccination months later, and just not stating here that they found a correlation; more details, including the mention of confounding variables if enough space is devoted to the Taddio article, would be given in the "main article". Others may wish to suggest other alternative wordings along these lines. --Coppertwig 16:36, 14 August 2007 (UTC)

I like mentioning the Taddio study directly and by name because it has been so influential. The "however" clause does not belong because it suggests that there are greater doubts about Taddio's results than there actually are. Coppertwig points out that neither the American Academy of Pediatrics nor Taddio thought that these concerns were enough to mention in a summary and so for us to talk about them gives them undue weight and is misleading. In a longer article that discussed the Taddio paper in full, they would belong, but not here, where most details of the paper are left out.

Just David 17:11, 14 August 2007 (UTC)

There's no need to describe the arguments in detail, Coppertwig. I understand them, and have already enumerated them above. Many rely upon an incorrect understanding of the source material, others upon personal opinion, and still others on lack of understanding of appropriate policy.

Regarding your suggestions, I think that "found a correlation in a non-randomized trial" is slightly OR-ish, but "found evidence suggesting a possible link" seems fair enough to me. Jakew 18:10, 14 August 2007 (UTC)

The old wording is good as it is. It is only the mention of possible coufounding factors that is not appropriate. In a longer article, talking about them would not give them undue weight. If there is great concern that they should be mentioned somewhere, a separate article on the Taddio studies would be fine. There could even be a link form this article. However, this article should just state Taddio's findings, in a way that reflects Taddio's summary and the summary of the AAP.

Edwardsville 13:08, 15 August 2007 (UTC)

Based on their recent comments, in my opinion both Just David and Edwardsvill correctly understand the source and Wikipedia policy. I also understand the source and Wikipedia policy.

If this were a discussion about Taddio's 1995 article, "found evidence suggesting a possible link" would be an accurate and NPOV way to present the article. However this discussion is about Taddio's 1997 article and "found evidence suggesting a possible link" is not a NPOV way to present it. The article says:

"There was a significant linear trend on all outcome measures, showing increasing pain scores from uncircumcised infants, to those circumcised with Emla, to those circumcised with placebo."

"Circumcised infants showed a stronger pain response to subsequent routine vaccination than uncircumcised infants."

"This study showed that neonatal circumcision in male infants is associated with increased pain response in vaccination 4-6 months after surgery. The results support our previous finding of a higher pain response in circumcised than uncircumcised male infants during routine vaccination."

"The results of this study are consistent with studies of pain response in animals and behavioural studies in humans showing that injury and tissue damage sustained in infancy can cause sustained changes in central neural function, which persist after the wound has healed and influence behavioural responses to painful events months later."

DanBlackham 18:25, 15 August 2007 (UTC)

Given the fact that they also said that "Factors other than circumcision may account for the observed differences in pain response", "found evidence suggesting a possible link" or "found evidence of a possible link" seems entirely reasonable, balanced, and NPOV presentation. But please, if you can think of a better compromise, share it. Jakew 18:58, 15 August 2007 (UTC)

How about something like the study showed that neonatal circumcision in male infants is associated with increased pain response in vaccination 4-6 months after surgery, suggesting a possible causal link and then going on to state their recommendations? Jakew: would you please quote the part of the NPOV policy that you say "arguably" supports your argument (I think you only gave the one argument?) Also, please develop your argument further: describe the POV that you feel is not being sufficiently represented; give an example of a reliable source whose author appears to hold this POV; and argue why you think it's significant. I think the POV you mean is the belief that, although a correlation was found and no evidence of confounding variables was found, nevertheless circumcision without anesthetic is not painful and the difference in response was not caused by pain of circumcision. Can you find an author who expresses this view significantly in relation to this study? Taddio et al. do not seem to hold this view, as evidenced by their conclusions and recommendations. Also, I'd be interested to see suggestions by you, Jakew, for wordings that you believe have a reasonable chance of being accepted by all editors. Thanks.

Jakew, I appreciate your listing and paraphrasing the arguments and I think that can be a starting point for clarifying those arguments -- it looks as if we might have to go into detail after all. I may add more on this later. --Coppertwig 20:54, 15 August 2007 (UTC)

At a push, I could go along with your suggestion ("...suggesting a possible causal link").

As for policy, I have already explained NPOV's requirement to represent viewpoints "fairly and without bias". Taddio's paper is a viewpoint that includes both "there was this difference in the study population" and "other factors may explain it". Failing to mention the qualifying part fails to represent the viewpoint fairly and without bias.

