tag:blogger.com,1999:blog-1097749014220347853.post7262507118651764761..comments2024-01-30T12:26:03.019-05:00Comments on The Blog of Garnel Ironheart: Liar, Liar, Shtreiml On FireMighty Garnel Ironhearthttp://www.blogger.com/profile/09571194550300367249noreply@blogger.comBlogger18125tag:blogger.com,1999:blog-1097749014220347853.post-14576661002528246022013-04-23T15:33:18.640-04:002013-04-23T15:33:18.640-04:00Does the fact that babies were dying for a million...Does the fact that babies were dying for a million other reasons mean that a higher risk for MbP was more permissible then than now? I mean, people might not have noticed it, but why wouldn't G-d drop a hint to Moshe, Yehoshua or Ezra with a way to do metzitzah without killing babies?micha bergerhttps://www.blogger.com/profile/11612144735431285113noreply@blogger.comtag:blogger.com,1999:blog-1097749014220347853.post-76463969860027694382013-04-23T08:16:16.208-04:002013-04-23T08:16:16.208-04:00Rav Micha, remember the surrounding environment. ...Rav Micha, remember the surrounding environment. In a place without antibiotics, alcohol-based mouthwash and toothpaste, contagious disease was not abnormal. If MBP was done and the infant got sick, well he had a more than 50% of getting sick no matter what.<br />Nowadays it is the exception for an infant to get seriously ill, B"H. That's why it's now noticed. In an era when sterility was an unknown concept direct MBP didn't cause anything outrageous. Today's standards and expectations are different.Mighty Garnel Ironhearthttp://garnelironheart.blogspot.comnoreply@blogger.comtag:blogger.com,1999:blog-1097749014220347853.post-68631651877222885472013-04-22T22:42:39.799-04:002013-04-22T22:42:39.799-04:00RAM:
But that was only half the argument. I also ...RAM:<br /><br />But that was only half the argument. I also wrote that based on the halakhos of cutting any remaining tzitzin on Shabbos that there is reason to assume metzitzah is part of the beris itself, unlike the rest of the post-op treatment.<br /><br />I think that makes the assumption that they felt it was part of the mitzvah more plausible than their simply not wanting to change a minhag.<br /><br />But whatever the various rabbanim in Germany or Litta held, that's grounds for the posqim who insist on direct metzitzah bepeh to feel that the alternative is giving up on the mitzvah altogether.<br /><br />There is also another oddity... When did direct MbP begin? Today there are far fewer diseases than can linger in a mohel than ever before, and far fewer of those diseases can't be treated if the baby were to ch"v contract them. And today we have things like scope, toothpaste, etc... If the risk today is too high to permit, how was metzitzah bepeh EVER safe enough to be permitted?micha bergerhttps://www.blogger.com/profile/11612144735431285113noreply@blogger.comtag:blogger.com,1999:blog-1097749014220347853.post-21604971220494024162013-04-22T19:43:46.881-04:002013-04-22T19:43:46.881-04:00If so, there's an excellent reason I'm ign...<i>If so, there's an excellent reason I'm ignoring it: it's irrelevant and frankly you should not be bringing it up. It compares complication rates between mohels and trained physicians and the mohels turn out to have a significantly higher complication rate albeit the overall numbers are low. But from what I can see they are looking for routine post-procedure complications like bleeding, tissue damage and standard wound infection. It is therefore not relevant to the HSV discussion.</i><br /><br />The only way to categorize that statement is willful dishonesty. I find it sad that you have to stoop to that level. <br /><br />Regarding the relevance of Andrew Wakefield, if you checked his methodology, and that of the mimic studies that immediately follwed his initial study, you will find that it is exactly the same as the methodology used in the studies that you are quoting. The Rabbinut position paper points out the problems with those studies. The Rabbinut position paper, I would like to point out, was written, not by Rabbis, but by physicians, two of whom happened to also be Rabbis.<br /><br />Yes Wakefield was fired from his position in a British hospital, though I am not sure you can say that was "defrocked". Though the ire came because of his shoddy science(which is being repeated in these "studies") which lead to a world wide scare regarding immunizations. You are unlikely to find the same outrage over the bad science being touted here.Rabbi Michael Tzadokhttp://mekubal.wordpress.comnoreply@blogger.comtag:blogger.com,1999:blog-1097749014220347853.post-43996591462756916022013-04-22T15:40:45.437-04:002013-04-22T15:40:45.437-04:00Micha, you could be right, but...
