[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:01.07,0:00:04.40,Default,,0000,0000,0000,,I am Ryan, a friend of Lizzie's.
Dialogue: 0,0:00:04.48,0:00:08.19,Default,,0000,0000,0000,,I do bio-physics research\Nat Georgetown University,
Dialogue: 0,0:00:08.31,0:00:13.11,Default,,0000,0000,0000,,and I also coordinate two non-profits\Nthat deal mostly with supporting families
Dialogue: 0,0:00:13.34,0:00:14.89,Default,,0000,0000,0000,,and supporting people in their relationships.
Dialogue: 0,0:00:15.59,0:00:17.02,Default,,0000,0000,0000,,Here is my family.
Dialogue: 0,0:00:19.00,0:00:23.02,Default,,0000,0000,0000,,So my mission in life basically \Nis to help people get along,
Dialogue: 0,0:00:23.36,0:00:25.51,Default,,0000,0000,0000,,and towards that end,\NI do a lot of workshops with families
Dialogue: 0,0:00:25.80,0:00:28.76,Default,,0000,0000,0000,,and I also help families\Nunderstand medical questions.
Dialogue: 0,0:00:31.36,0:00:34.13,Default,,0000,0000,0000,,So I am here to talk with you about circumcision,
Dialogue: 0,0:00:34.30,0:00:36.00,Default,,0000,0000,0000,,I am calling it an "Elephant in the Hospital"
Dialogue: 0,0:00:36.68,0:00:40.78,Default,,0000,0000,0000,,because it is this huge thing that happens\Nas far as I see in our culture
Dialogue: 0,0:00:41.20,0:00:43.05,Default,,0000,0000,0000,,but we have very little discourse about it.
Dialogue: 0,0:00:43.15,0:00:46.93,Default,,0000,0000,0000,,It is performed between 500,000 and 1,000,000\Nmillion times each year in the U.S.,
Dialogue: 0,0:00:47.44,0:00:51.67,Default,,0000,0000,0000,,almost entirely on infants within\Nthe first three days of life
Dialogue: 0,0:00:52.35,0:00:56.85,Default,,0000,0000,0000,,and it is completely unnecessary;\Nand I believe, based on my research,
Dialogue: 0,0:00:57.10,0:00:59.07,Default,,0000,0000,0000,,entirely harmful to children.
Dialogue: 0,0:01:00.39,0:01:03.85,Default,,0000,0000,0000,,So what we are going to run through,\Nas quickly as I can,
Dialogue: 0,0:01:04.46,0:01:08.89,Default,,0000,0000,0000,,is just a discussion what that process is like\Nfrom the child's point of view,
Dialogue: 0,0:01:09.32,0:01:11.11,Default,,0000,0000,0000,,what effects it has on adult survivors,
Dialogue: 0,0:01:11.47,0:01:15.75,Default,,0000,0000,0000,,how we get parents to agree to it\N(what understanding parents have),
Dialogue: 0,0:01:16.02,0:01:18.94,Default,,0000,0000,0000,,and how we get practitioners to perform it.
Dialogue: 0,0:01:20.71,0:01:25.95,Default,,0000,0000,0000,,So before we do that, I actually just want\Nto get a chance to see what our room is like
Dialogue: 0,0:01:26.45,0:01:32.21,Default,,0000,0000,0000,,so we can see each other; therefore, I will ask a few questions\Nand we're gonna use this technology for room assessment
Dialogue: 0,0:01:32.51,0:01:34.30,Default,,0000,0000,0000,,that goes back to a before clickers.\NI am going to ask you, if you are willing,
Dialogue: 0,0:01:34.41,0:01:36.97,Default,,0000,0000,0000,,to point in the direction as I ask you about each thing,
Dialogue: 0,0:01:37.00,0:01:39.21,Default,,0000,0000,0000,,from beneficial, this wall is the beneficial wall,
Dialogue: 0,0:01:39.58,0:01:43.58,Default,,0000,0000,0000,,neutral is the ceiling,\Nand harmful is the wall over there.
Dialogue: 0,0:01:44.60,0:01:47.82,Default,,0000,0000,0000,,For Example, what do you think of foot binding?
Dialogue: 0,0:01:48.10,0:01:50.11,Default,,0000,0000,0000,,I mean you are anthropologists,\Nmost of you have heard of foot binding.
Dialogue: 0,0:01:50.38,0:01:52.27,Default,,0000,0000,0000,,Where do you think it goes on the ...
Dialogue: 0,0:01:52.47,0:01:55.84,Default,,0000,0000,0000,,okay we have everyone who chose to respond,\Nthinks it is harmful.
Dialogue: 0,0:01:55.98,0:01:57.73,Default,,0000,0000,0000,,Good I am pleased with that response.
Dialogue: 0,0:01:58.03,0:01:59.38,Default,,0000,0000,0000,,Female Genital Cutting
Dialogue: 0,0:01:59.68,0:02:01.27,Default,,0000,0000,0000,,how many people have heard of that?
Dialogue: 0,0:02:01.60,0:02:03.21,Default,,0000,0000,0000,,Okay great, we have got universally harmful.
Dialogue: 0,0:02:03.78,0:02:07.07,Default,,0000,0000,0000,,Okay what about say we were going\Nto do prophylactic breast bud removal,
Dialogue: 0,0:02:07.75,0:02:09.18,Default,,0000,0000,0000,,say we wanted to stop breast cancer
Dialogue: 0,0:02:09.66,0:02:11.98,Default,,0000,0000,0000,,and save hundreds of thousands of women's lives per year,
Dialogue: 0,0:02:12.58,0:02:15.65,Default,,0000,0000,0000,,and say we just cut all babies' breast buds off?
Dialogue: 0,0:02:15.90,0:02:17.88,Default,,0000,0000,0000,,Beneficial? Harmful? Neutral?
Dialogue: 0,0:02:18.94,0:02:21.81,Default,,0000,0000,0000,,Okay some neutral and some harmful.
Dialogue: 0,0:02:22.00,0:02:23.32,Default,,0000,0000,0000,,Okay.
Dialogue: 0,0:02:24.04,0:02:27.07,Default,,0000,0000,0000,,And what about cutting off non-essential tissue from a child,
Dialogue: 0,0:02:27.27,0:02:29.34,Default,,0000,0000,0000,,say we just cut off all children's ear lobes
Dialogue: 0,0:02:29.59,0:02:32.23,Default,,0000,0000,0000,,because we thought they were an inconvenience,\Na pain or they looked ugly?
Dialogue: 0,0:02:33.00,0:02:34.39,Default,,0000,0000,0000,,Okay, we have got harmful.
Dialogue: 0,0:02:34.62,0:02:35.73,Default,,0000,0000,0000,,So what about Circumcision?
Dialogue: 0,0:02:36.01,0:02:37.69,Default,,0000,0000,0000,,What is our starting point?
Dialogue: 0,0:02:38.45,0:02:40.51,Default,,0000,0000,0000,,We have got every response,
Dialogue: 0,0:02:40.77,0:02:42.60,Default,,0000,0000,0000,,that's great; okay, so we have a diverse audience.
Dialogue: 0,0:02:44.61,0:02:46.02,Default,,0000,0000,0000,,Now a couple of other questions
Dialogue: 0,0:02:46.25,0:02:47.37,Default,,0000,0000,0000,,just to see who we are.
Dialogue: 0,0:02:47.60,0:02:49.45,Default,,0000,0000,0000,,Who here thinks that they have a foreskin,
Dialogue: 0,0:02:50.82,0:02:51.65,Default,,0000,0000,0000,,anyone?
Dialogue: 0,0:02:53.01,0:02:55.10,Default,,0000,0000,0000,,Who here believes that they have a foreskin,
Dialogue: 0,0:02:56.08,0:02:58.70,Default,,0000,0000,0000,,which is that part they remove during circumcision, right?
Dialogue: 0,0:02:59.02,0:03:00.33,Default,,0000,0000,0000,,Okay, so that is a trick question.
Dialogue: 0,0:03:01.05,0:03:03.92,Default,,0000,0000,0000,,Men and women, males and females, are both born with foreskins,
Dialogue: 0,0:03:04.27,0:03:08.10,Default,,0000,0000,0000,,the foreskin is just a name for a part of the clitoris or penis,
Dialogue: 0,0:03:08.63,0:03:11.72,Default,,0000,0000,0000,,and so probably most of the women here have one
Dialogue: 0,0:03:12.15,0:03:13.66,Default,,0000,0000,0000,,and perhaps some of the males also.
Dialogue: 0,0:03:14.42,0:03:16.45,Default,,0000,0000,0000,,Who here comes from a culture where
Dialogue: 0,0:03:16.71,0:03:19.26,Default,,0000,0000,0000,,female genital cutting is a social norm?
Dialogue: 0,0:03:19.47,0:03:20.55,Default,,0000,0000,0000,,No one, okay.
Dialogue: 0,0:03:20.75,0:03:22.79,Default,,0000,0000,0000,,Who here comes from a culture where
Dialogue: 0,0:03:22.98,0:03:24.59,Default,,0000,0000,0000,,male genital cutting is a social norm?
Dialogue: 0,0:03:24.86,0:03:26.49,Default,,0000,0000,0000,,Okay, all of us pretty much, that I can see, okay.
Dialogue: 0,0:03:27.44,0:03:30.92,Default,,0000,0000,0000,,And who knows someone who was genitally altered as a child
Dialogue: 0,0:03:31.22,0:03:34.27,Default,,0000,0000,0000,,it could be you, it could be a friend it could be your parents, or child?
Dialogue: 0,0:03:34.61,0:03:35.44,Default,,0000,0000,0000,,Mostly (all)!
Dialogue: 0,0:03:35.84,0:03:41.04,Default,,0000,0000,0000,,Great, so all of that is just to illustrate how it's something that has\Ntouched all of our lives in some way.
Dialogue: 0,0:03:43.99,0:03:48.12,Default,,0000,0000,0000,,So I am arguing that it is this big thing and that we don't talk about it a lot.
Dialogue: 0,0:03:48.96,0:03:51.07,Default,,0000,0000,0000,,So I have to sort of explain why I think that.
Dialogue: 0,0:03:51.30,0:03:54.49,Default,,0000,0000,0000,,So I believe that the discourse that we have in our culture about circumcision
Dialogue: 0,0:03:54.70,0:03:58.02,Default,,0000,0000,0000,,is one that is used to conceal what the nature of the process is.
Dialogue: 0,0:03:58.74,0:04:02.09,Default,,0000,0000,0000,,So you may have heard things like "well, you know,\Nit makes the penis cleaner" and things like that.
