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December 03, 2012

3 Major Medical Organizations Come Out Against Haredi Circumcision Rite

Brit milah circumcision blurAmerican Academy of Pediatrics, the Infectious Diseases Society of America, and the Pediatric Infectious Diseases Society all say metzitzah b'peh, the direct mouth-to-bleeding-penis suction done by haredi mohels is a danger to children, and they argue that an informed consent signed by parents is necessary.

Brit milah circumcision blur

The Jewish Week's Hella Winston has an article on the letter-turned-amicus-brief which can be read here.

Here are excerpts from that letter sent by Akiva Shapiro, and attorney with Gibson, Dunn & Crutcher LLP, to the federal judge hearing the case. She accepted this letter as an amicus brief on 11-20-2012:

I write on behalf of the American Academy of Pediatrics ("AAP'), the Infectious Diseases Society of America ("IDSA"), the Pediatric Infectious Diseases Society ("PIDS”), and the American Sexually Transmitted Diseases Association ("ASTDA") in opposition to the motion for a preliminary injunction filed by the plaintiffs in the above-captioned case. Our clients are the nation's foremost professional organizations of pediatrics, infectious diseases, pediatric infectious diseases, and sexually transmitted diseases physicians, and they are gravely concerned about the public health implications of an injunction against the implementation of the challenged parental consent regulation, and from a ruling that the regulation is unconstitutional. We respectfully request the Court's permission to file this amicus submission by letter in lieu of a formal motion.

We write regarding three central issues about which proposed amici have particular expertise, each of which has critical medical and public health implications. First, it is incontrovertible that infectious diseases can be, and have been, transmitted through direct orogenital suction of the penile incision during circumcision ("direct oral suction"), and that direct oral suction increases the risk that a neonate will acquire herpes simplex virus ("HSV") and other communicable diseases. Second, the regulation at issue is primarily directed at — and unquestionably furthers — the important public health and constitutional prerogative of ensuring informed parental decision-making, including communication of risks, before any non-emergency medical procedure is performed on a minor. Third, a ruling in plaintiffs' favor would severely hamper the government’s ability to effectively address a wide range of public health concerns, as it would undermine officials’ ability to rely on the advice and data-driven opinions of medical professionals in passing public health regulations.…

The clinical and epidemiological data evidencing the health risks of direct oral suction are incontrovertible. Numerous infectious diseases, including HSV, have been transmitted through direct oral suction, and direct oral suction increases the risk of infectious disease

Two hundred years of historical data also supports the straightforward proposition that direct oral suction increases the risk of transmission of HSV and other infectious diseases. Indeed as early as 1811, physicians had documented the risk of infectious agents passing from ritual circumciser to infant through the procedure. That year, Dr. Johann Rust, a prominent 19th century medical expert, documented an outbreak of syphilis in Krakow among infants who had been subject to direct oral suction. Dr. Rust concluded that the fatal epidemic was due to the "venereal lesions ... in the oral cavity of the local mohel." Shlomo Sprecher - Mezizah be-Peh —Therapeutic Touch or Hippocratic Vestige?, Hakirah, the Flatbush Journal of Jewish Law and Thought Vol. 3 (2006), 15,30-31 (Farley Decl., Ex. H). Similarly, in 1873 the New York City Board of Health investigated the cases of four otherwise healthy newborns who acquired genital ulcerations after they were subject to direct oral suction, three of whom ultimately died from their illnesses. ld Subsequently, the New York Medical Journal published an article on those four cases which explained that the children most likely acquired their infectious diseases from the oral-genital contact between them and their circumcisers. See R. W. Taylor, On the Question of the Transmission of Syphilitic Contagion in the Rite of Circumcision; N.Y. Med. Journal 561, 561-82 (1873) (Farley Decl., Ex. I). Moreover, the historical record contains numerous other instances of infectious disease transmission through direct oral suction, including of tuberculosis to the penis and syphilis.

Given the overwhelming scientific evidence demonstrating the .increased likelihood that newborns subject to direct oral suction will acquire HSV and that, because neonatal immune systems are underdeveloped, HSV infection in newborns is more likely to result in death or permanent disability, the risk associated with direct oral suction should be clearly communicated to parents or legal guardians in advance of the procedure, and written parental permission for the procedure should be obtained.…

The public health and policy considerations overwhelmingly support a government actor's right to defer to the judgment of medical professionals when issuing public health regulations.    State and local health boards must be permitted to defer to the professional medical judgment of their advisors when making such decisions as government actors often have neither the resources nor the expertise to perform their own medical research or reach their own medical conclusions. Adherence to the dangerous standard proposed by the plaintiffs — namely, that any degree of disagreement within the medical community precludes reliance on prevailing scientific data and medical experts' conclusions — would severely hamper the government's ability to effectively address public health concerns.

