Hi I’m Wendy Zukerman and you’re listening to Science Vs from Gimlet Media. This is the
show where we pit facts against foreskins. Today’s episode: circumcisions: to snip or not to
snip?

WZ: So how many circs do you reckon you’ve performed

AF: Laughter...that’s a good question. I think we could say more than 1000. 
WZ: That’s a lot of willies
AF: Laughter. Well, yeah..

The man trimming all those willies is Dr Andrew Freedman , a pediatric urologist at Cedars
Sinai Medical Center in Los Angeles. And when it comes to circumcisions, Andrew has
heard it all. He’s heard from anxious parents who don’t know what to do, grown men who
wish they still had their foreskins, and even teens struggling with their bodies. 

He told us about this one teenager who came to see him asking to get cut because the other
guys at school were teasing him for being uncircumcised. And Andrew was like, dude it’s not
about the foreskin.

AF They’re teasing you they’re not gonna stop teasing you if you have a circumcision
WZ Did you really tell him that?. 
AF: Yeah! Cause I believe that. He was a kid who was an awkward kid, and he was going to
teased it’s unfortunate but he didn’t need to change his body, wasn’t going to stop the
teasing. It wasn’t like the kids were gonna say wow you’re a cool guy now your penis looks
like my penis come over we’ll play football, life doesn’t work that way

OK, so Andrew doesn’t think a circumcision will save you from bullies. And he’s spent a lot of
time thinking about this. Several years ago… Andrew was asked to help write a review for
the American Academy of Pediatrics weighing the pros and cons of circumcisions. 

And some people think there are a lot of cons. In fact there's a group of people called
intactivists... who say it’s better to leave the penis as it is--in other words, intact. They argue
that this surgery is totally unnecessary and cruel. After all, you’re taking a healthy baby …
and cutting off a part of them.

AF People wrap up alot in their penis, and I have received thoughtful letters from adult men
who feel like something was taken away from them and they’re unhappy about it 

So. Do these intactivists have a point? And if you’re a parent trying to make this decision for
your baby, what are you supposed to make of all this? To find out, we’re entering the
foreskin firestorm ourselves. And asking. 

1. What are the risks of getting a circumcision? Could it hurt the baby?
2. What are the benefits? Can it prevent infections? Like UTIs or, much more serious
stuff like HIV?
3. And as weird as it is to think about your baby growing up and having sex, we have to
ask, -- could this affect his sex life? 

Yeah there are religious and ethical questions around circumcision -- but I’m a science
journalist, not a rabbi! 

<<ding!>>

So today we’re focusing on the scientific questions. Because when it comes to circumcisions
there are lots of willies. 
Well, yeah..

But then there is science

<<Ahha>>

Science Vs Circumcision is coming up break.

BREAK

Welcome back. 

People have been cutting of foreskins for ages… millennia even! All around the world… But
in the United States, circumcisions it didn’t become widespread until around the turn of the
20th century. Some doctors began to promote it as a sort of cure-all for all kinds of health
problems. They even said it would stop boys from masturbating. But where there’s a willy…
there’s a way… by the 1970s, though.. More and more people started questioning: why are
we doing this? 

And today, fewer parents are choosing this for their kids. According to the most recent stats
from the Centers for Disease Control… around 40 percent of baby boys born in the US didn’t
get circumcised… And in some parts of the country, intact boys are actually in the majority. 

So. Did these kids dodge a bullet? 

Our first question for today: What are the risks of this surgery? Because lopping off a baby’s
foreskin sounds pretty scary. Andrew, our pediatric urologist, told us that one a common
device you can use...

Sort of looks like a cigar cutter 

Yeah. A cigar cutter…Here’s how it works.  The foreskin is separated from the head of the
penis, pulled forward...

AF And then you clamp it down and then you basically just cut straight across
The way that circumcisions are done, with this cigar cutting tool, you would think a lot could
go wrong often… you have a little penis, and a little foreskin then a sharp knife near it all…
like can you Can you cut off the penis?
AF Ok sighhhhh
AF Having been in practice for 20 years I’ve seen this 3 times.

And in all of these cases… the penis wasn’t lopped off… it had just been clipped a little.

WZ Have you, did you, did you do it? Those 3 times?

AF No no no no no no.

Andrew was called in to fixed these mistakes… And he says these cases are  of course
awful but they’re also very uncommon.

AF It’s bad thing, it shouldn’t happen, I acknowledge it happens but it’s very very rare
And the data backs up Andrew.. A recent paper looked at almost one and a half million
circumcisions and found three cases of clipped penises. There are other risks, like bleeding
and infections. But, overall, the risk of serious complications is less than half a percent. 
Andrew does acknowledge though that this isn’t fun for babies.

WZ Is it painful for a baby to get a circumcision?

AF Yes. It is painful. People just need to be honest about this. It’s painful.

Andrew says the pain can be managed with local anesthetic,… so for the most part it’s not
thought to be a big deal.

Conclusion: In terms of the immediate risks for your baby boy: a circumcision can hurt, but
serious stuff is extremely rare. 

Still why risk it at all? What are the potential benefits of cutting off the foreskin? 

Well, that brings us to our second question: can circumcisions reduce the risk of getting an
infection? With the foreskin on… there’s this idea that that flappy bit makes a nice home for
gunk in your junk. Get rid of the flappy bit. Get rid of the gunk.  

In truth it’s more complicated… it’s not like it’s necessarily dirty down there. But getting a
circumcision can actually protect you from some infections- partly because the foreskin can
kinda shuffle in bacteria and viruses. 
,...The first time this might matter is when a baby is really young. Having a foreskin makes
the baby  more likely to get a urinary tract infection… .,,

AF and it is a real effect. Kids with foreskin had a higher risk of a Urinary Tract Infection in
their first year of life. 

UTis can be painful for the baby, in the worst case scenario the infection can spread to other
parts of the body. . Andrew told us though that these infections don’t happen very often …
even if you have a foreskin… only about 1 percent of intact babies get these infections.  And
another way to wrap your head around the stats is to ask: how many circumcisions do you
have to do to stop one willy getting one urinary tract infection? 