Dialogue: 0,0:04:02.92,0:04:06.72,Default,,0000,0000,0000,,You may have heard things like "everyone does it," "I am circumcised, I am fine,"
Dialogue: 0,0:04:07.52,0:04:10.53,Default,,0000,0000,0000,,"It is just a little snip" or "it removes a useless flap of skin,"
Dialogue: 0,0:04:10.73,0:04:12.33,Default,,0000,0000,0000,,this sort of trivializing language.
Dialogue: 0,0:04:13.35,0:04:14.89,Default,,0000,0000,0000,,Well, we have heard all of these things.
Dialogue: 0,0:04:15.07,0:04:17.42,Default,,0000,0000,0000,,What I am going to ask you to do is set all that aside,
Dialogue: 0,0:04:18.15,0:04:20.39,Default,,0000,0000,0000,,all of that mass of experience in your mind,
Dialogue: 0,0:04:20.67,0:04:24.00,Default,,0000,0000,0000,,and to try to come at it from a fresh angle where
Dialogue: 0,0:04:24.24,0:04:27.76,Default,,0000,0000,0000,,these sort of illogical arguments of support for it are not part of your way of thinking.
Dialogue: 0,0:04:30.19,0:04:33.96,Default,,0000,0000,0000,,I am going to propose that circumcision is this cyclical process in our culture
Dialogue: 0,0:04:34.16,0:04:37.56,Default,,0000,0000,0000,,where we do it to children, they grow up to become adult survivors,
Dialogue: 0,0:04:37.76,0:04:39.16,Default,,0000,0000,0000,,some of those people become parents,
Dialogue: 0,0:04:39.46,0:04:43.86,Default,,0000,0000,0000,,and practitioners engage them in order to perform this surgery on their children,
Dialogue: 0,0:04:44.11,0:04:48.73,Default,,0000,0000,0000,,which unlike any other surgery I am aware of in U.S. hospitals,
Dialogue: 0,0:04:48.93,0:04:50.66,Default,,0000,0000,0000,,it removes a healthy and unique organ part
Dialogue: 0,0:04:51.06,0:04:54.24,Default,,0000,0000,0000,,(actually with the exception of inter-sex genital modification,
Dialogue: 0,0:04:54.53,0:04:56.92,Default,,0000,0000,0000,,which bears a lot of resemblance to it by the way).
Dialogue: 0,0:04:57.12,0:04:58.97,Default,,0000,0000,0000,,It removes a healthy part of the body.
Dialogue: 0,0:04:59.15,0:05:00.79,Default,,0000,0000,0000,,It is not used as a treatment.
Dialogue: 0,0:05:00.99,0:05:03.32,Default,,0000,0000,0000,,Doctors don't think they are treating the children;
Dialogue: 0,0:05:03.60,0:05:05.30,Default,,0000,0000,0000,,they know it is a social surgery they are performing.
Dialogue: 0,0:05:05.51,0:05:07.51,Default,,0000,0000,0000,,It has significant complications.
Dialogue: 0,0:05:07.71,0:05:10.70,Default,,0000,0000,0000,,It is performed on minors who cannot give their consent.
Dialogue: 0,0:05:10.90,0:05:13.87,Default,,0000,0000,0000,,It is illegal, it is actually a federal felony to perform on girls,
Dialogue: 0,0:05:14.07,0:05:15.85,Default,,0000,0000,0000,,but it is actually encouraged and performed on boys.
Dialogue: 0,0:05:16.10,0:05:18.68,Default,,0000,0000,0000,,It results in life long function loss,
Dialogue: 0,0:05:18.89,0:05:20.89,Default,,0000,0000,0000,,and the tissue is then used commercially.
Dialogue: 0,0:05:23.13,0:05:25.10,Default,,0000,0000,0000,,So just a little context piece.
Dialogue: 0,0:05:25.63,0:05:28.38,Default,,0000,0000,0000,,I hear you, believe me, and I will show you evidence of that.
Dialogue: 0,0:05:28.90,0:05:31.57,Default,,0000,0000,0000,,I won't make such a radical claim without proving it.
Dialogue: 0,0:05:33.02,0:05:36.36,Default,,0000,0000,0000,,So let's just finish our context piece\Nwith both the geography and the history.
Dialogue: 0,0:05:37.21,0:05:40.34,Default,,0000,0000,0000,,So this is a map of the world sort of.
Dialogue: 0,0:05:41.17,0:05:46.38,Default,,0000,0000,0000,,As you can see green countries represent places where\Ngenital cutting of boys is not practiced, generally speaking.
Dialogue: 0,0:05:47.43,0:05:50.12,Default,,0000,0000,0000,,The small, the few yellow countries up in the northern regions
Dialogue: 0,0:05:50.39,0:05:52.83,Default,,0000,0000,0000,,are places where it is becoming legally questioned.
Dialogue: 0,0:05:54.52,0:05:57.89,Default,,0000,0000,0000,,Circumcision is now rare in Canada, England, and Australia
Dialogue: 0,0:05:58.11,0:06:00.32,Default,,0000,0000,0000,,where it used to be practiced on babies also, but stopped.
Dialogue: 0,0:06:00.80,0:06:03.38,Default,,0000,0000,0000,,In fact, in England, in the 1950's there was an article published
Dialogue: 0,0:06:03.67,0:06:06.59,Default,,0000,0000,0000,,showing it killed a number of children a year,
Dialogue: 0,0:06:06.79,0:06:08.59,Default,,0000,0000,0000,,about 14 a year,
Dialogue: 0,0:06:08.85,0:06:10.48,Default,,0000,0000,0000,,so they stopped the practice there.
Dialogue: 0,0:06:10.93,0:06:14.43,Default,,0000,0000,0000,,And the other places, besides the United States where it is done on babies,
Dialogue: 0,0:06:14.66,0:06:17.88,Default,,0000,0000,0000,,in the other regions, most of the time, it is done on adolescents
Dialogue: 0,0:06:18.18,0:06:21.62,Default,,0000,0000,0000,,in Sub-Saharan Africa and in Sunni Islamic cultures.
Dialogue: 0,0:06:24.14,0:06:25.35,Default,,0000,0000,0000,,Now how did we get here?
Dialogue: 0,0:06:26.73,0:06:30.75,Default,,0000,0000,0000,,It has become a medical practice rather than a\Ntribal practice or a cultural practice.
Dialogue: 0,0:06:31.61,0:06:33.74,Default,,0000,0000,0000,,And that came about in the late 1800's
Dialogue: 0,0:06:34.08,0:06:36.98,Default,,0000,0000,0000,,when people had not the germ theory of disease,
Dialogue: 0,0:06:37.18,0:06:40.08,Default,,0000,0000,0000,,but the nervous excitation theory of disease.
Dialogue: 0,0:06:40.57,0:06:42.31,Default,,0000,0000,0000,,And people had the Victorian morality,
Dialogue: 0,0:06:42.54,0:06:45.16,Default,,0000,0000,0000,,so people see what they expect to see a lot of the time.
Dialogue: 0,0:06:45.36,0:06:49.22,Default,,0000,0000,0000,,So you can find a lot of published medical literature\Nshowing that circumcision cured
Dialogue: 0,0:06:50.17,0:06:53.22,Default,,0000,0000,0000,,things such as, paralysis, epilepsy, hip joint disease,
Dialogue: 0,0:06:53.85,0:06:57.27,Default,,0000,0000,0000,,and all sorts of problems that today
Dialogue: 0,0:06:57.82,0:07:01.67,Default,,0000,0000,0000,,seem very unlikely for the process to have cured.
Dialogue: 0,0:07:02.92,0:07:06.43,Default,,0000,0000,0000,,And people really thought that actually harming,\Nthe intention was to harm the genitals of the children.
Dialogue: 0,0:07:07.79,0:07:09.96,Default,,0000,0000,0000,,And they thought that it would help in the long term
Dialogue: 0,0:07:10.34,0:07:13.03,Default,,0000,0000,0000,,because it would prevent them from\Nhaving so much sexual excitation
Dialogue: 0,0:07:13.76,0:07:18.66,Default,,0000,0000,0000,,that being, in the Victorian model, the most dangerous\Ntype of excitation that one could have.
Dialogue: 0,0:07:21.30,0:07:22.47,Default,,0000,0000,0000,,So, uhm, oops,
Dialogue: 0,0:07:22.67,0:07:24.84,Default,,0000,0000,0000,,I should have given you a caveat,
Dialogue: 0,0:07:25.54,0:07:26.74,Default,,0000,0000,0000,,my apologies...
Dialogue: 0,0:07:26.99,0:07:29.08,Default,,0000,0000,0000,,There are going to be some graphic slides here,
Dialogue: 0,0:07:29.39,0:07:33.37,Default,,0000,0000,0000,,and I certainly welcome you turn away at any point\Nif you don't feel comfortable about looking at what you see.
Dialogue: 0,0:07:34.05,0:07:36.97,Default,,0000,0000,0000,,And I will try to more often try to give you a warning\Nwhen they are about to come up.
Dialogue: 0,0:07:39.73,0:07:42.28,Default,,0000,0000,0000,,I would also mention actually another caveat:
Dialogue: 0,0:07:42.54,0:07:44.87,Default,,0000,0000,0000,,I am going to use language differently.
Dialogue: 0,0:07:45.10,0:07:49.33,Default,,0000,0000,0000,,I am going to switch now to mostly\Ncalling circumcision "genital cutting"
Dialogue: 0,0:07:49.69,0:07:52.00,Default,,0000,0000,0000,,because I think that is more of a neutral term,
Dialogue: 0,0:07:52.28,0:07:54.08,Default,,0000,0000,0000,,it's a more accurate or descriptive term.
Dialogue: 0,0:07:54.55,0:08:00.01,Default,,0000,0000,0000,,I think "circumcision" euphemistically embeds\Nour assumption that it is a fine thing.
Dialogue: 0,0:08:00.24,0:08:03.09,Default,,0000,0000,0000,,And the term uncircumcised\NI am going to replace with the term "intact",
Dialogue: 0,0:08:03.29,0:08:07.92,Default,,0000,0000,0000,,because likewise the term "uncircumcised"\Ngives the sense that circumcision is the norm
Dialogue: 0,0:08:08.37,0:08:11.25,Default,,0000,0000,0000,,and that those who are not circumcised are\Nsimply "not yet" circumcised.
Dialogue: 0,0:08:11.94,0:08:16.36,Default,,0000,0000,0000,,And to illustrate that it would be kind of weird\Nif we called women who had breasts"un-mastectomised"
Dialogue: 0,0:08:17.61,0:08:19.55,Default,,0000,0000,0000,,right that would be uncomfortable,
Dialogue: 0,0:08:20.05,0:08:25.05,Default,,0000,0000,0000,,and, likewise, I hope to sensitize us to the discomfort\Nof calling "intact" "uncircumcised".
