Ep 185 - The Big Daddy of Vasectomies: Doug Stein’s Calling for the Planet

Family Planning
Written By Paul Shapiro

SHOW NOTES

What if one of the most effective ways to improve women’s autonomy, reduce unintended pregnancies, and ease pressure on the planet didn’t require new technology, venture capital, or government mandates, but simply more men stepping up?

This episode’s guest is Dr. Doug Stein, better known as The Vasectomist. Dubbed many names in the press, including the Big Daddy of Vasectomies and sometimes The Vasectomy King, Dr. Stein is a Florida physician who made an unusual career choice: instead of practicing broadly, he focused almost exclusively on vasectomies—and so far has gone on to perform more than 45,000 of them.

But this conversation goes far beyond medicine.

Dr. Stein has taken his work around the world, providing free vasectomies from the Philippines and Haiti to Kenya and beyond, sometimes even offering financial compensation to men in low-income countries to offset lost wages and travel costs. That approach has sparked praise, controversy, and ample resistance from religiously conservative authorities in those countries.

In this episode, we talk candidly about:

  • Why men so rarely take responsibility for permanent contraception

  • Whether incentivized vasectomies should be offered in the US too

  • The role of religion, masculinity, and misinformation

  • Why Dr. Stein believes the planet would be better off with three billion humans instead of the eight billions of us currently walking around

  • And why family planning remains one of the most ignored levers for social and environmental good

DISCUSSED IN THIS EPISODE

You can now watch the 45-minute documentary on Dr. Stein for free on youtube.

Get to Know Dr. Doug Stein

After completing residency training in 1983, Dr. Doug Stein practiced adult general urology for over 17 years in Tampa, Florida. In 2000, he stopped seeing new general urology patients to devote all his time to vasectomy and vasectomy reversal, eventually providing vasectomy services at up to 21 locations in Florida, many under the federal Title 10 program for low-income men without insurance. In 2010, he began his international vasectomy mission work and has now led 38 vasectomy missions to a variety of countries including the Philippines, Haiti, Kenya, Mexico, and Indonesia. He is the Co-Founder of World Vasectomy Day, the largest annual male-oriented family planning event in history. In addition to training doctors overseas, Dr. Stein has provided individualized training for 224 doctors from 5 continents at his main office in Tampa/Lutz, Florida. He has performed over 45,000 vasectomies and 2000 vasectomy reversals.

TRANSCRIPT

Dr. Douglas Stein 0:00

Women have done enough. They had the periods, they took the contraceptives, they tolerated the pregnancy. They had to go through the deliveries. Isn't it time for men to step up to the plate?

Paul Shapiro 0:14

Welcome to the Business for good podcast where we spotlight people making money by solving some of the world's most pressing problems. I'm your host, Paul Shapiro, author of a nationally best selling book on food sustainability, and CEO of a company in the same space. On this show, I speak with founders, investors and thought leaders who prove that doing good and doing well can go hand in hand. The biggest challenges facing humanity are solvable and are often profitable too. My hope is that this podcast informs, inspires, and maybe even helps repel you to build a business that makes the world a better place. I'm glad you're here. Greetings, friend and welcome to episode 185

Paul Shapiro 0:51

of the business for good podcast as a reminder, this podcast is now both an audio and a video podcast, so you can keep enjoying it as you always have. But if you want to watch it, just go to YouTube. Search for business, for good podcast, subscribe and enjoy. Now. Speaking of enjoyment on YouTube, there is a great documentary available for free on YouTube about our guest on this very episode. The doc about this doc is called the vasectomist, and it chronicles Dr Doug Stein's trip to places like the Philippines and Haiti, where he takes out billboards advertising for free vasectomies that he performs himself. When I watched this inspirational documentary, I knew I had to get Dr Stein on the show, as he has made it his whole business to ease the pressure humanity is placing on the planet by helping people better control the reproductive destinies and have smaller families. Some of you may remember our past episode with Dr Esq Gorin, a very famous one, because the doctor became famous himself for vasectomizing himself. Yes, you heard that, right? He vasectomized himself well. On this episode, I'm talking with a man who inspired Dr Gurin in the first place. Both are convinced that the eight plus billion humans who are alive today represent quite a lot of miracles, and that we may all be better off by voluntarily bringing fewer future people onto the planet. That raises a lot of questions, including, what if one of the most effective ways to improve women's autonomy is and reducing unintended pregnancies and easing pressure on the planet didn't require a new technology or venture capital or government mandates, but simply more men stepping up to get vasectomized To answer that and more. This episode's guest again is Dr Doug Stein, better known as the vasectomist, dubbed many names in the press, including the big daddy of vasectomies and sometimes the vasectomy King. Dr Stein is a Florida physician who made an unusual career choice. Instead of practicing broadly, he focuses almost exclusively on vasectomies, and so far, he has performed over 45,000

Paul Shapiro 2:45

of them. But this conversation goes far beyond his medical practice. As mentioned, Dr Stein has taken his work around the world, providing free vasectomies from the Philippines and Haiti to Kenya and beyond, sometimes even offering financial compensation to men in low income countries to offset lost wages and travel costs associated with getting the vasectomy that day. That approach has sparked, obviously, praise and criticism and controversy and ample resistance from religiously conservative authorities in those countries. I'll let Dr Stein make the case for himself. Enjoy this conversation with the man they call the big daddy of vasectomies, the vasectomist himself, Dr Doug Stein.

