0:00:01.069,0:00:04.400 I am Ryan, a friend of Lizzie's. 0:00:04.484,0:00:08.193 I do bio-physics research[br]at Georgetown University, 0:00:08.312,0:00:13.111 and I also coordinate two non-profits[br]that deal mostly with supporting families 0:00:13.344,0:00:14.892 and supporting people in their relationships. 0:00:15.593,0:00:17.020 Here is my family. 0:00:19.000,0:00:23.025 So my mission in life basically [br]is to help people get along, 0:00:23.360,0:00:25.506 and towards that end,[br]I do a lot of workshops with families 0:00:25.800,0:00:28.760 and I also help families[br]understand medical questions. 0:00:31.363,0:00:34.131 So I am here to talk with you about circumcision, 0:00:34.304,0:00:36.000 I am calling it an "Elephant in the Hospital" 0:00:36.679,0:00:40.780 because it is this huge thing that happens[br]as far as I see in our culture 0:00:41.200,0:00:43.046 but we have very little discourse about it. 0:00:43.146,0:00:46.929 It is performed between 500,000 and 1,000,000[br]million times each year in the U.S., 0:00:47.441,0:00:51.667 almost entirely on infants within[br]the first three days of life 0:00:52.347,0:00:56.849 and it is completely unnecessary;[br]and I believe, based on my research, 0:00:57.100,0:00:59.067 entirely harmful to children. 0:01:00.387,0:01:03.852 So what we are going to run through,[br]as quickly as I can, 0:01:04.462,0:01:08.892 is just a discussion what that process is like[br]from the child's point of view, 0:01:09.319,0:01:11.112 what effects it has on adult survivors, 0:01:11.466,0:01:15.747 how we get parents to agree to it[br](what understanding parents have), 0:01:16.023,0:01:18.935 and how we get practitioners to perform it. 0:01:20.707,0:01:25.946 So before we do that, I actually just want[br]to get a chance to see what our room is like 0:01:26.450,0:01:32.209 so we can see each other; therefore, I will ask a few questions[br]and we're gonna use this technology for room assessment 0:01:32.510,0:01:34.303 that goes back to a before clickers.[br]I am going to ask you, if you are willing, 0:01:34.409,0:01:36.970 to point in the direction as I ask you about each thing, 0:01:37.005,0:01:39.212 from beneficial, this wall is the beneficial wall, 0:01:39.582,0:01:43.580 neutral is the ceiling,[br]and harmful is the wall over there. 0:01:44.597,0:01:47.816 For Example, what do you think of foot binding? 0:01:48.095,0:01:50.106 I mean you are anthropologists,[br]most of you have heard of foot binding. 0:01:50.384,0:01:52.268 Where do you think it goes on the ... 0:01:52.473,0:01:55.842 okay we have everyone who chose to respond,[br]thinks it is harmful. 0:01:55.984,0:01:57.731 Good I am pleased with that response. 0:01:58.029,0:01:59.383 Female Genital Cutting 0:01:59.683,0:02:01.271 how many people have heard of that? 0:02:01.599,0:02:03.209 Okay great, we have got universally harmful. 0:02:03.783,0:02:07.074 Okay what about say we were going[br]to do prophylactic breast bud removal, 0:02:07.752,0:02:09.185 say we wanted to stop breast cancer 0:02:09.662,0:02:11.975 and save hundreds of thousands of women's lives per year, 0:02:12.580,0:02:15.646 and say we just cut all babies' breast buds off? 0:02:15.896,0:02:17.880 Beneficial? Harmful? Neutral? 0:02:18.937,0:02:21.806 Okay some neutral and some harmful. 0:02:22.001,0:02:23.316 Okay. 0:02:24.045,0:02:27.067 And what about cutting off non-essential tissue from a child, 0:02:27.270,0:02:29.340 say we just cut off all children's ear lobes 0:02:29.590,0:02:32.229 because we thought they were an inconvenience,[br]a pain or they looked ugly? 0:02:33.005,0:02:34.394 Okay, we have got harmful. 0:02:34.623,0:02:35.726 So what about Circumcision? 0:02:36.008,0:02:37.688 What is our starting point? 0:02:38.451,0:02:40.513 We have got every response, 0:02:40.769,0:02:42.601 that's great; okay, so we have a diverse audience. 0:02:44.614,0:02:46.017 Now a couple of other questions 0:02:46.252,0:02:47.374 just to see who we are. 0:02:47.602,0:02:49.446 Who here thinks that they have a foreskin, 0:02:50.819,0:02:51.650 anyone? 0:02:53.008,0:02:55.096 Who here believes that they have a foreskin, 0:02:56.081,0:02:58.695 which is that part they remove during circumcision, right? 0:02:59.018,0:03:00.329 Okay, so that is a trick question. 0:03:01.054,0:03:03.922 Men and women, males and females, are both born with foreskins, 0:03:04.274,0:03:08.098 the foreskin is just a name for a part of the clitoris or penis, 0:03:08.627,0:03:11.721 and so probably most of the women here have one 0:03:12.149,0:03:13.658 and perhaps some of the males also. 0:03:14.417,0:03:16.452 Who here comes from a culture where 0:03:16.706,0:03:19.263 female genital cutting is a social norm? 0:03:19.472,0:03:20.550 No one, okay. 0:03:20.754,0:03:22.793 Who here comes from a culture where 0:03:22.978,0:03:24.587 male genital cutting is a social norm? 0:03:24.859,0:03:26.492 Okay, all of us pretty much, that I can see, okay. 0:03:27.435,0:03:30.920 And who knows someone who was genitally altered as a child 0:03:31.224,0:03:34.268 it could be you, it could be a friend it could be your parents, or child? 0:03:34.608,0:03:35.438 Mostly (all)! 0:03:35.839,0:03:41.039 Great, so all of that is just to illustrate how it's something that has[br]touched all of our lives in some way. 0:03:43.988,0:03:48.121 So I am arguing that it is this big thing and that we don't talk about it a lot. 0:03:48.956,0:03:51.069 So I have to sort of explain why I think that. 0:03:51.297,0:03:54.491 So I believe that the discourse that we have in our culture about circumcision 0:03:54.695,0:03:58.016 is one that is used to conceal what the nature of the process is. 0:03:58.744,0:04:02.089 So you may have heard things like "well, you know,[br]it makes the penis cleaner" and things like that. 0:04:02.919,0:04:06.717 You may have heard things like "everyone does it," "I am circumcised, I am fine," 0:04:07.521,0:04:10.526 "It is just a little snip" or "it removes a useless flap of skin," 0:04:10.727,0:04:12.327 this sort of trivializing language. 