Dialogue: 0,0:08:28.85,0:08:32.12,Default,,0000,0000,0000,,So the next few slides will have some\Nless-comfortable things to see,
Dialogue: 0,0:08:32.43,0:08:34.85,Default,,0000,0000,0000,,and, again, you are welcome to turn away if you want.
Dialogue: 0,0:08:35.84,0:08:37.77,Default,,0000,0000,0000,,So this is the section on the Child.
Dialogue: 0,0:08:38.30,0:08:41.67,Default,,0000,0000,0000,,The procedure for the child, we will\Nrun through what the procedure looks like.
Dialogue: 0,0:08:41.91,0:08:44.83,Default,,0000,0000,0000,,That's probably the most graphic section,\Nalong with the complications,
Dialogue: 0,0:08:45.45,0:08:48.78,Default,,0000,0000,0000,,and what I want you to think about is,
Dialogue: 0,0:08:49.08,0:08:52.78,Default,,0000,0000,0000,,it is often times talked about from the parents'\Nperspective,"parents have the right to choose".
Dialogue: 0,0:08:53.05,0:08:57.04,Default,,0000,0000,0000,,I want you to question that discourse and think\Nabout what the child's point of view is.
Dialogue: 0,0:08:57.32,0:08:59.02,Default,,0000,0000,0000,,Who owns the child's body?
Dialogue: 0,0:08:59.25,0:09:00.52,Default,,0000,0000,0000,,What rights do they have?
Dialogue: 0,0:09:00.72,0:09:02.67,Default,,0000,0000,0000,,Why are we doing it to boys and not girls?
Dialogue: 0,0:09:02.91,0:09:05.48,Default,,0000,0000,0000,,What does that say about our views on gender, and so on?
Dialogue: 0,0:09:09.21,0:09:13.26,Default,,0000,0000,0000,,So, this slide shows three different representations\Nof people in the genital cutting process.
Dialogue: 0,0:09:14.14,0:09:16.83,Default,,0000,0000,0000,,The top left is a young girl
Dialogue: 0,0:09:17.94,0:09:21.24,Default,,0000,0000,0000,,being circumcised in her cultural scenario.
Dialogue: 0,0:09:21.98,0:09:25.29,Default,,0000,0000,0000,,The top right is a young boy being\Ncircumcised in his cultural scenario.
Dialogue: 0,0:09:25.78,0:09:29.37,Default,,0000,0000,0000,,And the bottom right is an\Ninfant boy in a hospital.
Dialogue: 0,0:09:30.01,0:09:31.81,Default,,0000,0000,0000,,Now what I want you to look at is their faces.
Dialogue: 0,0:09:32.27,0:09:33.40,Default,,0000,0000,0000,,Just look at their faces
Dialogue: 0,0:09:33.70,0:09:36.12,Default,,0000,0000,0000,,because I am asking you to think about their experiences.
Dialogue: 0,0:09:36.38,0:09:39.20,Default,,0000,0000,0000,,To me it looks like they are having a very similar experience.
Dialogue: 0,0:09:40.29,0:09:41.95,Default,,0000,0000,0000,,And yet in our culture,
Dialogue: 0,0:09:42.38,0:09:44.47,Default,,0000,0000,0000,,where I think of us as being kind of imperialist
Dialogue: 0,0:09:44.67,0:09:46.61,Default,,0000,0000,0000,,we're very ready to point the finger and say,
Dialogue: 0,0:09:46.81,0:09:50.87,Default,,0000,0000,0000,,Oh these terrible things these people do in these other\Ncountries where they practice female genital cutting."
Dialogue: 0,0:09:51.16,0:09:54.73,Default,,0000,0000,0000,,yet we're silent about the male genital cutting
Dialogue: 0,0:09:54.93,0:09:57.75,Default,,0000,0000,0000,,that occurs to children under the same conditions of hygiene
Dialogue: 0,0:09:57.82,0:10:00.46,Default,,0000,0000,0000,,and the same death rates in those countries;
Dialogue: 0,0:10:00.66,0:10:02.70,Default,,0000,0000,0000,,and we promote doing it to boys in our country.
Dialogue: 0,0:10:05.22,0:10:06.95,Default,,0000,0000,0000,,So how do we do a circumcision?
Dialogue: 0,0:10:07.23,0:10:09.36,Default,,0000,0000,0000,,The next bits are going to be the most graphic.
Dialogue: 0,0:10:09.40,0:10:11.19,Default,,0000,0000,0000,,This is a circumcision restraint;
Dialogue: 0,0:10:11.59,0:10:12.85,Default,,0000,0000,0000,,they strap the baby down into it,
Dialogue: 0,0:10:13.43,0:10:16.02,Default,,0000,0000,0000,,and then they proceed with the procedure,
Dialogue: 0,0:10:16.31,0:10:17.55,Default,,0000,0000,0000,,which I am going to show you a short video of.
Dialogue: 0,0:10:17.75,0:10:18.96,Default,,0000,0000,0000,,This is going to include sound
Dialogue: 0,0:10:19.41,0:10:21.32,Default,,0000,0000,0000,,if I hooked it up correctly.
Dialogue: 0,0:10:23.00,0:10:25.67,Default,,0000,0000,0000,,and, again, you are welcome to not look;\NI find this uncomfortable.
Dialogue: 0,0:11:07.76,0:11:09.84,Default,,0000,0000,0000,,Okay, so I want to encourage you to take a deep breath
Dialogue: 0,0:11:10.22,0:11:13.48,Default,,0000,0000,0000,,if you have been having trouble breathing\Nas I have during that.
Dialogue: 0,0:11:15.84,0:11:19.47,Default,,0000,0000,0000,,Some things I think to notice is the sort of calm detachment
Dialogue: 0,0:11:19.70,0:11:21.02,Default,,0000,0000,0000,,of the physician's voice.
Dialogue: 0,0:11:21.99,0:11:23.97,Default,,0000,0000,0000,,So the physician is not at all distressed by this.
Dialogue: 0,0:11:24.21,0:11:25.40,Default,,0000,0000,0000,,And the way the baby is crying.
Dialogue: 0,0:11:25.69,0:11:27.73,Default,,0000,0000,0000,,I hear the baby's crying as the way I hear babies cry
Dialogue: 0,0:11:27.73,0:11:29.73,Default,,0000,0000,0000,,when they are under extreme duress,
Dialogue: 0,0:11:30.48,0:11:31.63,Default,,0000,0000,0000,,not you know, "I am hungry."
Dialogue: 0,0:11:36.45,0:11:38.19,Default,,0000,0000,0000,,So beyond the pain of the procedure itself
Dialogue: 0,0:11:38.59,0:11:40.18,Default,,0000,0000,0000,,and the pain of the many days it takes to heal,
Dialogue: 0,0:11:41.23,0:11:45.26,Default,,0000,0000,0000,,there are a number of complications that a\Ncircumcision procedure puts a child at risk for.
Dialogue: 0,0:11:45.79,0:11:47.49,Default,,0000,0000,0000,,You can sort of divide them into two categories.
Dialogue: 0,0:11:47.82,0:11:49.20,Default,,0000,0000,0000,,Surgical complications,
Dialogue: 0,0:11:49.43,0:11:51.12,Default,,0000,0000,0000,,which go from the more minor,
Dialogue: 0,0:11:51.42,0:11:54.16,Default,,0000,0000,0000,,you know everyone has a scar that has been circumcised.
Dialogue: 0,0:11:54.34,0:11:57.51,Default,,0000,0000,0000,,A lot of men don't actually know that\Nthe ring around their penis
Dialogue: 0,0:11:57.84,0:11:59.24,Default,,0000,0000,0000,,is a circumcision scar,
Dialogue: 0,0:11:59.47,0:12:00.78,Default,,0000,0000,0000,,or they learn it when they hear me talk.
Dialogue: 0,0:12:02.45,0:12:03.79,Default,,0000,0000,0000,,But that always happens.
Dialogue: 0,0:12:04.16,0:12:07.03,Default,,0000,0000,0000,,But a number of other complications can be problematic
Dialogue: 0,0:12:07.29,0:12:09.08,Default,,0000,0000,0000,,that don't occur all the time,
Dialogue: 0,0:12:09.24,0:12:10.57,Default,,0000,0000,0000,,like penile adhesions,
Dialogue: 0,0:12:10.77,0:12:12.20,Default,,0000,0000,0000,,when the healing process goes awry
Dialogue: 0,0:12:12.41,0:12:15.78,Default,,0000,0000,0000,,and two parts of the penis that weren't supposed\Nto be connected link together.
Dialogue: 0,0:12:17.01,0:12:19.72,Default,,0000,0000,0000,,Then these panels show in top left (A)
Dialogue: 0,0:12:20.10,0:12:21.74,Default,,0000,0000,0000,,(A) that's called a fistula,
Dialogue: 0,0:12:22.26,0:12:25.25,Default,,0000,0000,0000,,so its like a doctor induced hypospadias,
Dialogue: 0,0:12:25.45,0:12:28.52,Default,,0000,0000,0000,,the black line going down is a probe that's \Nentering the meatus, the opening of the urethra
Dialogue: 0,0:12:28.72,0:12:30.12,Default,,0000,0000,0000,,and exiting out the additional hole
Dialogue: 0,0:12:30.32,0:12:33.28,Default,,0000,0000,0000,,that the physician has caused.
Dialogue: 0,0:12:34.79,0:12:37.33,Default,,0000,0000,0000,,(B) Top Right is a nearly amputated head of the penis.
Dialogue: 0,0:12:37.81,0:12:39.76,Default,,0000,0000,0000,,(C) Bottom Left so much skin of the penis has been removed
Dialogue: 0,0:12:40.31,0:12:44.26,Default,,0000,0000,0000,,(C) that the child's corpus cavernosa and head of the penis\Nare lodged down inside the scrotum,
Dialogue: 0,0:12:45.02,0:12:47.66,Default,,0000,0000,0000,,and in (D) Bottom Right the penis was accidentally amputated entirely.
Dialogue: 0,0:12:49.01,0:12:51.54,Default,,0000,0000,0000,,There are also a number of post-operative complications
Dialogue: 0,0:12:51.79,0:12:53.82,Default,,0000,0000,0000,,ranging from difficulty in breast feeding,
Dialogue: 0,0:12:54.03,0:12:57.41,Default,,0000,0000,0000,,which is important because developing the ability to breast feed
Dialogue: 0,0:12:57.68,0:12:59.21,Default,,0000,0000,0000,,is essential for infants.