Some people who...Micha, you could be right, but...<br /><br />Some people who see a need to modify a minhag nevertheless want to preserve as much of the original minhag as possible. This is what a traditionalist might do.RAMnoreply@blogger.comtag:blogger.com,1999:blog-1097749014220347853.post-89293215456968105192013-04-22T14:41:40.498-04:002013-04-22T14:41:40.498-04:00RAM: If the reason were pragmatic, rather than a b...RAM: If the reason were pragmatic, rather than a belief that metzitzah is part of milah, then why does one care about "more similar"? And for that matter, why not advocate neosporin as "metzitzah"?<br /><br />The idea of trying for some definition of MbP, albeit indirect, is because we care about the process, not any supposed medical benefits.micha bergerhttps://www.blogger.com/profile/11612144735431285113noreply@blogger.comtag:blogger.com,1999:blog-1097749014220347853.post-88391921634553508272013-04-22T14:23:21.080-04:002013-04-22T14:23:21.080-04:00Micha Berger wrote, "R SR Hirsch and Litvishe...Micha Berger wrote, "R SR Hirsch and Litvisher posqim came up with methods of using oral suction without direct contact. Again, because it is believed that metzitzah bepeh is required for non-medical reasons, and therefore other forms of blood letting aren't just as good."<br /><br />Or maybe not for your reason, Micha, but because it's closer to the traditional suction method, namely MbP with no tube, than other immediate blood removal methods are.<br /><br />RAMnoreply@blogger.comtag:blogger.com,1999:blog-1097749014220347853.post-29291500167187827952013-04-22T13:50:11.619-04:002013-04-22T13:50:11.619-04:00RAMM, In terms of hygiene and health issues we hav...RAMM, In terms of hygiene and health issues we have to be careful. I could point out that saliva has anti-Bacterial properties which means metzitzah might reduce the post-procedure complication rate but Chazal would not have been aware of that. There is clearly a belief of a beneficial effect of metzitzah on the infant but we don't have a physical reason for it.Mighty Garnel Ironhearthttps://www.blogger.com/profile/09571194550300367249noreply@blogger.comtag:blogger.com,1999:blog-1097749014220347853.post-71185614787663676162013-04-22T13:30:42.505-04:002013-04-22T13:30:42.505-04:00RAMM: I'm pretty sure those who require direct...RAMM: I'm pretty sure those who require direct MbP do so because the issue is not medical. They have Qabbalistic sources, which I don't know well enough to discuss. I glean it has something to do with milah being a partial rectification of the sin of the fruit of the tree of knowledge, and eating is a sin of the mouth. But there is indication in the gemara that metzitzah bepeh isn't about blood letting.<br /><br />It is possible that after the circumcision there is left extra skin that doesn't invalidate the beris milah. If the beris is on Shabbos, then the mohel can clean them up as long as he didn't finish the beris. Once he finished doing the beris, it is not a health risk, it's not part of the mitzvah, it can't be done on Shabbos. The wound would have to be reopened after Shabbos.<br /><br />The definition of finishing the beris given in this discussion in the gemara is after metzitzah, but not including bandaging and medicine (which was cumin). Similarly the Rambam (Milah 2:2) groups metzitzah with milah and peri'ah, not with asplanis vekamon (bandage and cumine).<br /><br />AND, while the Chasam Sofer does say gauze was okay (and I agree that the Maharam Shik couldn't have seen his rebbe's actual teshuvah), his is a lonely opinion. R SR Hirsch and Litvisher posqim came up with methods of using oral suction without direct contact. Again, because it is believed that metzitzah bepeh is required for non-medical reasons, and therefore other forms of blood letting aren't just as good. Which really does open the door to a valid pesaq in which metzitzah must not only be done, and not only orally, but by direct contact.<br /><br />Yes, on Shabbos 133b, R' Papa tells you to fire a mohel who doesn't do metzitzah because he risks babies' lives. That doesn't mean the problem is /only/ medical. But R' Papa, like most fathers (we know of his 7 sons from the siyum formula), isn't going to talk about milah being done wrong when lives are at stake. The big problem is the health risk; not necessarily the only problem.