0:04:13.348,0:04:14.886 Well, we have heard all of these things. 0:04:15.067,0:04:17.425 What I am going to ask you to do is set all that aside, 0:04:18.154,0:04:20.394 all of that mass of experience in your mind, 0:04:20.673,0:04:24.005 and to try to come at it from a fresh angle where 0:04:24.240,0:04:27.765 these sort of illogical arguments of support for it are not part of your way of thinking. 0:04:30.190,0:04:33.963 I am going to propose that circumcision is this cyclical process in our culture 0:04:34.163,0:04:37.563 where we do it to children, they grow up to become adult survivors, 0:04:37.763,0:04:39.162 some of those people become parents, 0:04:39.463,0:04:43.863 and practitioners engage them in order to perform this surgery on their children, 0:04:44.112,0:04:48.726 which unlike any other surgery I am aware of in U.S. hospitals, 0:04:48.927,0:04:50.658 it removes a healthy and unique organ part 0:04:51.058,0:04:54.244 (actually with the exception of inter-sex genital modification, 0:04:54.530,0:04:56.917 which bears a lot of resemblance to it by the way). 0:04:57.118,0:04:58.969 It removes a healthy part of the body. 0:04:59.148,0:05:00.787 It is not used as a treatment. 0:05:00.987,0:05:03.318 Doctors don't think they are treating the children; 0:05:03.597,0:05:05.303 they know it is a social surgery they are performing. 0:05:05.510,0:05:07.510 It has significant complications. 0:05:07.714,0:05:10.700 It is performed on minors who cannot give their consent. 0:05:10.900,0:05:13.870 It is illegal, it is actually a federal felony to perform on girls, 0:05:14.070,0:05:15.852 but it is actually encouraged and performed on boys. 0:05:16.096,0:05:18.681 It results in life long function loss, 0:05:18.886,0:05:20.892 and the tissue is then used commercially. 0:05:23.134,0:05:25.104 So just a little context piece. 0:05:25.632,0:05:28.378 I hear you, believe me, and I will show you evidence of that. 0:05:28.904,0:05:31.571 I won't make such a radical claim without proving it. 0:05:33.016,0:05:36.356 So let's just finish our context piece[br]with both the geography and the history. 0:05:37.213,0:05:40.340 So this is a map of the world sort of. 0:05:41.166,0:05:46.375 As you can see green countries represent places where[br]genital cutting of boys is not practiced, generally speaking. 0:05:47.429,0:05:50.116 The small, the few yellow countries up in the northern regions 0:05:50.394,0:05:52.828 are places where it is becoming legally questioned. 0:05:54.518,0:05:57.886 Circumcision is now rare in Canada, England, and Australia 0:05:58.112,0:06:00.323 where it used to be practiced on babies also, but stopped. 0:06:00.802,0:06:03.382 In fact, in England, in the 1950's there was an article published 0:06:03.672,0:06:06.591 showing it killed a number of children a year, 0:06:06.792,0:06:08.592 about 14 a year, 0:06:08.850,0:06:10.482 so they stopped the practice there. 0:06:10.934,0:06:14.427 And the other places, besides the United States where it is done on babies, 0:06:14.662,0:06:17.882 in the other regions, most of the time, it is done on adolescents 0:06:18.177,0:06:21.623 in Sub-Saharan Africa and in Sunni Islamic cultures. 0:06:24.139,0:06:25.347 Now how did we get here? 0:06:26.731,0:06:30.747 It has become a medical practice rather than a[br]tribal practice or a cultural practice. 0:06:31.610,0:06:33.744 And that came about in the late 1800's 0:06:34.075,0:06:36.983 when people had not the germ theory of disease, 0:06:37.184,0:06:40.084 but the nervous excitation theory of disease. 0:06:40.573,0:06:42.312 And people had the Victorian morality, 0:06:42.540,0:06:45.158 so people see what they expect to see a lot of the time. 0:06:45.361,0:06:49.215 So you can find a lot of published medical literature[br]showing that circumcision cured 0:06:50.174,0:06:53.220 things such as, paralysis, epilepsy, hip joint disease, 0:06:53.847,0:06:57.268 and all sorts of problems that today 0:06:57.821,0:07:01.671 seem very unlikely for the process to have cured. 0:07:02.924,0:07:06.429 And people really thought that actually harming,[br]the intention was to harm the genitals of the children. 0:07:07.790,0:07:09.958 And they thought that it would help in the long term 0:07:10.336,0:07:13.027 because it would prevent them from[br]having so much sexual excitation 0:07:13.759,0:07:18.664 that being, in the Victorian model, the most dangerous[br]type of excitation that one could have. 0:07:21.302,0:07:22.474 So, uhm, oops, 0:07:22.666,0:07:24.838 I should have given you a caveat, 0:07:25.539,0:07:26.739 my apologies... 0:07:26.991,0:07:29.085 There are going to be some graphic slides here, 0:07:29.389,0:07:33.370 and I certainly welcome you turn away at any point[br]if you don't feel comfortable about looking at what you see. 0:07:34.054,0:07:36.969 And I will try to more often try to give you a warning[br]when they are about to come up. 0:07:39.729,0:07:42.280 I would also mention actually another caveat: 0:07:42.536,0:07:44.869 I am going to use language differently. 0:07:45.104,0:07:49.326 I am going to switch now to mostly[br]calling circumcision "genital cutting" 0:07:49.692,0:07:52.003 because I think that is more of a neutral term, 0:07:52.280,0:07:54.080 it's a more accurate or descriptive term. 0:07:54.548,0:08:00.009 I think "circumcision" euphemistically embeds[br]our assumption that it is a fine thing. 0:08:00.236,0:08:03.089 And the term uncircumcised[br]I am going to replace with the term "intact", 0:08:03.289,0:08:07.923 because likewise the term "uncircumcised"[br]gives the sense that circumcision is the norm 0:08:08.371,0:08:11.248 and that those who are not circumcised are[br]simply "not yet" circumcised. 0:08:11.936,0:08:16.362 And to illustrate that it would be kind of weird[br]if we called women who had breasts"un-mastectomised" 0:08:17.614,0:08:19.551 right that would be uncomfortable, 0:08:20.052,0:08:25.053 and, likewise, I hope to sensitize us to the discomfort[br]of calling "intact" "uncircumcised". 