To answer your other questions: "describe the POV that you feel is not being sufficiently represented" - that other factors may account for the observed differences. "give an example of a reliable source whose author appears to hold this POV" - Taddio et al. "and argue why you think it's significant" - think for a moment about the hypothetical consequences of that statement being proved either way. Also note that the authors spent 3 of 9 paragraphs (~33%) of their discussion section evaluating some example factors.

Your comments above indicate that you may have misunderstood the POV to which I referred. I hope that it is now clear. Jakew 21:45, 15 August 2007 (UTC)

I believe the statement (as DanBlackham quotes from the study) "This study showed that neonatal circumcision in male infants is associated with increased pain response in vaccination 4-6 months after surgery." adequately represents the point of view that other factors may account for the observed differences, because it carefully avoids stating that there was a causal link. I agree with Taddio et al. that their conclusions section is a reasonably fair, unbiassed summmary of their results. --Coppertwig 22:04, 15 August 2007 (UTC)

As far as I can tell, nobody at this page has disputed Taddio's statement. In it, they use the term 'associated' (Association (statistics) states that "In statistics, an association comes from two variables that are related and is often confused with causation though association does not imply a causal relationship."). Yet we should strive, wherever possible, to use accessible language. WP:MEDMOS advises that we should "Explain medical jargon or use plain English instead if possible." Since Taddio themselves supply alternative language in very plain English, let's simply quote it. Alternatively, several of the compromises proposed above express this clearly, so let's use one of them. Jakew 22:43, 15 August 2007 (UTC)

(<<<<outdent) I think you agree with me that a statement can be accurate, and yet quoting it out of context can be open to misinterpretation (at least by some types of readers, who may be unaware of certain possible usages of certain words or may be making assumptions about which type of usage is intended). For example, I think you think it would be open to misinterpretation to quote that sentence of Taddio's with "associated" out of context without further explanation. I think you have a point, although I don't see it as important enough in this case that I would myself advocate changing the words for it. How about putting "(statistically correlated)" or something in parentheses after "associated"? (and square brackets, if it's within a direct quote). And it can have a link to a page on statistics. Is it possible, though, that when Taddio et al. said "associated" they meant something a little stronger than just "statistically correlated in the general population", since they had post-hoc results comparing the two randomized groups as well as their main prospective results? The whole point of the study is to provide evidence supporting the hypothesis that there is a causal link. --Coppertwig 16:53, 16 August 2007 (UTC)

As a practical matter, I suspect that it will be difficult to include such a parenthetical explanation while avoiding OR. In controversial cases in which material is likely to be challenged, I prefer wherever possible to include a direct quote of source material. In this case, the "other factors" statement is a) balanced, b) in plain English, c) as a quote, quite obviously not OR. In your edit of 01:12, 8 August 2007, you suggested including a "however" clause to that, and I agreed. I have also, I note, agreed with several of your other suggestions.

I don't think it terribly productive to speculate about whether they might have meant a stronger usage. We know that they stated that "factors other than circumcision may account for the observed differences" and any attempt to interpret their other other statements in ways inconsistent with that is, at best, original research. To repeat myself, there is a very simple way to avoid any interpretation, and that is a direct quote. Jakew 20:18, 16 August 2007 (UTC)

Following your idea of using actual quotes from the study: one way to reduce the misinterpretation that might occur if a large fraction of the space devoted on this page to this study concerns the possibility of confounding variables is to reduce that fraction by increasing the amount of information given here about the study. Along those lines, here are some quotes that I think would be interesting and informative to include if there is room for them (for some of these I'm thinking possibly here or more likely at Medical analysis of circumcision; or perhaps the last quote as the only quote).

Taddio et al.'s "Interpretation" which DanBlackham pointed out the importance of:

Circumcised infants showed a stronger pain response to subsequent routine vaccination than uncircumcised infants. Among the circumcised group, preoperative treatment with Emla attenuated the pain response to vaccination. We recommend treatment to prevent neonatal circumcision pain.

All or part of the following quote (possibly just the last sentence, and probably with the second half of the first sentence summarized or elided) with "Emla" replaced with "[lidocaine-prilocaine cream]"; note that this same or very similar quote appears twice in the study report. I particularly like the last sentence:

Post-hoc analysis showed that the group circumcised with placebo had higher difference scores (p<0·05) than the uncircumcised group for percentage facial action (136·9 vs 77·5%), percentage cry duration (53·8 vs 24·7%), and visual analogue scale pain scores (5·1 vs 3·1 cm). In addition, visual analogue scale pain scores were significantly higher in infants circumcised with placebo than in those circumcised with Emla (5·1 vs 3·3 cm; p<0·05). There was a significant linear trend (p<0·05) in all three outcome measures, with scores increasing from the uncircumcised to the circumcised with placebo group.

another quote:

This study showed that neonatal circumcision in male infants is associated with increased pain response in vaccination 4–6 months after surgery. The results support our previous finding of a higher pain response in circumcised than uncircumcised male infants during routine vaccination;

and I particularly like this one:

Study of the vaccination pain response of infants who had received more effective circumcision pain management (ie, dorsal penile nerve block and adequate postoperative pain management) would be interesting.