Paul Shapiro 3:21

Dr Stein, welcome to the business for good podcast.

Dr. Douglas Stein 3:24

Thank you. Paula, hey. Really great to be with you.

Paul Shapiro 3:26

Let me ask you straight out. How did you become the vasectomist? There's a lot of people who are doctors, even urologists, who do maybe a lot of vasectomies. But you know, you've done over 45,000 vasectomies, and only do vasectomies. So what happened? What happened to you?

Dr. Douglas Stein 3:42

I became a surgeon because probably my father said using your hands is a nice thing to do. All surgeons start out in general surgery, and that was in I did that from 78 until 83 and during that time, in 1979 life on earth came out, and that was David Attenborough's groundbreaking documentary about the beauty of the planet. And I guess that was the start of my indoctrination. Anyway, I felt finished residency, and I started doing just a general urology practice from 83 until 90, and then in 90, I saw a little ad in a throwaway magazine about no scalpel vasectomy. Now I had been done, been doing traditional vasectomies. You make a little incision on either side and lift the vast out and divide the vast but no scalpel. What are these people talking about? So I called, and it was the Rockefeller Institute in New York, and coupled with the Association for voluntary surgical contraception. And I said, Wow, how can I learn how to do this? And the lay, very nice lady at the Rockefeller Institute said, well, we'll train you. I said, Well, okay, so when do I come? She said, Oh no. Will send a doctor down to you. So they sent Philip Lee down to Florida, and he showed me a technique of performing vasectomies that was much simpler in terms of the number of instruments that you had to use single, very small opening in the middle. And I said, Wow, this is, this is a really nice development. So I started using that technique during the 90s in my office. It just so happens that the no scalpel vasectomy involves few simple instruments that could all be nicely packaged. I was kind of a, I guess, a workaholic, actually, and my staff wouldn't come in on Saturdays. So I called the local Planned Parenthood and asked them if I could do vasectomies in their office on Saturdays. And they said, sure. Then one county told the other county, and then the other county said, Can you do them for us? And that county told the other county. So pretty soon, I'm starting to do vasectomies at a number of counties and at a number of Planned Parenthood. And I was getting so much into this that it was, it was really very rewarding. In fact, I think it was very rewarding to treat kidney stones and and take care of prostate cancer and fix leaky ladies and help guys who couldn't pee well, but you were only take it. We're only caring for one person, maybe one family at a time. But when you were doing a vasectomy by now, by the way, it's the late 90s. David Attenborough has come out with a living planet in 84 Private Life of Plants in 95 I'm watching all these things. This is my favorite thing to watch, and it's sort of feeding into me now that we've got this beautiful planet, but we're kind of screwing it up because there's too many of us, and in 2000 the population hit 6 billion. I said, I figured, wow, 6 billion is enough. So by this time, I had also learned that I could do vasectomies at private offices in distant counties, and so in 2000 I stopped seeing new general urology patients. It just so happened that I didn't have to take er call either, because I was grandfathered in. I had been on staff for 15 years, and I got out of that. So it was a wonderful arrangement. So I just started traveling all over Florida by the 2000s I was heavily invested in, you know, up to 21 locations in Florida by 2010

Paul Shapiro 7:29

Doctor, is there anyone on Earth you think, who has performed the number of vasectomies that you have or anywhere near it?

Dr. Douglas Stein 7:35

Ron Weiss in Ottawa. He happens to be he's now deceased. But Canada is very different from the United States in terms of when you want a vasectomy in Canada, you don't have to reach into your pocket. You've already paid for it through your taxes. So when the time comes, it's very heavily utilized in Canada, quite well utilized in New Zealand. It's paid for by the NHS in England. So again, your question was more, yeah. Ron Weiss did 65,001 of my heroes, ramchasa rom Chandra kaza in Delhi, is known as the father of vasectomy in India, spoke all seven Indian languages. Traveled throughout the country. He says he might have done 100,000 but that might be again, within this traveling and teaching arrangement.

Paul Shapiro 8:22

Are you like LeBron James, like trying to go for the high, the highest score on

Dr. Douglas Stein 8:25

your Oh, no, I have an associate now who handles the bulk of the vasectomies. So I I tapered back probably in 1819, and now I'm focused more on international work, vasectomy training and the administration of the practice.