0:08:28.849,0:08:32.120 So the next few slides will have some[br]less-comfortable things to see, 0:08:32.433,0:08:34.852 and, again, you are welcome to turn away if you want. 0:08:35.841,0:08:37.772 So this is the section on the Child. 0:08:38.301,0:08:41.674 The procedure for the child, we will[br]run through what the procedure looks like. 0:08:41.914,0:08:44.827 That's probably the most graphic section,[br]along with the complications, 0:08:45.451,0:08:48.775 and what I want you to think about is, 0:08:49.076,0:08:52.776 it is often times talked about from the parents'[br]perspective,"parents have the right to choose". 0:08:53.051,0:08:57.040 I want you to question that discourse and think[br]about what the child's point of view is. 0:08:57.323,0:08:59.016 Who owns the child's body? 0:08:59.248,0:09:00.519 What rights do they have? 0:09:00.725,0:09:02.672 Why are we doing it to boys and not girls? 0:09:02.907,0:09:05.481 What does that say about our views on gender, and so on? 0:09:09.210,0:09:13.262 So, this slide shows three different representations[br]of people in the genital cutting process. 0:09:14.142,0:09:16.828 The top left is a young girl 0:09:17.941,0:09:21.245 being circumcised in her cultural scenario. 0:09:21.977,0:09:25.294 The top right is a young boy being[br]circumcised in his cultural scenario. 0:09:25.777,0:09:29.374 And the bottom right is an[br]infant boy in a hospital. 0:09:30.006,0:09:31.814 Now what I want you to look at is their faces. 0:09:32.266,0:09:33.399 Just look at their faces 0:09:33.701,0:09:36.116 because I am asking you to think about their experiences. 0:09:36.384,0:09:39.201 To me it looks like they are having a very similar experience. 0:09:40.293,0:09:41.950 And yet in our culture, 0:09:42.382,0:09:44.471 where I think of us as being kind of imperialist 0:09:44.671,0:09:46.611 we're very ready to point the finger and say, 0:09:46.811,0:09:50.870 Oh these terrible things these people do in these other[br]countries where they practice female genital cutting." 0:09:51.165,0:09:54.727 yet we're silent about the male genital cutting 0:09:54.927,0:09:57.749 that occurs to children under the same conditions of hygiene 0:09:57.821,0:10:00.455 and the same death rates in those countries; 0:10:00.656,0:10:02.699 and we promote doing it to boys in our country. 0:10:05.222,0:10:06.954 So how do we do a circumcision? 0:10:07.232,0:10:09.364 The next bits are going to be the most graphic. 0:10:09.403,0:10:11.189 This is a circumcision restraint; 0:10:11.592,0:10:12.849 they strap the baby down into it, 0:10:13.427,0:10:16.020 and then they proceed with the procedure, 0:10:16.314,0:10:17.548 which I am going to show you a short video of. 0:10:17.752,0:10:18.959 This is going to include sound 0:10:19.413,0:10:21.318 if I hooked it up correctly. 0:10:23.005,0:10:25.671 and, again, you are welcome to not look;[br]I find this uncomfortable. 0:11:07.760,0:11:09.845 Okay, so I want to encourage you to take a deep breath 0:11:10.224,0:11:13.476 if you have been having trouble breathing[br]as I have during that. 0:11:15.837,0:11:19.472 Some things I think to notice is the sort of calm detachment 0:11:19.700,0:11:21.015 of the physician's voice. 0:11:21.994,0:11:23.970 So the physician is not at all distressed by this. 0:11:24.208,0:11:25.400 And the way the baby is crying. 0:11:25.693,0:11:27.726 I hear the baby's crying as the way I hear babies cry 0:11:27.727,0:11:29.727 when they are under extreme duress, 0:11:30.480,0:11:31.630 not you know, "I am hungry." 0:11:36.453,0:11:38.188 So beyond the pain of the procedure itself 0:11:38.590,0:11:40.175 and the pain of the many days it takes to heal, 0:11:41.232,0:11:45.260 there are a number of complications that a[br]circumcision procedure puts a child at risk for. 0:11:45.786,0:11:47.493 You can sort of divide them into two categories. 0:11:47.823,0:11:49.201 Surgical complications, 0:11:49.427,0:11:51.117 which go from the more minor, 0:11:51.419,0:11:54.159 you know everyone has a scar that has been circumcised. 0:11:54.337,0:11:57.513 A lot of men don't actually know that[br]the ring around their penis 0:11:57.837,0:11:59.241 is a circumcision scar, 0:11:59.470,0:12:00.779 or they learn it when they hear me talk. 0:12:02.451,0:12:03.786 But that always happens. 0:12:04.164,0:12:07.026 But a number of other complications can be problematic 0:12:07.286,0:12:09.082 that don't occur all the time, 0:12:09.245,0:12:10.566 like penile adhesions, 0:12:10.766,0:12:12.200 when the healing process goes awry 0:12:12.407,0:12:15.775 and two parts of the penis that weren't supposed[br]to be connected link together. 0:12:17.008,0:12:19.722 Then these panels show in top left (A) 0:12:20.101,0:12:21.735 (A) that's called a fistula, 0:12:22.257,0:12:25.249 so its like a doctor induced hypospadias, 0:12:25.452,0:12:28.516 the black line going down is a probe that's [br]entering the meatus, the opening of the urethra 0:12:28.716,0:12:30.121 and exiting out the additional hole 0:12:30.321,0:12:33.281 that the physician has caused. 0:12:34.789,0:12:37.329 (B) Top Right is a nearly amputated head of the penis. 0:12:37.807,0:12:39.758 (C) Bottom Left so much skin of the penis has been removed 0:12:40.310,0:12:44.260 (C) that the child's corpus cavernosa and head of the penis[br]are lodged down inside the scrotum, 0:12:45.015,0:12:47.656 and in (D) Bottom Right the penis was accidentally amputated entirely. 0:12:49.006,0:12:51.536 There are also a number of post-operative complications 0:12:51.791,0:12:53.818 ranging from difficulty in breast feeding, 0:12:54.028,0:12:57.406 which is important because developing the ability to breast feed 0:12:57.683,0:12:59.207 is essential for infants. 0:12:59.569,0:13:00.633 Bleeding, 0:13:00.833,0:13:02.340 which is another sort of minimizing term, 0:13:02.540,0:13:06.060 you see that on consent forms,[br]you know like"Oh, bleeding", 0:13:06.260,0:13:08.960 well it turns out an infant only has [br]about 12 ounces of blood 0:13:09.160,0:13:11.854 so bleeding a couple of ounces[br]might cause that child to die 0:13:12.055,0:13:13.905 or require a blood transfusion. 