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