AF You have to do like 100 circumcisions to prevent that one infection

WZ That’s a lot of foreskins being sacrificed to the god of UTIs
AF Yeah so it meant you had to do an awful lot of circumcisions to prevent every infection

HIV/STD BEAT
And maybe the god of UTIs doesn’t deserve our foreskins. Because these infections usually
aren’t that scary, and healthy kids can be treated and recover quickly. But what about
infections that are a lot more serious? When these babies grow up, and start having sex…
can circumcisions protect them from sexually transmitted diseases like HIV?  

We talked through this with another doctor, Godfrey Kigozi [CHI-GOZI]. Godfrey is the
director of research at Rakai Health Sciences Program in Uganda… and he’s been studying
this for more than a decade. And talking to men about their penises… was something that he
never expected he would do. Now he does it all the time.

GK yes sometimes i joke i have a machine that can scan you see if you're circumcised-01
WZ Ahahaha
GK I’m joking, chuckle
Godfrey’s path to studying circumcisions … started back in the 1990s…  HIV was spreading
across Uganda. And it was really scary. About one in ten adults in the country had the virus.
One in ten. 

GK oh, It was a terrible feeling because there was no medication that could help at all, GK
And we really felt very helpless it was so bad so bad

Medicines to treat HIV did exist, but they weren’t widely available in Uganda,,. And scientists
were desperately searching for solutions…  Godfrey remembers this one day in the midst of
the crisis… He was in a boardroom and another researcher said -- hey, we’re finding this
weird thing - men who have a circumcision seem to have a lower risk of getting HIV.,,. The
researcher asked … to stop this disease spreading..  should we start giving out
circumcisions? 

GK Of course everyone in board room laughed because everyone thought he was joking. 
WZ Why did you think it was a joke? 
GK It’s sounded weird a bit at the start? If there was anything easier to do… I would have
taken that. 

And the reason that Godfrey would have gone for any thing else… …  was because he knew
this would be a really hard sell. Testing this theory would mean convincing people .. - grown
men! - to get circumcisions.

But Godfrey and his team must be pretty persuasive, they ended up recruiting more than
2000 men to get circumcised. They then followed them for 2 years, comparing them to a
group of men who were not circumcised.. And in 2007 they published their results.

GK: Men who were circumcised actually had a more than 50 percent reduction in chances of
acquiring HIV.
WZ: More than 50 percent?! 
GK Yes
What did you feel, what were you thinking at the time you got those results?
GK Oh, my god. I was feeling like, this is it. 
 
Beat

The results were so impressive that the researchers stopped the trial early. Because the
data was so clear: circumcisions could reduce a man’s chance of getting HIV. At around the
same time two other trials in Kenya and South Africa found the same thing.,.

HIV/ STDS IN AMERICA

.,,,,   

And many public health researchers around the world were really excited about Godfrey’s
work and the other trials. In fact results of his work caught the attention of many US doctors
like our own urologist… Andrew… 

AF So the HIV is probably from world health perspective the most viable benefit to be
derived from circumcision 

But for Andrew, this research on HIV in Uganda doesn't give him a clear answer for parents
in the US who want to know whether they should circumcise their kid or not.
AF The question is how does that work out in the US experience? For a child having a
circumcision today, for HIV, it’s hard to tell you in terms of saving lives. Is it worth it?

Because on average - in the US many people aren’t that likely to have sex with someone
with HIV. And that means your circumcision has less of an opportunity to come to the
rescue.  This isn’t true for everyone though. According to data from the CDC - rates of HIV in
the US are higher among black men and men who have sex with men. Which could mean a
circumcision is more likely to protect you…  But when it comes to men who have sex with
men… things gets tricky. . Because here’s a surprising thing: …it’s unclear whether
circumcisions play an important role in reducing  HIV infections among gay men …The
majority of really good studies we have are in straight men.

So that’s HIV, a circumcision might reduce your risk of catching it. And what about other
sexually transmitted infections? Well… circumcisions have also been shown to help with
genital herpes and HPV ,,, , , it cuts the risk of having those diseases by roughly 30 percent.

Conclusion: When it comes to infections…  circumcisions do reduce the risk of UTIs in

babies. And they can reduce the risk of some sexually transmitted infections, including HIV,
herpes, and HPV. 

So that’s infections… but after the break, we change positions… and find out whether
circumcision can mess up your sex life… can snipping off the foreskin change the sensitivity
of the penis? That’s coming up...  After the break.

BREAK

Welcome back. So, circumcisions have some benefits - they reduce your risk of catching
some infections… including sexually transmitted ones, like HIV. But now we’re going to look
at this idea that a circumcision could make your sex life worse. Because … for most people
with penises -- this organ plays a really important role in having good sex. And a
circumcision is literally removing part of that penis. So how could it not affect things down
there? 

We asked a scientist who really knows her way around a penis. 

CP Hi there

This is Caroline Pukall a professor at Queen’s University in Ontario Canada, where she runs
a lab that studies sex.  And from early on, it was pretty clear that Caroline was going to grow
up to be a sex researcher.

When I was in High School I sort of became the person in the group, that everyone would
talk to and get advice from, and eventually it became let’s go ask Caroline about sex, she
seems to know I few things! 

And as Caroline grew up… and started her career … an idea kept coming up… that
circumcisions obviously made sex worse for people with penises… the claim was that the
skin at the tip of the penis - called the glans -  hardens a bit once there's no foreskin to
protect it.
CP Yeah It just makes sense,  right? CP You know the exposed glans penis is exposed to
different kinds of friction in jeans pants makes sense skin would be hardened lower
sensitivity in men who did not have a foreskin

It made sense, but Caroline didn’t want to just assume it was true… 

People were like well you know Caroline you know people who don't have a foreskin like
their glans is so much less sensitive. I was like I actually don't know that. And I thought to
myself if I ever get my own research lab I would like to examine this

Caroline, of course, now has her own research lab.

<<Ding>>

 So, she thought, time to get to the bottom of this!! 

Here’s what Caroline and her colleagues did: they got about 60 men… half circumcised at
birth, the other half still intact.. Then the fun… I mean the experiment could begin.. Caroline,
and her team, had a variety of ways of measuring whether circumcised men were really less
sensitive than uncircumcised men…  one involved prodding penises… with these poking
devices 

CP They’re short and they’re thick and they are bristles on a brush... 

Then she pushed the bristles into the head of their penises... 