0:13:14.105,0:13:15.563 Increase in pain response. 0:13:15.764,0:13:18.430 Infection, which is also very serious for a newborn. 0:13:19.031,0:13:21.550 Meatitus, which is an irritation of the opening. 0:13:21.750,0:13:24.345 That also can be problematic because if it gets bad enough 0:13:24.556,0:13:27.788 the child will not be able to pee, and that[br]would require the child to have catheterization. 0:13:29.000,0:13:30.034 Necrosis 0:13:30.260,0:13:32.760 and even permanent loss of the penis, or death. 0:13:35.723,0:13:37.809 I have talked with a pediatric urologist. 0:13:38.087,0:13:40.829 He is the type of person who gets the complications[br]to deal with. 0:13:41.708,0:13:44.978 He said that over a two-year period he had[br]more than 275 children to treat, 0:13:45.257,0:13:48.117 almost half who required surgery, 0:13:48.545,0:13:50.831 so they were subjected to an additional surgery 0:13:51.363,0:13:53.103 in attempt to correct whatever damage happened. 0:13:55.489,0:13:57.546 Okay, that's most of the graphic stuff, 0:13:58.078,0:14:01.651 except for in the next few slides we will see[br]pictures of the actual anatomy of adults, 0:14:02.004,0:14:04.270 so you are also welcome to turn your heads aside for that. 0:14:04.597,0:14:07.037 How many people have seen a penis that was intact? 0:14:07.494,0:14:09.102 Either your own or a friends, you know? 0:14:12.849,0:14:15.977 Okay, if you haven't yet, see if you[br]can find someone who is willing to show you. 0:14:19.781,0:14:21.818 I have talked to hundreds of men, 0:14:23.380,0:14:26.850 both men who have been circumcised [br]and men who have not been circumcised. 0:14:27.504,0:14:30.248 I hear a lot of men who have been circumcised 0:14:30.700,0:14:31.883 feel upset about that. 0:14:32.362,0:14:36.010 They are aware or have become aware[br]that something has been taken away from them, 0:14:36.514,0:14:39.230 and that their bodies were subjected[br]to something without their choice. 0:14:41.141,0:14:43.953 I also hear parents talk about[br]their regret from the procedure. 0:14:46.303,0:14:48.034 So what is the foreskin? 0:14:48.512,0:14:52.815 The foreskin is this sort of socially constructed thing. 0:14:53.016,0:14:54.373 It's really just part of the penis, 0:14:54.576,0:14:57.417 but now that we have cut it off,[br]we have to give it a separate name. 0:14:58.828,0:15:02.855 In fact, a lot of potential complications lists[br]that you get on your informed consent form 0:15:03.484,0:15:06.730 say that one of the risks is that you might injure the penis. 0:15:07.962,0:15:12.112 So we have constructed a reality in which[br]cutting of the penis is not injuring it; 0:15:12.498,0:15:15.460 it is if you then cut part that you intended to leave[br]that it is an injury. 0:15:18.360,0:15:20.447 So I want to show you what the foreskin is. 0:15:20.647,0:15:22.153 I want to spend some time on that. 0:15:22.357,0:15:25.000 The foreskin in the adult male,[br]the part that would have been removed, 0:15:25.200,0:15:27.430 is about 12 to 15 square inches, 0:15:27.630,0:15:29.992 it is about the size of a 3" x 5" index card. 0:15:30.192,0:15:32.115 It is the most erogenous part of the human male. 0:15:32.315,0:15:35.261 It contains 10 to 20 thousand fine touch nerve endings. 0:15:35.790,0:15:39.187 And it also makes the penis shaft skin motile. 0:15:39.935,0:15:42.065 So it is the difference, you know when[br]you are having sexual intercourse 0:15:42.268,0:15:44.339 or some kind of interaction, 0:15:44.540,0:15:47.000 it is the difference between this kind of interaction 0:15:47.200,0:15:50.880 or something if you can image a part[br]of your body where the skin moves around nicely 0:15:51.080,0:15:54.044 (My cheeks are floppy, so I can do that, you know). 0:15:54.244,0:15:56.340 And that is actually a significant thing 0:15:56.540,0:15:59.500 because there is another kind of nerve[br]that is called a stretch receptor 0:15:59.700,0:16:01.439 that gets stimulated in that motion, 0:16:01.639,0:16:05.640 and it is the male's contribution[br]to mechanical lubrication during intercourse, 0:16:07.000,0:16:09.889 either male-male or male-female. 0:16:10.563,0:16:13.260 The foreskin can be broken down into a couple of specialized areas: 0:16:13.834,0:16:14.949 the frenulum is this sort of... 0:16:15.565,0:16:17.752 my hand isn't really long enough but... 0:16:18.256,0:16:20.700 It is this fanning out region here. 0:16:20.900,0:16:24.592 and there is the ridged band below it,[br]that is were most of the nerves land. 0:16:24.792,0:16:26.852 and the dartos muscle is a cutaneous muscle 0:16:27.052,0:16:30.165 that allows the foreskin to respond to cold or fear 0:16:30.369,0:16:33.186 by surrounding the penis and pulling it in towards the body. 0:16:35.917,0:16:39.586 In 2007, the first research was done ever 0:16:40.015,0:16:42.732 to attempt to assess where the penis is sensitive. 0:16:44.394,0:16:47.312 So they took a group of males who were intact 0:16:47.615,0:16:48.969 and a group of men who were circumcised. 0:16:49.778,0:16:51.953 What you see on this color graph here 0:16:52.252,0:16:55.005 is that the most sensitive regions are that maroon color 0:16:55.260,0:16:57.993 and the second most sensitive regions are the purplish color. 0:16:59.130,0:17:02.012 If we compare that to a circumcised penis 0:17:02.408,0:17:07.044 what you see is that we have removed[br]most of the most sensitive areas 0:17:07.476,0:17:12.362 and left just this region around the scar[br]and the remainder of the frenulum 0:17:12.865,0:17:15.132 is really where most circumcised men are sensitive. 