Behind The Campaign Against Metzitzah B'peh
Uncovering The Real Public Menace
Is bris milah really under siege in New York City?
If the question triggers laughter or disbelief, consider this: A proposed amendment to the NYC Health Code that is under serious consideration would outlaw the performance of a ritual circumcision using metzitzah b’peh (oral suction), unless parents give their written consent.
The amendment would require mohelim to advise parents about the (imaginary) dangers of metzizah b’peh (mbp), “such as brain damage or death,” due to the risk that mbp “will transmit herpes and other infectious diseases.”
What’s appalling about this scenario is not only that the claims of serious health hazards attributable to mbp lack credible evidence, but that regardless of that fact, they are nevertheless being promoted as absolute truth.
Equally ominous, this amendment would be the first time in U.S. history that government interfered with any aspect of bris milah - a dangerous precedent that challenges the First Amendment right to freedom of religion. After the breach in the wall, who knows how far detractors will go?
Will today’s urgings against mbp on the part of the DOH and their recommendations to confine circumcision to a sterile hospital room one day morph into tomorrow’s legal measures enforcing these restrictions?
Most troubling, the uproar over mbp has brought about an Orwellian situation where the likely cause of neonatal deaths from HSV-1, namely from a herpes-infected family member or caregiver, is being ignored by the very officials whose job it is to alert the public to this health hazard.
Instead of nailing down the real “culprit” causing herpes infection in newborns, the Center for Disease Control (CDC) released a report by the DOH that focused the blame solely on mbp. The report asserted that mbp poses higher risks of HSV-1, which could be fatal to newborns.
[One of the lynchpin cases in the CDC report is the subject of an exclusive interview Yated conducted with the mother of the baby who died from a herpes infection last fall. That interview with its shocking implications about short-sighted health officials on a misguided crusade appears toward the end of the article.]
REPORT RIDDLED WITH INACCURATE DATA
The health report was the latest salvo in the DOH campaign to eradicate metzitzah b’peh. DOH head Tom Farley is as explicit about his agenda as he could be. Farley is quoted as saying he hopes to achieve the goal that mbp “never be performed.”
So hostile is DOH to mbp that it in its rush to judgment, its report is riddled with omissions and inaccurate data, experts say.
Most glaringly, “the report overlooks a much more obvious cause of herpes infection in newborns - direct contact with a family member with an open and infectious herpes cold sore,” noted Dr. Dan Berman, chief of infectious diseases at New York-Westchester Square Hospital in the Bronx.
This serious omission (among many others), and the report’s unreliable data and conclusions render it of dubious value, he said.
“The data prove nothing at all,” Berman said in a lengthy phone interview with Yated. “There simply is no evidence at all linking ritual circumcision with herpes.”
Dr. Berman noted that the health report cited the fact of 25 cases of newborn deaths from herpes - where mbp was not performed - over a 5-yer period. How then did the infants contract the infection? The medical consensus, he said, is that the infection came from the most common route - exposure to a family member or caregiver with herpes.
Why should it be any different in the religious community, he asked. If mbp was not in the picture, would there be the slightest doubt in anyone’s mind about how the herpes infection was most likely transmitted?
Dr. Berman was troubled by the fact that the report insisted on blaming mbp for the death of a newborn whose sibling had been afflicted with herpes at the time. The authors of the report refused to credit this documented fact as the likely source of the herpes infection that caused the newborn’s death.
Even without offering a shred of evidence that mbp had been performed, the report treated it as a given. The cause of death, according to chief medical examiner Charles Hirsch, (employed by the DOH), was disseminated herpes HSV-1 due to oral suction during circumcision.
Disturbed by this seemingly willful blindness, Dr. Berman reviewed the entire medical file on the above-mentioned tragedy. He found the record contained no information at all about the mohel or the milah. The weight of the evidence it did provide pointed overwhelmingly to the likelihood that the newborn’s acquisition of a fatal herpes infection had come from an infected sibling.
“Transmission from a family member is well established in the medical literature,” he said. “It’s been proved with DNA fingerprinting.” Yet the researchers chose to ignore the obvious in the witch hunt against mbp.
DIRECT CONTACT WIHT INFECTED 2-YEAR OLD IGNORED
Dr. Berman subsequently confirmed his findings with the mother of the baby, Mrs. K. from Brooklyn. She told him that her 2-year old had plucked a pacifier from the newborn’s mouth, stuck it into his own mouth for a second, then returned it to the infant’s mouth. The 2-year old had been afflicted with severe herpes blisters on and off prior to this incident and had an active cold sore at the time.
The mother said she had no idea that a herpes infection was so contagious and could be fatal to a newborn.
Astoundingly, neither the attending physicians in the hospital, the DOH researchers nor the medical examiner seized on this clue in determining the cause of the baby’s illness and death. They certainly were aware of this complication - it was in the medical file. If they acknowledged the 2-year old as a potential source for the newborn’s herpes infection, they gave no indication of it.
Their questions were solely about the circumcision, who performed it, how exactly he did it and questions of that sort, Mrs. K. later told one of her attorneys, Mr. Yerachmiel Simins, who shared this information with Yated.