Dialogue: 0,0:12:59.57,0:13:00.63,Default,,0000,0000,0000,,Bleeding,
Dialogue: 0,0:13:00.83,0:13:02.34,Default,,0000,0000,0000,,which is another sort of minimizing term,
Dialogue: 0,0:13:02.54,0:13:06.06,Default,,0000,0000,0000,,you see that on consent forms,\Nyou know like"Oh, bleeding",
Dialogue: 0,0:13:06.26,0:13:08.96,Default,,0000,0000,0000,,well it turns out an infant only has \Nabout 12 ounces of blood
Dialogue: 0,0:13:09.16,0:13:11.85,Default,,0000,0000,0000,,so bleeding a couple of ounces\Nmight cause that child to die
Dialogue: 0,0:13:12.06,0:13:13.90,Default,,0000,0000,0000,,or require a blood transfusion.
Dialogue: 0,0:13:14.10,0:13:15.56,Default,,0000,0000,0000,,Increase in pain response.
Dialogue: 0,0:13:15.76,0:13:18.43,Default,,0000,0000,0000,,Infection, which is also very serious for a newborn.
Dialogue: 0,0:13:19.03,0:13:21.55,Default,,0000,0000,0000,,Meatitus, which is an irritation of the opening.
Dialogue: 0,0:13:21.75,0:13:24.34,Default,,0000,0000,0000,,That also can be problematic because if it gets bad enough
Dialogue: 0,0:13:24.56,0:13:27.79,Default,,0000,0000,0000,,the child will not be able to pee, and that\Nwould require the child to have catheterization.
Dialogue: 0,0:13:29.00,0:13:30.03,Default,,0000,0000,0000,,Necrosis
Dialogue: 0,0:13:30.26,0:13:32.76,Default,,0000,0000,0000,,and even permanent loss of the penis, or death.
Dialogue: 0,0:13:35.72,0:13:37.81,Default,,0000,0000,0000,,I have talked with a pediatric urologist.
Dialogue: 0,0:13:38.09,0:13:40.83,Default,,0000,0000,0000,,He is the type of person who gets the complications\Nto deal with.
Dialogue: 0,0:13:41.71,0:13:44.98,Default,,0000,0000,0000,,He said that over a two-year period he had\Nmore than 275 children to treat,
Dialogue: 0,0:13:45.26,0:13:48.12,Default,,0000,0000,0000,,almost half who required surgery,
Dialogue: 0,0:13:48.54,0:13:50.83,Default,,0000,0000,0000,,so they were subjected to an additional surgery
Dialogue: 0,0:13:51.36,0:13:53.10,Default,,0000,0000,0000,,in attempt to correct whatever damage happened.
Dialogue: 0,0:13:55.49,0:13:57.55,Default,,0000,0000,0000,,Okay, that's most of the graphic stuff,
Dialogue: 0,0:13:58.08,0:14:01.65,Default,,0000,0000,0000,,except for in the next few slides we will see\Npictures of the actual anatomy of adults,
Dialogue: 0,0:14:02.00,0:14:04.27,Default,,0000,0000,0000,,so you are also welcome to turn your heads aside for that.
Dialogue: 0,0:14:04.60,0:14:07.04,Default,,0000,0000,0000,,How many people have seen a penis that was intact?
Dialogue: 0,0:14:07.49,0:14:09.10,Default,,0000,0000,0000,,Either your own or a friends, you know?
Dialogue: 0,0:14:12.85,0:14:15.98,Default,,0000,0000,0000,,Okay, if you haven't yet, see if you\Ncan find someone who is willing to show you.
Dialogue: 0,0:14:19.78,0:14:21.82,Default,,0000,0000,0000,,I have talked to hundreds of men,
Dialogue: 0,0:14:23.38,0:14:26.85,Default,,0000,0000,0000,,both men who have been circumcised \Nand men who have not been circumcised.
Dialogue: 0,0:14:27.50,0:14:30.25,Default,,0000,0000,0000,,I hear a lot of men who have been circumcised
Dialogue: 0,0:14:30.70,0:14:31.88,Default,,0000,0000,0000,,feel upset about that.
Dialogue: 0,0:14:32.36,0:14:36.01,Default,,0000,0000,0000,,They are aware or have become aware\Nthat something has been taken away from them,
Dialogue: 0,0:14:36.51,0:14:39.23,Default,,0000,0000,0000,,and that their bodies were subjected\Nto something without their choice.
Dialogue: 0,0:14:41.14,0:14:43.95,Default,,0000,0000,0000,,I also hear parents talk about\Ntheir regret from the procedure.
Dialogue: 0,0:14:46.30,0:14:48.03,Default,,0000,0000,0000,,So what is the foreskin?
Dialogue: 0,0:14:48.51,0:14:52.82,Default,,0000,0000,0000,,The foreskin is this sort of socially constructed thing.
Dialogue: 0,0:14:53.02,0:14:54.37,Default,,0000,0000,0000,,It's really just part of the penis,
Dialogue: 0,0:14:54.58,0:14:57.42,Default,,0000,0000,0000,,but now that we have cut it off,\Nwe have to give it a separate name.
Dialogue: 0,0:14:58.83,0:15:02.86,Default,,0000,0000,0000,,In fact, a lot of potential complications lists\Nthat you get on your informed consent form
Dialogue: 0,0:15:03.48,0:15:06.73,Default,,0000,0000,0000,,say that one of the risks is that you might injure the penis.
Dialogue: 0,0:15:07.96,0:15:12.11,Default,,0000,0000,0000,,So we have constructed a reality in which\Ncutting of the penis is not injuring it;
Dialogue: 0,0:15:12.50,0:15:15.46,Default,,0000,0000,0000,,it is if you then cut part that you intended to leave\Nthat it is an injury.
Dialogue: 0,0:15:18.36,0:15:20.45,Default,,0000,0000,0000,,So I want to show you what the foreskin is.
Dialogue: 0,0:15:20.65,0:15:22.15,Default,,0000,0000,0000,,I want to spend some time on that.
Dialogue: 0,0:15:22.36,0:15:25.00,Default,,0000,0000,0000,,The foreskin in the adult male,\Nthe part that would have been removed,
Dialogue: 0,0:15:25.20,0:15:27.43,Default,,0000,0000,0000,,is about 12 to 15 square inches,
Dialogue: 0,0:15:27.63,0:15:29.99,Default,,0000,0000,0000,,it is about the size of a 3" x 5" index card.
Dialogue: 0,0:15:30.19,0:15:32.12,Default,,0000,0000,0000,,It is the most erogenous part of the human male.
Dialogue: 0,0:15:32.32,0:15:35.26,Default,,0000,0000,0000,,It contains 10 to 20 thousand fine touch nerve endings.
Dialogue: 0,0:15:35.79,0:15:39.19,Default,,0000,0000,0000,,And it also makes the penis shaft skin motile.
Dialogue: 0,0:15:39.94,0:15:42.06,Default,,0000,0000,0000,,So it is the difference, you know when\Nyou are having sexual intercourse
Dialogue: 0,0:15:42.27,0:15:44.34,Default,,0000,0000,0000,,or some kind of interaction,
Dialogue: 0,0:15:44.54,0:15:47.00,Default,,0000,0000,0000,,it is the difference between this kind of interaction
Dialogue: 0,0:15:47.20,0:15:50.88,Default,,0000,0000,0000,,or something if you can image a part\Nof your body where the skin moves around nicely
Dialogue: 0,0:15:51.08,0:15:54.04,Default,,0000,0000,0000,,(My cheeks are floppy, so I can do that, you know).
Dialogue: 0,0:15:54.24,0:15:56.34,Default,,0000,0000,0000,,And that is actually a significant thing
Dialogue: 0,0:15:56.54,0:15:59.50,Default,,0000,0000,0000,,because there is another kind of nerve\Nthat is called a stretch receptor
Dialogue: 0,0:15:59.70,0:16:01.44,Default,,0000,0000,0000,,that gets stimulated in that motion,
Dialogue: 0,0:16:01.64,0:16:05.64,Default,,0000,0000,0000,,and it is the male's contribution\Nto mechanical lubrication during intercourse,
Dialogue: 0,0:16:07.00,0:16:09.89,Default,,0000,0000,0000,,either male-male or male-female.
Dialogue: 0,0:16:10.56,0:16:13.26,Default,,0000,0000,0000,,The foreskin can be broken down into a couple of specialized areas:
Dialogue: 0,0:16:13.83,0:16:14.95,Default,,0000,0000,0000,,the frenulum is this sort of...
Dialogue: 0,0:16:15.56,0:16:17.75,Default,,0000,0000,0000,,my hand isn't really long enough but...
Dialogue: 0,0:16:18.26,0:16:20.70,Default,,0000,0000,0000,,It is this fanning out region here.
Dialogue: 0,0:16:20.90,0:16:24.59,Default,,0000,0000,0000,,and there is the ridged band below it,\Nthat is were most of the nerves land.
Dialogue: 0,0:16:24.79,0:16:26.85,Default,,0000,0000,0000,,and the dartos muscle is a cutaneous muscle
Dialogue: 0,0:16:27.05,0:16:30.16,Default,,0000,0000,0000,,that allows the foreskin to respond to cold or fear
Dialogue: 0,0:16:30.37,0:16:33.19,Default,,0000,0000,0000,,by surrounding the penis and pulling it in towards the body.
Dialogue: 0,0:16:35.92,0:16:39.59,Default,,0000,0000,0000,,In 2007, the first research was done ever
Dialogue: 0,0:16:40.02,0:16:42.73,Default,,0000,0000,0000,,to attempt to assess where the penis is sensitive.
Dialogue: 0,0:16:44.39,0:16:47.31,Default,,0000,0000,0000,,So they took a group of males who were intact
Dialogue: 0,0:16:47.62,0:16:48.97,Default,,0000,0000,0000,,and a group of men who were circumcised.
Dialogue: 0,0:16:49.78,0:16:51.95,Default,,0000,0000,0000,,What you see on this color graph here
Dialogue: 0,0:16:52.25,0:16:55.00,Default,,0000,0000,0000,,is that the most sensitive regions are that maroon color
Dialogue: 0,0:16:55.26,0:16:57.99,Default,,0000,0000,0000,,and the second most sensitive regions are the purplish color.
Dialogue: 0,0:16:59.13,0:17:02.01,Default,,0000,0000,0000,,If we compare that to a circumcised penis
Dialogue: 0,0:17:02.41,0:17:07.04,Default,,0000,0000,0000,,what you see is that we have removed\Nmost of the most sensitive areas
Dialogue: 0,0:17:07.48,0:17:12.36,Default,,0000,0000,0000,,and left just this region around the scar\Nand the remainder of the frenulum
Dialogue: 0,0:17:12.86,0:17:15.13,Default,,0000,0000,0000,,is really where most circumcised men are sensitive.
