Metzitzah and the Halachic Process

by Rabbi Yerachmiel Seplowitz

The Metzitzah controversy is nothing new.

In the 1800’s, in Germany, the elements of Reform sought to ban circumcision entirely, attacking the “barbaric” practice of Metzitzah b’peh (MBP), where a Mohel would suck the blood away from the circumcision site.

A little earlier history is in order. The Talmud requires that after a Bris is performed, the blood must be suctioned away from the wound. The reason given is for the safety of the baby. Presumably, the purpose of Metzitzah is to cleanse the wound area of any germs and prevent infection.

It is easy to understand the claim that using the Mohel’s mouth to clean the wound is counterproductive. Some children were becoming ill in the 1800’s and Metzitzah was being blamed. Due to the controversy over Metzitzah b’Peh, many of the Sages of that time permitted the use of a tube to suction the blood.

This innovation was controversial, but many of the greatest authorities of that time and more recent times accepted it.

The Chofetz Chaim quotes the opinion of the Yad Eliezer, who permitted blood to be pressed out of the wound with an absorbent cloth, such as a gauze pad. (Biur Halacha 331:1) This opinion has also been attributed to the Chasam Sofer. The Chazon Ish opposed that practice, preferring the use of a tube, which he considered to be the Halachic equivalent of MBP. (Told to me by Rav Eliyahu Glucksman, ZTZ”L, Dayan of K’hal Adas Yeshurun (Breuer’s), a student of the Chazon Ish, whose son was circumcised on the Chazon Ish’s lap, with the Mohel using a tube.) Rav Moshe Feinstein considered the tube acceptable. My colleagues and I have performed Brisses, using a Metzitzah tube, in the presence of many contemporary Halachic authorities, with their acceptance, and sometimes encouragement. The Rabbinical Council of America has encouraged its members to follow the rulings of those authorities who permit the use of the tube.

Over the years, my use of a tube has occasionally put me at odds with parents who had requested my services. When they have insisted upon actual MBP with direct oral suction, I have suggested that the father do it. Sometimes that has happened, and sometimes they have opted to use a different Mohel.

However, such cases represent the exception, rather than the rule. Most of my Bris clientele are Modern Orthodox or non-orthodox. Both of those groups are very happy to utilize the services of a Mohel who uses sterile instruments and gloves, and who doesn’t do MBP. As well, most “Yeshiva” families who ask me to be their child’s Mohel accept my policy of doing Metzitzah with a tube.

My use of a sterile tube is not a Halachic compromise. It is the tradition that I have received from my teachers, and it is acceptable to the Poskim — Halachic authorities to whom I turn for guidance. So for me, it is a non-issue. The use of the tube is 100% acceptable.

So why have I not joined the call for the abolition of Metzitzah b’peh? Why do I not congratulate the New York City Health Department for getting involved in Bris Milah? Why have I not contacted the non-Jewish and non-orthodox press to express my opposition to MBP? Why do I applaud the RCA and Agudath Israel in their opposition to the actions of the NYC Health department?

The reason is simple. Major Poskim support Metzitzah b’peh, and that reality is not going away.

Consider the following:

  • Much has been written about MBP and herpes. Some medical experts, such as Dr. Daniel Berman, writing in the journal Dialogue, have disputed the findings, and claim that the studies have been inconclusive. (Full disclosure: I am not a doctor. I make no claim as to the accuracy of either side of this dispute.)
  • In 1989 a proclamation appeared in various Orthodox publications in support of MBP. The proclamation was signed by many of the most respected authorities in the Yeshiva and Chassidic worlds. (Of course, the issue back then was HIV, not herpes. One can only speculate as to whether those authorities, many of whom are no longer living, would sign it today. I suspect that most of them would.)
  • A few years ago, I attended a speech where a Mohel and Halachic authority who is well respected by the Yeshiva and Modern Orthodox communities stated that he had informed the NYC Health Department that if they ban MBP, he will give them the address and time when he is doing a Bris, “so you can come and arrest me.”
  • The Chassidic world, by and large, rejected the original introduction of the Metzitzah tube over a century ago. They still reject it today. Whether you or I agree with that opinion is irrelevant; that is their position.

