Thursday, September 11, 2014

What Does That Penn Study Actually Conclude?

In yesterday's post, Suckers for Strawmen, I responded to an article entitled "A scientific perspective on ‘A New York circumcision controversy,’ by Dr. Daniel Berman, Professor Brenda Breuer, and Professor Awi Federgruen. In support of their claim that there is no reason to believe that metzizah b'peh is dangerous, they wrote as follows:
A 2013 University of Pennsylvania study, moreover, analyzed the relevant evidence and all the prevailing literature and concluded [emphasis added - N.S.] that: “This evidence base is significantly limited by a very small number of reported infections, most of which were not identified or documented systematically. Other important limitations include incomplete data about relevant elements of the cases, the presence of confounding factors, and indirect data sources.”
I took a look at the University of Pennsylvania study, which most readers won't do. Here is the concluding paragraph:
Neonatal HSV infection can cause severe morbidity and death, so mitigating potential risks for infection is critical. Current evidence suggests that direct orogenital suction during ritual circumcision was the likely source of infection in recent cases that resulted in significant illness and death. Future research using cohort or case-control designs that fully capture all of the relevant data are needed to more rigorously examine this association.
In light of a misrepresentation such as this, it's all the more remarkable that the authors describe themselves as "disinterested medical and statistical expert witnesses."

For a thorough dissection of all the errors and flaws in the article, see the Rationalist Medical Halachist's extensive new post, "MBP Again! A Scientific Perspective?"

UPDATE: It turns out the University of Penn has already publicly criticized these people for distorting this study. Joel Betesh, project director of the study, stated, “I do not agree with the way they are portraying our report.” See this article in the Forward, "Penn Researchers Charge Orthodox Misused Report on Circumcision Rite."

UPDATE II: It was pointed out that the writers were actually referring to an earlier unpublished version of the Penn paper rather than the published version. First of all, this itself is dishonest. Second, even the earlier version is not in line with these writers' claims. Here is the final paragraph from the earlier version (from here):
Neonatal infection with HSV-1 carries a risk for potentially severe morbidity, including the possibility of death, so exposure to infection should be carefully considered. The available evidence indicates that circumcision with direct orogenital suction may be a risk factor for infection, but this evidence base is small and significantly limited. Hopefully, future studies will provide additional evidence on this and other risk factors for neonatal HSV-1 infection.

69 comments:

  1. It really doesn't take a rocket scientist to understand that you don't intentionally expose an open wound to another person's saliva. Do we really "studies" and medical articles to tell us this?

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    1. Nope. Not at all. The reason being that those who understand that basic fact don't need the study. Those who don't understand that basic fact will ignore the study.

      So why bother?

      I suppose lies must be fought and truth should be proved.

      But... ach... if people want to be fools and endanger their kids, then....

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    2. The answer is that there is a cost (often very high) to changing people's behavior. There are a lot of things that we do which is much more dangerous than MBP, such as handing over the car keys to our teenage children. We could say "well we already know that giving teenagers control over a machine which they were barely trained on and can kill themselves and others is a bad idea", but there needs to be some quantification and proof, for example, that delaying age of first licensing or that increased education or longer training periods will actually help and how much.

      Over here, it is important to quantify the issue to see whether it is worth pursuing.

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  2. Question:
    We take the bread knife off the table before bentching because one guy 2000 years ago stabbed himself over grief because Yerushalayim was in ruins and we don't want a repeat incident.
    Until relatively recently we covered water at night because of the remote chance a snake might drink from it and leave some venom behind, an incredibly unlikely possibility.
    We don't eat meat and fish together because of some vague unspecified danger.
    But here we have a proven danger that occurs far more often than snakes drinking from water and we lie about it to pretend it doesn't happen?

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    1. But in this case the danger was "proven" by evil atheist reshaim scientists and their so-called "frum" enablers, who are really anti-Semites in disguise or something. It's "not from us" and so it can't (mustn't) be taken seriously. Right?

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    2. Nicely put.

      Of course the "chiluk" between these cases and MBP would be that with MBP we're talking about stopping an existing ritual minhag, whereas there's no "minhag" to have a knife on the table, leave water uncovered, or eat meat and fish together.

      You can also use the Gemara's principle "chai bahem v'lo sheyimot bahem". Where there's a danger to life from doing a mitzvah, you don't do the mitzvah - even if it's a mitzvah d'oreita. And kal v'chomer you don't do it if it's just a minhag.

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    3. Until relatively recently we covered water at night because of the remote chance a snake might drink from it and leave some venom behind, an incredibly unlikely possibility.

      Actually, I still cover my food and so do you. Food poisoning is not a remote possibility. This is an example of something that Chazal got partially (mostly?) right, although their proposed etiology is clearly wrong because microbiology had not yet been invented. And if you look a the sources, you can see they themselves doubted the snake explanation in some places (sorry that I can't give the source here; quoting from memory).

      But of course, I agree with your conclusion.

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    4. Until relatively recently we covered water at night because of the remote chance a snake might drink from it and leave some venom behind, an incredibly unlikely possibility.

      We are still doing this and other things you mentioned because it became world minhagim and because that's how our fathers did. If during thousands of years Jews tried to rationalize and change minhagim, Judaism (and therefore Jews as a nation) would not survive. A very "minor" and seemingly "rationalist" innovations to be Jew at home and be like all outside that started reformism, in a very short time has lead to complete disintegration of some half of Jewry.