Paul Shapiro 8:44

I want to get into that international work. I was going to ask you, Is there, like a Guinness Book of World Records for who's done the most vasectomies? But sadly, it would not be you. But let me Okay, before we get into this international work, you mentioned David Attenborough. You mentioned 25 years ago, when the population was at 6 billion, you thought maybe more would not be merrier. Now we're at 8.2 billion. How much of your motivation is based on your concern about total population of Homo sapiens versus, let's say, other factors, like wanting to give men more control over the reproductive destiny, maybe taking some of the burden off of women. You noted Canada, which is an anomaly here in that globally, the rate of tubal ligations to vasectomies is like 10 to one in Canada. It's quite different. But including the US, there are way more tubal ligations, which is a far more complex surgery than a vasectomy, obviously. And yet, still, women are the ones who are getting these types of sterilizations done? So how much of your motivation doctor is environmental or something else? Aside from that,

Dr. Douglas Stein 9:50

I'll comment first on a lot of tubal ligations women are very become very comfortable with. Having their most private parts examined. They start with pap smears or exams when they're you know, late teens, early 20s, they become pregnant. They get examined every month they have a baby. They're getting examined every 15 minutes to see how the pregnancy is progressing. There's a shift change. So now another complete stranger comes in and examines their most personal parts. Then they go for all sorts. So women are become comfortable with their gynecologists. Women become comfortable, well, I shouldn't use the word comfortable. They become resigned to the fact that they are examined periodically. Men aren't like that. You know, I think even me, I may have had a hernia exam when I was in high school. But other than that, nobody has really done a full genital exam on me. So the idea of a man going to a complete stranger and revealing his most private treasures to that and having that stranger work on them, that's a big deal for a guy, and I appreciate that. But a woman, that gynecologist is her friend, he or she has already delivered the babies. There's a trust established there the gynecologist as well as it time for a tubal. She says, Sure, I'll be happy to do that. You see what I mean? There's is it type or does you want? Does your husband want to have a vasectomy? I can refer him to a stranger. What's easier? Go with the go with the known commodity or fear of the unknown.

Paul Shapiro 11:35

I do want to just dispel a couple myths while we're on the topic of male reticence here, because I've talked to so many people about vasectomies, and it is shocking to me how much unfamiliarity there is with it. I've had people who told me they thought that it literally meant castration, like you're actually removing the testicles. I've had people who thought that it meant that when you ejaculate, nothing will come out. I've had people think that it's going to affect their testosterone or their erections like none of that is true. As you know, these are all myths. But I do think that in addition to what you're saying, there's just a lot of lack of familiarity about what a vasectomy actually is, just snipping of the best difference, you still ejaculate. There's no effect on any other, any other component here, and I think that's part of it. To be honest with you,

Dr. Douglas Stein 12:21

I agree. I agree, but that's our job to keep with the education. I often tell trainees that about half of their job is going to be vasectomy. The other half of the job is going to be education and promotion of the service that they provide. So if they don't have a good website that has a nice page that explains vasectomy, if they don't have a nice brochure that they can leave a stack in the barber's office or in in the driver or they can't leave it in a public office. But sometimes the barbers will put up a stack of your brochures. Or you just, if you don't have a billboard out there that says easy vasectomy, at least a billboard, and that what, that's what started. The fascination for my billboards is really what started the movie, the vasec, the documentary film called the vasectomist. And that's sort of the underlying theme that outdoor, outdoor promotion of it. But let me, let me go back to your, your first question, what? What motivated me? I think there are in in this. I think there are basically three motivating factors that I have seen among providers of vasectomy,

Paul Shapiro 13:22

and particularly one provider, Doug Stein. What is Doug Stein's main motivation? Environmental, okay, and and so your your concern is 8.2 billion miracles is a lot of miracles. And we are scheduled to be at about 10 billion miracles by the year 2050, prevent. You know, presuming nothing catastrophic occurs between now and then, and if we can voluntarily help to reduce fertility, then that would help to ameliorate some of the pressures that we're putting on the planet and the rest of the species. Am I accurately assessing your point of view? Okay, yes,

Dr. Douglas Stein 13:57

and we think that about half of the pregnancies are

Paul Shapiro 13:59

unintended in America or around the world, or half of, oh,

Dr. Douglas Stein 14:04

in America, according to the Alan Guttmacher Institute, but certainly around the world, from what I've seen. In other words, you have your two I consider an unintended pregnancy, anything that happens after if somebody touched you with a wand and rendered you infertile, you wouldn't mind. In other words, you have your two. You're perfectly happy with your two. And if someone touched you with the wand of infertility and rendered you infertile, you wouldn't mind. That is what I mean by unintended anything that happens after that, whether you're not pulling out on time, or your, well, that's, that's the case in mo or a condom fails, or whatever it is, that's an unintended pregnancy in my book.

Paul Shapiro 14:52

Do you have, do you have your two Do you have kids? I

Dr. Douglas Stein 14:55

do I have to? I had my dystectomy when I wanted to be sure that my daughter, I. Wanted to, I wanted to be sure that my daughter was, you know, strong and healthy. So I had my vasectomy a year or two after she was after she was born, but was really careful during that winter, I didn't, I didn't

Paul Shapiro 15:12

want a third. On episode 90 of this podcast, we had Dr sguine, who is perhaps most well known for his mobile vasectomy clinic. Yes, vasectomies on wheels. But what really struck me the most was that the response from listeners was less about his mobile vasectomy clinic and more about the fact that he literally vasectomized himself to show how easy this surgery is, that he one weekend at home self, vasectomized. And the thought of a guy vasectomized to himself is, you know, totally mind blowing. So you said you had your vasectomy. I'm guessing you didn't do it yourself. Somebody else did this

Dr. Douglas Stein 15:49

for you. I did not. I always say that the scrotums are all about the same when you're in the gym, not too much. You can't tell from the other side of the gym that one's much different from the other. But when you get down to the nitty gritty of doing a vasectomy. There are thin vases and thick vases, thick walled scrotums, thin walled scrotums, short spermatic cords, longer spermatic cords, in some cases, prior surgery, in some cases, very retractile testes. You know the when you get cold and they yank up on you, like that. So not all the vasectomies are the same. There's a very nice variation from one patient to the next that always keeps you on your toes. Esgar might have judged that he had pretty easy anatomy.