A word about “changes” in Jewish Law. Your average rabbi can’t just wake up one morning and decide to modify religious practice. Questions of this nature must be ruled upon by a Poseik – an expert in all facets of Talmud and Halachah. He must be a very learned person – recognized by his teachers and his contemporaries as qualified to rule on such complex matters. He must be able to insure that his ruling will be consistent with Halachic standards and values. He must carefully weigh every nuance against the backdrop of Jewish Tradition, going all the way back to Sinai. (“Don’t try this at home, folks.”)

It is well and good that many of us follow the rulings of those authorities who permit the use of the tube. But let us not forget that there are other Poskim who insist that only direct contact will suffice. It is easy for me to say that I have a policy not to do MBP. But do I have a right to tell someone who has a tradition from his teachers to only do MBP that he must follow the rulings of MY Poskim?

There is a Halachic process. Poskim take into account the original sources of Laws and Customs. They also take into account the facts on the ground. These factors led many 19th Century Poskim to accept an innovation; similar factors have led many contemporary Poskim to the same conclusion.

But other Poskim have come to different conclusions. And for people who are not qualified to act as Poskim to call upon these authorities to change their rulings is preposterous. And the unfortunate decision to publicly issue these calls in the secular press is ill-advised and not at all helpful.

By all means, let the debate continue. Rabbis who oppose MBP are free to insist that it not be done in their synagogues. Doctors should continue to make their case as to the health issues, and bring their concerns to the Poskim. And many Mohalim like myself will continue to use Metzitzah tubes.

But using newspapers and health departments to try to influence Halachic rulings is not the way of Orthodox Judaism.

Rabbi Yerachmiel Seplowitz is a Mohel (BrisRabbi.com) and a member of the Executive Committee of the Rabbinical Council of America. His observations on the Weekly Torah Portion can be read at TorahTalk.org

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28 comments to Metzitzah and the Halachic Process

  • Nachum

    Let’s clarify some things:

    -The city isn’t trying to ban the practice. It wants parents to sign a consent form. If anything, the main beneficiaries will be mohalim. What’s the big deal? We have no problem admitting that even milah carries a degree of danger, and sign consent forms even for minor surgery all the time.

    -R’ Seplowitz says he gives the option of a father or another mohel doing the oral suction. Has he ever tried to educate the parents not to do it at all? Have we given up on that?

    -R’ Seplowitz writes, “Presumably, the purpose of Metzitzah is to cleanse the wound area of any germs and prevent infection.”

    This is apologetics and completely untrue. (And dangerous, because it allows people to perpetuate the idea that metzitza, or even metzitza b’peh, is somehow helpful and should be defended as such.) We *know* why it is required by the Gemara: Because Chazal, through no fault of their own (after all, the whole world believed in this), believed in the “four humors” theory of medicine, which states, among other things- logically but completely incorrectly- that infection results from too much blood in the body. Thus the use of leeches and “cupping” as cures until relatively recently. Thus, they required the suction of blood from the wound, only- only!- to prevent infection.

    If anything, we are probably on very safe ground interpreting this requirement as one that simply states “take precautions to avoid infection,” which we know, thanks to our knowledge of medicine, means “be sterile and use antibiotics on the wound,” which of course we do as a matter of course, and have no need for any form of suction at all. As metzitza, done right, doesn’t actually harm the baby, we shouldn’t be so quick to eliminate it, but it always helps to know the facts.

  • Torahis1

    Newsflash to rabbi seplowitZ: ( and i believe he knows this very well)

    The state of NY is merely requiring a consent form signed by the parents of the baby should they desire mbp.

    There is no ban on mbp taking place, and it is really counterproductive for you and many other rabbis to keep on misleading everybody by claiming this is a ban.

    Furthermore it is most interesting that the single opinion of doctor Berman is being relied upon when many many other doctors say this is very dangerous . How funny that is that all of a sudden the Orthodox community is relying on a das yochid.

    We should all applaud the health department for trying to look out for the welfare of little babies. Freedom of religion is not absolute and Rabbis should stop looking for a bogeyman over here.