So it would be like yes I feel that is it painful or not. No it isn't. We'd go to the next one. Is it
painful or not. Yes it is and that would be their pain threshold.
WZ Were men like ow ow ow ow ow
CP Some men were, cos it has a kind of sharp pricky unpleasant feeling to it. 

Hey, you can’t do a penis sensitivity study… without poking a few penises. And here’s what
Caroline’s team learned

CP We found that the penises overall of intact and circumcised men were not significantly
different in terms of tactile pain...which was actually very very interesting
WZ: Oh wow

So… the head of the penis… the bit that has spent all those years rubbing against
underwear and whatnot -- was just as sensitive in the circumcised men as it was in those
who still had their foreskins.

CS We were surprised, we were really, really surprised

And although this was just one study, we found two other research papers that saw the
same thing … no difference in the penises’ sensitivity.,. The only study we could find that
reported a difference here: was funded by a group that’s now called Genital Autonomy
America  Yep… Genital Autonomy America…  which is a group fighting for an independent
autonomous nation of penises and vaginas. No of course not, it’s an anti-circumcision group.

But it’s not the end of the story. Because Caroline and her team also tested the foreskins of
the intact men and found that the skin there really did respond to a prod. Or as Caroline
says…  
CP So the foreskin in of itself is exceptionally sensitive to touch. 
WZ Ah ha what does this tell us whether circumcision makes it less fun to have sex?
CP Well certainly something is amiss... umm in terms of … through circumcision the foreskin
is being removed and it is a sensitive part of the penis. 

And this really sounds like circumcision might make sex worse… but Caroline says hold your
horses...

Whether that translated to sexual sensation remains to be really demonstrated through

research

Caroline’s experiment was such an unsexy situation -- the men were in a lab, they were not
erect and they were not having sex. And sex, Caroline says, is about so much more than
sensitivity that can be measured with probes. 

CP Orgasms include more than just the genitals that are involved, and so it really depends
on novelty, state of mind, comfort with the partner, it’s more of a sort of whole body
experience 

And it's not like the foreskin is sensitive in a way you can’t even imagine... Caroline found it
was about as sensitive as another part of the body: the forearm.

CP So if you flip your forearm over looking at inside of it We test about 4 inches below the
wrist, and that area is a very sensitive part of the body surprisingly! 
WZ Well I’ve been having sex wrong haven’t I
CP We all have been really speaks to including the whole body as a sexual activity
absolutely don’t ignore the forearm go for it laughter

So, because sex doesn’t boil down to this body part or that body part... Caroline’s lab study
can only take us so far… another way to find out how circumcisions affect sex lives… is to
ask grown men who’ve gotten circumcisions to describe their experiences with sex before
and after. And researchers have done this. On the whole, these men report that sex doesn’t
change much. But everyone’s experience is a little different . And that made us really curious
to talk to some of these men who had circumcisions as adults. So our producer, Rose
Rimler, called up a bunch them.

RR I guess.. tell me about your penis

C Ok...
Something I noticed after I had it chopped off was it was just constantly brushing up against
things and it was driving me crazy!
 <<The head is just as sensitive everything feels great, you’re missing that extra surface
area 
 Honestly, if a fairy met with me in the woods now and offered me to give me the foreskin
back I would decline. It’s been so nice
 It’s healed and it’s actually totally fine … I think it’s pretty much just as good either way…
R The foreskin isn’t magic in other words? 
<<Yeah yeah it was super cool, great to have it, thought mine looked alright, but it’s no great
loss..>>

To bring this to a head, a recent review paper found there wasn’t hard evidence to support
the idea that circumcisions make sex worse for men.  Certainly millions of circumcised men
around the world still really, really enjoy sex.  
That’s not the case for everyone though… during Caroline's research on circumcisions …
she found a group of people that have real issues with their circumcised penises.

CP I did come across some people who actually seemed very traumatized by their lack of
foreskin. 

Some of them told Caroline they were upset that something important to them had been
removed from their body -- and they didn’t have any choice in it. Some blamed their long lost
foreskins for a lack of sexual confidence… or for their body issues.  

WZ So when you put it all together do you think being intact increases your chance of
having better sex?
CP Well... I think….Y’know, it doesn’t usually matter but when it matters it matters a lot. So
most people with penises don’t care don’t spend a lot of time thinking about it. If their
circumcision status does matter to them it is part of their identity. 

Conclusion: As best as science can tell, a circumcision does not make a penis less sensitive,
and it’s unlikely to affect a man’s sex life in a big way. But for a small group of men… they
take their circumcisions really hard… and then it does affect their sex life. 

BEAT: CONCLUSION

So when it comes to circumcisions do they stack up? 

1. Are there risks to this surgery?  Well, it can be painful and there can be serious
complications *bah bow*-- but they are very rare.
2. Does it reduce your risk of infections? Yes.*ding* For babies, it cuts down the risk of
UTIs. when the kid grows up and starts getting laid, it can reduce the risk of HIV,
HPV and herpes
3. When it comes to men’s sex lives. Does it put a damper on things?  *ba bow* It’s
unlikely getting snipped plays a huge role in sexual pleasure for most men.

Ok... what are we to make of this? Well… when Andrew our circumcision guru and his team
at the American Academy of Pediatrics wrapped up their review. What did they say?

In America we’ve medicalised this, so people agonise over the risks and benefits, and is this
more than that. To be fair the benefits are modest and the risks are very very modest… 

To cut to the chase?

We felt that the benefits probably outweigh the risk, enough that people who want it should
be allowed to access it but it doesn’t have enough benefit to say that everyone ought to
have it.

So to Andrew either choice is valid… and when he had to make the decision, it wasn’t about
the medical benefits. 

AZ So I have a son my son is 14

WZ: And when he was little did you decide to give him a circumcision
AF Yes I did decide to do circumcision. At the time i did it didn't feel like i was doing it as a
doctor. I was doing it as a religious ceremony. I’m a practicing Jew and in our traditions we
do the circumcision on the 8th day. 
 WZ: How did you feel as a scientist that you were making this big decision for your son
based on religion? 
AF You’re not one thing. I’m not a scientist 24/7. Like all people, we’re complicated! And
that’s why you have to respect that .It’s a messy decision. We want to try to make this a
black and white decision where you punch a bunch of numbers in computer it’s not that way.
It’s a messy decision.

