Baltimore, MD – A leading U.S. physician who serves as the Chief of the Division of Infectious Diseases at Johns Hopkins Bayview Medical Center in Maryland has written to Mayor Bloomberg to express his concerns about Agudath Israel’s position on metzitzah b’peh. The letter was made available to VIN News.
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Calling Agudah’s efforts to prevent the passage of the informed consent measure “a terrible disservice to the Jewish community and the public at large” and “a request for political interference in public health practice,” Dr. Jonathan M. Zenilman takes Agudah to task for “troubling and actually contradictory statements” contained in its letter to the Mayor.
He cites Agudah’s statement that mohels may not wear gloves when performing a bris even though “surgical gloves are required in ANY surgical or medical procedure.” Dr. Zenilman also mentions Agudah’s argument that the level of risk associated with metzitzah b’peh “would appear to be a significantly lower rate than that associated with many other common practices and activities….” He refutes this, saying that the studies Agudah refers to “actually underestimate the risk, and represent only data that is obtained in New York, where the disease is reportable.”
Dr. Zenilman further notes that there is a “unanimous consensus” among leaders in the infectious diseases field that MBP carries risk and is associated with HSV transmission. Neonatal herpes complications can include “death, critical illness, delayed cognitive development and neurological complications.” The Agudah’s “acceptance of an avoidable risk, even when low, contradicts any applicable modern standard of care, modern public health practice, and can even be considered as unethical,” Dr. Zenilman wrote.
Dr. Zenilman points out that MBP is not an issue of religious freedom despite the attempts of the Agudah and charedi publications to present it as such. He contends, “When children’s health and safety is involved, the government does have a compelling interest and responsibility to regulate.”
Dr. Zenilman has practiced medicine for more than 30 years, and has extensively researched and published journal articles and books on the subject of sexually transmitted diseases and hospital acquired infections throughout his career. In addition to his role as Chief of the Infectious Diseases Division at Johns Hopkins Bayview, he is also a Professor of Medicine and on the faculty of Johns Hopkins University Schools of Medicine and Public Health since 1989.
Dr. Zenilman has also served as the past-president of the American Sexually Transmitted Diseases Association.
Agudath has allowed this to become an irrational and emotional issue, replete with unjustified claims of anti-Semitism, hysterical claims that City health officials are “…really…” out to ban circumcision …and with all the anti-science head-in-the-sand nonsense of a flat earth society. Do you think they’ll change their tune now? I doubt it
Where are the peer reviewed studies to support his conjecture? Where is the license to ignore the Constitution?
So ny doesnt count?
The Agudah is using the very low Statistical probality of an infant contracting HSV as an excuse to ignore the risk of MB. I’m wondering what is the number of deaths that render MB acceptable or unacceptable risk and at what number would the Agudah back down. 1 in a 1000 deaths? 1 in 500?why is 1 in 5000 more acceptable than 1 in a 100? I’d like a number at which they would agree to back down.
“Dr. Zenilman has practiced medicine for more than 30 years,” but he practiced Yiddishkheit for… I am trying to remember that number… never. Our enemies were able to identify a self-hating Jew-in-name-only with proper credentials. Is that the chiddush?
Couple of thoughts. First off – he refers to it as an “avoidable risk”. Its a good thing that he feels it is avoidable. I guess he is a Posek now. Yes, if you dont hold you have to do MBP then it is classified as an “avoidable risk”. (in which case you wouldnt be doing it anyways). Thats where he is incorrect.
Second, the number given 1/4098 is approximately the same risk of dying from general anasthesia (Mortality associated with anaesthesia: a qualitative analysis
to identify risk factors – Arbous, 2001). So obviously according to this doctor any form of elective plastic surgery should be illegal. It would only follow. That is clearly an “avoidable risk” with a similar danger. (Maybe I shouldnt give Bloomberg any ideas, who know whats next). This is all aside from the halachic definitions of Sakanah (which are not simple at all).