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    5. We are still doing this and other things you mentioned because it became world minhagim and because that's how our fathers did.

      That is one approach, but there are others, and and the Rambam did not follow it for the most part. Professor Marc Shapiro shows quite clearly in his "Studies in Maimonides and His Interpreters" that Rambam did not codify many practices that he felt were based on superstition and not halacha. The Rambam doesn't not codify the prohibition on meat and fish; neither does he codify various rules around Ruach Ra such as the need to wash in the morning for that purpose.

      f during thousands of years Jews tried to rationalize and change minhagim, Judaism (and therefore Jews as a nation) would not survive.

      Of course the reverse is also true; if nothing changed, Judaism could not survive. The welcome changes in the education of women is a prime example.

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    6. Rambam did not codify many practices that he felt were based on superstition and not halacha. The Rambam doesn't not codify the prohibition on meat and fish; neither does he codify various rules around Ruach Ra such as the need to wash in the morning for that purpose.

      Halacha and practices of the mainstream of orthodox Jews follow majority opinion rather Rambam.

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    7. Halacha and practices of the mainstream of orthodox Jews follow majority opinion rather Rambam.

      Hardly. What percentage of medical advice from the Gemara do you follow? Maybe 1%? Do you use medicines in most instances on Shabbos? Put out fires? Eat uncovered food if you judge it to be safe? Do you educate your daughters? Learn in English and not Yiddish? Send your kids to schools with secular studies? Use the internet?

      We follow the Rambam's approach to these things in many cases.

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    8. Finally, if the only issue was "avoiding change" the we would presumably trust the Chasam Sofer's judgement on this, since he was against even many of the changes that everyone has accepted today.

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    9. Nobody ever died a painful and premature death by covering food.

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    10. Garnel, nobody does any of those things because they think it's dangerous. They do it because that's what you're supposed to do. Which is the same reason people do MBP - becuase that's what you're supposed to do. It's perfectly consistent.

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  3. Mighty Garnel:

    You are being way too rational about this. Haven't you figured it out? The Mesorah is the only thing that matters-- all else be damned!

    MO

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  4. UPDATE: It turns out the University of Penn has already publicly criticized these people for distorting this study. Joel Betesh, project director of the study, stated, “I do not agree with the way they are portraying our report.” See this article in the Forward, "Penn Researchers Charge Orthodox Misused Report on Circumcision Rite." http://forward.com/articles/175029/penn-researchers-charge-orthodox-misused-report-on/?p=all

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  5. Slifkin - These writers were basing themselves on a previous, unpublished version of the study. Because of the outrage from people like you Penn retracted and significantly changed their study. Failed Messiah had an article on it yesterday. Check it out

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    1. Interesting. You'd think that Berman, Breuer, and Federgruen should mention that they were quoting from an unpublished version and that the final version was different.

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    2. Furthermore, even the earlier version is not in line with these writers' claims. Here is the final paragraph from the earlier version:

      "Neonatal infection with HSV-1 carries a risk for potentially severe morbidity, including the possibility of death, so exposure to infection should be carefully considered. The available evidence indicates that circumcision with direct orogenital suction may be a risk factor for infection, but this evidence base is small and significantly limited. Hopefully, future studies will provide additional evidence on this and other risk factors for neonatal HSV-1 infection."

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  6. I wonder if anyone knows the death rates of babies caused by mandatory immunizations? This article http://www.nvic.org/nvic-vaccine-news/may-2011/in-memoriam--infant-deaths---vaccination.aspx may be eye opening to those who are obsessed with claimed dangers of our thousands years old customs.

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    1. Lazar, unfortunately, your post proves the existence of the very irrationality that you are trying to defend. Your "source" is a political organization, not a scientific one, and their purpose is to promote their anti-vax religion. You, like many other Orthodox Jews, who have unfortunately been trained to take all "modern" sources as tainted, are primed to fall for such pseudo-science. The use of vaccines has saved and continues to save countless lives, and, unfortunately, is it likely that many lives have been lost or tragically affected by the resistance by some to vaccinate. This effects not just the children of anti-vaxxers, but also those of others due to the reduction in herd immunity.

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    2. All medical procedures have fatalities. We do the procedures because they are remedial- i.e. we hope they will cure the patient. Every medical procedure involves a cost benefit analysis.. We hope the benefits, i.e. the cure, outweighs the "cost" i.e. the danger.. However, MBP has no remedial value at all. There is absolutely no medical reason to do it. It does not cure anything and has significant health risks.Therefore , it always fails the cost benefit analysis.. Therefore , it should not be done.

      How can the Charedi world, hang their hats on a Daas Yochid, Dr. Daniel Berman, with respect to a medical issue? No other infectious disease specialist in the world feels that its safe.

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    3. However, MBP has no remedial value at all. There is absolutely no medical reason to do it. It does not cure anything and has significant health risks.Therefore , it always fails the cost benefit analysis.. Therefore , it should not be done.

      It is not done for medical reason, at least nowadays. The reason is to keep our established customs that keeps Judaism alive.

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    4. I think that what you say has some merit, except that it's not that people are always so careful about established customs. For example, the American yeshivish crowd doesn't say Hanosen teshuah, even though most of their parents did.
      The reason today for MBP is not to keep our established customs. It's to keep the customs that are symbolic of Orthodox identity against perceived threats.