The part Jakew wants to include:

Factors other than circumcision may account for the observed differences in pain response. (along with a summary of the rest of the paragraph as discussed above)

Here's an interesting quote; possibly as a compromise this could be used instead of other quotes. "are consistent with" may be clearer than the mentions of "associated" or "correlation" in other quotes:

The results of this study are consistent with studies of pain response in animals and behavioural studies in humans showing that injury and tissue damage sustained in infancy can cause sustained changes in central neural function, which persist after the wound has healed and influence behavioural responses to painful events months later. Pretreatment and postoperative management of neonatal circumcision pain is recommended based on these results. —Preceding unsigned comment added by Coppertwig (talk • contribs)

(oops I had forgotten to sign my message --Coppertwig 22:59, 16 August 2007 (UTC))

The following is a little longer than is ideal, but is I think a reasonable compromise, and seems to address most concerns raised so far:

• One of the supporting studies, Taddio 1997, found a correlation between circumcision and intensity of pain response during vaccination months later. They acknowledge that there may be "other factors" besides circumcision that account for different levels of pain response, but stated that they did not find evidence of such. They concluded "[p]retreatment and postoperative management of neonatal circumcision pain is recommended based on these results." Jakew 22:15, 16 August 2007 (UTC)

Although it doesn't satisfy the concern DanBlackham raised and with which I concur, nevertheless as far as that concern goes it seems to be an improvement on what was in the article, so I went ahead and put it in. --Coppertwig 22:57, 16 August 2007 (UTC)

I removed the sentence for which there is no consensus. Please do not add it to the article again until there is a consensus. -- DanBlackham 05:38, 17 August 2007 (UTC)

(outdent) On what basis? It is verifiably and reliably sourced, and is not overshadowing the thrust of the argument? What is your basis for removal? -- Avi 06:07, 17 August 2007 (UTC)

As a method leading towards achieving consensus, let's try to all agree on a common statement like "We may not all agree with the arguments, but we agree that the position of some editors is ... and that the arguments in support of this position are ... and that the position of some other editors is ... and that the arguments in support of this position are ...". (Filling in the blanks, of course.)

DanBlackham has stated above, here, here etc., the user's reason for not including the discussion of confounding variables. I concur with this reason if the mention of the Taddio study is short (a few sentences) rather than long (at least a long paragraph). Earlier I thought including the summary of Taddio's "however" part of their paragraph could be acceptable, but after DanBlackham pointed out that Taddio's study contains a result of a randomized comparision as well as their main prospective result, I realized that the mention of confounding variables in that way within such a short summary of Taddio's study gives the wrong impression that there is a serious concern about possible confounding factors in this study as compared to other typical scientific studies one sees quoted.

Here's an attempt at filling in part of a common statement: "the position of some editors is that the sentence "Factors other than circumcision may account for the observed differences in pain response" must be quoted if the main results of the Taddio study are mentioned, and the argument in support of this position is that the NPOV policy might be interpreted to require that if a source is being summarized, and if the source contains statements that moderate or qualify the main point of view expressed by the source, then those statements must be quoted or referred to." --Coppertwig 17:02, 17 August 2007 (UTC)

There is something about the way Wikipedia works that I am not understanding. I agree with DanBlackham, for just the reasons that he states, that the possible counfounding elements don't belong in a section of this size (I don't object in principle to lenghtening the Taddio section so that it would no longer be a problem). What is the purpose of the "common statement" Coppertwig is offering?

Just David 17:16, 17 August 2007 (UTC)

Is the belief that the concern about confounding is not serious yours, Dan's, or Taddio's, Coppertwig? From everything you've described, it seems to be based upon your own analysis of Taddio's results and methodology. If so, it's original research. Jakew 19:47, 17 August 2007 (UTC)

Either I didn't word my previous message very well, or the word "serious" seems to change its meaning when the word "not" is put in front of it. "[N]ot serious" seems to mean "silly; to be dismissed". I don't have a belief along those lines in this context and I don't think Taddio et al. or Dan do either. Instead of "gives the wrong impression that there is a serious concern" above, let me say "gives the wrong impression that there is a more serious concern". To turn the question around: if there is a "concern", whose is it? I don't remember Taddio et al. using the word "concern" in this context.