Paul Shapiro 16:33

Yeah, I don't know. I don't know how one would know what your vas deferens are like, but maybe he had some intuition about it.

Dr. Douglas Stein 16:39

I'll just say real quickly, the vas deferens feels like a piece of al dente spaghetti surrounded by overcooked angel hair pasta. It's basically a tube that's a little stiffer and a little thicker than everything else around it, and your job is to be able to pick that out, and there's a lot of olive oil all over all that pasta, so it's trying to slip out of your fingers, but your job is to be able to lift that up, isolate it from that from the angel hair pasta, bring it up to the surface, and then anesthetize it and deliver it from the from the through the skin. So there is a variation from one person to the next in the level of difficulty of doing vasectomies. But you know, I had done seven on the day that I had my vasectomy done, and really, actually kind of like, it's like, it's almost like I was ready to lay back and let someone work on me instead of me always working on someone else.

Paul Shapiro 17:35

All right, fair enough. So, speaking of you working on folks, we're going to include the link to the documentary about your life and your mission. Again, it's called the vasectomist, which is available for free on YouTube, but we're going to include it in the show notes for this episode at business for good podcast.com so people can watch it. But the documentary focuses on your work in developing countries that have very high fertility rates, primarily the Philippines and Haiti. You go, and especially, you go to the Philippines, and you put up billboards that essentially say, I'm going to pay you $20 to get a vasectomy. And it is amazing. First of all, how many people line up to do this, right? They have lines out the door of people who want to come and get this vasectomy from you. But there's also a lot of resistance. You have religious resistance. You have resistance you have resistance from people who think it's going to make them so called less of a man. What led you to think, Hey, I have a good practice here. I'm making a living doing something that I love. Vasectomies here in Florida, I'm traveling around. I'm high in demand. What made you think I should be doing this in the Philippines in the

Dr. Douglas Stein 18:38

late 2000s around 2008 at an American Urological Association meeting, I met a fellow who was a Filipino American. He had seen my billboards, and my billboards had said, no needle, no scalpel. He practiced in Lebanon, Pennsylvania for years, and then retired to Naples Florida, and he saw a billboard down near Naples, Florida, and he got in touch with me, and we met at the AUA, and he said, can I come and watch you do vasectomies? And he loved it now, since the late 90s and throughout the 2000s again, this is the late 2000s 2008 2009 he had been going to the Philippines on medical missions. And he was doing urology over there, you know, squirrel swellings and WIPO, nothing, not taking out kidneys or anything, but doing minor, minor things. And the lines always got longer. Every year the line was longer and longer. And he said, Wait a minute. We can't keep up. Even if he was with an organization called the Bisaya Medical Association, and even if we bring more Filipino American doctors to the Philippines, we can't keep up with the with the demand. There's just too many people. So he started doing vasectomies there. And. In 2000 and he formed a group in 2002 incorporated in Pennsylvania, called no scalpel vasectomy International. I'm even reading my wearing the shirt for that. And he went to the Philippines during the 2000s met me in the late 2000s with this no scalpel business, he felt that this would really put the gap, you know, you know, put the gas under this, this program that they had, boy, this, this might be really a crowd pleaser in the Philippines. So we invited me to the Philippines. He said, Wow, the Philippines, like, that's like, on the other side of the planet, isn't it? And he said, Yeah. I said, I didn't know. My heart just soared. The idea of going to this remote place and doing the thing that I love to do best was, Wow, I couldn't believe it. So we went to the Philippines in February of 2010 that was the start of me doing this. And that was the year of the hurricane in Haiti. It it just so happens, not the hurricane, but the earthquake in Haiti. And it just so happened that by me running around in Florida, a pediatrician who was married to a Haitian, picked up a kind of a middle of the night, picked up this journal called the business of medicine. You're the you're the podcast for good. It is the business of medicine, and I was the cover story the business of vasectomy. And it told about me running around in Florida. And he got in touch with me, and he said, Could I come when you come to Orlando? Can I come watch you? And I said, Sure you can. So he told me then about his wife's cousin in Haiti was running around doing the same thing. So I said, Well, have your cousin come on up. Your wife's cousin come on up, and he can run around Florida with me, and maybe we can orient that toward Haiti. And sure enough, that developed the Haiti program. Lot of things happened in 2010 at the same time in 20 later, in 2010 I got an email from a doctor in Nairobi, kasumu, Kenya, actually, who said that his wife was at a wit's end. She couldn't do take any other forms of contraception. They had had their two sons. He tried to get a vasectomy. It was so hard to find a provider in Kenya, and finally he did, and it was like, Wow, this was great. We need more people doing this. So somehow he found me, and although he had never been out of Kenya, Uganda and South Sudan in his whole life, he was motivated enough to take flights to London, Detroit, and down to Florida. And I wasn't going to pay his way. I said, But, but Charles, if you can get over here, you can put your wallet away. When you get here, I will teach you everything I know about vasectomy. You can stay at our home, and that's what. And then, after he trained with me, he invited us to go to Ken, to Kenya. And that was the that was the involvement of Kenya. Now, Kenya wasn't in the documentary. Jonathan stack also, 2010 was thinking about doing a vasectomy, doing a documentary about his own vasectomy. And someone in New York who had been to train with me said, if you want to know about vasectomy, you really need to talk to Doug Stein. So he looked at me up and he came to Florida. And shortly after, after interviewing me about doing his vasectomy and my stories about going to the Philippines and to Haiti and to running around Florida, he said, Wait a minute, this documentary can't be about me. This has to be about you. I said, that's fine. I don't need a documentary about me, but I I'd like something that sort of tells the world about vasectomy, just as you Paul were saying, there's so much misinformation about it. What could be better, you know, to reach huge numbers of people, than a documentary film? So he went with us in 2011 to the Philippines and to Haiti. And when we determined that in March, and when we determined that we were going to Kenya, he said, No, no, I have enough. I said, Jonathan, this is Africa. Man, this is big. You've got to come to Kenya. So we came to Kenya with us, and a lot of documentary footage was taken in Kenya, but the documentary was financed by Australians, and if it's financed by Australians, the final final edit has to be an Australian editor, and it has to premiere in the country that financed it. So It premiered in 2013 at the Adelaide Film Festival.