  • Ori Pomerantz

    The Talmud requires that after a Bris is performed, the blood must be suctioned away from the wound. The reason given is for the safety of the baby.

    Ignorant Chiloni question. When the Talmud specifies a reason for a custom that is not mentioned specifically in the Pentateuch or the Mishnah, does that imply:

    1. The custom is de’Oraita, inseparable part of Oral Torah that must be followed unless weightier Mitzvot interfere (for example, fasting on Yom Kippur is a Mitzvah, but not when it interferes with Pikuach Nefes) and the reason is an Amoraic theory as to why G-d commanded us to do this.

    2. The custom is deRabanaan, a Rabbinic ruling that may have been ancient even back in Talmudic times, and the reason is an Amoraic theory as to why earlier Rabbis decided to impose that ruling.

    3. The custom is deRabanaan, and the reason stated in the Talmud is part of the oral tradition, having been transmitted over the generations along with the custom itself.

    In modern legal discourse, I think there is a clear distinction between known facts (“I saw Reuben running away from the scene of the theft”) and interpretive theories (“maybe he is the thief”, “maybe he was rushing to his job”). Does Talmudic discourse have such a distinction?

  • Natan Slifkin

    This post presents a beautiful description of what a posek SHOULD do. But I’m not so sure that it accurately describes what poskim actually do.

  • Shoshy

    “Some medical experts, such as Dr. Daniel Berman, writing in the journal Dialogue, have disputed the findings, and claim that the studies have been inconclusive.”

    Are you aware of any medical experts other than Dr. Berman, who has disputed the findings of the medical community linking herpes to MBP?

  • Whoa Nelly

    Yasher koyach

  • cvmay

    Thank you, Rabbi Seplowitz for reminding the readership that “Elui V’Elui Divrei Elyokim Chaim”.

  • dr. bill

    Missing from the discussion above is a third opinion which makes this “live and let live” argument for pluralism entirely untenable. there are also those who disallow MBP, because of safek sakanah. given three positions that physical contact to perform MBP is 1) required, 2) unnecessary and 3)disallowed forces a much differerent conclusion than a disgreement that does not incude the last position.

    a separate but much more general question is what part of traditional behavior can be assumed to have a halakhic base and hence may become obligatory and what just represents the way things were done. Traditional halakhic process required the former be demonstrated; those who require MBP have not provided that demonstration and I suspect some maintain that tradition even absent a halakhic base is sufficient to obligate adherence.

  • Nachum

    Yes, it’s best not to forget that pikuach nefesh is involved here. That pretty much overrides everything else. Or it should.

  • Tal Benschar

    Missing from the discussion above is a third opinion which makes this “live and let live” argument for pluralism entirely untenable. there are also those who disallow MBP, because of safek sakanah. given three positions that physical contact to perform MBP is 1) required, 2) unnecessary and 3)disallowed forces a much differerent conclusion than a disgreement that does not incude the last position.

    Why? That is precisely the situation you have with kapparos — some forbid it as darchei ha emori, others permit it although they also allow use of money, some uphold the custom and use chickens. The multiplicity of practice doesn’t seem to bother anyone.

  • Bob Miller

    How is a posek to react properly to data pointing to a newly discovered health risk associated with one particular traditional mode of practicing a mitzvah? I would hope that, at the very least, the posek (or his posek…) would do a comprehensive investigation of the facts, assertions, and principles involved. No effort to hold the City of New York or any government at bay has a chance of success without first making a proper case.

  • Dovid

    Although this essay sounds quite reasonable, I believe it is also somewhat misleading.

    A few points:

    1) The NYC Health Dept is not currently seeking to ban metzitsa b’peh. Why, then, is Rabbi Seplowitz making it seem that this is the issue?

    2)It not “some medical experts” who dispute the medical suspicions and oppose the Heath Dept’s consent initiative, but only one: Dr. Berman. As others have pointed out, this means we are relying upon a Da’as Yachid and not even a mi’ut of health professionals.