I’ve yet to see a letter from the esteemed Dr regarding the risk associated with “alternative lifestyles” acording to the CDC over 5k people in NYC get infected with HIV yearly the vast majority (over 65 %) thru the above mentioned lifestyle.
Even though it has nothing to do with MBP it does bring in question the Dr. motives if he really cares about the public health how come he dosen’t compaign against that lifestyle???. Hypocrose goes a long way to expose somones hidden agenda.
It is amazing that so many ignorant boors have the audacity to criticize someone who has knowledge and care for humanity. Remember “V’chai Bahem”; MBP is not yehareg v’al yaavor, on the contrary it is almost imbecilic to justify an act that runs contrary to current medical knowledge.
BTW we do not use bankes nor do we let blood. Maybe you guys who are pro MBP still do those things as well. Who knows?
“…Dr. Zenilman further notes that there is a “unanimous consensus” among leaders in the infectious diseases field that MBP carries risk and is associated with HSV transmission. ..”
That is simply not true. There are many doctors who have written to the NYC Bd Of Health that oral transmission is an unproven theory, not backed up by reliable research.
See testimony of Dr. Daniel S. Berman, infectious disease specialis at Montefiore Hospital on the Dept. of Health website.
I wish the Agudah would have been one tenth as interested in what happened to little yiddisher boys’ makom hamilah at the hands of Kolko and Mondrowitz as they are about what happens at his bris.
Sorry, I don’t know a more delicate way to put it.
I never realized that a bris was performed without gloves! I never watched a bris so close up to notice, as a frum woman from the other side of the mechitzah! Wow! I thought I could count on my husband to look out for our sons! I guess he never considered it as he had been conditioned to expect it that way from the hundreds of brisim that he attended up closer. What would be the halachic objection to wearing gloves for a bris Mila?
While there may be a tiny or no actually known case of herpes transmition leading to death, what about neurological impairment? Who would even know what caused an infant’s brain damage (that might later be assumed as congenital) and the costs of raising such an neurologically impaired child. There’s a lot to consider….
I am certain that every reader of this site would sue any doctor who touched his mouth to a patient. Why does the Agudah insist on keeping this practice when many Poskim have come up with alternatives. Loach DeHetera Adif, especially when it comes to protecting lives of children.
I’ve yet to see a letter from the esteemed Dr regarding the risk associated with “alternative lifestyles” acording to the CDC over 5k people in NYC get infected with HIV yearly the vast majority (over 65 %) thru the above mentioned lifestyle.
Even though it has nothing to do with MBP it does bring in question the Dr. motives if he really cares about the public health how come he dosen’t compaign against that lifestyle???. Hypocrose goes a long way to expose somones hidden agenda.
I would accept the research the Aguda has done over this guy any day!! What do you think, the Aguda isn’t concerned for chidren’s safety!!!
Very interesting article in the Ami a couple of weeks ago interviewing Rabbi Belsky shlita.
I put my money with Rabbi Belsky!!
Keep fighting and see what happens.
All we had to do 3 weeks ago was agree to sign a paper that parents understand the risks of it and end of story, but no! We had to put up a fight, so guess what now, the hospitals are chiming in and say no way you cannot do it.
Blame no one but yourselves. Our arrogance comes back to hurt us EVERY SINGLE TIME! we are always smarter and always looking for a way to go opposite of common sense.
Hope you are happy, we will never learn.
Ee efshar lhachazir nefesh achas miyisroel. Have all of you aguda gys forgotten this?? Metzitza is not meakev the bris. If you forget to do it then the bris is 100% kosher. Now there is evidence that it can damge kids or even chas v sholom kill someone the practice which is not meakev must be stopped. All who say that this is antisemitism are just burying their heads in the sand.
I am still trying to figure out the absolute necessity in the first place for the MBP done either B’Peh or via a glass tube. I am not questioning it, I am simply trying to understand the necessity of it. What I seem to gather from all I read is that it is not a Biblical obbligation, but rather a post Bris method to clear the area of any remaining blood which was either implemented sometimes later in time or simply not mentioned explicitly as a crucial procedure during the Bris; the necessity for it is yet unclear to me.