I'm not trying to hide information. I have nothing against the reader knowing that Taddio et al. said that they acknowledge X. It's just that, unfortunately, I see no way to give that information to the reader without also giving them the impression that whoever wrote this article thought that particular sentence in the Taddio et al. study was so important that it had to be quoted in a 3-sentence summary of the report. That gives an exaggerated impression of the importance of that sentence.

Avi, quoting that sentence doesn't "overwhelm" the result, to use a word you used in an edit summary; but it does something less than that yet still too much. It gives an impression of greatly weakening the result -- an impression that would not be given if it were balanced by other information in similar proportions that the information is given in the report itself. --Coppertwig 21:40, 17 August 2007 (UTC)

Coppertwig, we have to perform a balancing act: we have to fairly represent the findings of the study, in a balanced way, without devoting an excessive amount of space to a single study. You have personally proposed some possible wordings that clearly express the meaning yet use fewer words, but unfortunately those have been rejected by others. With the inclusion of "but stated that they did not find evidence of such", your complaint that it "greatly weaken[s]" the result is untenable: this is precisely what the researchers themselves said, and spent a third of their 'discussion' paragraphs discussing. The underlying problem, as far as I can tell from the arguments above, is that certain editors believe that the statement is wrong. Jakew 22:28, 17 August 2007 (UTC)

I do not believe that Taddio et al.'s statement is wrong. ("Factors other than circumcision may account for the observed differences in pain response." Sorry, I may have misquoted them above: they didn't say "We acknowledge that ..."; it was the AAP that quoted them with "They acknowledge that...".) Sorry, I don't think the AAP said "acknowledge" either in this context; I think it was a Wikipedian who said that. However, I believe they're talking about an unlikely possibility. --Coppertwig 22:55, 17 August 2007 (UTC)

I recognise your belief, but based upon your comment of 17:02, 17 August 2007, it seems to be based upon certain Wikipedia editors' analysis of the study methodology, rather than an analysis made explicitly by the source. You believe it to be an "unlikely possibility", Dan "unfounded speculation". Perhaps 'wrong' was not the best word, but the problem seems to be that you disagree with the choice of words used in the source itself. Jakew

I don't disagree with the choice of words used in the source, when taken in context. Their main results are repeated more than once in the paper; that one sentence about "other factors" only appears once and the rest of the paragraph moderates and qualifies it.

In this edit [18] you said about another study, "The purpose of that study was not to assess how frequently anaesthesia is given, so it can only be considered an opinion." So apparently you don't think we have to quote every sentence in every scientific paper. Re "unfounded speculation": To say that other factors "may" account for the results is accurate; to say (or imply) that other factors do account for the results is unfounded speculation. --Coppertwig 23:40, 17 August 2007 (UTC)

Taddio seems like the weakest study of its kind. It seems chosen so that it can be criticized. It doesn't seem to address the immediate pain from circumcision, but infers it based on psychological harm observed years later, which makes it unsuitable for the section it's in. Other studies, as well as common sense, do a much better job. Why not rip Taddio out and go with what all the medical organizations state out front, and what any sane person recognizes: circumcision is painful because it's the cutting off of a piece of a live person's penis. Blackworm 23:42, 17 August 2007 (UTC)

I think it would be best to mention the Taddio study and also mention the other studies. Blackworm, would you suggest wording for mentioning the other studies? Re Taddio: unfortunately, many people think and act as if babies are not real people or are not conscious or as if, if they are conscious, any suffering they do doesn't matter if they don't remember it later on. The Taddio study refutes that sort of reasoning. Also, the other studies say that there was increased heart rate, high-pitched crying and so on, but I'm not sure how firmly they establish that these things happen to a greater extent than in normal day-to-day activities such as crying because one is hungry or wants a diaper change. The Taddio study supports the hypothesis that it is a significantly greater suffering than that. --Coppertwig 20:06, 19 August 2007 (UTC)

Mentioning the Taddio and other studies seems best. It isn't as if Taddio is the only person to look into this. I agree with Coppertwig that people do still act as if babies are not real people or are not conscious. The very fact that there is an expectation that it should be proven that babies are hurt by something that would hurt any other human being, and can feel pain in that part of their body when they can feel pain in any other, it very strange.

I think quoting from the major medical organizations, as Blackworm suggests, would be an excellent idea here. Not all studies are equal and it isn't easy for the layperson to balance them. Presenting the views of major medical organizations would show how science is viewing the literature.

Edwardsville 13:52, 21 August 2007 (UTC)

Jakew, if you want to reflect "precisely what the researchers said", why don't you go with their own summary of their work? We can't quote everything that they say so we have to pick out what is important. The best guide to what is important is what they put in their summary (and what the AAP put in their summary).

Edwardsville 13:54, 21 August 2007 (UTC)