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April 12, 2013

Exclusive: Penn Study Cited By Agudath Israel Of America Not Peer Reviewed, Flawed, Authors Did Not Disclose Conflicts Of Interest

Metzitzah b'peh Chabad closeupThe University of Pennsylvania's Center for Evidence Based Medicine did what is known as a review study of the dangers of metziztah b'peh (MBP), the direct-mouth-to-bloody-penis sucking done by haredi and some Modern Orthodox mohels after cutting off the baby's foreskin. But that study is not peer reviewed. It is also flawed, and its authors have conflicts of interest they did not declare.

Metzitzah b'peh Chabad closeup

The University of Pennsylvania's Center for Evidence Based Medicine did what is known as a review study of the dangers of metziztah b'peh (MBP), the direct-mouth-to-bloody-penis sucking done by haredi and some Modern Orthodox mohels after cutting off the baby's foreskin. But that study is not peer reviewed. It is also flawed, and its authors have conflicts of interest they did not declare.

The study was actually done by one analyst, Brian Leas, and a project director who also conducted the internal review of Leas' work, Dr. Joel Betesh.

Both Leas and Betesch are connected to the Orthodox community, as you can see below.

Betesh was honored by the Philadelphia Kollel, a haredi institution, and was on its fundraising dinner committee at one time.

Leas was on an Orthodox email list (see the invitation to an Orthodox Torah study class at a kosher restaurant posted below) and is Orthodox affiliated.

Penn would not release the study to me or to at least one other journalist seeking it. When I asked Susan Phillips, Senior Vice President of PENN Medicine if it was peer reviewed she replied, "Never! It was an internal literature review."

The study appears to have been done specifically to help Agudath Israel's lawsuit against he City of New York seeking to block implementation of the city's new requirement that mohels must give an informed consent form to parents before the circumcision if MBP will be done.

Neither Betesh or Leas divulged their connection to Orthodoxy.

And while their study claims that previous studies were flawed because they did not have enough definitive information to properly reach the conclusions they reached, Betesh and Leas failed to note that was due to lack of cooperation from haredi mohels and haredi rabbis, although they do  mention that some parents of the sickened babies refused to cooperate with Department of Health and Mental Hygiene investigators.

Leas is not a physician.

Betesh is not a pediatric infectious disease specialist or an epidemiologist. He is an internist.

The Penn study says that "the Center for Evidence-based Practice at Penn Medicine has been asked to review the clinical evidence,” but it does not say who made that request or what entity that person or persons represent.

When told that it appeared that the Penn study had been written to help Agudath Israel of America and other haredi groups in their lawsuit against NYC, Penn’s Phillip's did not reply. She also did not reply when I asked how Agudath Israel of America got what was supposed to be an internal Center for Evidence-based Practice study.

Since Penn's study was completed, two more studies have been published showing a link between MBP and HSV-1 infection, and two more babies in New York City have reportedly contracted HSV-1 from MBP.

The study concludes that “the available evidence indicates that circumcision with direct orogenital suction may be a risk factor for infection” and says that because HSV-1 can kill babies, “exposure to the infection should be carefully considered."

Agudath Israel of America clearly misrepresented the study's conclusion, which does not fully support its position.

Even so, the inescapable conclusion is that two Orthodox Jewish employees of Penn, at least one with close ties to a haredi institution and local haredi leadership, conducted a brief study for Agudath Israel of America (or for one of its supporters) with the intent of bolstering Agudath Israel of America's lawsuit against the city, and did so using a degree of deception.

Joel Betesh Kollel 1
Joel Betesh kollel 2 annotated watermarked
Brian Lead Torah Class Email
The Penn review study:

Penn MBP 1
Penn MBP 2
Penn MBP 3
Penn MBP 4
Penn MBP 5
Penn MBP 6
Penn MBP 7
Penn MBP 8
Penn MBP 9
Penn MBP 10
Penn MBP 11
Penn MBP 12
Penn MBP 13

Comments

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Shmarya, I agree with all of your views on this matter, but do you know what "peer reviewed" actually means and whether that would even be relevant with regards to this report?

Maven –

Yes, I know. It is relevant because of how Agudah used the report and and because the author(s) were less than honest about their affiliations.

Investigative reporting at it's best!

actually I think betesh is a syrian jewish name (most of whom are cohanim). not to god forbids label anybody one way or another.

Technical question (I'm serious): I am against metzitzah b'feh (feh!) but I am curious as to its description as a "penis sucking" ritual -- as if the mohel performs fellatio on the baby. Is this truly the manner of the sucking, or does the mohel suck the wound only, in which case the entire penis would not be inserted in the mouth.

If it is the latter -- and I really don't know -- then opponents of the practice might discredit a legitimate position by making the mohelim look like perverts. Since the issue is hygiene, I think that inflaming the discussion by hinting at a sexual practice could backfire.

Do all studies written by Orthodox Jews have to be marked JUDE or just the ones that reach conclusions you dont like?
Also the fact tat he isan internist is completly irrelevat this is a form of meta-analysis he isnt doing any new research

Magnificent, Shmarya.

I hate to drag Penn State's name through the Agudah - or is it vice versa? Dirt, dirt everywhere.

Wow. Great work.

Outcast... so your distinction is whether the Mohel puts the entire penis in his mouth or only the head. Is there really that much difference when we are talking about an 8-day old infant.

Sorry. Either one looks to me like a perverted, disgusting practice. Could such a distinction also apply to girls ("I only licked the outside")?

First-rate investigative journalism. Excellent work. Deserves wide circulation (with credit).

"I hate to drag Penn State's name through the Agudah - or is it vice versa? Dirt, dirt everywhere.

Wow. Great work."