Paul Shapiro 24:43

Let's go back to the documentary. You're in the Philippines, and you're putting up these billboards now, there is one objection, simply to vasectomies, right? You have, like the Catholic Church in the documentary, where they're they're just concerned about family planning in general, which they think goes against the bill of. God, let's get to that in a minute. But before we do, there's the other component, where you say we'll pay you. It's not just that we're going to give you a free vasectomy. We're going to pay you to get a vasectomy. Now you claim in the documentary like this is so that they can afford to get it done, right? They're missing a day of work. They got to transport themselves there. It's not supposed to be a payment on top of it. It's supposed to be basically compensating them for what they would

Dr. Douglas Stein 25:23

have missed and for their transportation, because some of them have come from long distances.

Paul Shapiro 25:27

Your critics are saying, hey, you know, you're taking advantage of people who are very low socio economically, and they just need the money. What's your counter argument to that? Is it simply that, you know, they're what that it's not really a large enough sum to effectuate that type of incentive. Or what is it? What is it for you that you think this is actually the right thing to do, the right policy

Dr. Douglas Stein 25:49

that got started because when Ramon, my friend, friend who got me involved in the Philippines, went to Davao in the southern part of the Philippines, the mayor was a guy by the name of Duterte, who later became the President of the Philippines, as you know. And Duterte was a very strong proponent of contraception, maybe even limiting family size, because the slums in the Philippines, whether you're in Manila or Cebu or in Davao, are massive. It's just people living on dirt floors, you know, corrugated aluminum roofs, rains in, cooking their food on little fires, and invariably, there's just not enough infrastructure for alternative forms of conference contraception. I'll get into that in a minute. But, you know, if the clinics are overwhelmed, where are you going to get your birth control pills after you've had five kids? Where are you going to get your IUD after you've had four kids? You know, so even the families were sort of overwhelmed with children. And again, Mayor Duterte felt that, you know, what can we do to just sort of sweeten the pie a little bit? They're going to lose a day's worth of work, and if they don't, you know, if they're not driving a tap tap that day, they may not be able to feed their family. In addition, they may have to go to the other side of Manila to go there and arrange a ride back, because technically, they're not supposed to drive their motorbike or their tap tap back to where they live. So let's give them a little something to sweeten the pie a little bit. Now, I think that that goes in other ways. Everybody likes to know that they did the right thing. And you know when you tell that little girl that if she gets this shot, she's not going to get whooping cough and she's not going to transmit whooping cough to everybody else, she doesn't care. She does not want that shot. But if you give her a Cinderella sticker, if she knows she's going to get a Cinderella sticker after that shot she's all in, or a Spider Man sticker. In the case of a boy, if my dentist doesn't give me a free toothbrush and a little tube of toothpaste when he's done with me, I'm out of there, not really. But the point is, everybody likes a little something to say, you know, you're a good guy, you did the right thing.

Paul Shapiro 28:24

I understand where you're coming from, and I do think that adults are a lot more like children than we think. We may not want a sticker on a lollipop, but, you know, we want something. Now, in the documentary, it's very clear that the Catholic Church is concerned about what you're doing, because they are against family planning in general, right? It's not that they're against vasectomies, per se. It's simply that they are against family planning and they think that, you know, you should have as many kids as God decides he wants you to have. Okay, what is your response? I mean, people, I mean, it's a very Catholic place, but yet people are still lining up in droves to get these vasectomies. What is your counter argument to that? Like when people say, Well, you know, I don't want more kids, but the church is against doing this. What do you tell them

Dr. Douglas Stein 29:08

if it's not in your heart or you think that it's a sin to do it, well, then that's your free that's your prerogative to do that. I We're not forcing anybody to get a vasectomy. We're here. If you want us, fine. If you could reconcile that with your religious beliefs, then fine.