Supreme Court precedent definitively establishes that "medical and scientific uncertainty" does not "foreclose the exercise of legislative power."   Gonzales v. Carhan, 550 U.S. 124, 164 (2007). In fact, to conclude that a procedure involves “risk” does not require that there be conclusive understanding of causation. Instead, standard protocol in the medical community is to recognize a strong correlation as a "risk" "while further studies are conducted to clarify whether various underlying factors play causal roles." Planned Parenthood v. Rounds, 686 F.3d 889. 899 (8th Cir. 2012). "Thus, the truthful disclosure regarding increased risk cannot be unconstitutionally misleading or irrelevant simply because of some degree" of disagreement or uncertainty surrounding the underlying scientific facts. ld. at 900. Rather, the party challenging the existence of such risk must "show that any medical and scientific uncertainty has been resolved into a [scientifically accepted] certainty against a causal role." ld.

This standard reflects the notion that "the [government], rather than a federal court, is in the best position to weigh divergent results and come to a conclusion about the best way to protect its populace." Id at 904. The City's role in protecting the health and safety of the community is far too important to ignore scientific data showing a medical risk associated with direct oral suction. Ritual circumcisers' religious freedom "does not include [the] liberty to expose the community or the child to communicable disease or the latter to ill health or death." Prince, 321 U.S. at 166-67. It is, rather, for the City to rely on medical professionals' risk assessment and to create public health policy and regulations accordingly. The challenged regulation does just that, and the Court should defer to that judgment.

Here New York City properly relied on the recommendations and conclusions of its medical advisors in deciding that direct oral suction poses health risks. a position supported by the medical community and overwhelming scientific evidence. The plaintiffs have failed to demonstrate that there is a scientifically accepted consensus against a causation between direct oral suction and HSV (and other infections) simply because no such consensus exists. Just the opposite--there is a clear consensus in the medical community that such risks are serious and reaL Under the dangerous standard proposed by the plaintiffs, any dispute as to the medical facts justifying a public health regulation would render the regulation legally invalid. Not only would such a standard obviously undermine the government's legitimate objective in preventing the communication of infection in the specific circumstances of direct oral suction, such a precedent would set the bar impossibly high for scientific certainty, thus undermining the entire basis for public health regulation.

For the foregoing reasons  the American Academy of Pediatrics, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Sexually Transmitted Diseases Association respectfully request that this Court accept this letter in lieu of a formal amicus brief, and deny plaintiffs' request for a preliminary injunction.

The entire letter is posted as a downloadable PDF document below.

Marvin Schick submitted an affidavit in the case on November 30. Schick points out that the city erred when citing his school enrollment data, because it left out Chabad, which was put in a different category than standard haredi yeshivas in his study. Schick argues that for that reason and for several other less significant reasons, the population of infants who received metzitzah b'peh is higher than city claims, making the risk it calculated higher than it actually is. This is the strongest attack on the city's statistics I've seen. Even so, it doesn't change the city's argument or the arguments presented in this amicus brief.

Here is Schick's affidavit as a PDF file:

Download Marvin Schick MBP Affidavit 11-2012

Here is the amicus letter from the American Academy of Pediatrics, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society:

Download American Academy of Pediatrics, etc, Amicus Brief MBP 11-2012


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they argue that an informed consent signed by parents is necessary.

Will that really stop the practice or is this yet another legal document that people mindlessly sign like the pressing on the "I Agree" button when one installs software.

If I were jewish, I would consider this practice a horrible embarrassment.

Let's take a moment and summarize the trollish posts that are soon to follow:
1. More people die in automobiles than by MBP and no one is banning cars. Therefore MBP in cars is the best way to prevent auto accidents.
2. The Rebbeim say that MBP is safe. Therefore it is safe. If it weren't safe they would ban it, as they are omniscient
3. MBP has been proven to be safe for 5,000 years. It was done at Sinai by a holy column of fire. Even Avraham did MBP to himself after his bris, despite his advanced age. Shimon and Levi also performed MBP on all the men of Shechem when they agreed to be circumcised.
4. The only reason a Mohel won't perform MBP on an adult, for example a convert, is the solemnity of the moment would be ruined if he gagged because of the girth of said makom ervah.