Dialogue: 0,0:17:15.90,0:17:17.73,Default,,0000,0000,0000,,Therefore, you can compare them this way,
Dialogue: 0,0:17:18.09,0:17:21.54,Default,,0000,0000,0000,,but you don't have to believe me\Nif you can find a friend or two
Dialogue: 0,0:17:21.94,0:17:23.55,Default,,0000,0000,0000,,maybe one who is circumcised and one who is not,
Dialogue: 0,0:17:24.88,0:17:26.12,Default,,0000,0000,0000,,or maybe yourself,
Dialogue: 0,0:17:26.64,0:17:28.88,Default,,0000,0000,0000,,you can look and can see where\Nthe sensitivity actually lies.
Dialogue: 0,0:17:30.59,0:17:32.70,Default,,0000,0000,0000,,For most men it is in this region of the frenulum
Dialogue: 0,0:17:33.23,0:17:34.92,Default,,0000,0000,0000,,or the scar remnant.
Dialogue: 0,0:17:38.65,0:17:40.47,Default,,0000,0000,0000,,So just to get you a real picture,
Dialogue: 0,0:17:40.93,0:17:42.91,Default,,0000,0000,0000,,what John here has done,\Nhe's a photographer,
Dialogue: 0,0:17:43.30,0:17:45.57,Default,,0000,0000,0000,,he has taken a person with a foreskin
Dialogue: 0,0:17:45.93,0:17:49.23,Default,,0000,0000,0000,,and drawn these lines, so you can see\Nhow much tissue it is as it retracts.
Dialogue: 0,0:17:50.50,0:17:52.46,Default,,0000,0000,0000,,The other difference I want you to note
Dialogue: 0,0:17:52.80,0:17:57.25,Default,,0000,0000,0000,,is that the inside what it does it generally surrounds the penis,
Dialogue: 0,0:17:57.45,0:17:59.00,Default,,0000,0000,0000,,so it in a sense it invaginates it,
Dialogue: 0,0:17:59.30,0:18:00.34,Default,,0000,0000,0000,,it gives it an enclosure,
Dialogue: 0,0:18:00.54,0:18:01.85,Default,,0000,0000,0000,,and it keeps it moist.
Dialogue: 0,0:18:02.09,0:18:04.20,Default,,0000,0000,0000,,So, if you compare that with the circumcised penis,
Dialogue: 0,0:18:04.56,0:18:06.42,Default,,0000,0000,0000,,the tissue looks softer,
Dialogue: 0,0:18:06.75,0:18:08.28,Default,,0000,0000,0000,,moister and warmer,
Dialogue: 0,0:18:09.41,0:18:10.67,Default,,0000,0000,0000,,in addition to there being a lot more of it,
Dialogue: 0,0:18:11.05,0:18:12.20,Default,,0000,0000,0000,,and it doesn't have the scar.
Dialogue: 0,0:18:12.60,0:18:14.47,Default,,0000,0000,0000,,Those arrows there are pointing to the scar,
Dialogue: 0,0:18:14.67,0:18:16.12,Default,,0000,0000,0000,,so you can see where that is.
Dialogue: 0,0:18:18.29,0:18:21.31,Default,,0000,0000,0000,,I did want to invite, if you have any questions,
Dialogue: 0,0:18:21.59,0:18:23.62,Default,,0000,0000,0000,,it is okay to ask me as we go along
Dialogue: 0,0:18:23.82,0:18:25.78,Default,,0000,0000,0000,,because I am giving a lot of information.
Dialogue: 0,0:18:27.82,0:18:29.37,Default,,0000,0000,0000,,Okay, then, jumping along to the parent.
Dialogue: 0,0:18:31.31,0:18:33.15,Default,,0000,0000,0000,,Like I said I have talked with hundreds of parents
Dialogue: 0,0:18:33.35,0:18:35.65,Default,,0000,0000,0000,,also especially doing all this work I do with parents,
Dialogue: 0,0:18:35.91,0:18:38.21,Default,,0000,0000,0000,,I have talked with many who\Nwhen they receive their child back,
Dialogue: 0,0:18:38.54,0:18:42.42,Default,,0000,0000,0000,,that is the moment at which\Nthey understand what they had signed up for.
Dialogue: 0,0:18:43.14,0:18:46.09,Default,,0000,0000,0000,,So there is a problem with informed consent
Dialogue: 0,0:18:46.73,0:18:48.32,Default,,0000,0000,0000,,both that the information is lacking
Dialogue: 0,0:18:48.52,0:18:51.89,Default,,0000,0000,0000,,and that parents are sometimes\Nasked about it at an inconvenient moment,
Dialogue: 0,0:18:52.09,0:18:53.30,Default,,0000,0000,0000,,such as when they are in labor, you know.
Dialogue: 0,0:18:54.50,0:18:56.62,Default,,0000,0000,0000,,And they are also asked about it in this values neutral way.
Dialogue: 0,0:18:56.94,0:18:59.60,Default,,0000,0000,0000,,Like, would you like a pillow?\NWould you like a cup of tea?
Dialogue: 0,0:18:59.80,0:19:01.45,Default,,0000,0000,0000,,Would you like your child circumcised?
Dialogue: 0,0:19:01.82,0:19:03.37,Default,,0000,0000,0000,,It carries the same sort of tone, you know,
Dialogue: 0,0:19:07.67,0:19:08.72,Default,,0000,0000,0000,,and I am concerned about that.
Dialogue: 0,0:19:09.41,0:19:13.62,Default,,0000,0000,0000,,So I view us as having this sort of\Nmanufacturing pseudo informed consent process
Dialogue: 0,0:19:14.55,0:19:17.10,Default,,0000,0000,0000,,Where parents need to trust physicians --
Dialogue: 0,0:19:17.61,0:19:21.53,Default,,0000,0000,0000,,The physicians are supposedly the ones
Dialogue: 0,0:19:23.55,0:19:27.55,Default,,0000,0000,0000,,bringing in the discipline of medicine.
Dialogue: 0,0:19:27.87,0:19:30.49,Default,,0000,0000,0000,,So they come in, but they are given\Nthis information that is very cursory,
Dialogue: 0,0:19:30.69,0:19:32.11,Default,,0000,0000,0000,,it lacks real information about the complications,\Nthose are trivialized,
Dialogue: 0,0:19:32.31,0:19:34.34,Default,,0000,0000,0000,,the foreskin functions are completely omitted,
Dialogue: 0,0:19:34.68,0:19:36.51,Default,,0000,0000,0000,,it's not mentioned that it is actually a sexual organ,
Dialogue: 0,0:19:37.59,0:19:42.12,Default,,0000,0000,0000,,and the ethical questions of making decisions\Nabout your children's bodies are omitted,
Dialogue: 0,0:19:42.55,0:19:45.35,Default,,0000,0000,0000,,and there is also this undeclared conflict of interest
Dialogue: 0,0:19:45.60,0:19:48.44,Default,,0000,0000,0000,,there is really a lot of commercial use of the tissue.
Dialogue: 0,0:19:51.94,0:19:57.28,Default,,0000,0000,0000,,So the other thing parents don't know\Nis that it is painful for a week or longer afterwards.
Dialogue: 0,0:19:57.48,0:19:59.73,Default,,0000,0000,0000,,So the baby is not only in pain during the process,
Dialogue: 0,0:20:00.93,0:20:02.40,Default,,0000,0000,0000,,but the wound has to heal,
Dialogue: 0,0:20:02.60,0:20:04.00,Default,,0000,0000,0000,,it is a wound on the penis,
Dialogue: 0,0:20:04.20,0:20:06.30,Default,,0000,0000,0000,,and babies are very sensitive to pain.
Dialogue: 0,0:20:06.70,0:20:11.62,Default,,0000,0000,0000,,How many people have gotten to play with a baby, you know you\Nhad a friend with a baby or you have had a baby a few days old?
Dialogue: 0,0:20:12.37,0:20:13.66,Default,,0000,0000,0000,,They are very fragile beings.
Dialogue: 0,0:20:14.90,0:20:17.00,Default,,0000,0000,0000,,So what we have done is we've put this wound on this child,
Dialogue: 0,0:20:17.20,0:20:20.70,Default,,0000,0000,0000,,and now this new parent who is dealing with the healing process
Dialogue: 0,0:20:20.96,0:20:23.79,Default,,0000,0000,0000,,and the process of figuring out what it is like to have this new baby;
Dialogue: 0,0:20:24.47,0:20:28.43,Default,,0000,0000,0000,,this new parent also has this added complications\Nof having to watch for signs of infection,
Dialogue: 0,0:20:28.78,0:20:33.21,Default,,0000,0000,0000,,of having to keep changing the bandage, and having\Nthe baby be more upset than he normally would have been.
Dialogue: 0,0:20:34.93,0:20:37.26,Default,,0000,0000,0000,,In comparison, for the child who is not circumcised,
Dialogue: 0,0:20:38.24,0:20:40.68,Default,,0000,0000,0000,,all you have to do is well, almost nothing.
Dialogue: 0,0:20:41.11,0:20:43.45,Default,,0000,0000,0000,,In fact, you don't even wash the penis.
Dialogue: 0,0:20:43.68,0:20:46.38,Default,,0000,0000,0000,,Just like you wouldn't was a baby's vagina with soap,
Dialogue: 0,0:20:46.58,0:20:47.76,Default,,0000,0000,0000,,you just rinse it.
Dialogue: 0,0:20:47.96,0:20:49.45,Default,,0000,0000,0000,,You don't retract it;
Dialogue: 0,0:20:49.65,0:20:51.30,Default,,0000,0000,0000,,it becomes retractable on its own.
Dialogue: 0,0:20:51.64,0:20:54.18,Default,,0000,0000,0000,,You have a baby with fewer health problems,\Nand a child who is more content.
Dialogue: 0,0:20:56.34,0:21:01.05,Default,,0000,0000,0000,,Now, I promised you that I would show\Nthat we actually do use the foreskin tissue.
Dialogue: 0,0:21:01.26,0:21:02.74,Default,,0000,0000,0000,,We use it for three things
Dialogue: 0,0:21:02.95,0:21:04.68,Default,,0000,0000,0000,,that I have been able to find.
Dialogue: 0,0:21:05.08,0:21:06.56,Default,,0000,0000,0000,,We use it for research,
Dialogue: 0,0:21:06.76,0:21:09.70,Default,,0000,0000,0000,,there are a large number of products\Nyou can buy from Invitrogen
Dialogue: 0,0:21:09.92,0:21:13.55,Default,,0000,0000,0000,,which is actually a company from which\NI buy other things that don't contain foreskin
Dialogue: 0,0:21:13.75,0:21:15.62,Default,,0000,0000,0000,,cells from for my bio-physics research.