<br /><br />Also, another different between metzitzah and the other parts of milah: while the mitzvah was apparently not completely fulfilled without metzitzah, the result is not an areil. Even if you hold that metzitzah bepeh is a requirement of beris milah, the child who lacks one can still eat a qorban pesach, etc..micha bergerhttps://www.blogger.com/profile/11612144735431285113noreply@blogger.comtag:blogger.com,1999:blog-1097749014220347853.post-10691767732980975292013-04-22T13:21:28.041-04:002013-04-22T13:21:28.041-04:00Is this the study you're referring to: Isr Med...Is this the study you're referring to: Isr Med Assoc J. 7(6):368-70, 2005 Jun.Complications of circumcision in Israel: a one year multicenter survey<br />If so, there's an excellent reason I'm ignoring it: it's irrelevant and frankly you should not be bringing it up. It compares complication rates between mohels and trained physicians and the mohels turn out to have a significantly higher complication rate albeit the overall numbers are low. But from what I can see they are looking for routine post-procedure complications like bleeding, tissue damage and standard wound infection. It is therefore not relevant to the HSV discussion.<br />And bringing in Andrew Wakefield is similarly irrelevant. His study was a fraud and he was subsequently defrocked. These studies that I referenced have been validated.<br />As for the Rabbanut, let's say they had said the obvious and that there is halachic permissibility for indirect MBP. Would all the "Gedolim" now change their minds and allow it? The Rabbanut is a funny institution that way - it paskens but no poskim listen to it.<br /><br />Mighty Garnel Ironhearthttps://www.blogger.com/profile/09571194550300367249noreply@blogger.comtag:blogger.com,1999:blog-1097749014220347853.post-42415429280328064052013-04-22T12:22:01.606-04:002013-04-22T12:22:01.606-04:00Just to clarify my last question. It boils down t...Just to clarify my last question. It boils down to, "how does extraction of blood by some form of suction actually cause better health results than something else, such as wiping the wound with sterile gauze?"RAMnoreply@blogger.comtag:blogger.com,1999:blog-1097749014220347853.post-47131913949275107362013-04-22T12:08:45.686-04:002013-04-22T12:08:45.686-04:00Garnel, as a doctor, maybe you can help with this:...Garnel, as a doctor, maybe you can help with this:<br /><br />Assuming that a baby and his mohel are both free of disease, what has been the demonstrated positive physical effect of metzitza (direct or through a tube) on the baby? I'm trying to distinguish physical effects from other potential effects (spiritual, mystical).RAMnoreply@blogger.comtag:blogger.com,1999:blog-1097749014220347853.post-90456833832214955802013-04-22T10:04:00.943-04:002013-04-22T10:04:00.943-04:00Furthermore, when the authors of the Penn study th...<i>Furthermore, when the authors of the Penn study themselves are saying that the Agudah completely misread the study and that its conclusions aren't anything close to what you're saying they are you lose the only study out of many that even suggests support for your position.</i><br /><br />What you just said, is simply not true. There is the Ben Haim study, which is the only study that even meets scientific standard, which is a huge support for MBP. Which is why you prefer to pretend it doesn't exist.<br /><br />The Penn study, simply says that there isn't enough evidence to say either way, because of the lack of scientific studies.<br /><br />The two studies that you cite, are no more scientific than Andrew Wakefield's piece against MMR. Do you also believe that MMR vaccinations should be stopped? <br /><br /><i>As for these positions being minority positions, I wasn't aware that Judaism is a democracy. </i><br />Well since that is your view, their is no place to do MBP via a vessel. As the Rabbinut position paper makes clear, contemporary poskim all hold that MBP is a necessity and that a vessel should not be used. Rabbi Michael Tzadokhttp://mekubal.wordpress.comnoreply@blogger.comtag:blogger.com,1999:blog-1097749014220347853.post-51803168010422946982013-04-22T08:36:04.859-04:002013-04-22T08:36:04.859-04:00Both are scientific studies. Yes, neither are the...Both are scientific studies. Yes, neither are the highest level of evidence which would be a randomized double-blind trial in which you lined up 10 mohels with known HSV and 10 without, had them circumcise 10000 babies each during the asymptomatic phase and then looked for the incidence of HSV in the babies in both groups afterwards. But could you imagine any responsible parents signing up for such a trial?<br />So in the meantime we know that herpes is spread from skin to skin contact. We know that there is skin to skin contact in MBP. We have evidence of transmission occurring after such procedures. And sadly we have precedent after precedent of rabbinical authorities doing everything possible to cover up when bad things happen in the frum community. What further evidence would you like?<br />Furthermore, when the authors of the Penn study themselves are saying that the Agudah completely misread the study and that its conclusions aren't anything close to what you're saying they are you lose the only study out of many that even suggests support for your position.