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    5. The Chareidi world is not hanging its hat on Das Yochid. Its hanging its hat on 2000 years of tradition...
      Regarding Cost analysis, for the Charedi World the benefits of practicing an age old custom, with Kabalistic and Halachic ramifications according to some (Avnei Nezer, Maharil Diskin) is worth the slight, slight risk!

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    6. Fine, so say so. Don't deny the risk.

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    7. I would love to but the DOH in NYC forces us to go to court and fight with scientific proof etc. Internally we would love to be left alone...

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    8. I would love to but the DOH in NYC forces us to go to court and fight with scientific proof etc. Internally we would love to be left alone...

      This is very interesting. You are forced to lie publicly and in court to prevent the DOH from forcing you to have people sign an MBP consent form which you agree is accurate, but are forced to claim is inaccurate because... Why exactly? Sounds like R Slifkin's explanation is the only plausible one.

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    9. Here is the translation of the Ḥatam Sofer’s answer regarding meẓiẓah be-peh.. See Ḥakirah, Volume 3, pp. 61-62 for the original Hebrew text.

      He makes it very clear that where there is " even a minute danger" it should not be done.

      http://www.hakirah.org/Hatam%20Sofer%20Answer.pdf

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    10. I'm not saying that at all. I'm sure that Dr. Berman is accurately representing his opinion which is just as valid as anyone's. I was responding to the comment above by R. Slifkin that we should just come out and say that we are hanging our hat on our tradition. Unfortunately the courts do not accept that so we need to use scientific evidence, which we believe is valid. However to us internally, even if Dr. Berman would retract his opinion we would still want to perform MBP without DOH interference.

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    11. To clarify, we believe that MBP is required by law and therefore should always be performed (if the parents want to; Im not for coercion and the Aguda is not either). Moreover, the procedure has only very slight dangers as is evidenced every day in Brooklyn and Israel. Of course precautions should be taken and mohalim know that. There is no doubt that the DOH report is based on very incorrect assumptions and greatly overstates the risks, which are minimal.
      Now, as regards to Dr. Berman's work: His articles and testimony is directed towards the courts and public opinion. He believes them to be true and they very well might be. The courts will review the reports and decide accordingly. Our practice as a community is not AT ALL predicated on Dr. Berman being wrong or right. Even if he were wrong we would still object to regulation by the DOH!

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    12. NVIC are not "antivaxers." The organization advocates for safer vaccines (they campaigned for the acellular pertussis vaccine, hardly "antivax",) informed consent and parental choice.

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    13. Charedi4 you are a mecharef and megadef klapei maaloh. In our Torah, it is written "v'chai bahem." The monstrous Molech you worship , a cult following of mindless conformist prioritise headgear over head, death over life, falsehood over truth and metzitzah over retzichah. I believe it is a mitzvah to report your mohelim to the police and the criminal courts; and to take your children from you to a place of safety. Your children don't belong to you "avoday hem - velo avodim leavodim."

      Angry Moniker

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    14. "his opinion which is just as valid as anyone's"

      How post-modern of you. If he's wrong, his opinion is *not* as valid as anyone else's.

      "if the parents want to; Im not for coercion and the Aguda is not either"

      Sounds vaguely Reform to me. If it's "required" (which is nonsense), then shouldn't everyone have to do it?

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    15. NVIC are not "antivaxers." The organization advocates for safer vaccines (they campaigned for the acellular pertussis vaccine, hardly "antivax",) informed consent and parental choice.

      Yes, they are antivaxers, but they are careful to couch what they do in calls for freedom because everyone is for freedom, motherhood and apple pie, and because they understand that to be anti-vax is to make themselves sound nutty.

      Parental choice sounds good, except for two things:

      1) Declining to vaccinate creates what is called, in economics, "externality". That is, when you decline to vaccinate your child, you create risk for other children. Conversely, when you vaccinate your child, you provide protection for other children. And some of those other children have true medical conditions where they really can't vaccinate in some cases so they really need anyone who can tolerate the vaccine to vaccinate. Which also means by not vaccinating, you are "free riding" on other people's vaccinations to protect your child.

      To simplify, you are forced to vaccinate for the same reason that are not allowed to allow raw sewage to pile up on your own property, even though you own the property.

      2) There is a level of medical negligence where even parental choice is not respected.

      Have a look at their "Vaccine Memorial" http://www.nvic.org/Vaccine-Memorial.aspx. This is completely absurd in multiple ways. Beside the fact that this is all self-reported anecdote with no evidence that vaccines had anything to do with the reported results, they don't count up the number of people saved by vaccines nor the number of people harmed due to declining vaccinations. This memorial by itself removes all credibility from the organization.

      But getting back to the point of this post, it shameful that somehow the Orthodox are prone to be taken in by these people. What is the purpose of all that learning if the result is such poor judgement? That is the most disappointing aspect of the MBP dispute.

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    16. MonikerSeptember 11, 2014 at 11:58 PM
      Charedi4 you are [insults redacted]. In our Torah, it is written "v'chai bahem."


      Moniker, do you think that Milah itself presents zero risk? If not, how do reconcile that with your argument here?

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    17. Or indeed crossing a road? Or the Talmud's example of taking a ship, which is prohibited towards the end of the week because a life threatening situation will likely develop on shabbos requiring melachah - so how is it permitted to go on a ship at all? It's a balance of risk and neccesity - shades of grey - or shomer pesoyim in Talmudic dictum.

