-
I am Ryan, a friend of Lizzie's.
-
I do bio-physics research
at Georgetown University,
-
and I also coordinate two non-profits
that deal mostly with supporting families
-
and supporting people in their relationships.
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Here is my family.
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So my mission in life basically
is to help people get along,
-
and towards that end,
I do a lot of workshops with families
-
and I also help families
understand medical questions.
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So I am here to talk with you about circumcision,
-
I am calling it an "Elephant in the Hospital"
-
because it is this huge thing that happens
as far as I see in our culture
-
but we have very little discourse about it.
-
It is performed between 500,000 and 1,000,000
million times each year in the U.S.,
-
almost entirely on infants within
the first three days of life
-
and it is completely unnecessary;
and I believe, based on my research,
-
entirely harmful to children.
-
So what we are going to run through,
as quickly as I can,
-
is just a discussion what that process is like
from the child's point of view,
-
what effects it has on adult survivors,
-
how we get parents to agree to it
(what understanding parents have),
-
and how we get practitioners to perform it.
-
So before we do that, I actually just want
to get a chance to see what our room is like
-
so we can see each other; therefore, I will ask a few questions
and we're gonna use this technology for room assessment
-
that goes back to a before clickers.
I am going to ask you, if you are willing,
-
to point in the direction as I ask you about each thing,
-
from beneficial, this wall is the beneficial wall,
-
neutral is the ceiling,
and harmful is the wall over there.
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For Example, what do you think of foot binding?
-
I mean you are anthropologists,
most of you have heard of foot binding.
-
Where do you think it goes on the ...
-
okay we have everyone who chose to respond,
thinks it is harmful.
-
Good I am pleased with that response.
-
Female Genital Cutting
-
how many people have heard of that?
-
Okay great, we have got universally harmful.
-
Okay what about say we were going
to do prophylactic breast bud removal,
-
say we wanted to stop breast cancer
-
and save hundreds of thousands of women's lives per year,
-
and say we just cut all babies' breast buds off?
-
Beneficial? Harmful? Neutral?
-
Okay some neutral and some harmful.
-
Okay.
-
And what about cutting off non-essential tissue from a child,
-
say we just cut off all children's ear lobes
-
because we thought they were an inconvenience,
a pain or they looked ugly?
-
Okay, we have got harmful.
-
So what about Circumcision?
-
What is our starting point?
-
We have got every response,
-
that's great; okay, so we have a diverse audience.
-
Now a couple of other questions
-
just to see who we are.
-
Who here thinks that they have a foreskin,
-
anyone?
-
Who here believes that they have a foreskin,
-
which is that part they remove during circumcision, right?
-
Okay, so that is a trick question.
-
Men and women, males and females, are both born with foreskins,
-
the foreskin is just a name for a part of the clitoris or penis,
-
and so probably most of the women here have one
-
and perhaps some of the males also.
-
Who here comes from a culture where
-
female genital cutting is a social norm?
-
No one, okay.
-
Who here comes from a culture where
-
male genital cutting is a social norm?
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Okay, all of us pretty much, that I can see, okay.
-
And who knows someone who was genitally altered as a child
-
it could be you, it could be a friend it could be your parents, or child?
-
Mostly (all)!
-
Great, so all of that is just to illustrate how it's something that has
touched all of our lives in some way.
-
So I am arguing that it is this big thing and that we don't talk about it a lot.
-
So I have to sort of explain why I think that.
-
So I believe that the discourse that we have in our culture about circumcision
-
is one that is used to conceal what the nature of the process is.
-
So you may have heard things like "well, you know,
it makes the penis cleaner" and things like that.
-
You may have heard things like "everyone does it," "I am circumcised, I am fine,"
-
"It is just a little snip" or "it removes a useless flap of skin,"
-
this sort of trivializing language.
-
Well, we have heard all of these things.
-
What I am going to ask you to do is set all that aside,
-
all of that mass of experience in your mind,
-
and to try to come at it from a fresh angle where
-
these sort of illogical arguments of support for it are not part of your way of thinking.
-
I am going to propose that circumcision is this cyclical process in our culture
-
where we do it to children, they grow up to become adult survivors,
-
some of those people become parents,
-
and practitioners engage them in order to perform this surgery on their children,
-
which unlike any other surgery I am aware of in U.S. hospitals,
-
it removes a healthy and unique organ part
-
(actually with the exception of inter-sex genital modification,
-
which bears a lot of resemblance to it by the way).
