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Reasons for and against metzitzah

I have removed the comment that metzitzah b'peh is done 'to promote healing.' This comment is tendentious and controversial for the following reasons:

• We have no way of knowing the motivation of every mohel in sucking the blood from the circumcision wound. It might be in the belief that it promotes healing, or that the Talmud commands it, or that custom obligates it or for a thousand other reasons.
• To say 'to promote healing' implies that sucking the circumcision wound has this effect. This is hotly contested by many doctors who assert that it can spread disease.

Therefore this wording is POV and tendentious. I have tried to get over this problem by inviting interested readers to follow a variety of links to a variety of opinions. One is to the website of the Rabbinical Council of America. Another one is to an article in The Jewish Week. The third one is to a press release from a group opposed to circumcision. They complement the first link, which is pro-metzitzah. Here are the four links:

Michael Glass 23:30, 15 February 2007 (UTC)

The reason for metzitza is the Talmud in Shabbos, and the reasons there are to promote healing. Whether you or I think it is effective is WP:OR, and that it may spread herpes is already mentioned by the Gesundheit article. Putting in a link farm is completely out of scope, at BEST it belongs in Brit Milah. Please stop trying to push negative implications for metzitzah because you do not like it. -- Avi 01:42, 16 February 2007 (UTC)

Avi, please don't suppress other references. Not once have you even attempted to justify this form of censorship. If you believe that metzitzah b'peh is done to promote healing, so be it. However, we are writing a Misplaced Pages article, not the Talmud. The form of words that you have chosen can be taken to imply that this is indeed so. This is quite unacceptable because competent medical authorities are strongly of the opinion that metzitzah b'peh can spread life-threatening disease! Faced with this impasse, we need to work out the kind of wording that accommodates both points of view in a non-partisan way, and links with a variety of of views on the subject. Michael Glass 12:03, 16 February 2007 (UTC)

I removed three of the four references because it's tendentious to spam a single sentence with four links (and "prweb" is not really a useful source for anything, frankly). I agree with Michael that saying something like "Some believe that blah promotes healing" is a better wording than "To promote healing." Nandesuka 13:04, 16 February 2007 (UTC)

I disagree. By doing so you are confusing two issues. There is no doubt that it serves to promote the healing of the wound. The issue is does it ALSO open up the possibility of spreading certain diseases. These are two seperate issues, the same way breathing supports life, but is the ONLY way that the flu, rhinovirus, and tuberculosis is spread. We already make clear through the Gesundheit article that metztzah has the danger of spreading Herpes. This is no way shape or form chnages the medical fact that the act of metztzah helps promote the healing of the incision created by the bris. To say otherwise, inmy opinion, is disingenuous and indicative of either a misunderstanding of the process, of the English language, or a desire to cast metztzah in a poor light for outside POV reasons. -- Avi 13:20, 16 February 2007 (UTC)

Can I suggest changing the text to: "sucks blood from the circumcision wound, with the intent being to promote healing?" I think this would avoid the possibility of any such confusion. Jakew 14:24, 16 February 2007 (UTC)

But would Michael be so quick to demand that we place the following phrase in a surgery article. "The intent of performing an appendectomy is to promote the well being of a person suffering from appendicitis" or "The intent of radiation therapy is to promote healing of cancer" Even though nternal surgery carries phenomenal risk of infection and radiation therapy has significant deleterious side affects that sometimes prove terminal? -- Avi 15:37, 16 February 2007 (UTC)

I don't know. Michael was talking about 'belief,' which seems a weak term given Mordechai Halperin's statements. On the other hand, I'd feel uncomfortable with stating the benefit as absolute fact without citing scientific studies in support. It seems simplest, and perhaps a quick resolution, to simply specify the intent. It was, of course, just an idea. Jakew 15:49, 16 February 2007 (UTC)

"There is no doubt that it serves to promote the healing of the wound." I doubt it, or at least I can't imagine why other post circ antiseptic treatments might help much more. Intent fits, however crude. Remember, I'm withholding ritual infection rate information. Whatever's being done isn't enough!TipPt 01:46, 17 February 2007 (UTC)