      Nachmanides thought anger was always negative in his iggeret, and I believe Maimonides agreed in mishna Torah. In this respect they opposed the Talmudic and Biblical tradition of angry outbursts where deserved. Our prophets were passionately fierce in defence of decency and humanity.

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    18. "The reason today for MBP is not to keep our established customs. It's to keep the customs that are symbolic of Orthodox identity against perceived threats."

      Mostly it's kabbala. I know I keep saying this, but there's a reason: because it's true. If you look at any case where large amounts of orthodox/Jews are doing something manifestly stupid and/or wicked and/or contrary to the Torah scratch around for five minutes and you find kabbala. True, there's usually one or two other issues involved, but the consistent one that comes up absolutely every time is kabbala.

      Until you face up to this you are basically playing whack a mole.

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    19. If you look at any case where large amounts of orthodox/Jews are doing something manifestly stupid and/or wicked and/or contrary to the Torah scratch around for five minutes and you find kabbala. True, there's usually one or two other issues involved, but the consistent one that comes up absolutely every time is kabbala.

      If you look at any case where a person is afflicted with a fatal disease, look around for five minutes and you will find an umbrella in the house. True, there are other issues involved, but the consistent one that comes up absolutely every time is an umbrella. (OK, to be fair, they've often also eaten food containing DHMO, but think the umbrella link is more plausible.)

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    20. Unfortunately, the data you rely on to measure the externalities is not only understandably but deliberately skewed (not by you, as far as I know.) There are two main sources of data on vaccine safety: population surveillance such as VAERS, and formal research. A correct risk-benefit analysis depends on accurate data which the VAERS is designed to not provide. VAERS and voluntary VAERS reporting are such a flawed sytem – well documented adverse reports have been submitted but fail to make it to the website – that the only sound conclusion one can draw is that one cannot use VAERS to establish vaccine safety. So that leaves formal research, which of course depends on the integrity of the medical industrial complex.

      This leaves something to be desired; an example of the suppression of evidence was recently published: http://www.ncbi.nlm.nih.gov/pubmed/25114790

      The data in this new paper is not new. It, or rather a selected subset of the data, was used to exonerate the MMR vaccine from Andrew Wakefield's charges that MMR increased the risk of autism. I am certain you favor Wakefield having been struck off. Was it important enough to corrupt the scientific process?

      Perhaps it was so important to the public health that the millions of African-American boys who -- oops, sorry about that evidence we suppressed, but you know, omelettes, eggs, you kids gotta take one for the team so it's all good -- actually had to take the risk without their parents knowing, let alone being allowed to object.

      Julie Gerberding, then head of the CDC, was aware of the adverse but until now unpublished data. She now heads Merck's vaccine division.

      Informed parental consent may be as problematic as you fear. But as things are, we cannot properly assess the externalities without people like NVIC trying to keep things honest. I commend Federalist 51 to your attention: Men, even vaccine scientists, are not angels. Let interest be set against interest.

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    21. The Talmud itself condemns anger in almost identical terms, and if you read MilHmoth Hashem, you'll see Nahmanides could go on an attack tirade like the best of prophets. I don't think that's the best example.

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    22. David: The presence of an umbrella or water is irrelevant. Gavriel (or anyone) can *prove* that kabbalah is a cause. Your argument is the equivalent of someone saying "Look around lung cancer cases and almost always you'll find cigarettes or other pollutants" and you reply "And umbrellas and water!"

      Although I would argue that sometimes kabbalah isn't the original cause, but the reason something nonsensical continues- as here.

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    23. David: The presence of an umbrella or water is irrelevant. Gavriel (or anyone) can *prove* that kabbalah is a cause.

      But his proof was precisely "scratch around for five minutes and you find kabbala". Since, for better or worse, pretty much all Orthodox Jews says Lecha Dodi, Lurianic Kabbala is a common as umbrellas and water and you will always find it if you "scratch around". The proof needs to be better.

      Your argument is the equivalent of someone saying "Look around lung cancer cases and almost always you'll find cigarettes or other pollutants" and you reply "And umbrellas and water!"

      If the evidence was as simplistic as that, then the objection would be valid. Instead, a lot of study went into demonstrating mechanism, isolating elements of causation, and quantifying the risk until it was clear that smoking is really bad for you (and not just because of lung cancer).

      Although I would argue that sometimes kabbalah isn't the original cause, but the reason something nonsensical continues- as here.

      Here is another explanation which has been offered by others: outsiders are telling us that our custom is dangerous. These are the same fellows that enlightened us out of our ghettos and led to a rush for the exits of "observant" Judaism. Time to circle the wagons and claim deep significance for our ancient practice.




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  7. Reminder: Anonymous comments will either be summarily deleted, or posted under a pseudonym of my choosing.

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  8. Regardless of how they may have distorted the article, I don't really understand this blog post. When someone says that a study concludes "x", they don't mean that "x" is written in the physical conclusion section of the article. If the study really came to the conclusion (regardless of where in the article it was written) that "x", then it is fair to say "the study concluded x".

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    1. Lol what? The problem is that they are claiming the study concluded something which it most definitely did not, and as you can gather from that trusty 'conclusion section,' the study actually conveyed something very different. It was not statedlike you claim anywhere in the paper.

