Friday, December 22, 2006


Metzitzah b’peh: To suck or not to suck

Life is always stranger than anything I invent, so it's no wonder that friends and acquaintances occasionally question my accounts of the news, even at their own peril. That's what happened last week in the Pink Snapper when I told this tale. Normally my fellow convivialists accord my stories a modicum of respect, but this one overstretched their credulity.

Now given the nature of it I too would have been skeptical had it appeared in, say, a Rupert Murdoch paper. But the source is The Forward, a weekly which "has reached its largest-ever English-language circulation, while firmly cementing its reputation as American Jewry's essential newspaper of record...." Next to Torah there's The Forward, so believe it.

It seems that in the environs of Greater New York, where orthodox Jews once flocked like evangelicals to Colorado, it is not uncommon to encounter an ancient circumcision practice known as metzitzah b’peh. To put it simply, the circumciser, or mohel, sucks off the blood from the baby's penis after the foreskin is cut, thus "purifying" the aforesaid penis. Nothing out of the ordinary so far, right?

But here's where it gets sticky: Some of the babies have acquired a sexually transmitted disease (STD)—Herpes simplex, Type 1—without even having had the pleasure of acquiring it. In fact, one of them died of it and another was hospitalized with an infection that had spread to his spinal column.

In a sane, secular state the practice would simply have been banned forthwith, and young Jews would have to wait a few years for their introduction to fellational bliss and STDs. But this is New York, for God's sake, where the mayor's name is Bloomberg and where offending Orthodox Jewry is a sure way for a politician to find more time to spend with the family.

So to avoid banning the practice, Antonia Novello, New York state health commissioner and Republican, set forth a "protocol" that the mohels were to follow. At best the protocol would have only reduced the rate of viral transmission and at worst done nothing at all. In fact, the protocol was so irrelevant to accomplishing its supposed purpose that the health department might as well have said, "If you want to go on sucking those babies' cocks, you should agree (completely voluntarily, of course) to wash your mouth with soap and water and kiss the baby's ass three times." In other words, the protocol merely piled ritual on top of ritual.

In a libertarian sense some people might admire the New York health department for so determinedly trying to respect a traditional religious practice. But another odd feature to this tale is that the practice involves families apparently unaware of what's going on. New York City Health Commissioner Thomas Frieden wrote, “some parents whose infants had metzitzah b’peh say they did not know the mohel would perform it.” And reporter Steven Weiss goes on to write,

Jews outside of the Orthodox community often hire ultra-Orthodox mohels, but are believed to be largely unaware of the practice of direct oral suction.

So why go to an Orthodox mohel? Maybe it's similar to a practice I've observed among Latin Americans won over from Catholicism by evangelical "missionaries." They may consider themselves to be evangelical, but when the time comes to baptize the baby, they want a "real" Catholic priest to do the honors.

So there are some serious public health issues at stake, not the least of which is that untreated herpes is said to have a fatality rate of over 60% in newborns. This means that since the Republicans have shirked their duty, the proper way to perform a circumcision will be, in the words of Steven Weiss,

a hot potato on the desk of incoming New York state Governor Eliot Spitzer this January, after the administration of outgoing Republican Governor George Pataki reached an agreement with Hasidic leaders on precautions that medical experts say will do little to reduce the risks.

Absolutely breathtaking—the thought that the governor of maybe the most important State of the Union, the very home of 9/11 and Wall Street, must begin his term under the cloud of a circumcision controversy that at heart revolves about sucking blood from baby penises. And it involves only a minority within a minority since most mohels, even among the Orthodox, now use a straw—or as reporter Weiss puts it, "a sterile tube to draw away the blood."

We really must resecularize the government if it is to do anything useful. It is easy to believe that we need an American Ataturk, someone who could say "We've had enough of this nonsense. If you're going to risk killing people's offspring, you'll need a better excuse than that you've been doing it for 5,000 years." But it's not clear to me that Ataturk's secular reforms will ultimately succeed in Turkey, and maybe they would fail here as well.

In the U.S., thanks largely to the efforts and growth of the evangelical movement whose votes have been like manna to the Republican Party, we seem to be segregating ourselves into competing minisocieties with secularists and mainstream religious groups under constant challenge to tolerate the intolerant. Of course adherents to the various styles of religious orthodoxy are not unreasonable in their fear of secularism, since it is true that under a secular regime their right to suck blood from baby penises or keep their children ignorant of science may be curtailed. (Yet it isn't that the government has to be militantly "secular," but could we at least try for "sane"?)

When the secular authorities refuse to do their duty it is left for the religious to sort out. And for the matter at hand, Sherwin Nuland, a surgeon and biographer of the great medieval Jewish physician Maimonides, attempts just that—

One of the first things I was taught when I began my surgical training about 50 years ago was that I must never spit into an open wound. To my knowledge, that is still a good rule.

As ridiculous as such a statement sounds, it is not much more ridiculous than the idea of deliberately exposing a freshly cut incision on the penis of a newborn — whose immune mechanisms are, of course, not yet fully developed — to the germs in human saliva. Any fool should know that such virulent bacteria and viruses must never come into direct contact with a wound, much less that of a neonate.

The only rationale for putting lips to an open incision is the possibility that the alternative may be worse, such as the absorption of a more toxic substance such as snake venom. And yet, there currently rages a violent dispute about whether some of our ultra-Orthodox brethren should be permitted to continue a practice about which there seems to be only debatable probability of halachic justification. A custom is not a law, any more than a superstition is the manifestation of religious faith.

Maimonides railed against superstitions of all sorts, though it is true he was somewhat more lenient with local customs that could not be shown to have a basis in rabbinic law. But regardless of the position he might take in matters of human behavior, he never wavered from the precept that health trumps virtually anything else. Any commandment may be violated in the name of health, except those injunctions against idolatry, blasphemy, sexual immorality and murder.

.... To Maimonides — and he said this directly — the practice of medicine was a religious undertaking, because without health and life one could not study God and achieve an understanding of His ways.

It is this argument that ultimately supersedes any halachic argument that may be brought forward to justify metzitzah b’peh...

Unfortunately Dr. Nuland's rationale for stopping the practice is unlikely to persuade the men in this room.

Related posts
The Christian Right, STDs, monogamy and other wonders (5/30/05)
Condoms 1 Right-Wing 0 (6/22/06)
Ooh-la-la! Cheap condoms for school kids (12/16/06)


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