Navonim - The Ramblings of Garnel Ironheart

Navonim - The Ramblings of Garnel Ironheart

Saturday, 12 January 2008

Chemotherapy as a Lousy Metaphor

Rav Yonasan Rosenblum recently published a column in Mishpachah Magazine in which he compared the creation of the emphasis on mass learning in the Chareidi world after World War II to chemotherapy given to a cancer patient.

I know. I didn't think it made sense either but then I read through the article. After that... well, it still didn't make sense.

The opening arguments make sense:

Let us think of the destruction of the major centers of Torah learning during the Holocaust as the "disease." The body of Klal Yisrael could not go on after the Holocaust without its heart – the talmidei chachamim produced in the great yeshivos. Time was of the essence, for how long can a body survive without its heart?

This is absolutely true. The devastation to the Torah-observant world from the war could have led to the end of any meaningful Orthodox community ever developing again, chas v'shalom. Indeed, most people don't remember that the reason David Ben-Gurion acquiesed to the Chareidi community's request for draft exemptions is because he and the other secular Zionists figured that within 1-2 generations the Chareidim would simply disappear as a relevant segment of Israeli society so what harm was there in it? Such was the pessimistic mood in the years after the war.

The solution, however, seems to be introduced rather clumsily:

As a hora'as sha'a, in the wake of the Holocaust, the Torah leaders of the post-Holocaust generation advanced a societal model that had no obvious precedent in Jewish history. That new model was one of long-term, full-time Torah study for virtually all males. A necessary corollary of the model of long-term Torah learning for all men requires wives to become the primary breadwinners – at least for the period during which their husbands are sitting in learning. The only alternative would be for the parents of young couples to undertake to support them and their offspring as long as the husband is in full-time learning. While there might be some parents who can afford to hold out a number of sons and sons-in-laws in such a fashion, the number is obviously small. And so women working became the norm.

One is compelled to ask some questions at this point: who were these leaders? How were they chosen? From where did they get the authority to make this decision? And did they consult the people whose lives they were going to irrevocably change at any point?

But more than this, the basic metaphor that opens the article is flawed:

No one in their right mind would knowingly ingest poison. Unless, of course, he or she was diagnosed with the dreaded disease and the doctors prescribed chemotherapy. But even after the decision has been made that chemotherapy offers best hope of destroying the malignancy, doctors continue to monitor the effect of the toxins on the patient. There is no point to administering a "cure" that is worse than the disease. And if the chemotherapy proves successful, the patient's physicians do not simply ignore the adverse side affects. Everything possible is done to alleviate those side effects.

This is inaccurate. First of all, chemotherapy is not the only time doctors prescribe poison (I know how that sounds!). Warfarin, which is sold in hardware stores as rat poison, is used to thin the blood of people at high risk of stroke from certain heart-related conditions. Aspirin is used to produce heart attacks while digoxin improves the symptoms of heart failure.

Now, one could say that I'm quibbling but the point is that any treatment, if prescribed without care and outside of specific guidelines, has the potential to harm a patient. That's why expertise and careful monitoring of any therapy is essential.

I will grant, however, that chemotherapy is unique in that it is davka given to be toxic. Really, the hope in chemotherapy is that the drugs will kill the cancer before they manage to kill the patient!

And it is in that concept that Rav Rosenblum's analogy fails. The bottom line is that chemotherapy is given, in most cases, as a last-ditch attempt to control a cancer or force it to remission. Quite often it is given as a palliative measure, not to control the cancer but perhaps retard its growth so that the patient's life must be extended.

Finally, chemotherapy is not open-ended. Protocols exist to control the number of treatments, the measures of success or failure and the conditions for ending the therapy.

In this regard, the analogy to the shift in the post-war Chareidi community failed completely. The shift to mass kollel enlistment and women taking over the workplace was instituted without discrimination. If you're male, you're expected to learn irregardless of your aptitude or interest in the matter. If you're female, you're expected to work to support your family, produce babies to populate that family and look after those children while working to support the family, ALL AT THE SAME TIME! Even a casual examination of that system can spot its major flaws.

No protocols were set in place to determine how long this "repopulation effort" would be in effect. Will the day come when the Chareidi leaders stand up and say that there are enough people learning and it's time for men to return to the workplace? Doubtful. Too much time and effort has been spent on defending the system despite its dysfunctional attributes. To announce any changes would be theological suicide. It's not going to happen.

There is, however, another anaology I could suggest. Let's say a major flu pandemic sweeps across the world. Because of their front-line status, a disproportionate number of doctors and nurses die from the illness. After the pandemic ends, governments in the affected countries realize they need to rebuild their supply of medical staff. After all, surgeries still need to be performed and heart attacks still need to be treated. The problem is that is takes seven years to produce a basic emergency room physician from scratch and nine to ten years to produce a well-trained specialist while the need for new doctors and nurses is now.

Let us say, then, that medical school is truncated from four years to two. Residency programs cut back to a maximum of two years. It is impossible to be fully trained in such a short time but due to the emergency situation, it's done and four years later undertrained graduates are populating the hospitals. Fortunately, at the beginning, there are still many survivors of the pandemic to guide them and ensure some competence in the system.

Now it's thirty years later. The well-trained doctors are all retired or dead. The system is still churning out barely trained replacements. Would you feel confident about such doctors? Well then, do you feel comfortably about such learners?

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