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  9. What bothers me the most is when a community is forced to defend its practices using lies and misinformation instead of facing the truth. The issue then becomes how much of the other practices of the community, excluding MBP, are based on lies and misinformation. And that threatens the whole basis of the community.

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  10. American Academy of Pediatrics, the Infectious Diseases
    Society of America, and the Pediatric Infectious Diseases Society all asserted that metzitzah b'peh, is a danger to children, in the legal brief in support of the NYC informed consent law.. These groups encompass hundreds (thousands?) of doctors

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  11. Wait, if Rav Slifkin is now a major posek does that mean we have to refer to him in the third person when addressing him?

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  12. For those of you who cannot comprehend how the pro-metziza people can simply deny factual and scientific evidence I suggest they read "When Beliefs and Facts Collide"

    http://www.nytimes.com/2014/07/06/upshot/when-beliefs-and-facts-collide.html?_r=0&abt=0002&abg=1

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  13. A very "minor" and seemingly "rationalist" innovations to be Jew at home and be like all outside that started reformism, in a very short time has lead to complete disintegration of some half of Jewry.

    Temujin is no fan of Reform Judaism, but such jejune mischaracterisations of Jewish history (a.k.a. the unified Tevye theory of Judaic disintegration) are nearly as bad if one hopes to avoid similar pitfalls. Neither haskala, nor the Reform movement emerged from someone's head at the dinner table while everything was otherwise hunky-dory. The collapse of the political and economic orders of Europe, murderous pogroms, demographic displacement of geographically distant communities, pseudo-messianic lunacies, dysfunctional ultra-mystical obscurantism of popular preachers, the disintegration of the kehilla, the rise of Hasidism and the reaction, a rigidly stratified class system, corruption of the rabbinate and the opening of new social and economic opportunities probably had a tad more to do with the abandonment of what billed itself as tradition than a few "minor and seemingly rationalist" ideas.

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  14. I'm not saying that at all. I'm sure that Dr. Berman is accurately representing his opinion which is just as valid as anyone's. I was responding to the comment above by R. Slifkin that we should just come out and say that we are hanging our hat on our tradition. Unfortunately the courts do not accept that so we need to use scientific evidence, which we believe is valid. However to us internally, even if Dr. Berman would retract his opinion we would still want to perform MBP without DOH interference.

    OK, I misinterpreted the comment "I would love to but the DOH in NYC forces us to go to court and fight with scientific proof etc." as meaning that you would bend the truth for a good cause.

    There are two problems with your assertion:

    1) When the various articles in "Dialogue" are published, they are aimed completely internally. In many parts of the US, at least, there are significant number people who would avoid MBP if they thought that even a small number HSV deaths were the result. It simply isn't true these claims are only for the courts and that everyone that does MBP today would do it despite the risk, if they believed that there was a risk.

    2) The main issue before the court is the religious liberty issue. Hence the case being sent back down to the district court to be judged under a "strict scrutiny" standard. This could be defended as a simple religious liberty issue. In fact, while I think that the MPB proponents are unlikely to win (since there is a compelling government interest and informed consent is likely the least restrictive means, but IANAL), it likely will be based on the notion that the state did not use the least restrictive means or that they singled out religious practice, not in second-guessing the science of the health department.

    In addition, what exactly is being fought here? What is the religious principle against informed consent?

    To clarify, we believe that MBP is required by law

    Just curious: on what interpretation of the Gemara do you base this on?

    and therefore should always be performed (if the parents want to; Im not for coercion and the Aguda is not either).

    Then why are you against informed consent?

    Moreover, the procedure has only very slight dangers as is evidenced every day in Brooklyn and Israel.

    How many cases would rise above the level of slight danger? 1 per year? 10 per year? 100?

    Of course precautions should be taken and mohalim know that.

    This contradicts your thesis. If there is no causal link, why take precautions? If there is, then you have a Safek Sakanah which equals Sakanah in halacha.

    Also, there is no real precaution other than not doing it.

    There is no doubt that the DOH report is based on very incorrect assumptions and greatly overstates the risks, which are minimal.

    There is no doubt? Incorrect assumptions?

    How exactly are the risks overstated? One report suggests 11 cases in 10 years in NYC. Is that low or high?

    Now, as regards to Dr. Berman's work: His articles and testimony is directed towards the courts and public opinion. He believes them to be true and they very well might be. The courts will review the reports and decide accordingly. Our practice as a community is not AT ALL predicated on Dr. Berman being wrong or right. Even if he were wrong we would still object to regulation by the DOH!

    So even if there is a health issue, and even thought you say it is OK to follow other halachic Shitos like Chasam Sofer, parents should still not be informed?

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    1. Lets be clear, No one is against informing parents. We are not trying to ensnare parents into allowing MBP for their children. There is NO serious learned Rabbi who is out on a crusade for exclusive use of MBP. What we are against is the GOVERNMENT forcing us to sign informed consent forms. If the DOH is successful then who knows what the next step might be. The fact is that Brisim are inherently dangerous to some degree, and its in the public interest to regulate it as well. There are campaigns out there as we speak decrying Milah itself (#i2). The next Jewish Mayor may be bothered by the whole ceremony...

      Regarding the sakana: 10 cases out of thousands of cases is a very miniscule risk and is not included in "V'cha Buhem". If it were then driving on highways would be prohibited as well. Safek Sakana is not relevant here. The Chasam Sofer was speaking in a specific time where there was an outbreak of some sort.