-
It removes a healthy part of the body.
-
It is not used as a treatment.
-
Doctors don't think they are treating the children;
-
they know it is a social surgery they are performing.
-
It has significant complications.
-
It is performed on minors who cannot give their consent.
-
It is illegal, it is actually a federal felony to perform on girls,
-
but it is actually encouraged and performed on boys.
-
It results in life long function loss,
-
and the tissue is then used commercially.
-
So just a little context piece.
-
I hear you, believe me, and I will show you evidence of that.
-
I won't make such a radical claim without proving it.
-
So let's just finish our context piece
with both the geography and the history.
-
So this is a map of the world sort of.
-
As you can see green countries represent places where
genital cutting of boys is not practiced, generally speaking.
-
The small, the few yellow countries up in the northern regions
-
are places where it is becoming legally questioned.
-
Circumcision is now rare in Canada, England, and Australia
-
where it used to be practiced on babies also, but stopped.
-
In fact, in England, in the 1950's there was an article published
-
showing it killed a number of children a year,
-
about 14 a year,
-
so they stopped the practice there.
-
And the other places, besides the United States where it is done on babies,
-
in the other regions, most of the time, it is done on adolescents
-
in Sub-Saharan Africa and in Sunni Islamic cultures.
-
Now how did we get here?
-
It has become a medical practice rather than a
tribal practice or a cultural practice.
-
And that came about in the late 1800's
-
when people had not the germ theory of disease,
-
but the nervous excitation theory of disease.
-
And people had the Victorian morality,
-
so people see what they expect to see a lot of the time.
-
So you can find a lot of published medical literature
showing that circumcision cured
-
things such as, paralysis, epilepsy, hip joint disease,
-
and all sorts of problems that today
-
seem very unlikely for the process to have cured.
-
And people really thought that actually harming,
the intention was to harm the genitals of the children.
-
And they thought that it would help in the long term
-
because it would prevent them from
having so much sexual excitation
-
that being, in the Victorian model, the most dangerous
type of excitation that one could have.
-
So, uhm, oops,
-
I should have given you a caveat,
-
my apologies...
-
There are going to be some graphic slides here,
-
and I certainly welcome you turn away at any point
if you don't feel comfortable about looking at what you see.
-
And I will try to more often try to give you a warning
when they are about to come up.
-
I would also mention actually another caveat:
-
I am going to use language differently.
-
I am going to switch now to mostly
calling circumcision "genital cutting"
-
because I think that is more of a neutral term,
-
it's a more accurate or descriptive term.
-
I think "circumcision" euphemistically embeds
our assumption that it is a fine thing.
-
And the term uncircumcised
I am going to replace with the term "intact",
-
because likewise the term "uncircumcised"
gives the sense that circumcision is the norm
-
and that those who are not circumcised are
simply "not yet" circumcised.
-
And to illustrate that it would be kind of weird
if we called women who had breasts"un-mastectomised"
-
right that would be uncomfortable,
-
and, likewise, I hope to sensitize us to the discomfort
of calling "intact" "uncircumcised".
-
So the next few slides will have some
less-comfortable things to see,
-
and, again, you are welcome to turn away if you want.
-
So this is the section on the Child.
-
The procedure for the child, we will
run through what the procedure looks like.
-
That's probably the most graphic section,
along with the complications,
-
and what I want you to think about is,
-
it is often times talked about from the parents'
perspective,"parents have the right to choose".
-
I want you to question that discourse and think
about what the child's point of view is.
-
Who owns the child's body?
-
What rights do they have?
-
Why are we doing it to boys and not girls?
-
What does that say about our views on gender, and so on?
-
So, this slide shows three different representations
of people in the genital cutting process.
-
The top left is a young girl
-
being circumcised in her cultural scenario.
-
The top right is a young boy being
circumcised in his cultural scenario.
-
And the bottom right is an
infant boy in a hospital.
-
Now what I want you to look at is their faces.
-
Just look at their faces
-
because I am asking you to think about their experiences.
-
To me it looks like they are having a very similar experience.