Charedim dont give a fuck, they do what they want. that is why they need to be forced to stop, this wont change anything.

If 5,000 years ago our ancestors were pure enough of mind, body and soul to perform MBD it doesn't mean that our contemporaries are.

Bennyc -I am jewish and as you wrote i consider it a horrible horrible embarrassment for the past 50 years when i first saw it as a child i was unerved shaking i could not beleive that our rabbis are so dumb still cant beleive it.

Posted by: Eugene | December 03, 2012 at 06:37 PM

Do you realize that it was a satirical post?

lol, no. nicely done.

I can't wait to read Rav Avi Shafran's denouncement of this piece.


While I agree with you in this instance, the fact is when it comes to how Jews practice Judaism - you don't get a vote, and a goy publicly expressing that he finds what we do to be embarrassing is perhaps the fastest way to guarantee that we'll keep on doing it.

I've heard that NAMBLA has come out in favor :p

There Charedim need to voluntarily stop this Halachically unnecessary practise before it is done for them.

Those posters who point out that more people die in auto accidents than infants who undergo MBP are making an invalid comparison, and they know it. The fact is that MBP is an unsanitary practice, and in today's day and age, we do not undertake unsanitary practices. I really don't care if MBP has been practiced for thousands of years - it is time to,stop it.

Haredim claim that MPB is mandated by Jewish law. If Jewish law mandated salvery or pologmy, or some other unacceptable practice, would the Haredim still claim those practices should still be continued?

Studies show that circumcision causes significant pain and trauma, behavioral and neurological changes in infants, potential parental stress from persistent crying (colic) of infants, disrupted bonding between parent and child, and risk of surgical complications. Other consequences of circumcision include loss of a natural, healthy, functioning body part, reduced sexual pleasure, potential psychological problems, and unknown negative effects that have not been studied.

Some circumcised men resent that they are circumcised. Sexual anxieties, reduced emotional expression, low self-esteem, avoidance of intimacy, and depression are also reported. Some doctors refuse to perform circumcisions because of ethical reasons. Relying on presumed authorities (e.g., American Academy of Pediatrics or doctors who echo AAP views) is not sufficient because of personal, religious, financial, and political conflicts of interest.

Some circumcised men resent that they are circumcised.

Yes, so much easier to blame their circumcision instead of the real cause of their problems...

The current anti-circumcision discourse is part of an enlightenment; a world-wide mainstream movement against a mutilative practice that is a clear violation of human rights. "Circumcision" is vulgar and cruel child molestation and sexual mutilation. It amputates the most sensitive and mobile part of a victim's penis and renders the victim sub-normalized for life. It cannot be tolerated in a modern world and must be stopped. Jews found a way to give up slavery and stoning to death adulterers and those who did not observe the Sabbath. Now they need to find a way to give up infant sexual mutilation. I suggest they lead not follow.

Dear Gary Goldman and Ronald Harryman,
"It renders the victim sub-normalized for life" and causes "potential psychological problems".
Now I know why Jews have been baking matzahs with the blood of Christian children for the last 2000 years, control all the banks and media in the world, and win a lot of Nobel prizes.

NeverFrum - glad to hear the North American Marlon Brando Lookalike Assn. is standing up for MBP. :^)

Now I know why Jews have been baking matzahs with the blood of Christian children for the last 2000 years, control all the banks and media in the world, and win a lot of Nobel prizes.

Hunh?????? Is that supposed to be satire? Sorry Chief, but I don't find the sexual mutilation of Jewish boys amusing.

Skeptical Yid, you write:
"1. More people die in automobiles than by MBP and no one is banning cars. Therefore MBP in cars is the best way to prevent auto accidents.
2. The Rebbeim say that MBP is safe. Therefore it is safe. If it weren't safe they would ban it, as they are omniscient."

Are you that blind? Or, you must be kidding. You can't be serious!! Putting aside the disgusting aspect of MBP, it is not to be done because it is not a sanitary practice! Period.

Regarding your second comment, "the Rebbeim say that MBP is safe, therefore it must be safe," you can't possibly be serious! These are the last people on earth I would listen to.

I know, your comments must be a spoof. Good, really good.

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