Andrew says Americans should just get used to the idea that there will be different kinds of
penises. He envisions a better world, a beautiful world, a world where every sort of penis has
its place in the rainbow. 

Why do all penises have to look alike. Why can’t some people do one thing some people do
another let families do what they feel is best for them. 

Someday, maybe…. 

That’s Science Vs circumcisions.

WZ Great those are our only questions anything you wanted to add?
AF Yes to anyone out there if you have any complaints about anything I’ve said please send
your emails to Science Vs…
WZ Sorry something wrong with the connection, we’re gonna have to leave you there

We have a big favour to ask! If you listen to Science Vs, even every now and then, we’d love
you to fill out a survey. We want to know what you like about the show, what you want more
of/less of? Tell us! sciencevs.show/survey that’s sciencevs.show/survey. Thank you! 

CREDITS

This episode has been produced by Rose Rimler, with help from me, Wendy Zukerman,
along with Shruti Ravindran and Meryl Horn. Our senior producer is Kaitlyn Sawrey. We’re
edited by Blythe Terrell. Additional editing help from Caitlin Kenney. Extra thanks to Soraya
Shockley and Saidu Tejan-Thomas. Fact checking by Michelle Harris. Mix and sound design
by Emma Munger. Music written by Bobby Lord and Emma Munger. Recording assistance
from Gideon Brower, Ryan Delaney, Tom Wayne Harris, and Bahizi Ignatius. For this
episode, we also spoke to Dr. Jenn Bossio, Dr. Aaron Tobian, a bunch of folks at the CDC.
Thank you so much. A special thanks to the parents and circumcised men who spoke with
us for this story and Frank Lopez and to all my Family and Joseph Lavelle Wilson… 

We’re off next week, but when we come back in two weeks, we’re tackling Lyme Disease.
Should you be afraid of it?

<<physicians don’t want to help those patients...patients regarded as lepers...they don’t

want to go near them with a ten foot pole>>

I’m Wendy Zukerman, fact you next time.

Peanuts Public Transcript

Hi I’m Wendy Zukerman and you’re listening to Science Vs from Gimlet, this is the show
that pits facts against anaPHYlaxis.
Within the last few decades, it seems, the peanut has gone from one of America’s favorite
snack foods to Public Enemy Number 1[1].

A Milwaukee teenager has died after having an allergic reaction to peanuts

Peanuts have been banned in airlines and in schools

No peanut products in the classroom means lunch boxes are kept in the hall 

According to the CDC, 1.4 percent of kids in the US have peanut allergies ... 1.4%… it
may not sound like much, but it's quadrupled since the mid 1990s[2][3][4][5] [6][7][8][9][10]. 
According to the most recent data, several thousand kids a year end up in the ER because of a
peanut[11]. .[12] [13] [14].  So in today’s mini episode, we're asking: what’s going on with all these
peanut allergies? Is there anything parents can do about it?... And what does this have to do
with anything…  

<<BAMBA SONG>>

<<CUT IT COLD>> 

We'll get to ALL that. But let's start our story … with Gideon Lack… who has a bit of a cold
…

GL I may have to blow my nose embarrassingly… 

Gideon is a pediatrician and allergy researcher at King’s College London.[15] 

GL: Ok, SNIFFLE, Thanks

Gideon told us that back in the 1990s, he and other researchers were seeing more and more
kids with peanut allergies. [16] 

GL it was really very weird and ah, very surprising.

And it was also scary… because when the body has a severe allergic reaction…

GL It’s a bit like a battlefield.  Cheeks swelling, diarrhea, vomiting, swelling of the airways,
difficulty breathing, loss of consciousness[17] ,

And so in the late 1990s allergy researchers got together to try to work out what to do about
all these kids getting nasty peanut reactions…  And they decided to started giving some
parents some very clear advice…  

GL: Which was don't feed your baby peanuts

In the year 2000 -- the American Academy of Pediatrics -- came out with guidelines telling
parents just this. A lot of babies… just shouldn’t be eating peanuts...no peanut butter…
no peanut cookies. Until they’re 3 years old.[18] [19] And Gideon says this advice was
particularly meant for babies with a high risk of getting peanut allergies… say, if they had
other food allergies, or even eczema… [20] [21] [22]

GL They have really bad rashes.. We know that's the group that goes on to have a VERY
high rate of peanut allergy[23][24][25]

And eczema is common in babies[26][27][28], which meant a lot of parents were getting the
advice to put the peanut butter on the high shelf. Our producer Rose Rimler asked Gideon
about it..  

RR Were you telling your patients that?

GL Yes I was telling my patients that. I was giving that advice to my own family
as well. It seemed intuitively true that by avoiding peanuts and by sort of cocooning the
baby we would prevent the development of allergies. 

And so, after those guidelines in 2000 came out, doctors across the US and UK were telling
parents, don't give your babies peanuts..  And the world chugged along for a few
years… Gideon’s kids grew up… Harry Potter got made into movies[29]..

You’re a Wizard Harry

Britney Spears shaved her head[30]…

Brittany spears - she’s bald

 Yeah, a lot happened during the 2000s. But one thing that DIDN’T happen? Peanut allergies
didn’t go away. The advice to banish nutter butters from the kitchen… didn’t seem to be
working. Studies were finding that kids who weren’t eating ANY peanuts… were still
becoming allergic to them.[31][32][33].  And Gideon had noticed it too. 

GL My first inkling that this might be off base was really from listening to my patients

RR What were they saying to you?

GL Well they were saying I just don’t understand. We avoided giving our child peanuts and
yet my child peanut allergy

So what was going on? Gideon found the answer somewhere unexpected… Here’s what
happened… He was at a conference in Israel giving a talk on peanut allergies and he started
his talk the way he always did. He asked the doctors in the room - about 200 of them -

GL How many of you in the audience have seen a case of peanut allergy in the last year

When Gideon did this in the US or the UK… he told us that practically every doctor would
put their hand up…They couldn’t swing a dead cat without hitting a kid with peanut
allergy... But here in Israel?
GL I only saw just a couple of hands go up in the audience… I counted something like 2 or
3… I was startled and sort of question whether I was seeing things correctly...  Yes they were
seeing allergies in abundance, they were seeing asthma in abundance but they were not
seeing peanut allergy….