Paul Shapiro 29:28

Do you get threats from anybody? Nobody's ever threatened.

Dr. Douglas Stein 29:31

No, no, not within the Catholic faith. I don't have any experience. Well, I don't have any experience with a Muslim country. We've never gone to a Muslim country. So I don't know whether somebody who I think that if you shoot an abortion provider in the United States, you're going to jail. If you shoot a vasectomist in the Philippines, you're going to go to jail. So I think that I feel protected and safe even when there is. An opposing group. It may be an oversimplification on my part, but I look upon religion as a competing business. What is the business of religion? What is the business of a priest? It's to save souls, and the more souls they save, the more points they get from who's ever raiding the priest or the church? So at, you know, if you're if you've got a church of 1500 people versus a church of 500 people, who's the more important leader of the church? It's the guy with 1500 parishioners rather than 500 so, so their whole being is organized, is manifest in saving souls and having more of what they have, which is followers or parishioners. Walmart wants more stores. I want to do more vasectomies. They're just sort of, you know, varying business interests.

Paul Shapiro 30:58

Okay, fair enough, let us then think about your motivation, doctor, so you're primarily motivated by a concern about environmental pressures. Needless to say, the average American puts far more pressure on the planet than the average Philippines resident or the average Haitian in terms of carbon pollution, meat consumption, trash production, plastic use, air flights like you know it's it's very clear that an additional American is not the same as an additional Haitian on in terms of the planet's concern. Is it appropriate? Do you think to have a similarly missionary type approach in the United States, where you might pay people now 20 bucks may not be enough, but where you pay people to get vasectomized in the United States or other countries that are very high footprint countries

Dr. Douglas Stein 31:47

before that, let's talk about the motivations for being enthusiastic about performing vasectomies. Another big motivation is the people who are oriented toward women. Women have done enough. They had the periods, they took, the contraceptives, they tolerated the pregnancy. They had to go through the deliveries. Isn't it time for men to step up to the plate? And what we're really talking about is that interval between children and menopause. You're 35 you've had four kids. You're totally fulfilled. Now, what are you going to do for that 15 years between children and menopause, take birth control pills until menopause. You have an IUD until menopause. I don't know. You can do it. You can do those if you want. But vasectomy is so easy, it's so dependable, it's so what do it once and you're done?

Paul Shapiro 32:46

Should somebody be offering vasectomies in the US that you get paid to get them? Right? It just like in the Philippines or other countries where you're offering people, let's say, $20 should there be somebody in the US who is offering or even some charity, maybe world vasectomy day, that is offering some higher amount to say, we will vasectomize you for free and give you this incentive.

Dr. Douglas Stein 33:09

Where are you going to get the money to pay the providers?

Paul Shapiro 33:13

Well, where, I don't know. Where do you get the money for the Philippines? Where does all those $20 at a time come from

Dr. Douglas Stein 33:18

the doctors who go, have gone to the Philippines with me, traditionally, on missions pay, I don't know what we were, what we were charging 1000 or $2,000 to help pay the staff who works for us and to provide for those payments to patients and payments to facilitators. The the countries vary a little bit from from setup to setup. I'll give you an example in Haiti, the people who did that, the doctors who thought it was such a super experience. Now these aren't untrained vasectomists. They just thought that it was such a such a wonderful cultural experience, and it gave them an experience to be with super trained, well trained by virtue of practice, vasectomists, and work alongside them, such that if they had a challenging case, they could call me at the next table and say, Hey, Doug, can you give me a hand on this One that that to them was worth what they paid to do it. That's where we got those $20

Paul Shapiro 34:25

is, yeah, and that circumstance where, let's say there was either a Climate Foundation or a wealthy philanthropist who said, Hey, Doug, I'm willing to donate $5 million a year to this effort. And you can, you know, you can use it for whatever you want. Would you use some of it to do incentivized vasectomies in the US or some other low fertility country that is high impact on the environment?

Dr. Douglas Stein 34:53

I don't know if we would get to the point of paying patients back. In 2001 maybe 2002 I thought of that very same thing. In fact, I established a nonprofit called the vasectomy Support Foundation, which would pay doctors to do vasectomies on men whose counties were either didn't offer coverage through title 10 funds, or they had run out of title 10 funds, and it worked a little bit. It never really got off the ground in a very robust way. But that idea has already, has already come up. In other words, there's, let's say there's a vasectomy provider in Sacramento, California, and that vasectomy provider is charging $400 for a vasectomy, but he also is contracted with Aetna united, Cigna and Blue Cross. And so sometimes the patients are paying patients who have a 2000 $2,000 deductible, and it's January, haven't met it. They've got to come up with a Blue Cross allowable, which might be 450 and so they're they're paying in that they what your question is, would this organization pay that patient his deductible so that nothing came out of his pocket? That could happen, but it could be logistically complex, and in the United States, if you have to put up some money for a vasectomy, you might still be able to pay your feed your family that night. Chances are you already have a car so you can get to your vasectomy place without hiring a tap tap or a tuk tuk, or whatever those things are. You know, those public transportation things. So I don't know if I would do that. We have a lot of the patients are insured. Hopefully that will stay that way, unless the Affordable Care Act isn't refunded by the Senate.