<br />As for these positions being minority positions, I wasn't aware that Judaism is a democracy. Further, I have a problem with opposing opinions using statements like "Well it was a hora'as sha'ah" or "He didn't really mean it, he was just saying it for PR purposes". Take out those poskim who oppose those on my list using such excuses and the numbers change. But what's more, Judaism isn't a democracy. If it was we'd all be Reform.<br />How many of the poskim who supported direct MBP-only through the ages would still do so if they knew about HSV and infacts becoming terribly sick or dying from it?Mighty Garnel Ironhearthttp://garnelironheart.blogspot.comnoreply@blogger.comtag:blogger.com,1999:blog-1097749014220347853.post-12775762787567721942013-04-21T17:07:20.029-04:002013-04-21T17:07:20.029-04:00Garnel,
Neither of those are scientific studies a...Garnel,<br /><br />Neither of those are scientific studies and you know it. They are no more reliable than the Andrew Wakefield assertions regarding vaccinations. I mean he took twelve children who received MMR vaccination and then developed Autism. So clearly MMR carries serious risk of autism. You are simply repeating Wakefield's same bad science. Meanwhile you ignore the only scientific study done to date that sought to clarify the differences in infection and complication rates between ritual and medical circumcisions because you don't like it's conclusions. <br /><br />We seem to have very different opinions on what is accepted halakha. Like I said, if you want to hold a minority position(which those are, if you really wish I will deal with each one at a time, and bring those who argued on them and so fort) that is fine. Just stop using fruity science and scare tactics to do it.Rabbi Michael Tzadokhttp://mekubal.wordpress.comnoreply@blogger.comtag:blogger.com,1999:blog-1097749014220347853.post-88344394137972981352013-04-21T15:33:17.468-04:002013-04-21T15:33:17.468-04:00Rav Tzadok, while I recognize your superior Torah ...Rav Tzadok, while I recognize your superior Torah knowledge I have to disagree with you and I really feel like this conversation is going around in circles.<br />First of all, as I have provided before, here are studies proving the link between herpes and MBP:<br />http://pediatrics.aappublications.org/content/114/2/e259.full<br />http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6122a2.htm<br /><br />Secondly, your statement "despite it being contrary to established halacha" is incorrect. I'm sorry, but again here are a list of sources I've previously provided showing multiple poskim who are either kofrim (if your statement is correct) or upholders of a different but acceptable halachic approach:<br />We start with the Chasam Sofer. He shows quite convincingly that the purpose of MBP was to prevent illness and that therefore the final step of cicumcision is to prvent illness and that MBP was considered by the Chazal as a great way to do it.<br />The Maharam Shik, his student, came up with the idea that the CS's permission to do MBP indirectly was temporary. He has no evidence for this and, WADR to his greatness in Torah, the "it was only temporary" excuse comes up way too often whenever a great posek decides something in a manner that goes against "the grain". Did the CS pasken something controversial? Must've been temporary despite no evidence that it was. (Some Chareidim apparently are now doing this to "cleanse" Rav SR Hirsch, zt"l, by attributing all his non-Chareidi positions on science, the infallibility of Chazal, etc. to forgeries)<br />The Tiferes Yisrael(Shabbos 19 in Boaz), Shoel U'Meishiv 4:7, Ktzos HaShulchan 382:2 and Chochmas Adam 382:2 all hold that MBP isn't part of the circumcision process. Perhaps they're all heretics?<br />Then we have the Maharatz Chayot and the Mishnah Berurah in the Biur Halacha (ch 331)in the name of the Yad Eliezer where he again justifies using a sponge since the main point isn't to use your mouth but to get blood out of the wound and a sponge is superior therefore it's even permitted on Shabbos.<br />Word on the street is that Rav Yitzchak Elchanan permitted indirect MBP and the Briskers starting from Rav Chaim, zt"l, all forbid direct MBP. The Kores Bris (ch 264) also permits indirect MBP where direct MBP is not possible.<br />The Mateh Levi, acting on the advice of Rav Yaakov Posner, zt"l, also permitted indirect MBP.<br />The Har Zvi (YD ch 214) says you can do indirect MBP to prevent disease.<br />Even the Binyan Tzion, who opposed indirect MBP, apparently started that a mohel who is potentially contagious should not do MBP until he can guarantee he's not anymore. And since HSV sheds asymptomatically no mohel can guarantee a lack of a contagious state.