Gideon went searching for more data… his team did a study of more than 10,000 kids in the
UK and Israel… and he found that peanut allergies were ten times more common in the
British kids than Israeli ones[34] .

GL Yeah, ten times higher. It was the very first clear clue that there was something going on
here

And there was ONE curious thing that might possibly explain…what was going on in
Israel. And it had to do with a very particular Israeli snack...

GL puffs that contain peanut protein.

RR What are these puffs?

GL What are these puffs? they’re a bit like I think what you what you would call cheese
doodles. 

These[35] cheeseless cheese doodles…. Are packed with peanuts…. And they’re called
Bamba[36]. 

Bamba song!

Bamba is pretty much made for little kids - the mascot is actually a baby in a diaper.

GL In fact an Israeli parent actually told me that the first three words tha an Israeli baby
learns to speak are Aba, Ima and Bamba. Which is Dad, Mom and then Bamba.

WZ laugh

And the fact that all these Israeli babies were chowing down Bamba and not getting peanut
allergies…   made Gideon think: could these peanut puffs actually be protecting these kids?
So, back home in England, his team tested this out... on babies… They got more than 600
bubs[37] who had a high risk of getting peanut allergies…  

They had some of the pipsqueaks avoid peanuts like the plague…you know, the usual
strategy. And then there was another group of babies… who were fed peanuty snacks like
Bamba on the reg[38]  [39]… And after five years… Gideon found that Bamba babies were way
less likely to be allergic to peanuts[40]…. In fact they were around 5 times less likely to get
peanut allergies [41]. …     

GL This is a huge effect, and we didn't for a moment anticipate such an effect.

RR So, what was the mood when you crunched the final numbers? Did you pop the
champagne?
GL If I'm not mistaken we had a small glass of malt whiskey

<Chink!>

But they couldn’t party too hard...not yet. There remained the question of….why? Why did
eating peanuty Bamba seem to protect the little kids? After all, this flew in the face of
everything they thought they knew about allergies….

GL Well laugh I scratched my head over a long time and I started to think back to animal
model research that had been going on…  

Gideon cast his mind back to studies done in mice[42][43][44]… . [45]... which had found - like his
Bamba study - you could protect young mice from getting peanut allergies if you fed them
peanuty things when they were little…  And there was another group of researchers who
came at this from a different angle and instead of trying to prevent allergies.. They gave the
mice peanut allergies.[46] And it was all pretty mad scientisty. Here’s what they did.

They took young mice with basically rashes…[47].…

Red, broken down skin….

These mice have never eaten peanuts in their lives…

and peanut is applied to that skin

These scientists rub peanut bits right into their little mousey rash… 

After the mice get their weird peanut massage[48] then… scientists feed them peanuts. Ta da.
These mice got nasty allergic reactions.[49]

Exactly. Peanut makes it way through the skin, That seems to be enough to set up allergy

Thinking about these mouse studies… GIdeon… thinks huh… maybe the key here is HOW
babies are FIRST exposed to peanuts… Like.. if it’s through their mouth…with a friendly
little Bamba.. Then that’s good… but if it’s through their skin… that’s bad. Gideon has an
analogy for this . ..

GL If someone knocks on your door with a smile or carrying a bunch of flowers you might

think it’s strange but you’ll be polite to that individual and you’ll talk to them, whereas if you
hear a glass shattering in one of your rooms upstai rs, you see someone in a mask you might
be less friendly inclined.

So peanuts getting through the skin…maybe through an eczema rash… That’s like breaking a
window… and making our whole body angry. But our final question… is this: how are
peanuts getting through to our skin? Humans don’t have mad scientists rubbing peanuts into
OUR rashes? 

Well, one idea is that over the years… we’ve been putting so many peanuts in so many foods
and products and shipping them all around the world... that we’ve ended up with tiny traces
of peanuts all through our environment[50][51]. Like, Gideon has found peanut bits in the
beds of kids who don’t eat them.[52][53][54]! And he reckons that these peanut bits can then make
their way into our skin…[55]. And if this idea is true -- it means that what Gideon and other
doctors were telling parents….to keep babies away from peanuts.

GL It turns out it was exactly the wrong advice…

Because when babies DIDN’T EAT peanuty things it increased the chance that the FIRST
time their body was exposed to a peanut was through their skin…

GL Y’know there’s an ironic twist there that we got it wrong, and I was very much part of
that process, I was giving the what I perceive now to be the incorrect advice for quite a period
of time.

Now .. the rising rates of peanut allergies … probably aren’t just due to this bum advice. So
for example, we’re seeing all kinds of allergies going up[56], even stuff like asthma and
seasonal allergies.[57] And we can’t blame a lack of Bamba for that. So something else is
going on here.

But Gideon’s surprising findings on peanuts ... were enough to convince other scientists[58]
[59]
 that hiding peanuts away was the wrong call ...because in 2017, the American Academy of
Pediatrics released a brand new set of guidelines for doctors. They now say that most kids
should be given foods with peanuts early -- when they’re still babies[60].

But a note to parents out there: if your baby has severe eczema or some other allergies… take
your squirt to the doctor before giving them peanuts…. just to be safe. 

So in the end medicine did a total backflip. Which might feel like this is a science failure. But
maybe… this is a science success story. Afterall… scientists like Gideon saw what they were
telling parents wasn’t working… they tested a new idea…and they changed the dogma. It all
just took time… and a little bit of unexpected inspiration…

Crackle

RR Oh! It smells like peanut butter

WZ Crunch… Hmm, oh damn it’s like chewy, it’s like…. it sticks to every part of your
mouth

RR It takes just like peanut butter. It’s pretty good

WZ: Wow

RR Do you like it?

WZ Like is a strong word. I can tolerate it.

That’s Science Vs Peanuts. We’ll let the Bamba baby play us out.

Bamba song
Next week... How an assassination changed medicine in America forever…

This episode was produced by Rose Rimler with help from me, Wendy Zukerman, along with
Meryl Horn and Michelle Dang. Our senior producer is Kaitlyn Sawrey. We’re edited by
Blythe Terrell. Fact checking by Diane Kelly. Mix and sound design by Peter Leonard. Music
written by Emma Munger, Peter Leonard, and Bobby Lord. Recording assistance from
Andrea Rangecroft. A big thanks to Dr Andrew Dang, Professor Scott Sicherer, Dr Marshall
Plaut, Dr Kristin Sokol, Dr Robert Boyle, and others. As well as the Zukerman Family and
Joseph Lavelle Wilson.