Paul Shapiro 36:53

Okay, you're mentioning government policies. Let's talk that. So now there are a number of countries like Japan and South Korea, and some in Western Europe and even the United States, where fertility rates are now below replacement. Of course, there's still immigration. So some of these countries are not in experiencing population decline, but some of them are. So you have some of these governments that are trying to increase fertility rates. They're trying to incentivize people to have more kids, generally, without any success at all. They're offering financial incentives, they're offering tax breaks, all types of things to get people to have more kids. And it seems like, though, governments in the past have actually been effective at slashing fertility rates, but they seem to get them up. So like you know, China went from around six kids to under two due to massive government family planning campaigns, contraception, robots, and, of course, the one child policy, India, Iran, Bangladesh, South Korea. All of these were once in the not too distant past, pretty high fertility, where women were having six, seven kids, and now they're generally at or below replacement. What do you think that government should do to continue the practice of slashing fertility rates? It doesn't seem like they figured out how to get the figured out how to get them to go up yet, but they certainly know what to do to get them to go down. What of those programs gets the Stein seal of approval for helping reduce fertility rates?

Dr. Douglas Stein 38:13

Let's take a country that has pretty good infrastructure. Birth control pills readily available. IUDs readily available. You're in Germany, Italy, fairly high standard of living. You go to your clinic, you're going to get an IUD or birth control pills, easily done. You're in the middle of Chad, and you may not have birth control pills or IUDs at your local clinic. In fact, it might be especially low for the past year because USA ID has been canceled, and USA ID has been very instrumental in providing contraceptive options to exactly the countries that we're talking about. Those, you know, those, quote, unquote, third world countries who are in whose whose population growth rates exceed their ability to provide infrastructure growth that a com that accommodates that increase in population. When it comes to the, say, the first world countries, not only do they have better alternatives to vasectomy in terms of just availability, that's where you come into the well, isn't it time for guys to step up to the plate? Why would a Why would a German guy ask his wife to continue birth control pills from children until menopause, when he can easily get this when he can easily get this done? So then it becomes kind of a matter of, you're not trying to do vasectomies to decrease population growth rates, because they don't have a high population growth rate, and kudos to them for not having that. Because as our technology improves our our skill at resource extraction gets ever better everywhere we look, our ability to to extract resources. Is is improving, which drives the cost of those down and and drives our individual consumptions ever higher. So can the planet handle a stable population? Maybe, but it should certainly do better if we had a dwindling population. Now, there are those people who say, Yeah, but pretty soon, you're going to have a bunch of old people and not enough young people paying taxes to support those old people. I have a lot of faith in human ingenuity, and I think that any species who has figured out how to put 8.3 billion copies of itself on this planet. Can surely figure out how to take care of some old people with a dwindling tax base.

Paul Shapiro 40:51

Okay. Interesting point. I share your your confidence in human ingenuity, especially when there's 8.3 billion brains to try to figure something out right now that raises the question, then, if 8.3 billion is is too many, presumably 6 billion was too many, is there a number that you think is the appropriate number of humans that presuming that we're all enjoying a high level of welfare and our needs are being met, right? So not people who are living in squalwood poverty. Is there a number that you think if the population were to dwindle to that number would be appropriate?

Dr. Douglas Stein 41:27

Yes, 3 billion. And I don't say that, and I didn't pick that out of the hat. I'd like to show you a book up here, but I won't, I won't interrupt to get it. It's called a planet of 3 billion, and it's written very well referenced book by a fellow. I'd have to look for the book to get the thing, but it's right in one of my shelves. It's called a planet of 3 billion, and it explains that in our world of increased efficiency of resource extraction, anything other than a decreasing population is just kind of a time bomb. Now it also depends on what kind of a planet you want. If you feel that you're enriched by biodiversity, then you'd like a biodiverse planet. And you know is, is having 1000 elephants still in zoos, still enough? Or does it give you a feeling of fulfillment to know that there are still 800,000 elephants out there roaming freely? It sort of just depends on, on what you think is the best use of this one living planet that we have. And if you think, you think that we're all images of a supreme being, and our job is to coat this planet with images and likenesses of ourselves, Well, I'm not going to be able to fight that. I personally think that biodiversity is a wonderful thing, and I like to go to places where, you know, I can, I can hike through a wilderness area and see another hiker, you know, every hour. But when you go to a wilderness area and you're seeing another hiker every five minutes, you know, how much of a wilderness experience is that? So I think quality of life is almost directly proportional to population density on a country by country basis.

Paul Shapiro 43:18

Yeah, and I guess, and we'll link to that the book you referenced doctor in the show notes for this episode of business for good podcast.com and it really does seem to be dependent on what type of footprint each of those several billion people have, right? So if they're eating a lot of meat and flying a lot, for example, that's a much less biodiverse planet, right? The raising animals for food is the leading driver of biodiversity loss. So the question is, you know, what is the lifestyle like for those people? And one of the reasons I'm optimistic about human ingenuity is because I actually think we're going to figure out ways to produce protein for ourselves that are going to be far more efficient, that don't involve raising so many billions of animals for food. And there's a zero sum game played between all of these farmed animals and the number of wild animals who are out there, you have more of one, you have fewer of the other. So I'm optimistic about that, and I would love to see a world where we have space for non humans as well. That brings me then to the question, are there other resources, doctor that you would recommend? So we've got the book you referenced. I'm going to also reference the David Edinburgh documentaries that you mentioned, which I'm a huge fan of his, too. Is there anything else, though, that you would recommend that people check out if they want to learn more?

