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April 18, 2014 / 18 Nisan, 5774
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Metzitzah B’Peh – Where We Are And Where We Need To Go

Gelbfish-041312

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Some have said that the Chasam Sofer’s p’sak has no relevance today, since they claim that it was only a hora’at sha’ah; a ruling under unusual circumstances that is applicable only for a given time and place. Even if so, perhaps we qualify for a hora’at sha’ah p’sak today, considering that infection with herpes type-1 virus today is at epidemic levels in adults and the consequences to an infant who contracts it is so great. Let those who claim that MBP is absolutely safe prove its safety and we can then reverse this temporary modification.

What do I recommend? I believe that the time has come to establish a formal medical committee that will consider the input and opinions of multiple national experts on pediatric infectious disease, virology and public health. There are plenty of such experts who can weigh in on this debate. This committee will issue a report and make a best-determination of probable fact, considering what is known today. It will also highlight legitimate differences of opinion where they exist. This report can be updated as further data emerges. Poskim can then use these finding of fact to make a determination of halacha.

I know there are many halachic issues. Amongst them: Is MBP a minhag or part of the actual bris? Is it only a medical recommendation by the Talmud that can be modified or discarded as medical knowledge changes? Does metzitzah need to be b’peh or is any other suction source or method of drawing away blood equivalent? Since I am not a rabbi, I am not qualified to rule. I merely seek a way to have fair representation of medical facts and judgment for those ruling on halachic matters.

I believe an organized approach will increase medical factual accuracy, and also result in increased confidence in the halachic process. Our children deserve nothing less than both of these outcomes.

Gary A. Gelbfish MD, FACS, is a vascular surgeon in private practice. He is a mohel certified by the Rabbinate of the State of Israel.

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About the Author: Gary A. Gelbfish MD, FACS, is a vascular surgeon in private practice. He is a mohel certified by the Rabbinate of the State of Israel.


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5 Responses to “Metzitzah B’Peh – Where We Are And Where We Need To Go”

  1. This article makes to much sense. The crazies who run things today will never allow its sensable suggestions to see the light of day.

  2. William Kohn says:

    The bottom line — the chassidish kehillas will not bow to scientific proof and will exercise their political muscle to keep the civil authorities at bay. As such, the leaders of the various chassidish communities owe it to their members to review the strong circumstantial evidence that links one or more mohellim to the spread of the virus and to prevent those mohellim from continuing to perform bris milah. Until that happens, if ever, the leaders of the chassidish communities bear direct responsibility for the deaths and illness caused by MBP. These leaders can use their political muscle to intimidate the civil authorities, but there is a higher authority that cannot be bullied. He will ultimately pass judgment on their recklessness and disregard for their followers' health. As for the Yeshivish world, the past weeks have seen their cowardice as they hide behind Rabbi Shafran's double speak and Dr. Berman's article, which has been critically debunked by other scientists. Additionally, we have also all been witness to the spectacle of Rav Kamenestky's initial statement and his hasty retreat or "clarification".

  3. I actually read the four medical articles AND THEIR references and there is not one shred of correlation between the sources and statements made by Tendler and company. My favorite of Tendler's lies in his Aug 2004 Pediatrics paper is that the Ignacz Semmelweiss discovered disease transmission (May 1847) after a baby got Tuberculosis from an infected Mohel (First case in the literature- Lindemann, Deutsche Mediicinische Wochenschrift 1883. p442. [the 2 cases were in 1873, 8 years after Semmelweis died.]) As a result, Rabbi Moshe Schreiber, the Chasam Sofer, who died in 1839 permitted the Tube which was invented in by Max von Pettenkofer in 1887. Instead on describing the profile of maternally transmitted HSV-1, then expllaining why these cases differ and then claiming the mohel must therefore be the source, Tendler and company list five factors of textbook maternally transmitted HSV-1, ignore their own citations and then claim the mohel is the source. Specfically 1) The mother is immediately disqualified because she is asymptomatic in a disease that is 60% to 98% asymptomatic. 2) She is disqualified because she is seronegative. A seronegative mother with a primary infection has the highest risk of infection (50%). No follow up serology is done to confirm the mother remained seronegative and is not the source. 3) Neonatal HSV-1 infections have been on the rise in all industrialized nations due to declining adolescent HSV-1 seroprevalance and already exceed 50% in many countries. Yet, the authors imediately discount the mother on the basis of an HSV-1 infection. 4) The location of lesions is on a trauma site due to trauma of a maternally infected baby not due to metzitzah. 4) the onset is usually the exact timing stated in the AAP gudelines for maternally transmitted HSV as well as in several articles by Nahmias, Prober, Kimberlin, Whitley, including several papers cited by Lorry Rubin in his March 2000 PIDJ paper and ignored.

    The biggest idiots are the useless bureacrats in the NYC Dept of health, that are spoon fed all the facts, figures, numbers and statistics and have no clue what they mean. Susan Blank is a co-author of a 1998 CDC STD guidelines stating that an asymptomatic, seronegative mother with recently acquired HSV is at the highest risk to transmit to her baby (30%-50%) Julia Schillinger is the co-author of half a dozen papers on the demographics of HSV seroprevalance going back to at least 2000 (MMWR5106) that identify young white seronegative women as being at increased risk for having a baby with NHSV-1. She's the co-author of two paper that state multiple partners are an HSV-2 risk factor and not an HSV-1 risk factor, yet she's oblivious to the fact that Lorry Rubin exclude the mothers in his two cases of HSV-1 infection because "It's highly unlikely that either mother had multiple partners a risk factor for genital herpes" i.e., because she didn't engage in HSV-2 risk factors. Schillinger, after writing five or more papers on the demographics of HSV infection is oblivious to the fact that the authors use 1980 United States statistics to evaluate the likelihood of infection in their Israeli and Canadian cases. (Compare to Kropp RY, Pediatrics.2006. 117(6):1955, 62.5% cases are HSV-1, 98% are due to asyptomatic vertical transmission) In their 2007 ISSTDR presentation the NYC DoH reeled out their first year of mandatory NHSV statistics revealing that 39% of cases were HSV-1 (nearly two out of five) 66% of fatalities were HSV-1 and 66% of fataltites were girls. Yet despite their own data that Neonatal HSV-1 is on the rise due to factors other than metzitzah, NYC DoHMH prefers to follow the guidelined set by 22 authors that have never written a ppaer on herpes, 17 of whom have never witten a ppaer mentioning the word HSV or herpes (pubmed search with authors name) and every Jewish male baby is therefore immediately due to metzitzah instead of the normal 40 year old protocol for excluding the parents first, including first DNA testing of the PARENTS, the source in 90% of cases. Read the literature on NHSV, not Tendler's fabrications.
    And I'm not Danny Berman. I did a lot more research than he did.

  4. The Rambam believed it was dangerous to do a brit without MBP. He also believed the sun revolved around the earth. If we can prove that non-halachic circumcision is no more dangerous than milah with MBP (that shouldn't be too hard), would that convince anyone?

  5. Hey Mark did you ever meet him when you worked at Maimonides? I remember him. He is one of Jerry's wife's cousins (She is a Gelbfish).

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More Articles from Dr. Gary A. Gelbfish
Gelbfish-041312

As a vascular surgeon for over 20 years I care for wounds daily. As an occasional mohel for 30 years I am familiar with all aspects of milah. I thus feel obligated to share my perspective on this most important topic. If I don’t, who will? In order to decide halachic matters, rabbis need accurate and representative medical input. This is my only goal.

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