I’m Wendy Zukerman. Fact you next time.

[1] http://sci-hub.tw/https://www.sciencedirect.com/science/article/abs/pii/
S0277953613002657#!

[2] The prevalence of peanut allergy in children in 2008 was 1.4% (95% CI, 1.0% to 1.9%)
compared with 0.8% in 2002 (P = not significant) and 0.4% in 1997 (P < .0001).
https://www.ncbi.nlm.nih.gov/pubmed/20462634 

[3] https://www.ncbi.nlm.nih.gov/pubmed/20078504 Our data from three cohorts of 3- to 4-

year-old children born in the same geographical area shows that peanut allergy prevalence
has changed over time. Peanut sensitization and reported allergy in children born in 1994-
1996 increased from 1989 but seems to have stabilized or slightly decreased since the late
1990s, although not significant.

[4] We did not collect data on the changing prevalence of specific allergies, however, it has
been recently noted that while peanut allergy has increased dramatically in the USA [68], UK
[69, 70] and Australia [46], this is less evident in Asia although data are more limited
(reviewed recently in [55]). https://waojournal.biomedcentral.com/articles/10.1186/1939-
4551-6-21#Sec20 

[5] We conducted an observational study using a national administrative claims database

from 2005 through 2014. ….Emergency department visits for food-induced anaphylaxis
increased by 214% (P < .001);.....Peanuts accounted for the highest rates (5.85 per 100 000 in
2014) followed by tree nuts/seeds (4.62 per 100 000 in 2014).

[6] One review estimates that food allergy is going up 1.2% per decade.

[7] [this is for food allergies generally] In 2007, the reported food allergy rate among all
children younger than 18 years was 18% higher than in 1997. During the 10-year period 1997
to 2006, food allergy rates increased significantly among both preschool-aged and older
children.  https://www.cdc.gov/nchs/data/databriefs/db10.pdf 

[8]https://hosppeds.aappublications.org/content/6/5/269
[9] In the United States alone, the prevalence has more than quadrupled in the past 13 years,
growing from 0.4% in 1997 to 1.4% in 20081 to more than 2% in 2010.2

[10] There is a strong impression that there has been an increase in prevalence. A survey
study of government schools in Australia (>550,000 students) looking at those at risk of
anaphylaxis noted a 41% increase from 2009 to 2014 (0.98% to 1.38%).33 The US Centers
for Disease Control and Prevention, using data from one question in the US National Health
Interview Survey, reported that the prevalence of food allergies increased among children
from 3.4% in 1997 to 1999 to 5.1% in 2009 to 2011.34 A US survey relying on parental
report of child peanut allergy but using identical methodology over time showed a rate of
0.4% in 1997 increasing to 1.4% in 2008.35 An unrelated and unselected birth cohort study in
eastern Massachusetts estimated a peanut allergy rate of 2% around 2010 by using stringent
criteria (peanut IgE, >_14 kUA/L and prescribed epinephrine autoinjector), further suggesting
at least a very high rate if not confirming an apparent increase in prevalence.36 UK studies
have also suggested an increase in peanut allergy,37,38 and a cross-sectional study of infants
in a single clinic in China from 1999-2009 suggested an increase in food allergy prevalence
from 3.5% to 7.7% (P 5.17).39

[11] 6 ED visits for peanut related anaphylaxis per 100,000 kids enrolled in the database.  So
if you extrapolate that to 74 million kids in the US you would get 4,400 ED visits per year
specifically for PEANUT related anaphylaxis.  This is almost certainly an under estimate
because anaphylaxis is known to be under diagnosed.  But that is my best guess. [email]
Refers to this: https://www.ncbi.nlm.nih.gov/pubmed/29663520 74 million stat backed up
here (look at year 2014): https://www.childstats.gov/americaschildren/tables/pop1.asp 

[12] See table 2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5589409/ 

[13] Fatal food anaphylaxis for a food-allergic person is rarer than accidental death in the
general population. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4165304/ ; comparing
table 2 and table 3 in https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5589409/  suggests
fatal peanut anaphylaxis is also rarer than fatal reactions brought on by insect venom.

[14] Also helpful: https://www.bcbs.com/sites/default/files/file-attachments/health-of-

america-report/HealthOfAmerica.Childhood.Allergies.in_.America.pdf 

[15] https://www.kcl.ac.uk/lsm/research/divisions/aalb/about/people/profiles/lackg.aspx

[16] Twenty-two (92%) children had an allergic reaction to peanut during DBPCFC, ranging

from isolated oral pruritis to multisystemic reactions with severe bronchospasm, generalized
urticaria, and tachycardia.; see also https://www.jacionline.org/article/S0091-6749(17)32854-
3/pdf for a similar 2018 study

[17] Skin symptoms include acute urticaria, angioedema, or a pruritic erythematous skin rash.
The gastrointestinal symptoms include acute vomiting, and significant abdominal pain or
diarrhoea, or both. Respiratory symptoms can include both the upper and lower respiratory
tract, although lower respiratory symptoms, including laryngeal oedema, repetitive coughing,
voice changes, and wheezing are the most important. Anaphylaxis, a systemic allergic
response, can include any of these symptoms, and additionally may include cardiovascular
symptoms, such as hypotension and dysrhythmia. A biphasic, or secondary late-phase allergic
response up to 4 h later, has been noted in up to a third of patients with fatal or near fatal
anaphylactic reactions.36,37

-Lack is giving you a general description of the symptoms of anaphylaxis here:

https://www.aaaai.org/conditions-and-treatments/allergies/anaphylaxis

[18] http://pediatrics.aappublications.org/content/106/2/346.long   Conclusive studies are not

yet available to permit definitive recommendations. However, the following
recommendations seem reasonable at this time:

a)  Breastfeeding mothers should continue breastfeeding for the first year of life or longer.
During this time, for infants at risk, hypoallergenic formulas can be used to supplement
breastfeeding. Mothers should eliminate peanuts and tree nuts (eg, almonds, walnuts, etc) and
consider eliminating eggs, cow's milk, fish, and perhaps other foods from their diets while
nursing. Solid foods should not be introduced into the diet of high-risk infants until 6 months
of age, with dairy products delayed until 1 year, eggs until 2 years, and peanuts, nuts, and fish
until 3 years of age.