0:17:15.900,0:17:17.731 Therefore, you can compare them this way, 0:17:18.093,0:17:21.544 but you don't have to believe me[br]if you can find a friend or two 0:17:21.936,0:17:23.549 maybe one who is circumcised and one who is not, 0:17:24.884,0:17:26.121 or maybe yourself, 0:17:26.645,0:17:28.881 you can look and can see where[br]the sensitivity actually lies. 0:17:30.590,0:17:32.696 For most men it is in this region of the frenulum 0:17:33.234,0:17:34.919 or the scar remnant. 0:17:38.650,0:17:40.468 So just to get you a real picture, 0:17:40.930,0:17:42.907 what John here has done,[br]he's a photographer, 0:17:43.302,0:17:45.568 he has taken a person with a foreskin 0:17:45.926,0:17:49.233 and drawn these lines, so you can see[br]how much tissue it is as it retracts. 0:17:50.498,0:17:52.463 The other difference I want you to note 0:17:52.797,0:17:57.254 is that the inside what it does it generally surrounds the penis, 0:17:57.454,0:17:59.003 so it in a sense it invaginates it, 0:17:59.303,0:18:00.340 it gives it an enclosure, 0:18:00.540,0:18:01.846 and it keeps it moist. 0:18:02.093,0:18:04.197 So, if you compare that with the circumcised penis, 0:18:04.557,0:18:06.420 the tissue looks softer, 0:18:06.746,0:18:08.281 moister and warmer, 0:18:09.413,0:18:10.671 in addition to there being a lot more of it, 0:18:11.049,0:18:12.205 and it doesn't have the scar. 0:18:12.601,0:18:14.471 Those arrows there are pointing to the scar, 0:18:14.671,0:18:16.122 so you can see where that is. 0:18:18.286,0:18:21.306 I did want to invite, if you have any questions, 0:18:21.591,0:18:23.618 it is okay to ask me as we go along 0:18:23.818,0:18:25.785 because I am giving a lot of information. 0:18:27.825,0:18:29.367 Okay, then, jumping along to the parent. 0:18:31.310,0:18:33.147 Like I said I have talked with hundreds of parents 0:18:33.347,0:18:35.647 also especially doing all this work I do with parents, 0:18:35.913,0:18:38.213 I have talked with many who[br]when they receive their child back, 0:18:38.536,0:18:42.425 that is the moment at which[br]they understand what they had signed up for. 0:18:43.137,0:18:46.087 So there is a problem with informed consent 0:18:46.733,0:18:48.316 both that the information is lacking 0:18:48.522,0:18:51.891 and that parents are sometimes[br]asked about it at an inconvenient moment, 0:18:52.091,0:18:53.300 such as when they are in labor, you know. 0:18:54.499,0:18:56.621 And they are also asked about it in this values neutral way. 0:18:56.944,0:18:59.595 Like, would you like a pillow?[br]Would you like a cup of tea? 0:18:59.800,0:19:01.454 Would you like your child circumcised? 0:19:01.824,0:19:03.371 It carries the same sort of tone, you know, 0:19:07.673,0:19:08.715 and I am concerned about that. 0:19:09.410,0:19:13.615 So I view us as having this sort of[br]manufacturing pseudo informed consent process 0:19:14.552,0:19:17.102 Where parents need to trust physicians -- 0:19:17.608,0:19:21.531 The physicians are supposedly the ones 0:19:23.547,0:19:27.546 bringing in the discipline of medicine. 0:19:27.873,0:19:30.488 So they come in, but they are given[br]this information that is very cursory, 0:19:30.688,0:19:32.112 it lacks real information about the complications,[br]those are trivialized, 0:19:32.312,0:19:34.338 the foreskin functions are completely omitted, 0:19:34.677,0:19:36.511 it's not mentioned that it is actually a sexual organ, 0:19:37.589,0:19:42.119 and the ethical questions of making decisions[br]about your children's bodies are omitted, 0:19:42.553,0:19:45.346 and there is also this undeclared conflict of interest 0:19:45.605,0:19:48.445 there is really a lot of commercial use of the tissue. 0:19:51.944,0:19:57.276 So the other thing parents don't know[br]is that it is painful for a week or longer afterwards. 0:19:57.476,0:19:59.732 So the baby is not only in pain during the process, 0:20:00.932,0:20:02.402 but the wound has to heal, 0:20:02.602,0:20:04.004 it is a wound on the penis, 0:20:04.204,0:20:06.295 and babies are very sensitive to pain. 0:20:06.695,0:20:11.615 How many people have gotten to play with a baby, you know you[br]had a friend with a baby or you have had a baby a few days old? 0:20:12.369,0:20:13.663 They are very fragile beings. 0:20:14.900,0:20:17.000 So what we have done is we've put this wound on this child, 0:20:17.200,0:20:20.701 and now this new parent who is dealing with the healing process 0:20:20.960,0:20:23.787 and the process of figuring out what it is like to have this new baby; 0:20:24.471,0:20:28.427 this new parent also has this added complications[br]of having to watch for signs of infection, 0:20:28.784,0:20:33.207 of having to keep changing the bandage, and having[br]the baby be more upset than he normally would have been. 0:20:34.929,0:20:37.265 In comparison, for the child who is not circumcised, 0:20:38.235,0:20:40.679 all you have to do is well, almost nothing. 0:20:41.110,0:20:43.446 In fact, you don't even wash the penis. 0:20:43.679,0:20:46.378 Just like you wouldn't was a baby's vagina with soap, 0:20:46.578,0:20:47.762 you just rinse it. 0:20:47.963,0:20:49.446 You don't retract it; 0:20:49.650,0:20:51.303 it becomes retractable on its own. 0:20:51.641,0:20:54.184 You have a baby with fewer health problems,[br]and a child who is more content. 0:20:56.345,0:21:01.050 Now, I promised you that I would show[br]that we actually do use the foreskin tissue. 0:21:01.265,0:21:02.738 We use it for three things 0:21:02.953,0:21:04.677 that I have been able to find. 0:21:05.076,0:21:06.561 We use it for research, 0:21:06.761,0:21:09.701 there are a large number of products[br]you can buy from Invitrogen 0:21:09.924,0:21:13.548 which is actually a company from which[br]I buy other things that don't contain foreskin 0:21:13.748,0:21:15.624 cells from for my bio-physics research. 0:21:16.312,0:21:19.188 So there are some of the products they sell[br]using neo-natal foreskins, 0:21:19.367,0:21:21.848 you can look it up yourselves. 0:21:22.783,0:21:26.380 At a hospital you can get "magic skin treatment" 0:21:26.681,0:21:28.981 which is cultured, grown foreskin tissue, 0:21:29.182,0:21:31.604 and if you are very wealthy you can buy cosmetics 0:21:31.934,0:21:35.608 that are also derived from foreskin tissue. 