    3)As long as we are citing Dr. Berman’s Dialogue essay, allow me to cite Dr. Berman’s essay as well, page 23:

    “The rabbis and experts involved in the matter were eager to have DNA testing done. However, the City of New York
    offered the testing in a way that was extremely unfavorable to the Mohel with regard to his future.”

    There, Dr. Berman concedes that the Helth Dept has never been allowed the opportunity to obtain DNA from possibly infected mohelim. As Dr. Berman points out, the mohelim in question either refused to come forward or, even where they were known, refused to allow the Health Dept the opportunity to fully investigate — presumably under standard forensic protocols –whether there was a DNA match between themselves and the the infected children.

    So, in order to protect the mohel from testing that would have possibly led to results that would have been “extremely unfavorable to the Mohel with regard to his future,” a standard forensic investigation was thwarted.

    How, then, is it not disingenuous — OR SCIENTIFIC — to concede that the investigation had been thwarted and then score points in the debate by declaring that the Health Dept never proved its case and that its findings are presumptive rather than scientific?

  • S.

    Note that the Chasam Sofer’s ruling (which was an assent of the suggestion of the Yad Eliezer, his student) did not occur in a period of Reform attacks on milah (or MBP, which the author conflates in the beginning of this post). Indeed, Jacob Katz posits that had Reform rabbis been considering the question of whether or not to retain milah, as they did some years later, then it is quite likely that the Chasam Sofer would have ruled stringently instead of his lenient ruling.

    Rather, MBP was possibly under attack by the *government*. While MBP is not now under attack by the government – as others have pointed out, requiring the signing a consent form is not a ban – we do see that the rabbis who did not see MBP as an actual obligation were not pressed so much by the possibility of government regulation. I think it’s fair to say that the reaction of the Chasam Sofer can be summed up as a shrug. So use a sponge, he wrote.

  • Shlomo

    “This opinion has also been attributed to the Chasam Sofer”

    Doesn’t the author know that the Chasam Sofer’s teshuvah was published? All the relevant information is in Dr. Sprecher’s article in Hakirah. I also second Dovid’s comment. I hate to say it but Dr. Berman has said things that put him at odds with the minds of the medical community as a whole, including the greatest experts on infectious diseases. And besides, since when do we rely on a Daas Yachid in matters of pikuach nefesh?

  • dr. bill

    My comment:
    Missing from the discussion above is a third opinion which makes this “live and let live” argument for pluralism entirely untenable. there are also those who disallow MBP, because of safek sakanah. given three positions that physical contact to perform MBP is 1) required, 2) unnecessary and 3)disallowed forces a much differerent conclusion than a disgreement that does not incude the last position.

    In commenting on what i suggested Tal Benschar writes:

    Why? That is precisely the situation you have with kapparos — some forbid it as darchei ha emori, others permit it although they also allow use of money, some uphold the custom and use chickens. The multiplicity of practice doesn’t seem to bother anyone.

    there are a number practices that great poskim considered darckhiei he’emori that other poskim allowed and others refined. How MBP is “…precisely the situation you have with kapparos..” discounts the safek sakaneh element. and BTW poskim have at best limited and more than likely no standing in deciding what is a safek sakaneh. as far as i know, poskim ask an expert and in a case of sahkaneh a fortiori follow the majority of experts.

  • L. Zacharowicz MD

    I have personally spoken with a national authority on infectious diseases who told me that the risk in such cases is exceedingly low.
    It is certainly laudable that many in the community are concerned about possible risks to our precious infants. I suspect, however, that our distinguished rabbis are at least as concerned as those who have posted above.
    Interestingly, the Bloomberg administration has not seen fit to try to get informed consent for religious practices of other faiths. Should Catholic priests be required to obtain written consent before offering congregants wine, which can lead to alcoholism? Should Shiite leaders be required to obtain written consent before congregants, including minors, whip themselves with whips, which can cause all sorts of infections, let alone lead to psychological trauma? Should the government require those parents who decline circumcision to be made aware, in writing, of the heightened risk for all sorts of infection for those who do NOT get circumcised?
    There is a dangerous precedent being set here: the government is trying to regulate an ancient religious practice.

  • Moshe Y. Gluck

    Shkoyach, Rabbi Seplowitz!