Dialogue: 0,0:21:16.31,0:21:19.19,Default,,0000,0000,0000,,So there are some of the products they sell\Nusing neo-natal foreskins,
Dialogue: 0,0:21:19.37,0:21:21.85,Default,,0000,0000,0000,,you can look it up yourselves.
Dialogue: 0,0:21:22.78,0:21:26.38,Default,,0000,0000,0000,,At a hospital you can get "magic skin treatment"
Dialogue: 0,0:21:26.68,0:21:28.98,Default,,0000,0000,0000,,which is cultured, grown foreskin tissue,
Dialogue: 0,0:21:29.18,0:21:31.60,Default,,0000,0000,0000,,and if you are very wealthy you can buy cosmetics
Dialogue: 0,0:21:31.93,0:21:35.61,Default,,0000,0000,0000,,that are also derived from foreskin tissue.
Dialogue: 0,0:21:36.56,0:21:37.64,Default,,0000,0000,0000,,Oh, the cosmetics?
Dialogue: 0,0:21:40.90,0:21:42.22,Default,,0000,0000,0000,,Wait, say louder?
Dialogue: 0,0:21:42.86,0:21:44.89,Default,,0000,0000,0000,,Audience member,\N"why would people want to use them on their skin?"
Dialogue: 0,0:21:45.09,0:21:47.10,Default,,0000,0000,0000,,Oh, people think that\Nthey will make them less wrinkly.
Dialogue: 0,0:21:47.38,0:21:49.34,Default,,0000,0000,0000,,The idea is that baby cells,
Dialogue: 0,0:21:49.54,0:21:51.33,Default,,0000,0000,0000,,you know they are young, they do their job well,\Nyou know...
Dialogue: 0,0:21:53.91,0:21:56.10,Default,,0000,0000,0000,,And, if you are disturbed by that, I am glad
Dialogue: 0,0:21:56.46,0:21:58.51,Default,,0000,0000,0000,,because I would like us to be disturbed by that.
Dialogue: 0,0:22:02.07,0:22:06.05,Default,,0000,0000,0000,,So let's hear from an obstetrician\Nhow they frame these sorts of things.
Dialogue: 0,0:22:06.45,0:22:10.19,Default,,0000,0000,0000,,This is Lisa Masterson being interviewed\Non the Craig Ferguson Late, Late Show.
Dialogue: 0,0:22:10.84,0:22:12.74,Default,,0000,0000,0000,,LISA," Yeah, and again\Nyou know what that is a personal choice
Dialogue: 0,0:22:13.07,0:22:15.52,Default,,0000,0000,0000,,and as an Obstetrician,\NI talk to my patients a lot about this.
Dialogue: 0,0:22:15.64,0:22:19.19,Default,,0000,0000,0000,,And really there's a lot of health benefits\Nand there are some risk benefits,
Dialogue: 0,0:22:19.35,0:22:21.12,Default,,0000,0000,0000,,but it is really a social procedure.
Dialogue: 0,0:22:21.48,0:22:24.75,Default,,0000,0000,0000,,So you really have to decide,\Ndo you want your son to look like you?
Dialogue: 0,0:22:25.11,0:22:27.59,Default,,0000,0000,0000,,You know it is a cultural thing it is a social thing,
Dialogue: 0,0:22:28.02,0:22:31.80,Default,,0000,0000,0000,,And there are some health benefits,\Nmore for the lady than the man
Dialogue: 0,0:22:32.32,0:22:38.17,Default,,0000,0000,0000,,but as far as decreasing STDs and passing on to ah\Nyou know other women HPV, which can cause cervical cancer,
Dialogue: 0,0:22:38.57,0:22:41.38,Default,,0000,0000,0000,,so decreasing STDs and cancer all that good stuff."
Dialogue: 0,0:22:41.97,0:22:45.06,Default,,0000,0000,0000,,CRAIG,"But couldn't you achieve the same effect\Nby washing your pee pee on a regular basis?"
Dialogue: 0,0:22:46.74,0:22:47.97,Default,,0000,0000,0000,,LISA,"You absolutely could."
Dialogue: 0,0:22:48.72,0:22:51.33,Default,,0000,0000,0000,,CRAIG,"So we're talking,\NYou can have this chopped off, or you can wash it,
Dialogue: 0,0:22:51.72,0:22:52.66,Default,,0000,0000,0000,,your call?"
Dialogue: 0,0:22:53.52,0:22:54.39,Default,,0000,0000,0000,,LISA,"Exactly."
Dialogue: 0,0:22:55.59,0:22:58.32,Default,,0000,0000,0000,,CRAIG,\N"That's a tough choice there Doctor ... I dunno!"
Dialogue: 0,0:23:01.12,0:23:03.20,Default,,0000,0000,0000,,So obviously I appreciate Craig's point of view there.
Dialogue: 0,0:23:03.81,0:23:06.97,Default,,0000,0000,0000,,He is from Scotland,\Nwhere they coincidentally don't do this to children.
Dialogue: 0,0:23:08.45,0:23:10.10,Default,,0000,0000,0000,,And think about her discourse,
Dialogue: 0,0:23:10.33,0:23:13.06,Default,,0000,0000,0000,,she's saying you have to choose as a parent,
Dialogue: 0,0:23:13.83,0:23:16.22,Default,,0000,0000,0000,,and I want to question that framing of it.
Dialogue: 0,0:23:17.07,0:23:21.64,Default,,0000,0000,0000,,Do you have to choose other\Nbody modification options for your child?
Dialogue: 0,0:23:22.22,0:23:24.22,Default,,0000,0000,0000,,Like a nose job, or things like that?
Dialogue: 0,0:23:25.87,0:23:29.54,Default,,0000,0000,0000,,And, if the idea of doing things to our children\Nbecause we want them to look a certain way chills you,
Dialogue: 0,0:23:29.74,0:23:31.25,Default,,0000,0000,0000,,I am glad because I want it to chill us.
Dialogue: 0,0:23:31.45,0:23:32.88,Default,,0000,0000,0000,,I want us to wonder
Dialogue: 0,0:23:33.04,0:23:37.95,Default,,0000,0000,0000,,why are we so busy making our children look like\Nwhat we think boys and girls should look like?
Dialogue: 0,0:23:38.48,0:23:42.47,Default,,0000,0000,0000,,In this case, we have this idea that boys\Nshould look a certain way in their genitals.
Dialogue: 0,0:23:44.20,0:23:47.50,Default,,0000,0000,0000,,Okay, so the last section is,\Nhow do we get practitioners doing this?
Dialogue: 0,0:23:48.93,0:23:51.97,Default,,0000,0000,0000,,So I have a few quotes\Nfrom practitioners who stopped doing it,
Dialogue: 0,0:23:52.18,0:23:53.28,Default,,0000,0000,0000,,like Marilynn Milos,
Dialogue: 0,0:23:53.48,0:23:55.98,Default,,0000,0000,0000,,a nurse who, after seeing it,\Nrefused to assist with them
Dialogue: 0,0:23:56.18,0:23:59.38,Default,,0000,0000,0000,,and was fired for telling parents\Nthey don't need to do it.
Dialogue: 0,0:23:59.92,0:24:02.61,Default,,0000,0000,0000,,Michelle Storms, who is a very well known Obstetrician\N[sic, she is a Family Medicine Practitioner]
Dialogue: 0,0:24:03.33,0:24:07.43,Default,,0000,0000,0000,,who said she was ridiculed and patronized\Nafter stopping them in 1988.
Dialogue: 0,0:24:08.40,0:24:13.00,Default,,0000,0000,0000,,And I am at Georgetown, so I went and talked\Nto the Head of Obstetrics at Georgetown University Hospital,
Dialogue: 0,0:24:13.22,0:24:15.30,Default,,0000,0000,0000,,Obstetricians do most of them, and she says,
Dialogue: 0,0:24:15.66,0:24:17.36,Default,,0000,0000,0000,,"Medically it doesn't make sense"
Dialogue: 0,0:24:17.56,0:24:20.07,Default,,0000,0000,0000,,"I don't even like doing the procedure, but I do it well."
Dialogue: 0,0:24:20.73,0:24:22.88,Default,,0000,0000,0000,,"I have performed thousands of circumcisions."
Dialogue: 0,0:24:23.24,0:24:24.68,Default,,0000,0000,0000,,She was clear that it is a social procedure,
Dialogue: 0,0:24:25.11,0:24:26.87,Default,,0000,0000,0000,,she was clear that it doesn't make sense medically,
Dialogue: 0,0:24:27.22,0:24:30.39,Default,,0000,0000,0000,,And she told me in our conversation\Nthat she would not stop doing them.
Dialogue: 0,0:24:33.52,0:24:37.74,Default,,0000,0000,0000,,So how do we make physicians into that?
Dialogue: 0,0:24:39.89,0:24:42.02,Default,,0000,0000,0000,,Well, first we start by pathologizing a healthy organ.
Dialogue: 0,0:24:42.63,0:24:47.66,Default,,0000,0000,0000,,Not only is the foreskin absent\Nfrom most U.S. medical and anatomy texts,
Dialogue: 0,0:24:48.20,0:24:50.57,Default,,0000,0000,0000,,There is, therefore, no education of the function.
Dialogue: 0,0:24:50.89,0:24:52.97,Default,,0000,0000,0000,,It is not viewed as a sexually important organ.
Dialogue: 0,0:24:54.95,0:24:57.43,Default,,0000,0000,0000,,Physicians are only taught\Nhow to remove it as a procedure.
Dialogue: 0,0:24:58.16,0:25:01.60,Default,,0000,0000,0000,,and they are mistaught care, they are mistaught\Nthis "retract and wash" philosophy,
Dialogue: 0,0:25:02.35,0:25:06.18,Default,,0000,0000,0000,,which is problematic because as you can see\Ndown at the bottom,
Dialogue: 0,0:25:06.57,0:25:09.23,Default,,0000,0000,0000,,the foreskin when you are born\Nis usually attached to the head of the penis.
Dialogue: 0,0:25:09.73,0:25:11.75,Default,,0000,0000,0000,,What you saw earlier in the circumcision video
Dialogue: 0,0:25:12.07,0:25:16.49,Default,,0000,0000,0000,,was the physician running this tool around to break\Nthe foreskin loose so that they could cut it off.
Dialogue: 0,0:25:17.67,0:25:21.52,Default,,0000,0000,0000,,It is bonded like that to protect babies from,\Nwell all the sorts of things that babies do,
Dialogue: 0,0:25:22.10,0:25:24.47,Default,,0000,0000,0000,,they might have feces or urine in their diaper,
Dialogue: 0,0:25:24.76,0:25:26.34,Default,,0000,0000,0000,,they might get scratched up.