I have read the above discussion and have revised the article to bring back the links. I hope that they will be respected. It is quite unsatisfactory to remove links and so leave just one or two points of view in this admittedly controversial area. I have also added that though some believe that metzitzah prromotes healing, other have implicated metzitzah b'peh in the spreading of herpes to babies. I have not written or implied anything about the rightness or wrongness of the two positions so I hope that will be staiscfactory to most, if not all. Michael Glass 05:01, 17 February 2007 (UTC)

I note that Jake has removed three of the four links that I supplied. I accept that a link to Misplaced Pages is not appropriate, because Misplaced Pages is constantly changing. However, it is unfortunate to remove the other links as well. It isn't just a case of the Jewish view versus the medical view. Metzitzah b'peh is a matter of lively debate in the Jewish community and sometimes in the community generally. This is something that can be gleaned from the other links. I will let it rest for the moment, but I will try again to restore the other links so that interested readers can find out more about the different positions if they want to. Michael Glass 12:53, 17 February 2007 (UTC)

Another attempt of mine to document how and why metzitzah b'peh is controversial has been frustrated and overturned. This time Avi's flimsy excuse is that the paragraph is overloaded - by two footnotes! I did not object when Avi added links to supporters of metzitzah b'peh, as long as this practice is listed as a belief. However, when I try to document the controversy that surrrounds this practice, it gets reverted! This from an editor who will turn round and blast anyone who dares disagree with him and his approach as being biased or worse. I think it is about time that Avi has a good look at himself and his behaviour. I, for one, find it intolerable. All I am asking for is that a statement in the article be verified by appropriate footnotes. That is totally in line with Misplaced Pages policy. I am willing to discuss what articles will document this best but I won't stand I won't stand the nonsense that footnoting articles overloads them. I am putting those footnotes back. I also am putting Avi on notice that either he respects those footnotes or he comes up with a mighty good reason why they need to be changed. If he cannot abide by these minimum standards, I will take this further.Michael Glass 01:15, 19 February 2007 (UTC)

With all due respect, there is a HUGE difference between commenting on the intent of an established, and well documented, lifesaving medical procedure … as opposed to commenting on the motivating intent of what is NOTHING more than a dubious religious ritual, the true origins of which are lost in pre-history. Just one word: Commonsense! .. and don’t try telling me that “dubious” is simply a point of view, or original research. The raction to Michael's edits just goes to show that some, here, are blinded by a wholly irrational, and quite obsessive, need to promote what they themselves believe in. Orpingtonian 08:34, 22 February 2007 (UTC)

shorter article

People say this article should be shorter. I agree. The HIV and HPV (which is like 40 paragraphs) should be removed. This is taking up ALL THE SPACE. Someone w/not an entire penis typed all that in probably in the spirit of Pro-Circ bias. We will gather together and edit out all this non-essential studies. Lets just say if we chop off our hands we wont get arthritis in the hands and be done with it. I have to wonder about so called self-proclaimed "nerds" who don't know what bias is.— Preceding unsigned comment added by 24.167.107.118 (talk • contribs)

AIDS virus?

The second paragraph of the quite appallingly biased section 5.2 (HIV) states:

“Research by the World Health Organization published in the US Public Library of Science Medicine journal in July, 2006, showed that men who had been circumcised had a significantly lower risk of infection with the AIDS virus, and calculated that if all men were circumcised over the next 10 years, some two million new infections could be avoided”

Overall bias aside, the authour somewhat betrays ignorance of the subject by referring to the “AIDS virus” … when there is no such thing in existance. AIDS is merely a syndrome (thought to be) caused by the Human immunodeficiency virus (HIV).

The paragraph should read:

“Research by the World Health Organization published in the US Public Library of Science Medicine journal in July, 2006, showed that men who had been circumcised had a significantly lower risk of infection with the Human immunodeficiency virus (HIV) ......”