    One question that has been bothering me about this issue is that if MBP is really a sakanah, shouldn’t so many more babies be dying? Doesn’t the fact that they are clearly not, prove that the risk is nil to negligible? We accept low levels of risk both as a necessity for societal functioning (we cross streets) and as a valid personal choice (we go play football and smoke), as well as in Halachic discourse (permitting working in a clearly hazardous environment for Parnassah reasons, for example). Why should MBP be different?

  • Dovid

    In response to Moshe Y. Gluck:
    See Teshuvas Chasam Sofer.

    MBP is different because:

    1)Chazal’s stated intent was to PROTECT the infant, not to endanger him!
    (The other activities you mentioned have some benefit. MBP has none, other than — in Chazal’s view — protecting the child. Once we know that it does not protect him, but rather its opposite, what justifies it — particularly when an alternative exists?)

    2)Metzitsa done through a tube is still considered b’peh, according to normative poskim (like Rav SHlomo Zalman Auerbach).

    3)Nowhere is gemara or Rishonim does it specify that it must be done b’peh, which is why the Chasam Sofer said to use a bandage.

    4)How many deaths would be too many, in your estimation?

    5)Does possible brain damage count as well?

  • Dovid

    In response to L. Zacharowicz MD:

    Would it be possible for you to point us to an in-depth, in-writing halachic analysis of this issue that acknowledges that MBP carries even a small risk of death and then advocates for its continuance, davka ba peh?

    If that responsum explains as well how it is that one may ignore rov d’rov of experts and rely upon a Da’as Yochid in a matter of pikuach nefesh, that would be an added bonus!

  • Shoshy

    Moshe Gluck
    Neonatal herpes is a vicious disease. More babies aren’t dying because they are rushed to the hospital for emergency treatment. Without that most of the cases of neonatal herpes would be fatal.
    The CDC found 11 cases of infection following MBP in 11 years in NYC alone. That’s not including Lakewood, Kiryas Yoel, or Monsey. One korban in this city every year. Doesn’t that seem like a lot to you? If it were chas v’shalom your child, would you consider it “nil and negligible”? Furthermore, infectious disease specialists estimate that there are more cases that are not detected or reported.

    Recently I got a glossy pamphlet on my doorstep. There were many quotes from Torah authorities in it, including an admonition that it is assur to knowingly expose yourself to a virulent and contagious disease, even if you take all necessary precautions. Unfortunately, they were referring to the internet. Funny how the same people don’t apply that psak to neonatal herpes.

    “We accept the level of risk associated with smoking?” Maybe you do, but many poskim say it is assur. And you should look both ways before you cross the street.

  • c-l, c

    By Yerachmiel Simins

    The Centers for Disease Control, an agency of the US Department of Health and Human Services, just published a report stating that the risk for herpes simplex virus type 1 (HSV-1) following circumcision with oral suction, or metzitzah b’peh (mbp), was over 3 times greater than among male infants who did not have mbp. However, a closer examination of the data and methodology set forth in the report could point to a contrary conclusion – the risk of HSV-1 with or without mbp may be statistically the same. If so, the demonization of mbp caused by this report may lead public health officials away from addressing some real – and avoidable – causes of neonatal HSV-1.

    The report, published in the June 8th issue of the CDC’s MMWR newsletter, looked at cases of HSV-1 in NYC dating from April 2006, when the disease became mandatorily reportable by hospitals, healthcare providers and clinical laboratories, through December 2011. It found 5 cases of HSV-1 after mbp during that time period, out of an estimated 20,493 mbp circumcisions (or 1 in 4,099). This rate, it said, was 3.4 times greater than that found in the City’s general population. CDC editors commend the report’s findings as “consistent with a cause-and-effect relationship” between mbp and neonatal HSV-1. Asserting that the data “strongly suggest HSV-1 can be transmitted to a neonate” by mbp, the CDC is encouraging “preventive” public-health tactics and, if necessary, even “legal measures” to ensure “that parents can choose not to have their newborn exposed” to HSV-1 through mbp.