Dialogue: 0,0:25:26.73,0:25:29.03,Default,,0000,0000,0000,,The foreskin has a protective function\Nwhen you are young.
Dialogue: 0,0:25:29.80,0:25:31.16,Default,,0000,0000,0000,,Gradually that detaches
Dialogue: 0,0:25:31.49,0:25:33.93,Default,,0000,0000,0000,,and the foreskin becomes retractable,
Dialogue: 0,0:25:34.18,0:25:36.50,Default,,0000,0000,0000,,but if you forcibly retract it, that tears it up
Dialogue: 0,0:25:36.78,0:25:38.53,Default,,0000,0000,0000,,and creates a site for infection,
Dialogue: 0,0:25:38.76,0:25:41.96,Default,,0000,0000,0000,,also if you wash with soap\Nthat creates a site for infection.
Dialogue: 0,0:25:42.76,0:25:46.03,Default,,0000,0000,0000,,And finally,\Nwe make this misdiagnosis called "phimosis".
Dialogue: 0,0:25:46.73,0:25:49.25,Default,,0000,0000,0000,,There is a true problem called phimosis\Nwhen there is scar tissue
Dialogue: 0,0:25:49.45,0:25:52.52,Default,,0000,0000,0000,,at the opening of the foreskin, so it can't retract
Dialogue: 0,0:25:52.72,0:25:55.95,Default,,0000,0000,0000,,and there are treatments for it use steroidal cream\Nto help the scar tissue soften.
Dialogue: 0,0:25:56.100,0:26:00.23,Default,,0000,0000,0000,,But when we think that a baby who is three weeks old
Dialogue: 0,0:26:00.56,0:26:03.43,Default,,0000,0000,0000,,because you can't pull the foreskin back without\Nmaking the baby scream, that's wrong.
Dialogue: 0,0:26:04.40,0:26:09.57,Default,,0000,0000,0000,,It is actually meant to be attached that way,\Nit grew that way and it will become retractable on its own.
Dialogue: 0,0:26:12.73,0:26:15.24,Default,,0000,0000,0000,,So, why do we do the circumcisions?
Dialogue: 0,0:26:15.53,0:26:18.83,Default,,0000,0000,0000,,Well if you look at why parents say they choose\Nthe number one reason is appearance.
Dialogue: 0,0:26:19.23,0:26:23.54,Default,,0000,0000,0000,,They want their child to look like the other children\Nthey'll see or they want them to look like their Dad.
Dialogue: 0,0:26:25.10,0:26:28.11,Default,,0000,0000,0000,,They think it looks better,\Nor they think it is easier to keep clean.
Dialogue: 0,0:26:28.65,0:26:33.79,Default,,0000,0000,0000,,And I believe it is the solicitation by physicians\Nthat reinforces or validates the choice to do this.
Dialogue: 0,0:26:34.26,0:26:39.04,Default,,0000,0000,0000,,The fact that physicians do it\Nmakes it look like a reasonable thing.
Dialogue: 0,0:26:39.87,0:26:44.09,Default,,0000,0000,0000,,Physicians may also give several reasons\Nto collude with this idea,
Dialogue: 0,0:26:44.29,0:26:46.50,Default,,0000,0000,0000,,they may say it reduces penile cancer rates.
Dialogue: 0,0:26:46.70,0:26:49.13,Default,,0000,0000,0000,,That it reduces urinary tract infections (UTIs),
Dialogue: 0,0:26:49.45,0:26:53.73,Default,,0000,0000,0000,,Cervical Cancer rates in female partners\Nthat your child might have when they grow up.
Dialogue: 0,0:26:54.84,0:26:57.84,Default,,0000,0000,0000,,And female to male HIV transmission rate reduction
Dialogue: 0,0:26:58.06,0:26:59.63,Default,,0000,0000,0000,,is sort of the newest reason.
Dialogue: 0,0:27:00.03,0:27:02.62,Default,,0000,0000,0000,,So as I showed you in the beginning, \Nwe have this sort of cultural baggage
Dialogue: 0,0:27:03.18,0:27:08.36,Default,,0000,0000,0000,,a lot of reasons why we used to do circumcisions\Nthat don't make sense in today's cultural setting,
Dialogue: 0,0:27:09.04,0:27:13.60,Default,,0000,0000,0000,,so we have had to come up with a posteriori reasons\Nin order to feel more comfortable with what we are doing.
Dialogue: 0,0:27:14.36,0:27:15.76,Default,,0000,0000,0000,,But I'll analyze those in more depth.
Dialogue: 0,0:27:16.15,0:27:20.21,Default,,0000,0000,0000,,Besides the social critique that I think they are reasons\Nwe made up after the fact, in order to feel comfortable with it.
Dialogue: 0,0:27:20.53,0:27:25.87,Default,,0000,0000,0000,,If we think about them carefully, appearance\Nand cleanliness, the number one reason that circumcision is done.
Dialogue: 0,0:27:26.16,0:27:30.26,Default,,0000,0000,0000,,Well that argument is used to support both\Nmale and female genital cutting
Dialogue: 0,0:27:30.65,0:27:34.96,Default,,0000,0000,0000,,in every culture that I am aware of\Nthat either of those practices occurs in.
Dialogue: 0,0:27:35.44,0:27:37.09,Default,,0000,0000,0000,,And they are just made up arguments,
Dialogue: 0,0:27:37.41,0:27:40.40,Default,,0000,0000,0000,,I mean, how can you say that something is cleaner\Nif you do one thing to it or another?
Dialogue: 0,0:27:41.73,0:27:45.70,Default,,0000,0000,0000,,Penile Cancer, the American Cancer Society says no,\Nit won't protect you from penile cancer.
Dialogue: 0,0:27:46.29,0:27:49.38,Default,,0000,0000,0000,,It is also irrelevant; the rate is 1 in 100,000.
Dialogue: 0,0:27:49.69,0:27:51.100,Default,,0000,0000,0000,,More people may die from circumcision than penile cancer.
Dialogue: 0,0:27:52.47,0:27:54.18,Default,,0000,0000,0000,,Urinary tract infections,
Dialogue: 0,0:27:54.56,0:27:56.82,Default,,0000,0000,0000,,well that was based on a big study in 1986,
Dialogue: 0,0:27:57.18,0:27:59.66,Default,,0000,0000,0000,,done by a fellow, I kid you not, his name was Wiswell.
Dialogue: 0,0:28:01.44,0:28:05.45,Default,,0000,0000,0000,,And the problem was his instructions\Ncaused urinary tract infections,
Dialogue: 0,0:28:05.68,0:28:07.02,Default,,0000,0000,0000,,selectively in subjects with foreskins
Dialogue: 0,0:28:07.22,0:28:10.53,Default,,0000,0000,0000,,because he told the parents to forcibly\Nretract the foreskin and wash with soap.
Dialogue: 0,0:28:10.94,0:28:14.00,Default,,0000,0000,0000,,So that is just like if you had a girl\Nand you forcibly douched her,
Dialogue: 0,0:28:14.25,0:28:17.44,Default,,0000,0000,0000,,you know a little girl, you would get \Na higher rate of yeast and urinary tract infections
Dialogue: 0,0:28:17.64,0:28:20.89,Default,,0000,0000,0000,,because you have messed up\Nthe colonies of protective bacteria.
Dialogue: 0,0:28:21.93,0:28:24.37,Default,,0000,0000,0000,,Cervical cancer in female partners,
Dialogue: 0,0:28:25.41,0:28:28.00,Default,,0000,0000,0000,,Well, first of all, a surgical preventive measure on an infant
Dialogue: 0,0:28:28.29,0:28:31.29,Default,,0000,0000,0000,,for a potential female partner when they grow up.
Dialogue: 0,0:28:31.50,0:28:34.94,Default,,0000,0000,0000,,I mean, how do we know this person\Nis not going to be a monk or gay?
Dialogue: 0,0:28:35.52,0:28:37.71,Default,,0000,0000,0000,,And they could do it themselves later.
Dialogue: 0,0:28:38.32,0:28:41.88,Default,,0000,0000,0000,,Also, cervical cancer is cause by human papilloma virus (HPV).
Dialogue: 0,0:28:42.09,0:28:44.57,Default,,0000,0000,0000,,Probably most of you guys know that because you\Nlearned that in Sex Ed, right?
Dialogue: 0,0:28:45.07,0:28:49.21,Default,,0000,0000,0000,,Well the same authors went back and looked\Nat the husbands and wives in that study
Dialogue: 0,0:28:49.49,0:28:52.36,Default,,0000,0000,0000,,and they had different strains of HPV.
Dialogue: 0,0:28:52.61,0:28:57.39,Default,,0000,0000,0000,,So I don't know if there was\Nunder-the-table non-monogamy or what.
Dialogue: 0,0:28:57.93,0:29:00.63,Default,,0000,0000,0000,,But that throws the results\Nof that study totally into question
Dialogue: 0,0:29:00.92,0:29:06.31,Default,,0000,0000,0000,,because the husbands were not carrying the HPV\Nstrains that gave the women the cervical cancer.
Dialogue: 0,0:29:07.37,0:29:08.44,Default,,0000,0000,0000,,Gesundheit.
Dialogue: 0,0:29:09.98,0:29:13.26,Default,,0000,0000,0000,,Okay, so the last one is circumcision\Nas an HIV preventative.
Dialogue: 0,0:29:13.94,0:29:17.39,Default,,0000,0000,0000,,Okay, that idea started in the 2000's mostly.
Dialogue: 0,0:29:17.71,0:29:20.27,Default,,0000,0000,0000,,The evidence for it is three randomized control trials.
Dialogue: 0,0:29:20.47,0:29:21.61,Default,,0000,0000,0000,,They were performed in Africa,
Dialogue: 0,0:29:21.90,0:29:25.92,Default,,0000,0000,0000,,probably because you couldn't get a\Nhuman review board to permit such a study in the U.S.
Dialogue: 0,0:29:26.28,0:29:28.75,Default,,0000,0000,0000,,They got volunteer men\Nwho were willing to be circumcised;
Dialogue: 0,0:29:29.06,0:29:30.76,Default,,0000,0000,0000,,they randomly circumcised half of them.
Dialogue: 0,0:29:30.96,0:29:33.28,Default,,0000,0000,0000,,And they watched to see how quickly they got HIV.
Dialogue: 0,0:29:34.39,0:29:37.64,Default,,0000,0000,0000,,They had some problematic methodology\Nthat I will get into later.
Dialogue: 0,0:29:38.25,0:29:42.81,Default,,0000,0000,0000,,And their claim was that that reduced\Nthe rate at which men got HIV by 60%.