For the sake of retaining credibility, the paragraph should perhaps also be edited to reflect the fact that the 'calculation' referred to (which used data from using data from UNAIDS, not the study itself) actually stated “three million HIV infections could be averted in Africa by 2026” (which was 20 years into the future, not 10).

It would perhaps also be prudent to balance the information in this section with the facts that these studies looked solely at MEDICAL circumcisions - not ritual circumcsions – and that WHO explicitly stated:

“Countries or health care institutions which decide to offer male circumcision more widely as an additional way to protect against HIV infection must ensure that it is performed safely by well-trained practitioners in sanitary settings under conditions of informed consent, confidentiality, risk reduction counselling and safety.”

It also fails to make any mention of the fact that Bertran Auvert himself, the director of the South African study, noted that 31% of those circumcised in the trial complained of pain and that 15% had subsequent problems with their penis .. and that these problems could well have lead to a reduction of sexual activity, that could - rather than the circucision - therefore quite possibly explain the reduced transmisiion of HIV.

Orpingtonian 13:03, 17 February 2007 (UTC)

I see a couple of other issues with the way this study is referenced:

First, it was not conducted by the WHO but by an interdisciplinary team of nine researchers from several institutions, two of whom are affilliated with the Stop TB Department of the WHO and one of whom is affilliated with Family and Community Health department of the WHO. The other six are not affilliated with the and the WHO is not named among the funding institutions nor did it release the articles findings as a report.

Second, the portion that reads "Research conducted by...and published in...showed that men who had been circumcised had a significantly lower risk of infection with the AIDS virus" is misleading at best and incorrect at worse. The only research conducted by this team was a statistical modelling of data from another separate study which had shown that men cirumcised had a significantly lower risk of infection (with the virus of course, not the syndrome which results). The fact that one of the authors of this study is also an author of the other study does not mean that we can say that the research done in one study was also done in the other. This is standard academic protocol for discussing multiple researches by a given individual.

How about something like "Research published in the Public Library of Science Medicine journal in July, 2006, calculated that if all men in sub-Saharan Africa were circumcised over the next 10 years, two million new infections could potentially be avoided." ? In accordance with the controversial nature of this article, I will await discussion before making any changes.Zandrous 13:41, 18 February 2007 (UTC)

Could we make that “Controversial research published in the Public Library ............."?. I don't think that there is any real dispute about the fact that it is controversial .. and that is, and will continue to be, the subject of much heated scientific debate, is there? Surely it is reasonable to highlight the fact that it is controversial. Orpingtonian 15:15, 18 February 2007 (UTC)

Only if you have a source that claims it is controversial. If you or I think it is controversial, that is original research and editor commentary. The issues raised above may be well and true, but the fact that they were raised by an editor, and not a wiki-acceptable source, makes them original research and unacceptable for addition to the article without an outseide source. —The preceding unsigned comment was added by Avraham (talk • contribs) 15:46, 18 February 2007 (UTC).

I am sorry, Avraham, no offence intended; but that comment is nothing short of preposterous and only goes to hint at your own lack of objectivity and determination to forward your own beliefs and POINTS OF VIEW (and demanding much lesser standards of edits that support your own view). You certainly don’t have to search very hard to find the controversy about the conclusions, the questioning of the (almost total lack of) proper scientific methodology, the quality of the very obvious assumptions made and the idea of widespread unnecessary and pointless genital mutilation of infants.