-
And yet in our culture,
-
where I think of us as being kind of imperialist
-
we're very ready to point the finger and say,
-
Oh these terrible things these people do in these other
countries where they practice female genital cutting."
-
yet we're silent about the male genital cutting
-
that occurs to children under the same conditions of hygiene
-
and the same death rates in those countries;
-
and we promote doing it to boys in our country.
-
So how do we do a circumcision?
-
The next bits are going to be the most graphic.
-
This is a circumcision restraint;
-
they strap the baby down into it,
-
and then they proceed with the procedure,
-
which I am going to show you a short video of.
-
This is going to include sound
-
if I hooked it up correctly.
-
and, again, you are welcome to not look;
I find this uncomfortable.
-
Okay, so I want to encourage you to take a deep breath
-
if you have been having trouble breathing
as I have during that.
-
Some things I think to notice is the sort of calm detachment
-
of the physician's voice.
-
So the physician is not at all distressed by this.
-
And the way the baby is crying.
-
I hear the baby's crying as the way I hear babies cry
-
when they are under extreme duress,
-
not you know, "I am hungry."
-
So beyond the pain of the procedure itself
-
and the pain of the many days it takes to heal,
-
there are a number of complications that a
circumcision procedure puts a child at risk for.
-
You can sort of divide them into two categories.
-
Surgical complications,
-
which go from the more minor,
-
you know everyone has a scar that has been circumcised.
-
A lot of men don't actually know that
the ring around their penis
-
is a circumcision scar,
-
or they learn it when they hear me talk.
-
But that always happens.
-
But a number of other complications can be problematic
-
that don't occur all the time,
-
like penile adhesions,
-
when the healing process goes awry
-
and two parts of the penis that weren't supposed
to be connected link together.
-
Then these panels show in top left (A)
-
(A) that's called a fistula,
-
so its like a doctor induced hypospadias,
-
the black line going down is a probe that's
entering the meatus, the opening of the urethra
-
and exiting out the additional hole
-
that the physician has caused.
-
(B) Top Right is a nearly amputated head of the penis.
-
(C) Bottom Left so much skin of the penis has been removed
-
(C) that the child's corpus cavernosa and head of the penis
are lodged down inside the scrotum,
-
and in (D) Bottom Right the penis was accidentally amputated entirely.
-
There are also a number of post-operative complications
-
ranging from difficulty in breast feeding,
-
which is important because developing the ability to breast feed
-
is essential for infants.
-
Bleeding,
-
which is another sort of minimizing term,
-
you see that on consent forms,
you know like"Oh, bleeding",
-
well it turns out an infant only has
about 12 ounces of blood
-
so bleeding a couple of ounces
might cause that child to die
-
or require a blood transfusion.
-
Increase in pain response.
-
Infection, which is also very serious for a newborn.
-
Meatitus, which is an irritation of the opening.
-
That also can be problematic because if it gets bad enough
-
the child will not be able to pee, and that
would require the child to have catheterization.
-
Necrosis
-
and even permanent loss of the penis, or death.
-
I have talked with a pediatric urologist.
-
He is the type of person who gets the complications
to deal with.
-
He said that over a two-year period he had
more than 275 children to treat,
-
almost half who required surgery,
-
so they were subjected to an additional surgery
-
in attempt to correct whatever damage happened.
-
Okay, that's most of the graphic stuff,
-
except for in the next few slides we will see
pictures of the actual anatomy of adults,
-
so you are also welcome to turn your heads aside for that.
-
How many people have seen a penis that was intact?
-
Either your own or a friends, you know?
-
Okay, if you haven't yet, see if you
can find someone who is willing to show you.
-
I have talked to hundreds of men,
-
both men who have been circumcised
and men who have not been circumcised.
-
I hear a lot of men who have been circumcised
-
feel upset about that.
-
They are aware or have become aware
that something has been taken away from them,
-
and that their bodies were subjected
to something without their choice.
-
I also hear parents talk about
their regret from the procedure.
-
So what is the foreskin?
-
The foreskin is this sort of socially constructed thing.
-
It's really just part of the penis,
-
but now that we have cut it off,
we have to give it a separate name.
-
In fact, a lot of potential complications lists
that you get on your informed consent form
-
say that one of the risks is that you might injure the penis.
-
So we have constructed a reality in which
cutting of the penis is not injuring it;
-
it is if you then cut part that you intended to leave
that it is an injury.