    Such alarming conclusions about a millennia-old religious practice have rightfully occasioned concern in the public-health arena as well as in the Jewish community, warranting a second look at the terms of the study. This further review exposes several troubling weaknesses, a few of which follow.

    The data. In order to connect neonatal HSV-1 with mbp, researchers looked for cases of HSV-1 that had onset of symptoms as much as 20 days post-circumcision. Yet the universally accepted view is that HSV-1 has an incubation period of 2 to 12 days from exposure. Limiting the incubation period to 12 days – or even extending the limit up to 19 days – would decrease the number of cases in the report by 20%, bringing the HSV/mbp rate down to 1 in 5,123.

    Methodology. Researchers drove their rate higher by including an unspecified number of cases from Jewish families that were not ultra-Orthodox in its estimate of “relative risk.” We learn in an editorial note that “the findings in this report are subject to at least one limitation. . . . not all of the cases were in ultra-Orthodox Jewish families.” This means that the study estimated the relative rate of incidence of HSV-1 in NYC using a formula that had as its “denominator” an estimated population of ultra-Orthodox Jewish males, but its “numerator” – actual cases of neonatal HSV-1 – included an unspecified number of cases from outside its “denominator” population.

    As the editors explicitly note on this point, “”relative risk depends, in part, on assumptions . . . and those assumptions might not be valid.” Correcting for this arbitrary skewing of the formula could drastically reduce the rate of HSV-1 after mbp, perhaps to a rate even less than that of the general population. (One clear counter-example to the report’s findings is the community of Kiryas Joel in Orange County, which has an estimated 100% rate of mbp and 0 reported cases of associated HSV-1.)

    Omission. Another significant weakness in the report is that it fails to cite even a single case where mbp was definitively determined to be the cause of HSV-1, for example by DNA testing. Some attempts were made to definitively link mbp to HSV-1, but the report relates that they were unsuccessful. In fact, despite the heightened focus on mbp and despite mandatory reporting of neonatal HSV-1, no definitive case of mbp-caused neonatal HSV-1 exists anywhere in the medical literature. Without any such case, the most the editors can say is that the data “are consistent with” or “strongly suggest” a correlation to mbp.

    On the other hand, the new data could actually prove a contrary conclusion – that mbp poses no statistically greater risk of HSV-1.

    Correcting for the overextended incubation period and/or faulty population figures, the report’s findings of HSV-1 incidence after mbp would be statistically equivalent to the rate found nationally. The national rate, as stated in medical literature, is anywhere from 1 in 1500 to 1 in 3200. This rate can be influenced by factors such as living in a metropolitan area and family size – dense areas and big families tend to have higher rates. Considering that NYC ultra-Orthodox Jews have large families and live in the most densely populated US city, neonatal HSV should occur closer to the higher (1/1500) rate. This rate, though, includes both HSV-1 and HSV-2, and HSV-2 has never been associated with mbp. Even assuming a 2:1 to 3:1 ratio of HSV-2 to HSV-1, the resulting rate of HSV-1 would be 1/4500 to 1/6000, right in line with the report’s data as corrected. (Indeed, it is curious that the report estimated the rate of incidence in the general NYC population to be much lower than the presumed national rate. Is neonatal HSV-1 that much rarer in NYC than elsewhere in the country?)

    Even without adjusting for incubation period or population, the report finds the same rate – one HSV-1 case per year – both before and after neonatal HSV-1 became reportable in 2006. (In fact, right-sizing the incubation period would make the rate lower after HSV-1 reporting was mandated.) This is quite significant, as one of the reasons neonatal HSV-1 was made reportable in NYC stemmed from a suspicion that cases occurring after mbp were somehow hidden, and thus that the actual incidence was much higher than previously known.