The authors of the study themselves - who include epidemiologists from the World Health Organization, UNAIDS, the University of California, South Africa and France - ALL warn that MUCH better data will be needed before the report(s) and figures can be used to make ANY public health policy decisions .. in particular, they say, better information is needed on HIV prevalence (UNAIDS prevalence estimates have a margin of error of up to 30%) and information on the prevalence of circumcision, the age at circumcision and the safety of current circumcision practices. Try reading: & .. and it is controversial as hell according to:

1: the CDC, who say “As CDC proceeds with the development of public health recommendations for the U.S., individual men may wish to consider circumcision as an additional HIV prevention measure, but must recognize that circumcision 1) does carry risks and costs that must be considered in addition to potential benefits; 2) has only proven effective in reducing the risk of infection through insertive vaginal sex; and 3) confers only partial protection and should be considered only in conjunction with other proven prevention measures (abstinence, mutual monogamy, reducing number of sex partners, and correct and consistent condom use).” (http://www.cdc.gov/hiv/resources/factsheets/circumcision.htm)

2: Marilyn Milos, a nurse who is executive director of NOCIRC in San Anselmo, said that while the trial results were interesting, "anybody who believes that circumcision will protect them from HIV is obviously making a deadly mistake. (http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2006/12/14/MNGDIMVHF81.DTL&type=health)

3: another PLS article (http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030074), which cites and Orpingtonian 17:00, 18 February 2007 (UTC)

As I said, if you have reliable/verifiable sources speaking about that very study, which you seem to, then it is perfectly acceptable to add that to the discussion. The fact that YOU or I may not like a given study, or WE think that there are problems with it, may be well and true, but unacceptable to wikipedia until WE are published in a third-party source. The fact that Jake IS published in a third-party source makes that letter an acceptable reference. The fact that Jake may think circumcision is the best possible method to preventing who-knows-what is NOT acceptable license for him to add it to the article. Do you understand the difference? -- Avi 17:22, 18 February 2007 (UTC)

The fact that you (Orpingtonian) are engaging in original research is somewhat obvious. The study concerned (our ref 92), as noted in the article, was published in July 2006. In support of your claim that it is controversial, you offer:

1. the CDC, who do not cite our ref 92 at all.
2. Milos, in an article about the two NIH studies (and that did not mention our ref 92).
3. A January 2006 article, citing a 2005 and a 2004 article. All of these articles clearly predate the study and thus cannot possible dispute the findings. Jakew 17:44, 18 February 2007 (UTC)

Try again. 92 *IS* mainly based on the work done in the study commented on by the CDC and Milos (it even shares authors). The PLS article is specifically about (and thanks the authors of) the study on which 92 is based and extrapolated from. 92 REPEATEDLY refers to the work and 92 DOES include ALL the qualifications listed above. Orpingtonian 17:57, 18 February 2007 (UTC)

If 92 is controversial, then please cite a published work saying so explicitly. Otherwise any original argument that it is controversial, based upon work cited or whatever, is by definition OR. Jakew 18:53, 18 February 2007 (UTC)

Look, the very fact that the comment refers to the "AIDS virus" shows the staggering lack of comprehension going in here. There is NOTHING even remotely original in 92 and it is just a rehash of the work that I have already shown is controversial and to which the authors themselves (along with the WHO UNAIDS) have attached so many riders as to render it totally meningless. Trying to promote it as anything else is a pretty desperate fraud. Go ahead and keep it if you are really so desperate to promote the totally barbaric mutilation of tens of millions of infant males, without even so much at hinting at the widely published cautions that go with that. Orpingtonian 19:31, 18 February 2007 (UTC)

Okay, adding the word 'controversial' apppears to be too controversial...how about the rewrite I proposed above, namely "Research published in the Public Library of Science Medicine journal in July, 2006, calculated that if all men in sub-Saharan Africa were circumcised over the next 10 years, two million new infections could potentially be avoided." Does anyone see any issues with that? I think it addresses the substantive issues that Orpingtonian raised with the sentence as it's now written. Zandrous 12:35, 19 February 2007 (UTC)

Seems basically ok to me, though I think the journal calls itself PLoS Medicine. Jakew 12:39, 19 February 2007 (UTC)

Sounds good to me too. -- Avi 23:27, 19 February 2007 (UTC)

It still doesn't really cover it, but it will do for now. I’m just knocking up a letter to the BMJ to comment of the controversial nature of this preposterous ‘study’ .. I am told they will publish ;) Orpingtonian 23:57, 19 February 2007 (UTC)