-
So I want to show you what the foreskin is.
-
I want to spend some time on that.
-
The foreskin in the adult male,
the part that would have been removed,
-
is about 12 to 15 square inches,
-
it is about the size of a 3" x 5" index card.
-
It is the most erogenous part of the human male.
-
It contains 10 to 20 thousand fine touch nerve endings.
-
And it also makes the penis shaft skin motile.
-
So it is the difference, you know when
you are having sexual intercourse
-
or some kind of interaction,
-
it is the difference between this kind of interaction
-
or something if you can image a part
of your body where the skin moves around nicely
-
(My cheeks are floppy, so I can do that, you know).
-
And that is actually a significant thing
-
because there is another kind of nerve
that is called a stretch receptor
-
that gets stimulated in that motion,
-
and it is the male's contribution
to mechanical lubrication during intercourse,
-
either male-male or male-female.
-
The foreskin can be broken down into a couple of specialized areas:
-
the frenulum is this sort of...
-
my hand isn't really long enough but...
-
It is this fanning out region here.
-
and there is the ridged band below it,
that is were most of the nerves land.
-
and the dartos muscle is a cutaneous muscle
-
that allows the foreskin to respond to cold or fear
-
by surrounding the penis and pulling it in towards the body.
-
In 2007, the first research was done ever
-
to attempt to assess where the penis is sensitive.
-
So they took a group of males who were intact
-
and a group of men who were circumcised.
-
What you see on this color graph here
-
is that the most sensitive regions are that maroon color
-
and the second most sensitive regions are the purplish color.
-
If we compare that to a circumcised penis
-
what you see is that we have removed
most of the most sensitive areas
-
and left just this region around the scar
and the remainder of the frenulum
-
is really where most circumcised men are sensitive.
-
Therefore, you can compare them this way,
-
but you don't have to believe me
if you can find a friend or two
-
maybe one who is circumcised and one who is not,
-
or maybe yourself,
-
you can look and can see where
the sensitivity actually lies.
-
For most men it is in this region of the frenulum
-
or the scar remnant.
-
So just to get you a real picture,
-
what John here has done,
he's a photographer,
-
he has taken a person with a foreskin
-
and drawn these lines, so you can see
how much tissue it is as it retracts.
-
The other difference I want you to note
-
is that the inside what it does it generally surrounds the penis,
-
so it in a sense it invaginates it,
-
it gives it an enclosure,
-
and it keeps it moist.
-
So, if you compare that with the circumcised penis,
-
the tissue looks softer,
-
moister and warmer,
-
in addition to there being a lot more of it,
-
and it doesn't have the scar.
-
Those arrows there are pointing to the scar,
-
so you can see where that is.
-
I did want to invite, if you have any questions,
-
it is okay to ask me as we go along
-
because I am giving a lot of information.
-
Okay, then, jumping along to the parent.
-
Like I said I have talked with hundreds of parents
-
also especially doing all this work I do with parents,
-
I have talked with many who
when they receive their child back,
-
that is the moment at which
they understand what they had signed up for.
-
So there is a problem with informed consent
-
both that the information is lacking
-
and that parents are sometimes
asked about it at an inconvenient moment,
-
such as when they are in labor, you know.
-
And they are also asked about it in this values neutral way.
-
Like, would you like a pillow?
Would you like a cup of tea?
-
Would you like your child circumcised?
-
It carries the same sort of tone, you know,
-
and I am concerned about that.
-
So I view us as having this sort of
manufacturing pseudo informed consent process
-
Where parents need to trust physicians --
-
The physicians are supposedly the ones
-
bringing in the discipline of medicine.
-
So they come in, but they are given
this information that is very cursory,
-
it lacks real information about the complications,
those are trivialized,
-
the foreskin functions are completely omitted,
-
it's not mentioned that it is actually a sexual organ,
-
and the ethical questions of making decisions
about your children's bodies are omitted,
-
and there is also this undeclared conflict of interest
-
there is really a lot of commercial use of the tissue.
-
So the other thing parents don't know
is that it is painful for a week or longer afterwards.
-
So the baby is not only in pain during the process,
-
but the wound has to heal,
-
it is a wound on the penis,
-
and babies are very sensitive to pain.