      Regarding MBP Halachic basis: Kabbalistically it is an absolute requirement. For us as a community that is as binding as a halacha, especially since there is no strong medical reason not to do it.

      Mohalim take precautions by testing themselves for Herpes and sterilizing their mouths. While its not foolproof, it does lessen the (insignificant) dangers.


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    2. Lets be clear, No one is against informing parents. We are not trying to ensnare parents into allowing MBP for their children.

      This just wrong. The point of all those articles in Dialogue and elsewhere is precisely to convince Jews that there is no real risk at all and all this is made up by those against Milah so that everyone should do MBP.

      There is NO serious learned Rabbi who is out on a crusade for exclusive use of MBP.

      I don't think that this is true. If you think that MBP is required or even just traditional and claimed risks are really FUD, then you want everyone to do it.

      What we are against is the GOVERNMENT forcing us to sign informed consent forms. If the DOH is successful then who knows what the next step might be. The fact is that Brisim are inherently dangerous to some degree, and its in the public interest to regulate it as well. There are campaigns out there as we speak decrying Milah itself (#i2). The next Jewish Mayor may be bothered by the whole ceremony...


      It is incorrect that this is the only issue. But lets take this one up. What do you think will raise the ire of the others against Jews more than the continued use of obviously unsafe procedures (mouth on open wound) which has proven to cause disease and death?

      Your argument is comparable to claiming that we must oppose laws requiring health providers provide health emergency care to all on Shabbos if required by law, because if we allow that, then they'll prohibit all Shabbos observance. Of course, we take the opposite approach.

      Regarding the sakana: 10 cases out of thousands of cases is a very miniscule risk and is not included in "V'cha Buhem". If it were then driving on highways would be prohibited as well. Safek Sakana is not relevant here.

      This is just made up and is obviously incorrect. Let's take a simple example: you have a very tasty soda that you enjoy drinking every day that kills or seriously injures you in only 10 cases in "thousands" let's say 10,000. That would mean death or serious injury in a average of years or say. Make it 10 in 100,000. That would be death or serious injury expected in a an average of 30 years. Not considered relevant? Or course not.

      You are simply being fooled by the fact that you don't see the harm. We drive on the highway (and cross the street) because there are immense benefits to doing so which outweigh the benefits. Driving is in fact one of the most dangerous things we do and would not be justifiable without the immense benefits. That doesn't mean that V'Chai Bahem doesn't apply.

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    3. The Chasam Sofer was speaking in a specific time where there was an outbreak of some sort.

      This is again made up. Read his reasoning.

      Regarding MBP Halachic basis: Kabbalistically it is an absolute requirement.

      You realize that this contradicts the Gemara, don't you? But OK, maybe kabbalah can do that. What is the source? Is there a Zohar?

      For us as a community that is as binding as a halacha, especially since there is no strong medical reason not to do it.

      Again, we come back to the root. There is a strong medical reason, but you don't want to believe it because it goes up against you worldview: how could something endorsed by "kabbalah" be dangerous?

      Mohalim take precautions by testing themselves for Herpes and sterilizing their mouths. While its not foolproof, it does lessen the (insignificant) dangers.

      1) The statistics are not based on theory, but on what has been observed with the supposed precaution you are talking about. If they are already being used, then they can't reduce the risk further than the observed risk. You are double counting.

      2) What test are you talking about? Considerably more than 50% of the population is infected. Are you claiming that the most Mohelim retire early for this reason? Has even one retired? Even the ones that were suspected of transmitting refused to cooperate with further testing because they didn't want their reputations to be harmed.

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    4. OK let's begin with the chasam Sofer: did the chasam Sofer or any of his descendants or students change their method of metziza? They didn't because they believed that it is not meant as ongoing psak.

      Which part of metziza bpeh contradict the gemara, pray tell? The gemara says that metziza is necessary. The Ran is mistapek if its a part of mitsvat mila itself. No talks about metziza "bpeh" specifically but the kabbalists starting with the talmidei Ari so please explain what u mean.

      Regarding precautions: I'm talking about precautions taken since these issue became public. Prior to that people were unaware. Now many mohalim test themselves to see if they carry herpes and if they do then they DO NOT do Mbp. I can't speak to the one specific novel you're referring to but the mohel i used and my friends use test themselves frequently.

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    5. OK let's begin with the chasam Sofer: did the chasam Sofer or any of his descendants or students change their method of metziza?

      According to his Teshuva, the answer is yes! That is why people like to either ignore or suppress it. And this is from the Chasam Sofer who thought that a non-Yiddish sermon should be prohibited because it would be "Chadash". The reasoning still applies. Did you read it?

      Which part of metziza bpeh contradict the gemara, pray tell?

      It doesn't. What does contradict the Talmud is the claim that it is there for something other than as a health benefit:

      WE SUCK OUT, etc. R. Papa said: If a surgeon does not suck [the WOUND], it is dangerous and he is dismissed. It is obvious? Since we desecrate the Sabbath for it, it is dangerous?33 — You might say that this blood is stored up, therefore he informs us that it is the result of a wound, and it is like a bandage and cummin: just as when one does not apply a bandage and cummin there is danger, so here too if one does not do it there is danger.34

      If the Metzitzah is a regular part of the mitzvah, then the Gemara's reasoning makes no sense. Of course you would do it on Shabbos even if there was not danger in leaving it out. Rather, you must say that it is ONLY done to protect the life of the baby (according to their understanding of medicine).