See also https://www.ncbi.nlm.nih.gov/pubmed/27820622: a 2017 review of changes in

peanut/infant recommendations

[19] They also seem to have said to avoid while pregnant. I think that recommendation can be
found in this book chapter, which I don’t have access to: American Academy of Pediatrics.
Food sensitivity. In: Kleinman RE, ed. Pediatric Nutrition Handbook. 5th ed. Elk Grove
Village, IL: American Academy of Pediatrics; 2004:593– 607; pregnancy avoidance is also
reported in https://www.ncbi.nlm.nih.gov/pubmed/27820622: a 2017 review of changes in
peanut/infant recommendations

[20] The UK had similar advice. In 1998,  a government committee said that when there’s
family history of atopy (aka the kid is in the high risk group) the mother should avoid peanuts
while breast-feeding and avoid giving them peanuts until age 3. The report notes the evidence
is inconclusive, though. (Also that refined peanut oil has no protein in it, so isn’t allergenic)

[21] “Mothers should eliminate peanuts and tree nuts (eg, almonds, walnuts, etc) and consider
eliminating eggs, cow's milk, fish, and perhaps other foods from their diets while nursing.
Solid foods should not be introduced into the diet of high-risk infants until 6 months of age,
with dairy products delayed until 1 year, eggs until 2 years, and peanuts, nuts, and fish until 3
years of age.” http://pediatrics.aappublications.org/content/106/2/346.long 

[22] https://cot.food.gov.uk/committee/committee-on-toxicity/cotreports/cotwgreports/
cotpeanutallergy 

[23] A review of the literature suggested that eczema severity, early onset of eczema, and
frequent use of topical corticosteroids might be useful high-risk factors for the development
of PA.14, 21 There are also data showing an association between egg allergy and PA.22 We
therefore decided to use severe eczema, egg allergy, or both as inclusion criteria for the
LEAP study. https://www.jacionline.org/article/S0091-6749(12)01510-2/fulltext#sec1.3 

[24] This systematic review confirms a strong and dose-dependent association between AD,
food sensitization, and FA. AD of increased severity and chronicity is particularly associated
with FA. There is also evidence that AD precedes the development of food sensitization and
allergy, in keeping with a causal relationship.  https://www.jacionline.org/article/S0091-
6749(15)03165-6/pdf 

[25] Early soy consumption, rash over the joints and skin creases (eczema), and oozing,
crusted rash remained independent risk factors for peanut allergy and for a positive peanut-
challenge test after adjustment for other factors (Table 2).
https://www.nejm.org/doi/full/10.1056/NEJMoa013536

[26] Atopic dermatitis affects approximately 20% of children internationally and is

commonly associated with

the development of other allergic conditions, such as peanut allergy.

[27] Performed studies demonstrated the prevalence of atopic dermatitis in 17.3% of

examined children.

[28]12.4% 0-2 aged kids

https://www.cdc.gov/nchs/data/health_policy/eczema_skin_problems_tables.pdf

[29] https://www.imdb.com/news/ni5641042 

[30] https://www.yahoo.com/entertainment/remember-when-britney-spears-shaved-her-head-
10-years-ago-today-125252791.html ; news of the time:
https://www.foxnews.com/story/britney-spears-shaves-head-gets-new-tattoo

[31] In 2003, an analysis of kids from the “children of the 90s” study (big longitudinal study
in England) found no evidence that the kids who had peanut allergies were sensitized via
maternal diet. (Similar outcome in study published 2014. There is also evidence, though, that
maternal consumption of peanut was associated with sensitization to peanut later in life.)) --
also should be pointed out here that there’s no way of telling from this study whether the
mode of sensitization is via ingestion or some other route.

[32] In 2003, a Cochrane Review found that pregnant women avoiding allergy foods were not
more likely to have allergy- free kids. (It didn’t focus on peanuts-- only one ref discussed
peanuts.)

[33] In 2008, the AAP replaced its original recommendation with this recommendation, based
on new evidence: “Although solid foods should not be introduced before 4 to 6 months of
age, there is no current convincing evidence that delaying their introduction beyond this
period has a significant protective effect on the development of atopic disease regardless of
whether infants are fed cow milk protein formula or human milk. This includes delaying the
introduction of foods that are considered to be highly allergic, such as fish, eggs, and foods
containing peanut protein.”

[34] We demonstrate that Jewish children in the UK have a prevalence of PA that is 10-fold
higher than that of Jewish children in Israel. https://www.jacionline.org/article/S0091-
6749%2808%2901698-9/fulltext 
[35] Bamba is a baked snack containing 50% peanuts
https://www.osem.co.il/en/product/classic-bamba/ 

[36] From Osem, the manufacturer: "In Israel, more than tens of millions of bags are sold
each year." email 3/18

[37] Almost all the participants (98.4%) were available for assessment at 60 months of age,
with 617 (96.4%) assessed by means of an oral food challenge

[38] Or peanut butter, for the kids that didn't like Bamba:
https://www.nejm.org/doi/full/10.1056/NEJMoa1414850

[39] https://www.nejm.org/doi/full/10.1056/NEJMoa1414850 

[40]  In the intention-to-treat analysis, peanut consumption was associated with an 86%
reduction in peanut allergy at 60 months of age among participants who had had negative
results on a peanut-based skin-prick test at study entry and with a 70% reduction among those
who had had positive test results at study entry. Source:
https://www.nejm.org/doi/full/10.1056/NEJMoa1414850

[41] At 5 years of age, the children were given a peanut challenge to determine the
prevalence of peanut allergy. The results are striking — overall, the prevalence of peanut
allergy in the peanut avoidance group was 17.2% as compared with 3.2% in the consumption
group.