-
How many people have gotten to play with a baby, you know you
had a friend with a baby or you have had a baby a few days old?
-
They are very fragile beings.
-
So what we have done is we've put this wound on this child,
-
and now this new parent who is dealing with the healing process
-
and the process of figuring out what it is like to have this new baby;
-
this new parent also has this added complications
of having to watch for signs of infection,
-
of having to keep changing the bandage, and having
the baby be more upset than he normally would have been.
-
In comparison, for the child who is not circumcised,
-
all you have to do is well, almost nothing.
-
In fact, you don't even wash the penis.
-
Just like you wouldn't was a baby's vagina with soap,
-
you just rinse it.
-
You don't retract it;
-
it becomes retractable on its own.
-
You have a baby with fewer health problems,
and a child who is more content.
-
Now, I promised you that I would show
that we actually do use the foreskin tissue.
-
We use it for three things
-
that I have been able to find.
-
We use it for research,
-
there are a large number of products
you can buy from Invitrogen
-
which is actually a company from which
I buy other things that don't contain foreskin
-
cells from for my bio-physics research.
-
So there are some of the products they sell
using neo-natal foreskins,
-
you can look it up yourselves.
-
At a hospital you can get "magic skin treatment"
-
which is cultured, grown foreskin tissue,
-
and if you are very wealthy you can buy cosmetics
-
that are also derived from foreskin tissue.
-
Oh, the cosmetics?
-
Wait, say louder?
-
Audience member,
"why would people want to use them on their skin?"
-
Oh, people think that
they will make them less wrinkly.
-
The idea is that baby cells,
-
you know they are young, they do their job well,
you know...
-
And, if you are disturbed by that, I am glad
-
because I would like us to be disturbed by that.
-
So let's hear from an obstetrician
how they frame these sorts of things.
-
This is Lisa Masterson being interviewed
on the Craig Ferguson Late, Late Show.
-
LISA," Yeah, and again
you know what that is a personal choice
-
and as an Obstetrician,
I talk to my patients a lot about this.
-
And really there's a lot of health benefits
and there are some risk benefits,
-
but it is really a social procedure.
-
So you really have to decide,
do you want your son to look like you?
-
You know it is a cultural thing it is a social thing,
-
And there are some health benefits,
more for the lady than the man
-
but as far as decreasing STDs and passing on to ah
you know other women HPV, which can cause cervical cancer,
-
so decreasing STDs and cancer all that good stuff."
-
CRAIG,"But couldn't you achieve the same effect
by washing your pee pee on a regular basis?"
-
LISA,"You absolutely could."
-
CRAIG,"So we're talking,
You can have this chopped off, or you can wash it,
-
your call?"
-
LISA,"Exactly."
-
CRAIG,
"That's a tough choice there Doctor ... I dunno!"
-
So obviously I appreciate Craig's point of view there.
-
He is from Scotland,
where they coincidentally don't do this to children.
-
And think about her discourse,
-
she's saying you have to choose as a parent,
-
and I want to question that framing of it.
-
Do you have to choose other
body modification options for your child?
-
Like a nose job, or things like that?
-
And, if the idea of doing things to our children
because we want them to look a certain way chills you,
-
I am glad because I want it to chill us.
-
I want us to wonder
-
why are we so busy making our children look like
what we think boys and girls should look like?
-
In this case, we have this idea that boys
should look a certain way in their genitals.
-
Okay, so the last section is,
how do we get practitioners doing this?
-
So I have a few quotes
from practitioners who stopped doing it,
-
like Marilynn Milos,
-
a nurse who, after seeing it,
refused to assist with them
-
and was fired for telling parents
they don't need to do it.
-
Michelle Storms, who is a very well known Obstetrician
[sic, she is a Family Medicine Practitioner]
-
who said she was ridiculed and patronized
after stopping them in 1988.
-
And I am at Georgetown, so I went and talked
to the Head of Obstetrics at Georgetown University Hospital,
-
Obstetricians do most of them, and she says,
-
"Medically it doesn't make sense"
-
"I don't even like doing the procedure, but I do it well."
-
"I have performed thousands of circumcisions."
-
She was clear that it is a social procedure,
-
she was clear that it doesn't make sense medically,
-
And she told me in our conversation
that she would not stop doing them.