If my assumption is correct that it is a procedure done primarily for health reasons and not as a component of the actual Mitzvah of the Bris, what would be the problem then to do it via the glass tube or via some other effective way? As long as the blood is cleared from the wound immediately post bris?! Surely now that a health risk has come to light, there is no reason to blindly stop an improvement on a procedure now that some health risk is a possibility.
MPB needs to be proven halachically as a non amendable step, and if that cannot be accomplished, then it would appear to be an obsolete and outdated method compared to the safer alternative solutions. No?
I have just heard a story about a Rebbe in Russia, whom upon hearing about the health damaging effects of smoking from a doctor, instructed all who would heed to his directives, to immediately cease the practice, and he himself being a smoker up to that point in time, immmediately ceased as well.
The connection to MBP:
the Rebbe, with all his ruach hakoidesh and complete self annullment to Torah etc, did not, up to the point when the doctor told him so, realise the negative effect of smoking, althou the habit seemed to have had a positive effect on his ability to concentrate etc. The Rebbe was also upset with those Chasidim who were “out in the world” IE business people etc who must have come accross an article in a newspaper or seen advertised somewhere regarding the adverse effects of smoking on health and who did not inform him of these findings.
So too, possibly, would have been the case with MBP had the Rishoinim then known what we know now about bacteria and all other harmful microbes.
Is it not possible then that they would have instructed to use safer alternatives to MBP?
As an aside, looking at the broader picture, generally, an impediment to performance of a mitzvah is a consequence of hisrashlus in that mitzva. The mitzva of Bris Milah is rooted in mesiras nefesh (i.e. Avrohom Avinu). Our materialistic pleasure seeking generation lacks mesiras nefesh. Hence, the attack on Bris Milah.
Medical research has identified as many as 500 to 650 different species of bacterial species that can be found in the mouth, and that there are about 20 billion bacteria microbes in the mouth and that these reproduce every five hours. Yes, medical science has long known that the human mouth is a virtual petri dish. But hey, I am sure there is nothing to be concerned about and that the Agudah have done their research just as thoroughly.
Hey what is so has about signing a waiver.
Years ago, the hillbillies laughed when the government public health doctors told them not to build their water wells near their latrines. The water will get contaminated, and you will get sick.
The tension over MBP, between the government and religion, is one more chapter in a long story. Basically, whenever a new medical or scientific discovery is made, somebody, in industry, or religion, objects. The milk industry objected to pasteurized milk. The auto industry objected to seat belts. The food industry objected to expiration dates. Religious groups have long objected to government regulation of their schools, even secular curriculum, and to child protection laws. Some Amish refuse to put state-mandated reflectors on their horse-drawn wagons, even after getting into nighttime accidents. Today, its MBP and Aguda. The government and the doctors will win, of course, as they should, because they are in the right. Yasher koach, Dr. Zenilman, and to VIN News, for educating the public. Well done!
Dr. Jonathan M. Zenilman only vouches for the “morbity weekly” he dosn’t present one fact of research on his own Dr Berman and Rabbi Belsky wrote thourough articles on the subject I don’t care how many degrees the Dr has I like to read facts and studys I don’t need his haskomah for the “morbity weekly”
Once upon a time the attack on MBP came from “reformists”, i.e., those Jews who wanted to mock the ways of Torah and minhag yisrael in the eyes of the goyim. The fight of gedolei torah against them was ferocious, because the attack was not really for the sake of the children, but against Yiddishkeit. However, now the source is “science” – not necessarily anti-Semitic, but possibly biased in its view and assumptions. Statistics can be misused and misinterpreted. Studies have to be designed very carefully. The work should be very critically analyzed and not just relied on because of the researchers rep. That said, I would like to hear some mention of 2 principles: Chamira sakanta me’isura (you make a l’chaim between fish and meat?), and Nishtaneh hateva. I really would like to understand why some are going to the barricades over this. And just to avoid signing a waiver?! (Agav, I mahled my own children and did MPB, and would continue to do so, but my questions still deserve answers!)