Dr. Douglas Stein 44:28

Well, the organization world vasectomy day, we don't have a book. You know, it's not a is not a book, but it is a website. WVD, dot, O RG, which kind of is a is a Living Documentary of what we've done through the years. It's podcasts, kind of like this, webinars, actually. They're not podcasts. They're webinars, which are have all been recorded, and they go into such interesting topics as, should you be offering vasectomy to 19 year old American guys? Should you. Be performing vasectomies. When a couple comes to you and says, you know, I have a disabled son who's 21 now, and he lives in a group home, and there's so much that he can't do, I just don't want to see the poor guy deprived of sex. So will you do his vasectomy? You know, that kind of thing, these very complex issues that encompass family planning are sort of addressed. So for resources, I would, I would most highly recommend the world vasectomy Day website and some of the webinar, some of the webinars that have been recorded on there, and they will reference getting involved donating to world vasectomy day, where we're going. This past year we were in Argentina. The year before that, we were in Zambia. The Week every year there is a celebration of men who have chosen to go the vasectomy route, and a celebration of the doctors who provide that service. Great.

Paul Shapiro 45:57

Well, we'll certainly link to wvd.org so people can check it out, I will say I am a personal donor to the organization, so I'm grateful for Thank you. Thank you the work of it. I will note I know a lot of guys who share your motivation in terms of the environment and animal welfare who have been vasectomized since they were very young, maybe not 19, but certainly in their 20s. And you know, several of them had a hard time finding a doctor who would do it right. These are people who had zero kids, and they just said, I don't want kids. And the doctors thought, well, you're going to change your mind. I don't want to do this. And I always thought it seemed so paternalistic to tell an adult what they can and cannot do with their own body. And I always thought like if this kid, let's say the 19 year old, goes to a tattoo shop and says, Oh, I want to get a tattoo on my back or on my face. You know, you might think, Oh, well, that's a bad idea. You're going to regret it. But nobody thinks that that should be illegal to do, right? Nobody thinks they shouldn't be able to do it. The tattoo 18 in Florida. 18 in Florida, the tattoo shop isn't going to turn them away, right? That tattoo artist is not going to say, No, I'm not going to perform a tattoo for you. And I just think, you know, people should be able to do with their own bodies what they like. So anyway, that's an interesting thought. I find that far less ethically complex than some other people might though. Now, finally, is there anything that you wish existed, either a company or a business idea or some mission somewhere, or government policy that you think would be conducive to advancing the goals that you have devoted your life to. Oh, a

Dr. Douglas Stein 47:29

government policy Absolutely. Well, in the United States, we do have title 10, which is a wonderful thing, but I can only speak for the state of Florida. No. Title 10 is, as I said, is a program established in 1970 it's under the Health and Human Services, the Office of Population Affairs. And money is dispersed. It's about 280 5 million per year, about $1 per less than $1 per American to the biggest 50 title 10 providers, which are the health departments of the 50 states, and then there are another 35 independent providers, but the money goes to Florida, and then the Florida Department of Health disperses it to our 67 counties. But the counties have a lot of autonomy. I mean, some counties just don't, don't promote it. And you know, they'll, they'll contract for one vasectomy per year, and none of the title 10 funds are used to promote vasectomy. Some of the WIC and Healthy Start funds are used. You might see billboards about women infants and children's program or Healthy Start programs. You're in California, which is a very nice state in terms of providing community services like family planning, et cetera. But in Florida, it's not quite as nice as it is, and in some of the more community oriented states. So I would say that promotion of that of the funds that we already have available would be nice change of the policy. Why don't doctors do title 10? These are patients who, by definition, are low income and have no insurance. What if you have a complication?

Paul Shapiro 49:04

It's always surprising to me that you have many very wealthy nonprofit organizations that are devoted to advancing climate solutions and environmental solving environmental challenges, and virtually none of them even talk about this issue, let alone put funds toward lobbyists to try to permit the type of policies that you're referring to. And it's always very shocking to me. It's very shocking to me. I just cannot fathom why the environmental groups are not even recommending this as an idea, let alone putting their own largesse behind it. That's a topic for a different episode, perhaps. But for now, Dr Stein, I want to say thanks for your important work. I appreciate it. Check out the vasectomist on YouTube. We'll link to again at the show notes for this episode, and we will hope that maybe one day you'll get above. Dr Weiss, in terms of the number of vasectomies that you have done. We'll see. But I would like to say I talked to the guy and. Better to use than anybody else. That's very nice of you. Thank you. Thanks for listening to the business for good podcast to explore more conversations like this one, visit business for good podcast.com. And be sure to subscribe so you don't miss future episodes with founders, investors, thought leaders and more, turning global problems into powerful opportunities. And if this episode resonated with you, please share it with your network. You never know who you might inspire to be in the business of doing good.

Paul Shapiro
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Ep. 184 - The Food System Isn’t Broken—And Here’s How to Make It Better