[42] https://www.ncbi.nlm.nih.gov/pubmed/8111600 : from 1994; allergen used in this study

is ovalbumin (from egg), but it demonstrates the skin sensitization route

[43] From 2005; tested peanuts as an antigen, mice 6-8 weeks old; abraded skin to simulate
eczema before exposure to peanut …..The stratum corneum was removed from both sides of
the earlobe by application and removal of cellophane tape (ScotchTM (3M, Cergy-Pontoise
Cedex, France)) five to eight times. Twenty-four hours later, 25 mL of peanut protein in PBS
(4 mg/mL) were applied to both sides of the earlobe with a cotton bud. The application of
peanut protein to the skin was repeated on the next 2 consecutive days. An estimated
maximum of 100 mg of protein was deposited on the ear by this technique. Antigen applied
to intact skin that had not been tape stripped and PBS without antigen applied to stripped skin
and intact skin were included as controls. (Another link to the paper:
https://www.ncbi.nlm.nih.gov/pubmed/15969667)

[44] [note this is a paper written by Lack; review from 2012] Oral tolerance is well
recognized in murine models. Numerous studies have demonstrated that early high-dose oral
exposure confers both immunologic and clinical tolerance to food allergens. A single oral
dose of allergen (b-lactoglobulin, OVA, or peanut) is sufficient to achieve tolerance and
prevent subsequent allergic sensitization.69-71 In a murine model a single high dose of
peanut flour (100 mg) promoted oral tolerance and prevented subsequent IgE sensitization
and T-cell proliferation.71 ; similar study in 2014 had similar results re: sensitization
https://www.jci.org/articles/view/75660  and this one also cited

[45]  The American scientist Harry Gideon Wells (1875-1943) conducted a large series of
experiments in guinea pigs and showed that anaphylactic reactions to proteins could be
inhibited by prior feeding of the same soluble antigens. The immunological nature of oral
tolerance was established in 1946 by another American scientist, Merrill Chase, who applied
contact-sensitizing agents. By exploiting the increasing knowledge on cellular immunity and
on the induction of tolerance in other test systems, Chase demonstrated how readily the
immune system could be down-regulated in an antigen-specific manner.

[46] http://sci-hub.tw/https://www.ncbi.nlm.nih.gov/pubmed/15969667 Epicutaneous
exposure to peanut protein can prevent induction of oral tolerance, and may even modify
existing tolerance to peanut.

[47] https://www.jci.org/articles/view/75660 Tape stripping is a model of excoriation of the

skin analogous to that observed in atopic dermatitis [eczema]

[48] Animals exposed to peanut protein on barrier-disrupted skin 6 days prior to a tolerogenic

feed not only failed to suppress IgE responses, but produced levels of peanut-specific IgE
significantly higher than saline-fed peanut-sensitive controls….Feeding a tolerogenic dose of
peanut protein 20 days after epicutaneous exposure to peanut no longer induced oral
tolerance and the epicutaneous sensitization was dominant in all parameters
assessed….http://sci-hub.tw/https://www.ncbi.nlm.nih.gov/pubmed/15969667 

[49] Administration of peanut proteins on barrier-disrupted skin (24 h following removal of

the stratum corneum by tape stripping) induced dose-dependent peanut-specific T cell
proliferation in vitro both at 6 and 20 days after the epicutaneous exposure
https://www.ncbi.nlm.nih.gov/pubmed/15969667 

[50] There was a positive correlation between peanut protein levels in the infant's bed, crib
rail, and play area and reported HPC over 1 and 6 months.

Peanut levels of dust samples were measured with ELISA. Overall, peanut was detectable in
19 of 21 households in the eating area and/or in bed.

Household peanut consumption was subsequently shown to be highly correlated with peanut

levels in dust and surfaces of the infant’s cot and play area, even if the infant was not
consuming peanut. Of note, if the infant did consume peanut, household peanut consumption
did not increase their risk of peanut allergy, in keeping with the dual allergen exposure
hypothesis. … Peanut protein found in the dust of the infant’s home environment is
biologically active in that it stimulates activation of basophils from peanut-allergic children in
a dose-dependent manner.

[51] The dual allergen exposure hypothesis is supported by large cohort studies documenting
an association between childhood atopic dermatitis, environmental peanut exposure, and
peanut allergy. The Avon LongitudinalStudy of Parents and Children cohort study of 13,971
children found that application of creams containing peanut oil onto the skin of infants was
significantly associated with the development of peanut allergy in children with atopic
dermatitis (odds ratio, [OR] 6.8; 95% CI, 1.4-32.9

[52] The median level of peanut detected in the bed dust of participants in the avoidance
group was 4.1 μg per gram of dust (interquartile range, 1.4 to 14.5), whereas the level in the
consumption group was 91.1 μg per gram of dust (interquartile range, 27.2 to 362.0) (Fig. S2
in the Supplementary Appendix).  
[53] https://www.ncbi.nlm.nih.gov/pubmed/23608728 

[54] https://www.jacionline.org/article/S0091-6749(13)00365-5/abstract

[55] See table 1, “dual allergen exposure hypothesis”

https://www.ncbi.nlm.nih.gov/pubmed/29157945 

[56] The prevalence of food and skin allergies increased in children aged 0-17 years from
1997-2011.

[57] Trend data suggest that the prevalence of asthma, including forms of the disease
triggered by pollen, mold, and other allergenic substances, is on the rise. Childhood asthma
rates in the United States, for instance, doubled from 1980 to 1995 before slowing to a more
gradual (albeit ongoing) increase. … There is evidence suggesting that hay fever prevalence
is rising in many parts of the world, particularly in urban areas, although some of the most
recently published studies date back to the late 1990s. A newer report from France’s Rhône-
Alpes Center of Epidemiology and Health Prevention shows that hay fever prevalence rose
from 8% of the local population in 2004 to 12% in 2015.

[58] Principally as a result of the dramatic results of the Learning Early About Peanut study,
an expert panel convened by the National Institute of Allergy and Infectious Diseases
released an addendum guideline on peanut allergy prevention with advice based largely on
the study

[59] The ‘‘dual allergen exposure hypothesis’’ attributed to Gideon Lack was considered by
this group to have limited but consistent evidence that an impaired skin barrier plays a role in
sensitization as a first step toward food allergy. The theory suggests that low-dose cutaneous
exposure is sensitizing and facilitated by an impaired skin barrier and inflammation, whereas
oral exposure could be potentially tolerizing but might come too late to avert allergy. Support
for the hypothesis includes the efficacy of peanut early feeding in infants with eczema56 and
the increased risk of food allergy in those with mutations in filaggrin, a protein responsible in
part for maintaining the skin barrier.57

[60] http://www.aappublications.org/news/2017/01/05/PeanutAllergy010517

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