-Mosheh
As a yeshiva educated physician and mohel, let me set the record straight. Dr. Zenilman’s letter should be commended. It is high time all the sheep stop being led to their slaughter by ignorant so-called religious leaders. The Chasam Sofer allowed metzitza to be performed through a sponge or gauze. Most early meforshim likewise held the belief that it was strictly a health measure and NOT an actual part of the mitzva of milah. While there are others who disagreed with the Chasam Sofer (Sdei Chemed, Maharam Schick), a bris performed entirely without it is still a valid bris. When the risks are as high as they are, surgical gloves and metzitza through gauze or a pipette should be mandated by any rabbi worth his salt. In my humble opinion, I would have to strongly question the credibility of any rabbi who thinks otherwise.
The legislation attempting to be passed would require informed consent. It is not attempting to ban metzitza b’peh. It is saying, if you want to perform it, you must properly notify the parents about the risks involved. If they so choose, the ritual may be performed. There is NOTHING antisemitic or non-constitutional about this.
And for anyone quoting Dr. Berman’s “research” as authoritative, brutha please.It’s worse than quoting Andrew Wakefield on vaccine research.
A few points to ponder:
1) The Chazon Ish permitted metzitaz to be done with a tube (shforeres) lechatchilo.
2) What is the statistical risk of contractiong tzoraas as a result of eating fish and meat together? Does anyone here actually know anyone who contracted tzoraas from doing so? Nevertheless, we say chamiro sakanto me-issuro and forbid it (some poskim hold that even bittul beshisim does not apply and are more machmir with it than bossor becholov).
3) On the other hand, the issue here is not really MBP. The issue is a fundamental one of whether the State authorities may interfere in the regular kiyyum hamitzvos. That is why Aguda has fought against this measure, even though many of the Aguda gedolim hold like the Chazon Ish (and others) who permit the use of a shforeres (see (1) above).
This is all very interesting. Parents who give their children prophylactic meds prescribed by doctors to avoid a very low risk disease, have no problem allowing a tiny infant to be handled questionably with a risk of disease? This is an emotional issue. When Halacha states we must fast, there are those who are Meikel for assorted health issues, which they readily make use of. But a baby is stronger?? Dr. Zenilman lists several risks, amongst those health issues which may not surface immediately. Why in the world would anyone put their infant at any risk? When pregnant women are tested for Strep B, they automatically allow themselves to be put on prophylactic intervenous antibiotics during labor. The chances of the baby contracting Strep B in the birth canal are extremely rare. Look at the research. So why are mothers allowing their baby boys to be exposed to a potential risk during Milah????? This is a selfish double standard.
The consent form is what will save MBP. Accept the need to sign it, sign it and move on. It also protects mohalim against lawsuits.
Aside from all the arguments here, the main point in this argument by the Agudah is that we do not want government intervening on our religious observance. It is an extremely slippery slope. After a consent form, the next easy step is not allowing at all. Then consent forms for Mila. Then not allowing that. Once the government steps in to regulate your activities it gets very very dangerous. You only have to look at the process of Bloomberg’s regulations to see this. It started with taxing cigarettes. Then banning them. Then banning soda. Then baby formula. Who knows what is next?
Bottom line – once government starts getting involved it is a very slippery slope which is extremely dangerous.
And to quote #70 – “Whats so bad about wearing this gold Magen Dovid armband?”
When religion is involved the government should keep out unless it is an extreme extreme necessity.
Your local hospital is one of the most dangerous places in town–staph infections, MRSA, etc. are all over the place. The AMA admits that doctors kill over 100,000 people a year through various mistakes and side effects of their procedures.
Does the Board of Health require hospitals to provide an informed consent form to each patient, detailing the risks involved in entering the hospital?