Monday, February 3, 2014

A tale of 2 rants.

Rant 1:

Circumcising babies for no medical reason.

I have worked in paediatric surgery for 6 months, so I am aware I see skewed picture. On average we see about one admission a month for complications of the aforementioned procedure. Now I understand it is an important religious rite for some people, but that doesn't have to mean I like it. People who say it is a low risk procedure, have you ever seen a 3 day old baby exsanguinating from the tip of their penis? Or a young boy which a suprapubic catheter because he lost the end of his urethra? It's not low risk, which is why it should be performed by urologists, in hopsitals, with consent forms and machines that go beep, for reasons that are physical not metaphysical.

The WHO suggested that male circumcision should be included in a comprehensive HIV prevention strategy. This is aimed at populations with high rates of HIV, and not at the expense of education and actual prevention. It does not stop transmission of HIV, only a modest reduction in transmission. There is no firm evidence to support its use to prevent UTIs, STIs or HPV penile cancer (which is rare as it is). Safe sex is the only way to actually reduce any of these. A recent paper in JAMA has suggested it is cost effective if used in the USA by reducing these. This is because their government funds the procedure. I'm upset about private procedures having complications that cost the NHS. People compare circumcision with vaccinations in terms of perceived health benefits. There is a large discrepency between the benefits of vaccinations and that of routine circumcision.

The reason it is done privately by GPs in their own rooms is because no right thinking doctor would do it otherwise in the UK. It is done without anaesthesia or pain relief. What really gets me is that these private, unnecessary procedures may only go wrong in a small proportion but the cost is born by the NHS not the privateers. Each baby that has been brought in this year has had to spend a night in observation for it. This indirect cost is not measured in pro circumcision papers.

Also, the boys have no say in whether or not they lose their foreskin. I would quite like to be informed if I was going to lose some of my genitals. Female genital mutilation is rightly seen as a ghastly act in most of the world, but if a study advocated its reduction in STIs or HIV would we still want to be using it? I'm aware the risk profile increases with age with the procedure, but waiting a few years or not getting it done at all would be more in keeping with my notion of primum non nocere.

So, if you are thinking of getting your infant son circumcised, firstly the NHS do not recommend it, secondly perhaps you should ensure that the guy who makes a mint out of you to do it, gets invoiced for the bill when it goes wrong.  Whilst you're at it, teach your son that condoms are better than lacking a foreskin at reducing STIs. Not that any of that would happen, because questioning 15,000 year old rituals would appear to be the height of bigotry.

Rant 2

People hating stay at home mothers.

When I tell people that we have a new son, one of the first questions I get is. "When is your wife going back to work?" When I tell them "Not for the foreseeable future." I am met with at best surprise and at worse criticism.

Things seemed to have changed in the world. It seems that it is no longer acceptable for just one partner to do money work and one partner to do child work. Many people including writers for "the newspaper that shan't be linked to" seem to think it's lazy and that people revel in being lazy whilst extolling the virtues of living such blatantly idle lives. It is as if child rearing has suddenly become an easy service that can be outsourced.

Luckily, I have a wage that can support a family of 3 which doesn't necessitate the need for my partner to go back to work to keep a roof over our head. Actually, Luckily is the wrong word, because there is nothing lucky about studying for 12 years passing medical school, post graduate exams and post graduate qualifications and accruing 30K worth of debt in the process. I've worked very hard to be in a position where I can allow my partner to raise our child.

The government seems to want everyone to make as much money as possible and outsource care to make even more money. This is not how I see living my life. I don't want some minimum wage dolt raising my children for over a third of it's life, surrounded by dirty toys and even dirtier children. Surely I trust my wife more than anyone else to raise our children, and she has a vested interest in raising him well as he is her child too!

From a simple economic view the gains do not outweigh the costs. A simple Google search of nurseries in my area puts the cost of a months day care at between 750-1000 pounds per month which does not include unsociable hours or extra curricular activities. If my partner was also a doctor we would have to find time out of hours, overnight, weekends, evenings at a premium rate or rely on parents/family to see us through. My wife's last job before maternity leave paid slightly more than the above quoted figure. Is it worth her working full time to come out with about 25% of her wages at the end of the month.

But wait! What if the government want to pay all of your childcare costs (in whatever fantasy land that will happen in). My wife still misses out on all the positive life affirming aspects of seeing your child grow themselves and not learn 2nd hand from an (NVQ certified!) child care assistant that her son strung a sentence together. Possibly along the lines of "Is it my fag break yet?".

Sure, we made a decision to spawn a being and are paying for it, we are 1000s pounds a year worse off for doing so. But this is our decision based on how we wanted to live our lives. Making a small proportion of it back by sending my wife out to work doesn't make up for the chance to raise the child yourself in an environment you have control over.

But it's sexist! I'm enforcing 1950s gender stereotypes on my wife by forcing her to stay at home! Not really. She has a choice to work or stay at home and she made it. I happened to agree with it. Working 160 hours a month for £300 sounds more exploitative to me. If I was the minority earner in the relationship, you might have found me at home in the day doing the housework and baby changing.

Lastly, being a stay at home mum is fun! Why shouldn't I encourage that. There is a fair share of one on one care work for our son, and then there is time for cake making and such! A lot of the negative criticism comes from simple jealousy that my wife leads a nicer life than slaving at an office to earn a bit of cash for somebody else, missing their child develop. Agitator in chief, you know the woman who quit The Apprentice and was on This Morning, her, the one who doesn't like the name Tyler, decries the coffee sipping, lunch goers. That is because these women are very happy, with partners who don't have to put up with the likes of her!

In conclusion, we pay for ourselves and have a happy, productive home, so you can take your opinions about our childcare arrangements and stick em.


  1. re Rant 2; Yet if YOU had decided to stay at home that would have been OK.

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