      No talks about metziza "bpeh" specifically

      That is a second issue in addition to the one above.

      but the kabbalists starting with the talmidei Ari so please explain what u mean.

      But then those who follow the נודע ביהודה and Chasam Sofer and do not have "Esek Im HaNistar" should not be doing it. But you don't see that split.

      Regarding precautions: I'm talking about precautions taken since these issue became public. Prior to that people were unaware. Now many mohalim test themselves to see if they carry herpes and if they do then they DO NOT do Mbp. I can't speak to the one specific novel you're referring to but the mohel i used and my friends use test themselves frequently.

      I'm afraid that this is a comforting falsehood that you've led yourself to believe. This woudl mean many more than 50% of Mohelim giving themselves a lifetime ban on Mbp which hasn't happened, and would put them out of business in may places if they tried.

      I'm quite sympathetic, since it appears that on the one hand, you really don't want to believe that anyone is putting any babies at risk, and on the other hand, how could these great people say that there is no problem with MBP? It is hard to reconcile...

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    6. Regarding the Gemara: See Shu”t Avnei Nezer, Yoreh Deah sec. 338, where the author acknowledges that this is the simple understanding of the gemara, but then offers an alternate interpretation, which would define metzitzah as an integral part of the mitzvah. See also Shu”t Meshiv Nefesh 2, sec. 6. The Ran also has a sefak if its integral to the mitzvah. Where these poskim against the gemara? You need to know all the shitos before you make such an broad and, frankly idiotic, statement....

      No Chareidim nowadays follow the ein esek bnistar approach. Both the Hasidim and Talmudei Hagra accepted Kabala as authoritative where it doesn't contradict Halacha. We don't see that split you speak about because that split no longer exists. We have no quibble with the MO who follow that approach, we just don't appreciate them imposing their shita on us like R. Moshe Tendler and others have done.

      On a side note, please don't feel the need to sympathize with us. We are really not that confused and/or worried....

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    7. Regarding the Gemara: See Shu”t Avnei Nezer, Yoreh Deah sec. 338, where the author acknowledges that this is the simple understanding of the gemara, but then offers an alternate interpretation, which would define metzitzah as an integral part of the mitzvah.

      This is long one, but let me try to shorten it:

      1) The Teshuva proves exactly my point. It is clear that is there only for health and would not be done otherwise. His Chiddush is that precisely because it had to be done for health, it was an "implied" part of the Mitzvah from Sinai, which despite the "change in nature" is still part of the Mitzvah because the rules were set at Sinai (similar to the 2000 years of Torah idea of the Chazon Ish). (According to one of his possibilties. According to the other it is not part of the Miztvah). And it is definitely not Me'akev.

      2) MPB plays no intrinsic part in the Mitzvah, only getting blood from all the areas which he claims can only be done with the mouth directly.

      3) None of this would make any difference if there was actual harm involved which people normally avoid. If that was true, then of course it could not be done. When he discusses the possibility of harm, he mentions 3 things:

      A) Maybe they are wrong.
      B) The Mitzvah provides protection.
      C) Since people do it "God watches over fools".

      Going to our present situation:

      A) This is not conjecture. By modern medical standards that we all use everywhere else, one should not put a mouth on an open wound.
      B) The danger is present and the Mitzvah has not protected these babies.
      C) The germ theory of disease is not something that the public ignore, so this heter doesn't apply (as they ignored astrology in the Gemara's time so that having a bris on a dangerously inauspicious day was allowed).

      I'll add that the T'shuva has a factual premise that we now know to be false: that somehow the germ theory of disease is new and "nature has changed". It was not safe or beneficial at Sinai to put one's mouth on an open wound.

      If you took the Avnei Nezer seriously, here is what you would do: you would use something to draw blood from all possible places followed by using a tube. This would get all aspects of his Teshuva without inviting a danger.

      BTW, there is one other huge problem with your proof from the Avnei Nezer: it is clear from his Teshuva that he was first and foremost concerned with those who he felt were getting rid of Metzitza because it provided no help, not because it did harm. This is either equal to or very close to the reform position. If so, his preference for his own chidush in the Gemara could have been influenced (rightly) by his need to make a polemic statement towards those who would changes the Milah process due to perceived non-optimality rather than a true danger.

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    8. No Chareidim nowadays follow the ein esek bnistar approach. Both the Hasidim and Talmudei Hagra accepted Kabala as authoritative where it doesn't contradict Halacha.

      I think that this is wrong, although it would take a much greater scholar than me to prove it one way or another. I believe that many or most Charedi Misnaged poskim didn't or don't even study Zohar and would probably put it at the level of a Rishon at best for halacha. In any case, the Zohar doesn't override Sakanah which is what R. Tendler and others are concerned about. They don't care if you feel the need to wash off the Ruach Ra before going 4 amos.

      On a side note, please don't feel the need to sympathize with us. We are really not that confused and/or worried....

      Then why the need to claim that the science is made up or that Mohelim have suddenly changed their ways? Here is how to argue it:

      MBP is a bit dangerous and few babies will die and become seriously injured who otherwise would not have, but we believe that kabbalah tells us that MBP is important enough to do even if it is dangerous, although the Gemara does not support this. If you think that MPB is merely an important Minhag, or that Kabbalah has the authority of a Rishon, use a tube.