0:21:36.556,0:21:37.637 Oh, the cosmetics? 0:21:40.901,0:21:42.224 Wait, say louder? 0:21:42.864,0:21:44.893 Audience member,[br]"why would people want to use them on their skin?" 0:21:45.093,0:21:47.104 Oh, people think that[br]they will make them less wrinkly. 0:21:47.378,0:21:49.345 The idea is that baby cells, 0:21:49.545,0:21:51.334 you know they are young, they do their job well,[br]you know... 0:21:53.910,0:21:56.102 And, if you are disturbed by that, I am glad 0:21:56.461,0:21:58.508 because I would like us to be disturbed by that. 0:22:02.067,0:22:06.052 So let's hear from an obstetrician[br]how they frame these sorts of things. 0:22:06.447,0:22:10.190 This is Lisa Masterson being interviewed[br]on the Craig Ferguson Late, Late Show. 0:22:10.843,0:22:12.743 LISA," Yeah, and again[br]you know what that is a personal choice 0:22:13.066,0:22:15.522 and as an Obstetrician,[br]I talk to my patients a lot about this. 0:22:15.645,0:22:19.194 And really there's a lot of health benefits[br]and there are some risk benefits, 0:22:19.349,0:22:21.120 but it is really a social procedure. 0:22:21.479,0:22:24.749 So you really have to decide,[br]do you want your son to look like you? 0:22:25.110,0:22:27.591 You know it is a cultural thing it is a social thing, 0:22:28.021,0:22:31.797 And there are some health benefits,[br]more for the lady than the man 0:22:32.319,0:22:38.173 but as far as decreasing STDs and passing on to ah[br]you know other women HPV, which can cause cervical cancer, 0:22:38.574,0:22:41.382 so decreasing STDs and cancer all that good stuff." 0:22:41.968,0:22:45.058 CRAIG,"But couldn't you achieve the same effect[br]by washing your pee pee on a regular basis?" 0:22:46.744,0:22:47.972 LISA,"You absolutely could." 0:22:48.725,0:22:51.328 CRAIG,"So we're talking,[br]You can have this chopped off, or you can wash it, 0:22:51.724,0:22:52.659 your call?" 0:22:53.521,0:22:54.390 LISA,"Exactly." 0:22:55.589,0:22:58.321 CRAIG,[br]"That's a tough choice there Doctor ... I dunno!" 0:23:01.119,0:23:03.198 So obviously I appreciate Craig's point of view there. 0:23:03.809,0:23:06.973 He is from Scotland,[br]where they coincidentally don't do this to children. 0:23:08.446,0:23:10.095 And think about her discourse, 0:23:10.327,0:23:13.061 she's saying you have to choose as a parent, 0:23:13.830,0:23:16.219 and I want to question that framing of it. 0:23:17.066,0:23:21.644 Do you have to choose other[br]body modification options for your child? 0:23:22.220,0:23:24.218 Like a nose job, or things like that? 0:23:25.871,0:23:29.542 And, if the idea of doing things to our children[br]because we want them to look a certain way chills you, 0:23:29.742,0:23:31.250 I am glad because I want it to chill us. 0:23:31.454,0:23:32.880 I want us to wonder 0:23:33.040,0:23:37.946 why are we so busy making our children look like[br]what we think boys and girls should look like? 0:23:38.483,0:23:42.474 In this case, we have this idea that boys[br]should look a certain way in their genitals. 0:23:44.202,0:23:47.502 Okay, so the last section is,[br]how do we get practitioners doing this? 0:23:48.928,0:23:51.974 So I have a few quotes[br]from practitioners who stopped doing it, 0:23:52.175,0:23:53.275 like Marilynn Milos, 0:23:53.475,0:23:55.975 a nurse who, after seeing it,[br]refused to assist with them 0:23:56.175,0:23:59.379 and was fired for telling parents[br]they don't need to do it. 0:23:59.918,0:24:02.610 Michelle Storms, who is a very well known Obstetrician[br][sic, she is a Family Medicine Practitioner] 0:24:03.334,0:24:07.432 who said she was ridiculed and patronized[br]after stopping them in 1988. 0:24:08.405,0:24:13.001 And I am at Georgetown, so I went and talked[br]to the Head of Obstetrics at Georgetown University Hospital, 0:24:13.220,0:24:15.302 Obstetricians do most of them, and she says, 0:24:15.660,0:24:17.361 "Medically it doesn't make sense" 0:24:17.561,0:24:20.067 "I don't even like doing the procedure, but I do it well." 0:24:20.728,0:24:22.881 "I have performed thousands of circumcisions." 0:24:23.239,0:24:24.678 She was clear that it is a social procedure, 0:24:25.108,0:24:26.866 she was clear that it doesn't make sense medically, 0:24:27.225,0:24:30.387 And she told me in our conversation[br]that she would not stop doing them. 0:24:33.524,0:24:37.741 So how do we make physicians into that? 0:24:39.894,0:24:42.015 Well, first we start by pathologizing a healthy organ. 0:24:42.627,0:24:47.657 Not only is the foreskin absent[br]from most U.S. medical and anatomy texts, 0:24:48.198,0:24:50.566 There is, therefore, no education of the function. 0:24:50.890,0:24:52.974 It is not viewed as a sexually important organ. 0:24:54.951,0:24:57.430 Physicians are only taught[br]how to remove it as a procedure. 0:24:58.156,0:25:01.595 and they are mistaught care, they are mistaught[br]this "retract and wash" philosophy, 0:25:02.352,0:25:06.177 which is problematic because as you can see[br]down at the bottom, 0:25:06.572,0:25:09.229 the foreskin when you are born[br]is usually attached to the head of the penis. 0:25:09.733,0:25:11.746 What you saw earlier in the circumcision video 0:25:12.069,0:25:16.488 was the physician running this tool around to break[br]the foreskin loose so that they could cut it off. 0:25:17.673,0:25:21.519 It is bonded like that to protect babies from,[br]well all the sorts of things that babies do, 0:25:22.100,0:25:24.473 they might have feces or urine in their diaper, 0:25:24.760,0:25:26.342 they might get scratched up. 0:25:26.733,0:25:29.034 The foreskin has a protective function[br]when you are young. 0:25:29.803,0:25:31.163 Gradually that detaches 0:25:31.487,0:25:33.931 and the foreskin becomes retractable, 0:25:34.182,0:25:36.504 but if you forcibly retract it, that tears it up 0:25:36.785,0:25:38.531 and creates a site for infection, 0:25:38.762,0:25:41.958 also if you wash with soap[br]that creates a site for infection. 