<br />Shevet HaLevi 6:148:2 suggests indirect MBP can be done if there is a risk of infection. The Aruch HaShulchan rules permissively. Rav SR Hirsch and Rav E Hildeheimer permit it.<br />The Nishmas Avraham says his colleagues can't recall any baby getting Hepatitis or HIV from direct MBP. He does NOT mention HSV.<br />Finally, Daat Kohen brings the reason for defending MBP from charges that it spreads disease from the concept that since science is always changing, what doctors say today they change their mind about tomorrow. We are not going to do that with HSV. The virus and its mode of transmission are well understood. Oh, and he also permits indirect MBP (Daat Kohen 140)<br /><br />See further:<br />http://www.hakirah.org/Vol%203%20Sprecher.pdf<br />Mighty Garnel Ironhearthttp://garnelironheart.blogspot.comnoreply@blogger.comtag:blogger.com,1999:blog-1097749014220347853.post-81227178343894808522013-04-21T07:46:35.245-04:002013-04-21T07:46:35.245-04:00attempts to nullify established scientific results...<i>attempts to nullify established scientific results.</i><br />Well that is the first problem. There are none. There has been no scientific study that shows a direct correlation between MBP and an increase in neonatal herpes.<br /><br />There has been a study Ben Haim Et Al 2005 that found that infection rates were the same between children who had a traditional circumcision including MBP and those done under medical conditions in hospital.<br /><br /><i>They compromised an intellectual approach that is intrinsic to Talmudic discourse in persuit of their selfish and bird brained agenda, by attempting to use an incomplete scientific study- not available to the public.</i><br />While I admit they shouldn't have used the study to try to prove what they did, when the conclusion of the study is that more study needs to be done. However, it is available to the public, one need only send an email to get a copy.<br /><br />While I respect a parent's right to choose to go with MBP, or to have a vessel of some sort used(despite it being contrary to established halakha). However to try to villify the practice of MBP with false claims of scientific proof is just cheap.Rabbi Michael Tzadokhttp://mekubal.wordpress.comnoreply@blogger.comtag:blogger.com,1999:blog-1097749014220347853.post-63485700871325948522013-04-19T16:18:58.027-04:002013-04-19T16:18:58.027-04:00This is a great column...I really enjoy your blog....This is a great column...I really enjoy your blog. You know what pisses me off the most about people like Shafran, the entire Agudas Israel, and Haredim in general? Their unhesitant alacrity to assume the position of "victims" the second their postion meets any sort of resitance. Of course they will immediately resort to accusations of "anti-semitism" if convenient (like le affair d'Rubashkin)- or in the case of MBP, they will immediately vilify their critics and resort to vacuous attempts to nullify established scientific results.<br /><br />The latest charade by Agudah- who felt privaleged to use the University of Penn. research to support THEIR recalcitrant position on MBP- is so embarrasing I cannot understand why there are no threats of a lawsuit against them (oh, wait!- that would be anti-semitism; so sorry).<br /><br />Here's another spin on the latest Agudah antics. Judaism and scientific inquiry share a common approach toward the proper interpretation and application of acceptable source material. In other words, if you quote a source, you better be damn certain it is a reliable one, and the interpretation of that source better be accurate. In Halacha, it means quoting say, a certain Rishon is done in the proper context and utilizes an acceptable method to arrive at a p'sak that will withstand scutiny by rabbinic peers. In science, a source article, for exmple, that derives a potential conclusion can have vast reprecussions for a public health matter. I guess it boils down to intellectual honesty in method and conclusion as a common understanding between scientific inquiry, and Torah law. <br /><br />Well,well,well- the Agudah royally blew it, and created an enormous hillul HaShem with their latest grasp at straws. They compromised an intellectual approach that is intrinsic to Talmudic discourse in persuit of their selfish and bird brained agenda, by attempting to use an incomplete scientific study- not available to the public. Its bad enough they shot themselves in the foot by citing incomplete scientific research. They also compromised the intellectual framework of Halachic Judaism (in public, no less...)by resorting to such cheap methodology. <br /><br />To paraphrase George Orwell...such methods must be the work of intellectuals, for an ordinary layman could never be such a fool.Frednoreply@blogger.com