-
So how do we make physicians into that?
-
Well, first we start by pathologizing a healthy organ.
-
Not only is the foreskin absent
from most U.S. medical and anatomy texts,
-
There is, therefore, no education of the function.
-
It is not viewed as a sexually important organ.
-
Physicians are only taught
how to remove it as a procedure.
-
and they are mistaught care, they are mistaught
this "retract and wash" philosophy,
-
which is problematic because as you can see
down at the bottom,
-
the foreskin when you are born
is usually attached to the head of the penis.
-
What you saw earlier in the circumcision video
-
was the physician running this tool around to break
the foreskin loose so that they could cut it off.
-
It is bonded like that to protect babies from,
well all the sorts of things that babies do,
-
they might have feces or urine in their diaper,
-
they might get scratched up.
-
The foreskin has a protective function
when you are young.
-
Gradually that detaches
-
and the foreskin becomes retractable,
-
but if you forcibly retract it, that tears it up
-
and creates a site for infection,
-
also if you wash with soap
that creates a site for infection.
-
And finally,
we make this misdiagnosis called "phimosis".
-
There is a true problem called phimosis
when there is scar tissue
-
at the opening of the foreskin, so it can't retract
-
and there are treatments for it use steroidal cream
to help the scar tissue soften.
-
But when we think that a baby who is three weeks old
-
because you can't pull the foreskin back without
making the baby scream, that's wrong.
-
It is actually meant to be attached that way,
it grew that way and it will become retractable on its own.
-
So, why do we do the circumcisions?
-
Well if you look at why parents say they choose
the number one reason is appearance.
-
They want their child to look like the other children
they'll see or they want them to look like their Dad.
-
They think it looks better,
or they think it is easier to keep clean.
-
And I believe it is the solicitation by physicians
that reinforces or validates the choice to do this.
-
The fact that physicians do it
makes it look like a reasonable thing.
-
Physicians may also give several reasons
to collude with this idea,
-
they may say it reduces penile cancer rates.
-
That it reduces urinary tract infections (UTIs),
-
Cervical Cancer rates in female partners
that your child might have when they grow up.
-
And female to male HIV transmission rate reduction
-
is sort of the newest reason.
-
So as I showed you in the beginning,
we have this sort of cultural baggage
-
a lot of reasons why we used to do circumcisions
that don't make sense in today's cultural setting,
-
so we have had to come up with a posteriori reasons
in order to feel more comfortable with what we are doing.
-
But I'll analyze those in more depth.
-
Besides the social critique that I think they are reasons
we made up after the fact, in order to feel comfortable with it.
-
If we think about them carefully, appearance
and cleanliness, the number one reason that circumcision is done.
-
Well that argument is used to support both
male and female genital cutting
-
in every culture that I am aware of
that either of those practices occurs in.
-
And they are just made up arguments,
-
I mean, how can you say that something is cleaner
if you do one thing to it or another?
-
Penile Cancer, the American Cancer Society says no,
it won't protect you from penile cancer.
-
It is also irrelevant; the rate is 1 in 100,000.
-
More people may die from circumcision than penile cancer.
-
Urinary tract infections,
-
well that was based on a big study in 1986,
-
done by a fellow, I kid you not, his name was Wiswell.
-
And the problem was his instructions
caused urinary tract infections,
-
selectively in subjects with foreskins
-
because he told the parents to forcibly
retract the foreskin and wash with soap.
-
So that is just like if you had a girl
and you forcibly douched her,
-
you know a little girl, you would get
a higher rate of yeast and urinary tract infections
-
because you have messed up
the colonies of protective bacteria.
-
Cervical cancer in female partners,
-
Well, first of all, a surgical preventive measure on an infant
-
for a potential female partner when they grow up.
-
I mean, how do we know this person
is not going to be a monk or gay?
-
And they could do it themselves later.
-
Also, cervical cancer is cause by human papilloma virus (HPV).
-
Probably most of you guys know that because you
learned that in Sex Ed, right?
-
Well the same authors went back and looked
at the husbands and wives in that study
-
and they had different strains of HPV.
-
So I don't know if there was
under-the-table non-monogamy or what.
-
But that throws the results
of that study totally into question
-
because the husbands were not carrying the HPV
strains that gave the women the cervical cancer.
-
Gesundheit.