0:25:42.756,0:25:46.028 And finally,[br]we make this misdiagnosis called "phimosis". 0:25:46.732,0:25:49.250 There is a true problem called phimosis[br]when there is scar tissue 0:25:49.450,0:25:52.525 at the opening of the foreskin, so it can't retract 0:25:52.725,0:25:55.948 and there are treatments for it use steroidal cream[br]to help the scar tissue soften. 0:25:56.995,0:26:00.233 But when we think that a baby who is three weeks old 0:26:00.558,0:26:03.432 because you can't pull the foreskin back without[br]making the baby scream, that's wrong. 0:26:04.402,0:26:09.572 It is actually meant to be attached that way,[br]it grew that way and it will become retractable on its own. 0:26:12.729,0:26:15.239 So, why do we do the circumcisions? 0:26:15.527,0:26:18.834 Well if you look at why parents say they choose[br]the number one reason is appearance. 0:26:19.232,0:26:23.544 They want their child to look like the other children[br]they'll see or they want them to look like their Dad. 0:26:25.100,0:26:28.107 They think it looks better,[br]or they think it is easier to keep clean. 0:26:28.647,0:26:33.788 And I believe it is the solicitation by physicians[br]that reinforces or validates the choice to do this. 0:26:34.255,0:26:39.037 The fact that physicians do it[br]makes it look like a reasonable thing. 0:26:39.869,0:26:44.088 Physicians may also give several reasons[br]to collude with this idea, 0:26:44.288,0:26:46.497 they may say it reduces penile cancer rates. 0:26:46.697,0:26:49.129 That it reduces urinary tract infections (UTIs), 0:26:49.451,0:26:53.729 Cervical Cancer rates in female partners[br]that your child might have when they grow up. 0:26:54.843,0:26:57.838 And female to male HIV transmission rate reduction 0:26:58.063,0:26:59.629 is sort of the newest reason. 0:27:00.029,0:27:02.625 So as I showed you in the beginning, [br]we have this sort of cultural baggage 0:27:03.178,0:27:08.356 a lot of reasons why we used to do circumcisions[br]that don't make sense in today's cultural setting, 0:27:09.039,0:27:13.604 so we have had to come up with a posteriori reasons[br]in order to feel more comfortable with what we are doing. 0:27:14.359,0:27:15.759 But I'll analyze those in more depth. 0:27:16.154,0:27:20.210 Besides the social critique that I think they are reasons[br]we made up after the fact, in order to feel comfortable with it. 0:27:20.532,0:27:25.873 If we think about them carefully, appearance[br]and cleanliness, the number one reason that circumcision is done. 0:27:26.159,0:27:30.256 Well that argument is used to support both[br]male and female genital cutting 0:27:30.651,0:27:34.963 in every culture that I am aware of[br]that either of those practices occurs in. 0:27:35.436,0:27:37.088 And they are just made up arguments, 0:27:37.412,0:27:40.396 I mean, how can you say that something is cleaner[br]if you do one thing to it or another? 0:27:41.727,0:27:45.697 Penile Cancer, the American Cancer Society says no,[br]it won't protect you from penile cancer. 0:27:46.291,0:27:49.383 It is also irrelevant; the rate is 1 in 100,000. 0:27:49.693,0:27:51.995 More people may die from circumcision than penile cancer. 0:27:52.474,0:27:54.183 Urinary tract infections, 0:27:54.559,0:27:56.825 well that was based on a big study in 1986, 0:27:57.184,0:27:59.658 done by a fellow, I kid you not, his name was Wiswell. 0:28:01.444,0:28:05.449 And the problem was his instructions[br]caused urinary tract infections, 0:28:05.676,0:28:07.017 selectively in subjects with foreskins 0:28:07.217,0:28:10.530 because he told the parents to forcibly[br]retract the foreskin and wash with soap. 0:28:10.940,0:28:14.005 So that is just like if you had a girl[br]and you forcibly douched her, 0:28:14.251,0:28:17.441 you know a little girl, you would get [br]a higher rate of yeast and urinary tract infections 0:28:17.641,0:28:20.893 because you have messed up[br]the colonies of protective bacteria. 0:28:21.926,0:28:24.372 Cervical cancer in female partners, 0:28:25.414,0:28:28.002 Well, first of all, a surgical preventive measure on an infant 0:28:28.290,0:28:31.291 for a potential female partner when they grow up. 0:28:31.499,0:28:34.942 I mean, how do we know this person[br]is not going to be a monk or gay? 0:28:35.515,0:28:37.708 And they could do it themselves later. 0:28:38.319,0:28:41.885 Also, cervical cancer is cause by human papilloma virus (HPV). 0:28:42.088,0:28:44.569 Probably most of you guys know that because you[br]learned that in Sex Ed, right? 0:28:45.072,0:28:49.212 Well the same authors went back and looked[br]at the husbands and wives in that study 0:28:49.487,0:28:52.363 and they had different strains of HPV. 0:28:52.614,0:28:57.390 So I don't know if there was[br]under-the-table non-monogamy or what. 0:28:57.930,0:29:00.628 But that throws the results[br]of that study totally into question 0:29:00.915,0:29:06.306 because the husbands were not carrying the HPV[br]strains that gave the women the cervical cancer. 0:29:07.367,0:29:08.442 Gesundheit. 0:29:09.984,0:29:13.255 Okay, so the last one is circumcision[br]as an HIV preventative. 0:29:13.938,0:29:17.390 Okay, that idea started in the 2000's mostly. 0:29:17.713,0:29:20.271 The evidence for it is three randomized control trials. 0:29:20.471,0:29:21.612 They were performed in Africa, 0:29:21.899,0:29:25.925 probably because you couldn't get a[br]human review board to permit such a study in the U.S. 0:29:26.284,0:29:28.751 They got volunteer men[br]who were willing to be circumcised; 0:29:29.065,0:29:30.765 they randomly circumcised half of them. 0:29:30.965,0:29:33.280 And they watched to see how quickly they got HIV. 0:29:34.393,0:29:37.637 They had some problematic methodology[br]that I will get into later. 0:29:38.247,0:29:42.813 And their claim was that that reduced[br]the rate at which men got HIV by 60%. 