Dialogue: 0,0:29:44.25,0:29:47.52,Default,,0000,0000,0000,,Now the evidence against circumcision\Nas an HIV preventative
Dialogue: 0,0:29:47.85,0:29:50.00,Default,,0000,0000,0000,,are pretty much all the\Nother studies that have been done.
Dialogue: 0,0:29:50.58,0:29:51.97,Default,,0000,0000,0000,,The geographic data,
Dialogue: 0,0:29:52.17,0:29:55.32,Default,,0000,0000,0000,,if you look at correlation between\Ncircumcision percentage and HIV rates
Dialogue: 0,0:29:55.52,0:29:58.19,Default,,0000,0000,0000,,in populations, it contradicts this conclusion.
Dialogue: 0,0:29:58.50,0:29:59.54,Default,,0000,0000,0000,,For example,
Dialogue: 0,0:29:59.88,0:30:03.80,Default,,0000,0000,0000,,the United States has the highest HIV rate\Nof any industrialized nation,
Dialogue: 0,0:30:04.26,0:30:07.14,Default,,0000,0000,0000,,and also has the highest circumcision rate\Nof any industrialized nation.
Dialogue: 0,0:30:07.85,0:30:10.40,Default,,0000,0000,0000,,You would expect something different\Nif circumcision were so protective.
Dialogue: 0,0:30:12.85,0:30:17.43,Default,,0000,0000,0000,,So, I've got a few minutes left. I am going to quickly\Nrun through what I think was wrong with the study.
Dialogue: 0,0:30:17.90,0:30:23.81,Default,,0000,0000,0000,,Again, there were three studies, they took a group of intact men,\Ncircumcised them and watched how quickly they got HIV.
Dialogue: 0,0:30:24.71,0:30:28.47,Default,,0000,0000,0000,,The problems were, each time they came\Nto the clinic they gave them condoms
Dialogue: 0,0:30:28.73,0:30:31.28,Default,,0000,0000,0000,,and safe sex counseling.
Dialogue: 0,0:30:31.48,0:30:33.97,Default,,0000,0000,0000,,But the circumcised group came\Nat least twice more
Dialogue: 0,0:30:34.42,0:30:36.96,Default,,0000,0000,0000,,because they had to come to get circumcised\Nand they had to come to get a follow up study.
Dialogue: 0,0:30:38.18,0:30:39.80,Default,,0000,0000,0000,,In addition, if you are circumcised,
Dialogue: 0,0:30:40.00,0:30:43.08,Default,,0000,0000,0000,,it will take you about four to six weeks\Nuntil you are able to have sex again.
Dialogue: 0,0:30:44.11,0:30:48.07,Default,,0000,0000,0000,,And the circumcised group was asked\Nto abstain for six weeks.
Dialogue: 0,0:30:48.93,0:30:51.26,Default,,0000,0000,0000,,But they didn't start the clock\Nuntil after waiting for six weeks,
Dialogue: 0,0:30:51.46,0:30:52.90,Default,,0000,0000,0000,,they started the clock at the beginning,
Dialogue: 0,0:30:53.10,0:30:55.81,Default,,0000,0000,0000,,so the circumcised group had six weeks
Dialogue: 0,0:30:56.14,0:30:57.51,Default,,0000,0000,0000,,of protection by being unable to have intercourse.
Dialogue: 0,0:30:58.78,0:31:00.77,Default,,0000,0000,0000,,In addition, they used an anti-body test, which
Dialogue: 0,0:31:01.02,0:31:03.53,Default,,0000,0000,0000,,you know, if you go to an STD clinic
Dialogue: 0,0:31:03.73,0:31:06.08,Default,,0000,0000,0000,,and they use an antibody test,\Nthere is a three-month window.
Dialogue: 0,0:31:06.28,0:31:08.89,Default,,0000,0000,0000,,They tell you, you've got to wait\Nuntil three months after your last exposure
Dialogue: 0,0:31:09.09,0:31:10.59,Default,,0000,0000,0000,,if you really want to know if you have HIV.
Dialogue: 0,0:31:10.79,0:31:12.98,Default,,0000,0000,0000,,But again, they didn't start the clock after three months
Dialogue: 0,0:31:13.31,0:31:16.24,Default,,0000,0000,0000,,and most the benefit or half the benefit\Noccurred during those first three months.
Dialogue: 0,0:31:16.53,0:31:19.58,Default,,0000,0000,0000,,So those infections occurred prior\Nto the start of the trial,
Dialogue: 0,0:31:19.58,0:31:21.56,Default,,0000,0000,0000,,prior to the randomization and intervention.
Dialogue: 0,0:31:22.60,0:31:24.80,Default,,0000,0000,0000,,There were a lot of problems concerning controls,
Dialogue: 0,0:31:25.00,0:31:28.31,Default,,0000,0000,0000,,including blood exposure\Nand receptive anal intercourse.
Dialogue: 0,0:31:30.75,0:31:32.80,Default,,0000,0000,0000,,I am also concerned because the authors of that study
Dialogue: 0,0:31:33.05,0:31:36.32,Default,,0000,0000,0000,,likened circumcision to an effective vaccine.
Dialogue: 0,0:31:37.72,0:31:40.80,Default,,0000,0000,0000,,Now all they are saying is that,\Nif their results are accurate,
Dialogue: 0,0:31:41.00,0:31:42.08,Default,,0000,0000,0000,,which I don't believe,
Dialogue: 0,0:31:42.28,0:31:44.36,Default,,0000,0000,0000,,that it would reduce\Nyour likelihood of getting HIV,
Dialogue: 0,0:31:44.56,0:31:47.20,Default,,0000,0000,0000,,you know each time you had sex, by 60%.
Dialogue: 0,0:31:47.40,0:31:50.51,Default,,0000,0000,0000,,So, if you have sex enough, you will \Net HIV anyway with enough risky behavior.
Dialogue: 0,0:31:51.34,0:31:52.22,Default,,0000,0000,0000,,The measles vaccine,
Dialogue: 0,0:31:52.50,0:31:56.61,Default,,0000,0000,0000,,if you took that and its boosters,\N99% of you become immune to measles.
Dialogue: 0,0:31:56.81,0:31:58.13,Default,,0000,0000,0000,,Probably you are actually.
Dialogue: 0,0:31:58.42,0:32:00.40,Default,,0000,0000,0000,,So that is what an effective vaccine looks like.
Dialogue: 0,0:32:00.80,0:32:02.38,Default,,0000,0000,0000,,Ninety-nine per cent permanent immunity.
Dialogue: 0,0:32:02.58,0:32:06.14,Default,,0000,0000,0000,,Not sixty per cent less likelihood\Nto become infected each time you are exposed.
Dialogue: 0,0:32:06.34,0:32:09.96,Default,,0000,0000,0000,,And real human beings think they are immune\Nto HIV because they have been circumcised
Dialogue: 0,0:32:10.20,0:32:11.29,Default,,0000,0000,0000,,in African countries,
Dialogue: 0,0:32:12.98,0:32:15.32,Default,,0000,0000,0000,,and I am very concerned about that.
Dialogue: 0,0:32:15.84,0:32:17.48,Default,,0000,0000,0000,,But anyway, so to re-cap,
Dialogue: 0,0:32:17.84,0:32:20.79,Default,,0000,0000,0000,,I think we have a social bias\Ntoward cutting children,
Dialogue: 0,0:32:21.51,0:32:22.77,Default,,0000,0000,0000,,particularly boys.
Dialogue: 0,0:32:22.97,0:32:24.98,Default,,0000,0000,0000,,I think that it is very harmful to children.
Dialogue: 0,0:32:25.18,0:32:26.88,Default,,0000,0000,0000,,It also hurts survivors.
Dialogue: 0,0:32:27.08,0:32:29.78,Default,,0000,0000,0000,,It hurts parents, who really want\Nthe best for their children.
Dialogue: 0,0:32:30.27,0:32:31.43,Default,,0000,0000,0000,,And it also hurts practitioners
Dialogue: 0,0:32:31.72,0:32:34.74,Default,,0000,0000,0000,,because I believe that medical students\Ncome into school wanting to help people,
Dialogue: 0,0:32:35.18,0:32:38.41,Default,,0000,0000,0000,,and they get taught about this procedure\Nin an out-of-context kind of way.
Dialogue: 0,0:32:40.21,0:32:43.43,Default,,0000,0000,0000,,Most of the people I talk to think it is\Nnot their responsibility to do anything about it,
Dialogue: 0,0:32:43.63,0:32:47.66,Default,,0000,0000,0000,,including professional organizations\Nlike the American Academy of Pediatrics,
Dialogue: 0,0:32:47.90,0:32:50.45,Default,,0000,0000,0000,,the American College of Obstetricians and Gynecologists,
Dialogue: 0,0:32:50.74,0:32:51.64,Default,,0000,0000,0000,,the practitioners, you know,
Dialogue: 0,0:32:51.82,0:32:54.76,Default,,0000,0000,0000,,because their job is to keep the practitioners looking good.
Dialogue: 0,0:32:55.02,0:32:59.40,Default,,0000,0000,0000,,So, if you say something is bad that your practitioners\Nare doing, that doesn't look so good.
Dialogue: 0,0:33:00.23,0:33:04.18,Default,,0000,0000,0000,,The administrators of the hospital\Nand the practitioners there don't want to stand out.
Dialogue: 0,0:33:04.58,0:33:07.52,Default,,0000,0000,0000,,The obstetricians don't even think\Nthe child they are operating on is their patient.
Dialogue: 0,0:33:07.80,0:33:09.90,Default,,0000,0000,0000,,The ethics committee of the hospital
Dialogue: 0,0:33:10.10,0:33:12.59,Default,,0000,0000,0000,,told me that they are not\Nthe appropriate venue for this concern.
Dialogue: 0,0:33:14.06,0:33:18.02,Default,,0000,0000,0000,,And I think all of these organizations\Nare neglecting parents, children, and us.
Dialogue: 0,0:33:20.30,0:33:22.27,Default,,0000,0000,0000,,So I am hopeful\Nthat I have engaged you with some interest
Dialogue: 0,0:33:22.54,0:33:24.28,Default,,0000,0000,0000,,and that maybe you will go and tell people about this.
Dialogue: 0,0:33:24.48,0:33:28.22,Default,,0000,0000,0000,,Because, if they are not going to take responsibility,\NI hope that we will.
Dialogue: 0,0:33:28.42,0:33:29.88,Default,,0000,0000,0000,,So tell your friends.
Dialogue: 0,0:33:30.08,0:33:32.43,Default,,0000,0000,0000,,I am going to give a link to this slide show to your professor.\N[A link to the files is available in the description.]