NEGATIVITY ABOUT MBP CLOUDS JUDGEMENT
“There’s a kind of tunnel vision in some parts of the medical community when it comes to mbp,” Dr. Berman observed. “In some ways this is understandable. To an outsider, the practice of sucking blood from the circumcision wound on the baby’s organ is incomprehensible. There is a predisposition to see it as unhealthy even though when done properly, it isn’t.”
The problem is that the negativity about mbp clouds people’s judgment, he said. “When you have a clear family history of a herpes risk factor in front of you, no one should question for a split second where the newborn’s herpes infection came. Logically no one should be scratching their head, wondering if the baby picked up an infection from the mohel. It makes no sense.”
AN EXCRUCITATING SAGA
Mrs. K., a mother of seven, graciously consented to an interview with Yated this week, about ten months after her newborn baby died of a herpes infection. During the interview, conducted in the presence of one of her attorneys, she recalled the excruciating chain of events that led up to her baby’s death, and the nightmarish harassment that followed.
Her baby was about two and a half weeks old when she noticed one evening profuse bleeding in the diaper area. When she was unable to stanch the bleeding, she rushed the baby to the emergency room.
Amid a barrage of tests, the infant was immediately hooked up to an IV and given an array of medications to treat a possible herpes infection or staff infection. An examination revealed a blister on the baby’s heel that later turned out to be a herpes blister, but few other outer clues.
“Someone asked me if anyone in the family had herpes and I told them yes, one of my children had had cold sores,” Mrs. K. recalled. “At the time, I had no idea that cold sores in a sibling - even a small sore - could be life threatening to an infant. I’ve always been a very cautious mother, maybe even over-cautious when it came to newborns. But it took this tragedy to open my eyes to the danger of herpes transmission.”
BADGERED ABOUT THE CIRCUMCISION
“I was asked again and again about the circumcision by various people in the emergency room,” Mrs. K. recalled. “Was it a traditional circumcision, they wanted to know. Can you tell us who did the procedure, they kept repeating.
“I didn’t respond to those questions. It confused me that this was all that seemed to matter to these people. My focus was on my baby… I remember feeling so frustrated. My baby was dying but that seemed to be secondary! Can we please just take care of this sick baby, I wanted to shout. Isn’t that what matters most right now?”
Tragically, the infant did not respond to the medications and after struggling for two days, passed away. The doctors noted liver failure on his medical chart but could not explain the cause for it.
It was four months before Mrs. K. and her husband would learn the cause of death. “We were getting over the tragedy, trying to put our lives back together after the trauma,” she said. “Then in February, we received a letter from the medical examiner that our baby died of herpes.”
“I still did not make the connection between that information and the fact that my 2-year old, who had a small sore on his lip, had licked the baby’s pacifier before sticking it back into the baby’s mouth. It was only after talking to Dr. Berman that I realized how fatal this was. He said the most dangerous time for a newborn to be exposed to herpes is up to two months after birth. I simply never knew. I don’t think most mothers have a clue.”
The family was in the midst of trying to put the nightmare behind them, when a fresh one erupted.
Following the medical examiner’s letter, the media picked up the story and sensationalized it, setting the stage for a renewed attack on mbp, and putting Mrs. K. in the line of fire.
“There were non-stop telephone calls from strangers, from reporters and news stations. Many of my relatives were harassed as well. They all harped on one question: the baby’s circumcision. Callers wanted to know who performed the circumcision, what exactly he did or didn’t do. I felt no obligation to answer and made no comment. It was clear this harassment was being orchestrated.”
Mrs. K. recalled returning home one evening when a woman from the Brooklyn DA’s office stopped her at the entrance to her home.
“She introduced herself and after some honeyed words about my ‘tragic loss,’ said the DA would like to ask me a few questions - just a brief, friendly talk. She presented herself as a sympathetic friend, who even in the midst of making a wedding, wanted to be of assistance to me. She offered to drive me down to the DA’s office.
“I told her it was impossible at that hour. I was holding bags in my arms, I had my children waiting for me, supper and bedtime to take care of. She suggested I call her the following day and she would pick me up and drive me to the office. I said I would consider that. The next day she called me. I said I would prefer not to come in, that if they wanted to pursue this, they could speak to my lawyer.’
“She got really angry. ‘Why did you have to do that?’ she demanded. ‘What did you do that for? This was just going to be a friendly talk.’
“I was now on my guard. It was clear this person was no friend and the talk with the DA would be anything but ‘brief” and ‘friendly.’”
Harassed by the DA and the media, Mrs. K. said she and her family are being denied closure on a searing tragedy. She is still wanted for questioning by the Brooklyn DA’s office in connection with a pending criminal investigation regarding her baby’s death. The focus of the investigation is clearly mbp.
“People have different degrees of faith,” she said. “If I were not who I was, our lives would be in shambles now,” she said. A less strong person would have crumbled, becoming a pawn in what is clearly a political agenda.
What emerges from this saga is that in demonizing mbp as chiefly responsible for causing HSV-1 in newborns, and ignoring other more likely routes of herpes transmission, the Department of Health is allowing a political agenda to trump its mission to educate, inform and protect. This is deeply troubling.
The public deserves better from those entrusted with the public good.