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Thursday, January 05, 2006

NYT on MBP

Today's NY Times has a piece about Metzitzah B'Peh. It basically recaps the most recent developments on the issue between Hasidic leaders and NYC health officials. They don't seem to see eye-to-eye on the topic:
Some Orthodox Jewish leaders are calling on city health officials to end their campaign to educate parents about the alleged health dangers associated with an ancient form of ceremonial circumcision. But officials say they will not oblige.

... Early last year city officials said the procedure might have led to three recent cases of herpes in infants, one of them fatal. But the city put off taking any aggressive action as it continued to investigate the cases, though it said even then that it would most likely not ban the procedure because it did not want to violate religious freedoms and a ban would be impossible to enforce.

But after concluding last month that the procedure had indeed caused those three cases along with two others - one in which the infant suffered brain damage - the Department of Health and Mental Hygiene said it would recommend against the procedure and begin a public education campaign about its risks. The practice is nearly universal in many Hasidic sects.
The Hasidim were not happy with the recommendations of the Health Department officials.
Several Hasidic rabbis, arguing that the city was unconstitutionally interfering with their centuries-old religious practice, met on Friday with Dr. Thomas R. Frieden, the commissioner of Health and Mental Hygiene, asking him to stand down, city officials and religious leaders who were there said yesterday. The leaders, who maintain that the practice is safe and that the evidence that it causes herpes is not definitive, had even threatened to protest at Mayor Michael R. Bloomberg's inauguration on Sunday, the attendees said.
I posted here about my feelings on MBP. I come down firmly against any efforts at regulation of it by government agencies at this time. I simply do not feel that any study has been produced that shows that the few infants that have so tragically died from HSV-2 had been infected through MBP. I agree that the studies have shown that some sort of correlation between the practice and the deaths - but showing a possible correlation is far from proving causation. There are many practices that have shown correlation to a risk on infant safety, that have not been regulated by government safety boards. For example, putting an infant on his back to sleep instead of his stomach has shown to greatly reduce the numbers of babies dying from Sudden Infant Death Syndrome. The causation has been shown to a much more incontrovertible degree than it has been with MBP. Yet I don't hear people sounding the cry for government regulation of the sleeping positions parents choose. All the more so, in a case like this, when there are such thorny issues at stake like religious freedom, I don't think the government has any place attempting to restrict a practice that has not shown any firm evidence of being fatal. That said, I do not fully agree with the stance of the Hasidic community against the education campaign by the city health boards. Public education is a perfectly reasonable tool for the health officials to use if they feel that a practice is potentially dangerous. That is the approach they have similarly taken against SIDS, with a "Back to Sleep" campaign which educates parents to protect against SIDS by putting their children to sleep on their backs. I'm not even sure what the Hasidic groups got so worked up about. I don't think that an education campaign would have been in the least bit effective against the firmly entrenched beliefs of the Hasidic community anyhow.

12 Comments:

Anonymous Anonymous said...

I'm not sure why you think the education campaign is OK. It is veryu close to regulation. Its a slippery slope.

8:57 AM  
Anonymous Anonymous said...

Orthomom,

I think the relationship between MBP and neonatal herpes is more than "correlation". See this article:

http://pediatrics.aappublications.org/cgi/content/full/114/2/e259

9:01 AM  
Blogger orthomom said...

anonymous:
I have read the article, and discussed it with more than one physician. The study does not show evidence of causation.

9:08 AM  
Blogger Krum as a bagel said...

"I'm not even sure what the Hasidic groups got so worked up about. I don't think that an education campaign would have been in the least bit effective against the firmly entrenched beliefs of the Hasidic community anyhow."

The issue is partially economic. MBP mohelim tend to refuse to perform brisim without MBP as they believe that such a a bris is inavlid. If Jews without a tradition on MBP become convinced by the health campaign to opt for a non-MBP brisim, the livelihood of pro-MBP mohelin will be comprimised.

10:08 AM  
Blogger MUST Gum Addict said...

I spoke to Paysach Krohn about this once. People seem so worked up about the risk to the baby, and don't take into account that there's a risk to the Mohel as well when MBP is done. For that reason, Rabbi Krohn uses a tube, which is disputed in some circles as well.

11:10 AM  
Blogger AMSHINOVER said...

this whole thing sucks



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12:18 PM  
Anonymous onionsoupmix said...

Nice post. I also agree that correlations do not prove causation. Driving home from the hospital with the infant strapped into a car seat is probably statistically more risky than mbp. On the other hand, it just seems like yet another situation in which the religious community is not willing to self-examine to any extent.

5:28 PM  
Blogger Ezzie said...

A mohel told our family by my nephew's bris that he uses a tube, though I believe if the family insists on MBP he does so.

Education seems wise, though perhaps the Chasidim are getting worked up because they feel that a non-MBP bris is no good. Educating others to not do MBP would be a violation of halacha to them.

6:02 PM  
Anonymous Anonymous said...

The problem the chassidic community has with the "education" is, that the Health commissioners office is only giving half the story. They are "educating" with the intent of convincing people not to do it. What people don't realize is that the Commissioners office set out TARGETING MBP. The truth is that the fact that the incidents of HSV2 are so few in cases where MBP was done (less than .0%), are the greatest indicator that MBP is NOT the cause. Would MBP be the cause, why are the percentages so low? That having been said, why were they not looking into all cases of HSV2, for causes, why did they limit their study to cases where MBP was done? It can only lead the Chassidic community to one conclusion: This is a witch hunt.

9:35 PM  
Anonymous charliehall said...

Note the eighth author on the paper in *Pediatrics*.

I was in Williamsburg for a wedding five days before the election. I could not believe the number of pro-Bloomberg signs all over the place. Huge banners announced the mentioned in the NY Times article.

I have a doctorate from a school of public health. The NYC Health Department should know that a public "education" campaign is very unlikely to change the practice of anyone in the Chasidic community. Most other orthodox Jews would probably follow Rabbi Tendler anyway without any education campaign, so the only reason I can think of for an education campaign would be to convince non-orthodox who plan to give their son a brit away from MBP.

Question: Suppose a brit is done completely correctly by an orthodox mohel without MBP, and 20 years later that now-adult Jewish man wants to join the Satmar community. Will they tell him to get the brit re-done? If not, then I don't see the insistence on MBP in the first place.

10:07 AM  
Blogger Larry Lennhoff said...

For example, putting an infant on his back to sleep instead of his stomach has shown to greatly reduce the numbers of babies dying from Sudden Infant Death Syndrome. The causation has been shown to a much more incontrovertible degree than it has been with MBP. Yet I don't hear people sounding the cry for government regulation of the sleeping positions parents choose.
Perhaps you would hear such a cry if a group of people had a cultural or religious tradition of having a baby sleep on its stomach. As it is, since we can assume most people want their babies to live, education by itself can counteract SIDS because there is no counter-tradition to resist it. The same is not true of MPB.

That said, I agree that explicit regulation of the practice by the government is not the way to go at this time.

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8:35 PM  

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