    Ultimately, focusing on mbp as a mode of transmission for HSV-1 may have the effect of ignoring other routes known to transmit the virus, with potentially tragic consequences. It is well established that HSV-1 is much more easily transmitted by symptomatic individuals than by asymptomatic “shedders.” No practitioner of mbp has been shown to be symptomatic, so those presuming mbp to transmit HSV-1 assume practitioners are shedders. And yet, as the report mentions, attempts to find such shedding in mbp practitioners have failed. Moreover, one case known to be included in this report involved a newborn in close contact with a symptomatic sibling who had recurring outbreaks of active herpes lesions. This was known to the attending physicians, and thus, we assume, to the researchers. Yet this fact was apparently ignored, and focus instead was trained on mbp. Nor were any follow-up attempts made to educate parents about the dangers posed by symptomatic individuals – whether they be siblings, caregivers, or the parents themselves – having contact with newborns. One has to wonder if the single-minded focus on mbp might itself be a public health issue, allowing for a much more common danger – one widely known to have serious, even fatal, outcomes.

    In its Notice of Public Hearing in early 2006, the NYC Department of Health and Mental Hygiene (headed at the time by the current director of the CDC) wrote: “Making neonatal herpes reportable would ensure that such instances [of neonatal HSV-1 after mbp] are reported, and thus enable the Department to identify outbreaks of this disease in a timely fashion, identify the source, and intervene to prevent subsequent cases.” Ironically, this new CDC report may finally quash the suspicion of underreporting, and thus belie the notion that mbp is the public health issue concerning neonatal herpes that officials need to address.

  • c-l, c

    I recently read another article on this topic at Jlaw.com that points out some other signifigant flaws in the studies as well.

    1) Tests for HSV-1 anti-bodies are inconclusive because 90% plus of adults have been exposed to the virus at some point and thus will test positive anti-bodies present.
    In each of the above alleged cases, not one single mohel was ever tested to see if they had ACTIVE HSV-1. It is ONLY when active that transmission is possible (”shedding”). By the way, in one alleged case the mohel tested NEGATIVE on the anti-body test!

    2) There has never been a DNA test done to determine if the HSV-1 found in any of these children matched that of the mohel alleged to have transmitted the virus to them.

    Testing for active virus and DNA matching are STANDARD protocol in epedemiology. Without BOTH of these tests (let alone even EITHER of them), it is IMPOSSIBLE to conclude that person “A” transmitted the virus to person “B.”

    That these studies are so far outside normative practice and, therefor, nothing more than sloppy, non-scientific conjecture leads one to the inescapable conclusion that there is something else going on here other than “the interests of public health.”

    And I think we all know what that “something else” is.

  • L. Zacharowicz MD

    The reason MBP is different is because it is performed by our community.

  • Tal Benschar

    there are a number practices that great poskim considered darckhiei he’emori that other poskim allowed and others refined. How MBP is “…precisely the situation you have with kapparos..” discounts the safek sakaneh element.

    Dr. Bill, you misunderstood my post. The point of which is that there are other areas where you have a wide spectrum of views — from a practice is completely forbidden, to optional, to mandatory. Yes, I know that safeik sakanah is not the same thing as darchei ha emori. The latter is still an issur Torah and not something to be trifled with.

    and BTW poskim have at best limited and more than likely no standing in deciding what is a safek sakaneh. as far as i know, poskim ask an expert and in a case of sahkaneh a fortiori follow the majority of experts

    I could not disagree more. Whether there is some level of danger in something might be a question for experts. But whether that reaches a sufficient level to impact the halakha, and how it impacts, IS a matter for poskim. We don’t just say that because there is a slight risk in something then it is forbidden. If that were the case, we would ban milah itself. One important issue in MBP is whether the risk (which appears to be very slight, but not non-existent) is significant enough to cause a deviation from prior practice. Without giving a psak, such principles as shomer pesaim Hashem — for which we rely on for a large number of low-risk activities — might be applicable. Don’t know why you think poskim have no say in that analysis.

    Of course, the other issue with MBP is what is the religious significance, if any, of MBP versus other methods, such as a tube or gauze. That clearly is an issue for poskim.

  • Observer

    For all the people who are claiming that NY is not trying to ban MBP, this is not true. They have actually made it very clear that this is what they would rally like to do. However, they CANNOT do so at this point, so they are trying to shut down this practice in any way that they know how. In fact, the original form was designed to scare parents into not allowing the Mohel to do MBP. It was changed because they were faced with a lawsuit that they had no hope of winning. The new form uses somewhat less inflammatory and absolutist language, thus giving the government a chance to win the inevitable lawsuit, they hope.