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    9. Again, the ratios of Metziza Bpeh are most certainly not considered Sakana according to Halacha. If it were then we would not be allowed to drive cars etc.

      According to the Avnei Nezer and the Ran, it is possible that Chazal considered MBP to be an integral part of Mila for whatever reason. As R. Slifkin explained in Sacred Monsters, the reason we have to listen to Chazal is not because they were necessarily right but because they have the ultimate authority in halacha. As R. Slifkin wrote in Tradition on Parasites:
      "It is the approach of R. Moshe
      Shmuel Glasner (Dor Revi’i, introduction to Hullin) and R. Yitshak
      ha-Levy Herzog (Heikhal Yitshak, Orah Hayyim 29), as stated with
      regard to the case of lice. They acknowledge that the gemara is apparently
      relying upon an erroneous belief in spontaneous generation to permit
      killing lice on Shabbat, but maintain that the halakha remains in force,
      due to the authority of Hazal’s rulings that were canonized in the Talmud.
      This is similar to how R. Shlomo Fisher explains the Kesef Mishneh
      comments on Hilkhot Mamrim 2:1—that we follow all of Hazal’s rulings
      not because they are necessarily infallible, but because of a nationwide
      acceptance of their authority (Derashot Beit Yishai 15)."

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    10. Again, the ratios of Metziza Bpeh are most certainly not considered Sakana according to Halacha. If it were then we would not be allowed to drive cars etc.

      I explained why that is not a proof above: driving has great benefits so that we do it even though it is dangerous. A better example would be driving without a seatbelt. While at on time it was acceptable (because they were not invented, or were not placed in the car in all locations), at this time, it is pretty clear that if you don't wear one that you are likely in violation of halacha.

      Let someone come out and say that X number of baby deaths per year is worth it and see how far they get.

      According to the Avnei Nezer and the Ran, it is possible that Chazal considered MBP to be an integral part of Mila for whatever reason.

      Not "for whatever reason". Because it was thought essential to health, and therefore was implicitly part of the command. If it is damaging to health, it becomes a nonsensical act; in fact, if you think that Metzitza is required as a medical act, you are not Yotzei. How could you fulfill a Mitzvah to do an appropriate remedy after Milah by doing something harmful?

      As R. Slifkin explained in Sacred Monsters, the reason we have to listen to Chazal is not because they were necessarily right but because they have the ultimate authority in halacha.

      This doesn't apply to human health issues. Treifos for an animal don't change. Treifos for a person does.

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    11. "As R. Slifkin explained in Sacred Monsters, the reason we have to listen to Chazal is not because they were necessarily right but because they have the ultimate authority in halacha. "

      1. What David Ohsie said. We don't follow Chazal when it's fatal. E.g. eight month baby, building collapsed on person on Shabbos and no respiration.
      2. Chazal never spoke about metzitzah b'peh. They just said metzitza.

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    12. Whoa, back up a second! Chazal decided that killing lice, which would otherwise be a Issur D'oiraisa, is allowed because of spontaneous generation. You say that Chazal were wrong but it remains allowed because of their authority. What you are saying is that Chazal's psakim were right even were the reasoning was wrong! So how is Metzizta according to the Avnei Nezer and the Ran different? Killing lice is just as nonsensical if spontaneous generation is worng yet you still allow it??

      Regarding Sakana: I think you are being disingenuous when you say that the difference between dring and metzitza is that driving has "great benefits". The halacha of Vchai Buhem does not distinguish between beneficial and non-beneficial acts, as you are well aware. Furthermore, driving is not always for an important reason. In fact, most of the time its just for convenience. Would Vchai Buhem disallow such driving? No it would not! Does Halacha disallow hiking or going on safari in Africa (;-))? No it does not! The reason is because Halacha distinguishes between actions according to the likelihood of hezek happening, and where its only a small chance of danger. According to the numbers, Driving on highways is significantly more dangerous than MBP! Furthermore, for us a Kabballistic Inyan also has "great benefits"!!

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    13. R. Slifkin - You are right that Chzal did not speak of MBP, but the Mekuballim did and as long as they do not contradict Halacha, Chareidim follow their direction. Ohsie claimed that it does contradict Halacha which it does not!

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    14. Chareid4, I think that you are now repeating questions already answered, so I'll let it stand rather than repeating.

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    15. If you want to leave it here I understand. I would leave you with 2 points:

      1. Even if all the evidence marshaled by NYC as to the danger of MBP, it would still not be disallowed by torah law, just like hiking, hang-gliding and other similar activities which present a danger. Danger must be immediate and likely.

      2. If Chazal believed that Metzitza is part of the mitzvah of milah, even if they were wrong, we would still be obligated to perform it due to their authority. This is no different than killing lice on Shabbos which they allowed because of spontaneous generation. Rav Herzog believed them to be wrong, but still allowed it due to Chazals authority.

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  15. At a rabbinical conference in London, Rav Hershel Schachter,claimed 15 Jewish babies die every year in the NYC area from herpes

    http://failedmessiah.typepad.com/failed_messiahcom/2013/03/15-babies-die-every-year-in-nyc-from-metzitzah-bpeh-herpes-hospitals-cover-up-deaths-leading-yu-rabbi-claims-567.html

    ReplyDelete

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