If you get published in a reliable source, good for you . And add it to the article, properly cited, of course ;) -- Avi 07:56, 20 February 2007 (UTC)

Great, I'll make the change. And then I'll get back to preparing a chapter for a scholarly volume (my second) and a presentation for a peer-reviewed research conference (my seventh) but I won't go self-citing them here, nor would I ever consider compromising my professional integrity by submitting academic work with the intention of generating a reliable source for a wikipedia article because I actually believe that wikipedia is not should not be a soapbox. If active editors find my work in the natural course of sourcing articles, all the better for all of us. Forgive my sharp comments, long observation of this page has led me to become somewhat cynical about the process.Zandrous 10:44, 20 February 2007 (UTC)

Question about Reliable Sources

Is a letter to the editor (which is not subject to peer review) of a journal (which is peer reviewed) a reliable source? I am thinking particularly about reference 101 which cites a letter by someone with no formal training or credentials in the discipline of the journal (as far as I know) criticizing a published study on technical grounds. Given that the published study passed peer review and the letter criticizing it did not, is it fair to say in our article that the study has been criticized on techincal grounds? Shouldn't we find a peer-reviewed source that does so, and if one is lacking, notate that it has been criticized by a non-expert or a researcher from an unrelated discipline? I must say I feel a bit awkward bringing this up since the letter happens to be from a wikipedian who is very active on this page. But I also feel that it's very important to keep up the standards for sources on this page.Zandrous 14:00, 18 February 2007 (UTC)

The letter is published in a reliable source (unlike some of these websites like "National Organization of Restoring Men". The link followed goes to the letters section, which allows the reader to make their own decision. Anyway, most peer-reviewed journals do not publish crackpot letters; regardless, the source is an acceptable one, so the reference should be as well. -- Avi 15:49, 18 February 2007 (UTC)

"The letter is published in a reliable source (unlike some of these websites like "National Organization of Restoring Men")". Point of view .. and a pretty dubious one at that. Orpingtonian 16:47, 18 February 2007 (UTC)

Last I checked, peer-reviewd journals are acceptable sources. You differ? -- Avi 17:18, 18 February 2007 (UTC)

Was the letter peer-reviewed BEFORE publication? If not, then I think it is a back door entry and simply exploits a flaw in Wiki policy .. but that is just a (my) point of view ;) Orpingtonian 17:42, 18 February 2007 (UTC)

I understand that peer-reviewed articles are reliable sources, but this letter is not peer-reviewed, even though it appeared in a scholarly journal. Not everything that appears in a scholarly journal is peer-reviewed, ie letters and book reviews typically are not. My main concern is that the letter (which was not peer-reviewed) is being cited here as a critique of Fleiss et al (that was peer-reviewed). Is this is the only critique of Fleiss et al anywhere in print? Can't we find a more reliable source than someone who has no qualification in anything related to medicine, physiology, or biology? If not, shouldn't we at least qualify the sentence to make clear that Fleiss et al has been criticized by an avocational researcher with no formal training or credentials in medicine, biology, physiology, or any related fields? Lots of unqualified people write lots of letters about lots of things, but having a letter printed doesn't automatically make it a suitable source for an encyclopedia. Zandrous 12:28, 19 February 2007 (UTC)

Looking at this, it appears to me that

1. You can't include a qualifier like "non-expert" without a reliable source for it.
2. The editor of the specialist journal concerned - Sex Trans Infect - thought it worthy of publication.
3. The claim isn't particularly extraordinary.

-- Jayjg 16:01, 20 February 2007 (UTC)

Change to sentence referencing PLoS Medicine article in HIV section

I made this edit (after discussing it above) for the following reasons:

First, it was not conducted by the WHO but by an interdisciplinary team of nine researchers from several institutions, two of whom are affilliated with the Stop TB Department of the WHO and one of whom is affilliated with Family and Community Health department of the WHO. The other six are not affilliated with the WHO and the WHO is not named among the funding institutions nor did it release the article's findings as a report.