    I’d like to make another point. There is, at this point, absolutely no scientific evidence that MBP poses any real health threat. One of the prominent medical experts who has written against the practice admitted as much – there have been no studies showing risk but “it’s just logical” that this practice poses a risk.

    What of the most recent CDC study? Well, to start with, correlation does not mean causation even when there is a strong correlation. Here the numbers are simply too small for any statistical correlations anyway so, what do we have? We have 5 cases of Herpes in 20,000 brisim that were “presumably” done with MBP. In once case the Mohel tested negative for antibodies, meaning that he could not have been the source of the infection. In one case, the mother actually had herpes (“cold sores”) around her mouth, and she was unaware that her habit of biting her thumbnail could be dangerous to her baby. (For some reason no one bothered to warn her to wash her hands with soap before diapering the child.) And in once case there was a 2 year old older sibling with cold sores who (as toddlers tend to do) tried to stuff her pacifier in the baby’s mouth on more than one occasion. Which leaves 2 cases of herpes where it is unknown what the vector was (the Mohalim were not tested.) 2 cases in 20,000 Brisim.

    Going to the hospital for any reason is more risky than that…

  • Yerachmiel Seplowitz

    A brief response to some of the comments on my above article.

    A number of posters commented disagreemant with Dr. Berman. As I stated, I am not a doctor, and I am not qualified to take sides in this dispute. My point was that people are going to continue to do MBP because not everyone agrees that it is dangerous. My own opinion on the medical issue is irrelevant.

    Nowhere in the article did I state that the NYC Board of Health is trying to ban MBP.

    One poster quoted from my article: “This opinion has also been attributed to the Chasam Sofer” and asked, “Doesn’t the author know that the Chasam Sofer’s teshuvah was published?”

    Yes, I am aware that it was published. The reason I wrote it that way is because there are those who claim — incorrectly, I believe — that the Chasam Sofer never wrote it, and that it is a forgery. To pre-empt someone else writing with that challenge, I decided to use that wording.

    Most importantly, there is no reason why anyone who feels — based upon the above, or any other arguments — that there are good reasons to oppose MBP shouldn’t convey their concerns to Poskim. My main point is that this is not a discussion that the Jewish community should be conducting in the secular press.

  • dr. bill

    Moshe Gluck, I would leave this to poskim, but imho your examples differ in one critical dimension.

    MBP is not a sakanah unless the mohel is infected. we know this has caused death and the halakha does not allow you to endanger another life.

    as far as your own life, i heard from the Rav ztl in discussing a tosefot in BM – on makom shemishtamair ktzat a discussion of the right of an individual to make choices for himself but not others. i suspect that is relevant. how far that goes in terms of sakanah, was unclear.

    my guess is that it does not include smoking. as is reported about a great Gadol who died recently and smoked – he said he feared being being judged as a meabaid atzmoh le-daat.

  • Yisrael Asper

    Corrected spelling typo.

    “Natan Slifkin

    This post presents a beautiful description of what a posek SHOULD do. But I’m not so sure that it accurately describes what poskim actually do.”

    The author of this piece wrote:He must be a very learned person – recognized by his teachers and his contemporaries as qualified to rule on such complex matters. He must be able to insure that his ruling will be consistent with Halachic standards and values. He must carefully weigh every nuance against the backdrop of Jewish Tradition, going all the way back to Sinai. (“Don’t try this at home, folks.”)”

    You may question the reasoning of a posek but the fact is we rely on them and not on our perceptions of their rulings. A posek certainly feels he is ruling correctly in accordance “with Halachic standards and values” and weigh “carefully weigh every nuance against the backdrop of Jewish Tradition, going all the way back to Sinai.” If we in questioning what their psychology is in deciding a ruling, make that our guide to decide if we are to listen to them we shouldn’t hold back. Let’s question Hillel and Shammai as well. Rabbis of lesser stature than a posek who don’t understand distinctions between them and poskim so well, certainly have a hard time fighting their biases in evaluating Halacha. We have better luck with poskim who devote their whole lives to Torah.