-
Okay, so the last one is circumcision
as an HIV preventative.
-
Okay, that idea started in the 2000's mostly.
-
The evidence for it is three randomized control trials.
-
They were performed in Africa,
-
probably because you couldn't get a
human review board to permit such a study in the U.S.
-
They got volunteer men
who were willing to be circumcised;
-
they randomly circumcised half of them.
-
And they watched to see how quickly they got HIV.
-
They had some problematic methodology
that I will get into later.
-
And their claim was that that reduced
the rate at which men got HIV by 60%.
-
Now the evidence against circumcision
as an HIV preventative
-
are pretty much all the
other studies that have been done.
-
The geographic data,
-
if you look at correlation between
circumcision percentage and HIV rates
-
in populations, it contradicts this conclusion.
-
For example,
-
the United States has the highest HIV rate
of any industrialized nation,
-
and also has the highest circumcision rate
of any industrialized nation.
-
You would expect something different
if circumcision were so protective.
-
So, I've got a few minutes left. I am going to quickly
run through what I think was wrong with the study.
-
Again, there were three studies, they took a group of intact men,
circumcised them and watched how quickly they got HIV.
-
The problems were, each time they came
to the clinic they gave them condoms
-
and safe sex counseling.
-
But the circumcised group came
at least twice more
-
because they had to come to get circumcised
and they had to come to get a follow up study.
-
In addition, if you are circumcised,
-
it will take you about four to six weeks
until you are able to have sex again.
-
And the circumcised group was asked
to abstain for six weeks.
-
But they didn't start the clock
until after waiting for six weeks,
-
they started the clock at the beginning,
-
so the circumcised group had six weeks
-
of protection by being unable to have intercourse.
-
In addition, they used an anti-body test, which
-
you know, if you go to an STD clinic
-
and they use an antibody test,
there is a three-month window.
-
They tell you, you've got to wait
until three months after your last exposure
-
if you really want to know if you have HIV.
-
But again, they didn't start the clock after three months
-
and most the benefit or half the benefit
occurred during those first three months.
-
So those infections occurred prior
to the start of the trial,
-
prior to the randomization and intervention.
-
There were a lot of problems concerning controls,
-
including blood exposure
and receptive anal intercourse.
-
I am also concerned because the authors of that study
-
likened circumcision to an effective vaccine.
-
Now all they are saying is that,
if their results are accurate,
-
which I don't believe,
-
that it would reduce
your likelihood of getting HIV,
-
you know each time you had sex, by 60%.
-
So, if you have sex enough, you will
et HIV anyway with enough risky behavior.
-
The measles vaccine,
-
if you took that and its boosters,
99% of you become immune to measles.
-
Probably you are actually.
-
So that is what an effective vaccine looks like.
-
Ninety-nine per cent permanent immunity.
-
Not sixty per cent less likelihood
to become infected each time you are exposed.
-
And real human beings think they are immune
to HIV because they have been circumcised
-
in African countries,
-
and I am very concerned about that.
-
But anyway, so to re-cap,
-
I think we have a social bias
toward cutting children,
-
particularly boys.
-
I think that it is very harmful to children.
-
It also hurts survivors.
-
It hurts parents, who really want
the best for their children.
-
And it also hurts practitioners
-
because I believe that medical students
come into school wanting to help people,
-
and they get taught about this procedure
in an out-of-context kind of way.
-
Most of the people I talk to think it is
not their responsibility to do anything about it,
-
including professional organizations
like the American Academy of Pediatrics,
-
the American College of Obstetricians and Gynecologists,
-
the practitioners, you know,
-
because their job is to keep the practitioners looking good.
-
So, if you say something is bad that your practitioners
are doing, that doesn't look so good.
-
The administrators of the hospital
and the practitioners there don't want to stand out.
-
The obstetricians don't even think
the child they are operating on is their patient.
-
The ethics committee of the hospital
-
told me that they are not
the appropriate venue for this concern.
-
And I think all of these organizations
are neglecting parents, children, and us.
-
So I am hopeful
that I have engaged you with some interest
-
and that maybe you will go and tell people about this.
-
Because, if they are not going to take responsibility,
I hope that we will.
-
So tell your friends.
-
I am going to give a link to this slide show to your professor.
[A link to the files is available in the description.]