Second, the portion that reads "Research conducted by...and published in...showed that men who had been circumcised had a significantly lower risk of infection with the AIDS virus" is misleading at best and incorrect at worse. The only research conducted by the team that authored this article was a statistical modelling of data from a different, separate study which had shown that men cirumcised had a significantly lower risk of infection (with the HIV virus of course, not the Acquired Immune Defiency Syndrome which may result from infection). The fact that one of the authors of this study is also an author of the other study does not mean that we can say that the research done in one study was also done in the other. This is standard academic protocol for discussing multiple researches by a given individual, even when published in the same journal on separate occasions.

I hope that clears it up. Please feel free to discuss! Does anyone prefer the earlier formulation, and if so why? Zandrous 17:39, 20 February 2007 (UTC)

Circumcision rates in Britain

I have changed the reporting on Rickwood to put the information on circumcision rates in chronological order (as in Rickwood's paper). I have also included more information about why Rickwood thought that too many children were being circumcised (a misdiagnosis of phimosis) as this particularly applied to children under 5. Michael Glass 22:29, 20 February 2007 (UTC). I then reordered the section to put the general survey of sexual attitudes before the survey of children. Michael Glass 22:53, 20 February 2007 (UTC)

Circumcision rates in Australia

Jake certainly did improve the article by quoting figures from the Sydney Morning Herald. There are, in fact, two reprints of the article, one on CIRP and one on Circumcision Info . The quality of the article can be judged by the fact that both CIRP (anti circumcision) and Circ Info (pro circumcision) saw fit to quote it.

Jake's footnote linked the article to Circ Info but attributed the link to CIRP. Now the wording is essentially the same on both websites, but the layout and presentation of the article on CIRP is far superior, with properly justified paragraphs and links to the Royal Australasian College of Physicians etc. By contrast, the layout on Circumcision Info is confusing because the paragraphs are centred instead of justified.

Because the layout on the CIRP site in this instance is far superior to the alternative, and because the footnote had attributed the reprint to CIRP I changed the link in line with the footnote. I realise that pro circumcision editors do their best to avoid quoting from CIRP but in this instance the superior layout of the CIRP reprint tips the balance in its favour. Michael Glass 12:07, 21 February 2007 (UTC)

Oops. Well spotted.

I partly agree and partly disagree with you, Michael. I'd prefer the version without the links (because it is truer to the original text), but the layout of the CIRP version is more readable.

I don't know about "pro circumcision editors," but I don't have a big problem with linking to reprints at CIRP (or elsewhere), provided of course that the original is otherwise unavailable and that the reprint is faithful to the original. However, CIRP's original (non-reprint) content does not conform to WP:RS - it is no more reliable than any random web page - and must not be cited. The same would be true of circumcisioninfo or any other privately-maintained site, regardless of their position. Jakew 12:50, 21 February 2007 (UTC)

Just one point of clarification, Jake. You say you prefer the version without the links because it is truer to the text. Are you saying that the transcription is more accurate or are you saying that providing links is a problem? Michael Glass 13:37, 21 February 2007 (UTC)

I'm saying that providing links is a problem if they were not present in the original. Jakew 15:12, 21 February 2007 (UTC)

Cirp has this policy of using yellow highlighting for text that demonstrates detriments of circumcision and policy statements that are against circumcision tendencies, but does not highlight or make any other corresponding text emphasis for statements that oppose their bias. That is what makes me uncomfortable quoting from cirp, unless we absolutely HAVE to. I know of no other site that bias the data the way CIRP does. -- Avi 15:14, 21 February 2007 (UTC)

There is no yellow highlighting in the text quoted, so the above comment is not relevant to this particular discussion. As for other sites, I believe that CIRCS occasionally uses hotlinks. Take the list of references in this article . Understandably, the links are to pro-circumcision articles. While I understand the concern, the main thing is that the wording is accurate. In any case, we do have a disclaimer in the article Michael Glass 07:06, 22 February 2007 (UTC)

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