0:29:44.251,0:29:47.522 Now the evidence against circumcision[br]as an HIV preventative 0:29:47.846,0:29:50.003 are pretty much all the[br]other studies that have been done. 0:29:50.578,0:29:51.971 The geographic data, 0:29:52.171,0:29:55.320 if you look at correlation between[br]circumcision percentage and HIV rates 0:29:55.520,0:29:58.186 in populations, it contradicts this conclusion. 0:29:58.503,0:29:59.543 For example, 0:29:59.878,0:30:03.796 the United States has the highest HIV rate[br]of any industrialized nation, 0:30:04.262,0:30:07.139 and also has the highest circumcision rate[br]of any industrialized nation. 0:30:07.851,0:30:10.404 You would expect something different[br]if circumcision were so protective. 0:30:12.848,0:30:17.434 So, I've got a few minutes left. I am going to quickly[br]run through what I think was wrong with the study. 0:30:17.900,0:30:23.811 Again, there were three studies, they took a group of intact men,[br]circumcised them and watched how quickly they got HIV. 0:30:24.710,0:30:28.466 The problems were, each time they came[br]to the clinic they gave them condoms 0:30:28.728,0:30:31.280 and safe sex counseling. 0:30:31.480,0:30:33.973 But the circumcised group came[br]at least twice more 0:30:34.424,0:30:36.958 because they had to come to get circumcised[br]and they had to come to get a follow up study. 0:30:38.180,0:30:39.801 In addition, if you are circumcised, 0:30:40.001,0:30:43.082 it will take you about four to six weeks[br]until you are able to have sex again. 0:30:44.112,0:30:48.066 And the circumcised group was asked[br]to abstain for six weeks. 0:30:48.927,0:30:51.262 But they didn't start the clock[br]until after waiting for six weeks, 0:30:51.462,0:30:52.895 they started the clock at the beginning, 0:30:53.099,0:30:55.813 so the circumcised group had six weeks 0:30:56.136,0:30:57.506 of protection by being unable to have intercourse. 0:30:58.782,0:31:00.769 In addition, they used an anti-body test, which 0:31:01.020,0:31:03.533 you know, if you go to an STD clinic 0:31:03.733,0:31:06.079 and they use an antibody test,[br]there is a three-month window. 0:31:06.280,0:31:08.886 They tell you, you've got to wait[br]until three months after your last exposure 0:31:09.087,0:31:10.587 if you really want to know if you have HIV. 0:31:10.788,0:31:12.983 But again, they didn't start the clock after three months 0:31:13.306,0:31:16.239 and most the benefit or half the benefit[br]occurred during those first three months. 0:31:16.527,0:31:19.582 So those infections occurred prior[br]to the start of the trial, 0:31:19.585,0:31:21.562 prior to the randomization and intervention. 0:31:22.603,0:31:24.801 There were a lot of problems concerning controls, 0:31:25.001,0:31:28.308 including blood exposure[br]and receptive anal intercourse. 0:31:30.751,0:31:32.795 I am also concerned because the authors of that study 0:31:33.046,0:31:36.317 likened circumcision to an effective vaccine. 0:31:37.719,0:31:40.799 Now all they are saying is that,[br]if their results are accurate, 0:31:41.000,0:31:42.079 which I don't believe, 0:31:42.279,0:31:44.365 that it would reduce[br]your likelihood of getting HIV, 0:31:44.565,0:31:47.202 you know each time you had sex, by 60%. 0:31:47.402,0:31:50.507 So, if you have sex enough, you will [br]et HIV anyway with enough risky behavior. 0:31:51.335,0:31:52.216 The measles vaccine, 0:31:52.502,0:31:56.608 if you took that and its boosters,[br]99% of you become immune to measles. 0:31:56.808,0:31:58.133 Probably you are actually. 0:31:58.423,0:32:00.400 So that is what an effective vaccine looks like. 0:32:00.796,0:32:02.377 Ninety-nine per cent permanent immunity. 0:32:02.577,0:32:06.143 Not sixty per cent less likelihood[br]to become infected each time you are exposed. 0:32:06.343,0:32:09.958 And real human beings think they are immune[br]to HIV because they have been circumcised 0:32:10.200,0:32:11.287 in African countries, 0:32:12.985,0:32:15.321 and I am very concerned about that. 0:32:15.835,0:32:17.485 But anyway, so to re-cap, 0:32:17.839,0:32:20.791 I think we have a social bias[br]toward cutting children, 0:32:21.506,0:32:22.766 particularly boys. 0:32:22.966,0:32:24.983 I think that it is very harmful to children. 0:32:25.183,0:32:26.885 It also hurts survivors. 0:32:27.085,0:32:29.785 It hurts parents, who really want[br]the best for their children. 0:32:30.269,0:32:31.430 And it also hurts practitioners 0:32:31.716,0:32:34.736 because I believe that medical students[br]come into school wanting to help people, 0:32:35.183,0:32:38.414 and they get taught about this procedure[br]in an out-of-context kind of way. 0:32:40.210,0:32:43.429 Most of the people I talk to think it is[br]not their responsibility to do anything about it, 0:32:43.629,0:32:47.665 including professional organizations[br]like the American Academy of Pediatrics, 0:32:47.897,0:32:50.454 the American College of Obstetricians and Gynecologists, 0:32:50.738,0:32:51.640 the practitioners, you know, 0:32:51.817,0:32:54.764 because their job is to keep the practitioners looking good. 0:32:55.016,0:32:59.401 So, if you say something is bad that your practitioners[br]are doing, that doesn't look so good. 0:33:00.227,0:33:04.180 The administrators of the hospital[br]and the practitioners there don't want to stand out. 0:33:04.575,0:33:07.522 The obstetricians don't even think[br]the child they are operating on is their patient. 0:33:07.800,0:33:09.900 The ethics committee of the hospital 0:33:10.100,0:33:12.586 told me that they are not[br]the appropriate venue for this concern. 0:33:14.063,0:33:18.017 And I think all of these organizations[br]are neglecting parents, children, and us. 0:33:20.300,0:33:22.274 So I am hopeful[br]that I have engaged you with some interest 0:33:22.541,0:33:24.283 and that maybe you will go and tell people about this. 0:33:24.483,0:33:28.219 Because, if they are not going to take responsibility,[br]I hope that we will. 0:33:28.419,0:33:29.877 So tell your friends. 0:33:30.077,0:33:32.434 I am going to give a link to this slide show to your professor.[br][A link to the files is available in the description.]