Posted by: dh | April 12, 2013 at 05:50 PM

This is the University of Pennsylvaina where the "research" report was written, not Penn State. I am sure the University's research rules were violated due to not disclosing the lack of independence. Leas' and Betesh's reputation just took a big hit.

Runner, I agree.

What kind of published study cannot be released to an interested member of the public? I could understand if they want a fee for the item or for a paid subscription, but Shmarya wasn't given such options.

Every peer-reviewed medical journal requires a formal statement to disclose conflicts of interest.

http://www.cspinet.org/new/pdf/20080711
_a_common_standard_for_conflict_of_interest
_disclosure__final_for_conference.pdf

Most such conflicts of interest are financial, and journals require these to be disclosed, but non-financial conflicts are an area where folks like the frumma can play fast and loose with their personal ethics.

"...Non-Financial Conflicts of Interest: Authors may have strongly-held views about the article being submitted for publication. Authors should consider disclosing and editors may choose to print any affiliations or expressions of these views that may be relevant. These may be personal, political, or intellectual and may include any expression of strongly held views relevant to the subject of the submission. Such disclosures may be original, or they make reference to opinions previously expressed in books or monographs, op-eds or public comments, or to sworn testimony before or lobbying of legislators or legislative bodies. Disclosable non-financial conflicts of interest would also include membership or affiliation with non-governmental organizations that have an interest in the submission..."

Pretty sure you don't have to declare your religion if you are doing a study about a religious practice that your religion follows. For instance if I did a sociological study of OTDers I would not have to declare on the publication that I am an OTDer myself.

Articles are not peer reviewed until they are submitted for publication. If this lit review was to be used for some sort of lawsuit, and not a publication, there is no reason it would ever be peer reviewed. There are all sorts of lit reviews done by experts that are used for law cases, and none are ever peer reviewed. They are considered experts based on their other publications that have been peer reviewed.

If you have a legitimate reason to believe they ignored or misrepresented evidence in their lit review that is one thing, but to attack it becasue it was written by jews and wasn't 'peer reviewed' is a seriously flawed argument.

Full disclosure: I got my Phd at Penn (Not in medicine though)

Also you don't have to be a physician to write a lit review on medical science. Physicians are not typically trained in research methods, they are trained in the practice of medicine, which is an entirely different thing. According to the internet this Leas guy has a masters of science in health policy, is working on a phd in health policy, and has years of experience as a health policy research analyst, which makes him more than qualified to write a lit review of this nature.

I disagree with AE, and I agree with Runner.

If an author does indeed have a personal agenda, or if there could emerge such motives which would cast aspersions on the integrity of the work, then such disclosure is necessary. The author(s) of an article that appears on his university's website owes it to his employer not to set them both up for a conflict of interest charge.

http://www.cspinet.org/new/pdf/20080711_a_common
_standard_for_conflict_of_interest_disclosure__final_
for_conference.pdf

"...Non-Financial Conflicts of Interest: Authors may have strongly-held views about the article being submitted for publication. Authors should consider disclosing and editors may choose to print any affiliations or expressions of these views that may be relevant. These may be personal, political, or intellectual and may include any expression of strongly held views relevant to the subject of the submission. Such disclosures may be original, or they make reference to opinions previously expressed in books or monographs, op-eds or public comments, or to sworn testimony before or lobbying of legislators or legislative bodies. Disclosable non-financial conflicts of interest would also include membership or affiliation with non-governmental organizations that have an interest in the submission..."

U of Penn's Center for Evidence-Based Practice is meant to showcase the scholarly work of its faculty for the furtherance of good medical practice. If it doesn't quite reach the level of peer-reviewed publication, and remains an internal method to promote scholarly work, that's fine if stated as such, but when an author may very well have an underlying agenda, there should have been disclosure.

Those who challenge the article should point out its source, lack of peer review, and lack of full disclosure of conflicts of interest.

I am also concerned about the fact that the full text of the work could not be released to Shmarya or another reporter upon request. I could understand if UPenn wanted a fee for the reprint or download, as many medical journals do, but that was not the case here. Gee whiz, I wonder how the Agudah got ahold of the article if the authors had no conflict of interest.

Disclosures of potential conflicts of interest that are routinely made with medical articles usually involve financial ties. Other ties, such as political agendas or potential use of the material for other legal matters, seem to be an area where people whose personal ethics are dubious can play fast and loose. And we all know where the frumma fit in when it comes to 'people whose personal ethics are dubious'.

Yes, UPENN, aka Penn aka University of Pennsylvania, aka U. of P. (that one is a bit archaic). in Philadelphia, member of the Ivy League, Top Med School.
NOT the penn state of the sports sex scandals. Just for the record and because UPENN is my alma mater.
That being said, it was clear from the beginning that there was some "foylashtick" involved. I would have guessed first a payoff rather than "politco-religious", but why not both.
Kol Hakavaod to Shmarya who works at the speed of light.

Posted by: WoolSilkCotton, I am a work of art as well as a sports and rock superstar | April 13, 2013 at 10:55 AM

Great post, not only a man with all the attributes assigned to by him, but from now you should also be known as the “Gate Keeper”.

Joe, thanks! You are too kind.

Sorry, just caught up. Dapper Danny, no, that's not my distinction. I was considering the possibility that the suction was applied laterally, similar to how one would draw venom from a snake bite.

No matter the answer, it's a dangerous practice. I'm only wondering whether depicting suction from a wound as "penis sucking" distracts from the true reasons why this is a reprehensible practice.

I agree that for an 8-day-old there's not much difference between the head and the whole organ.

Outcast Yid –

It is ***NOT*** applied laterally like sucking out snakebite venom. And even if it was, it would make no difference. The practice is dangerous.

Failed Shmarya, you are such an open bigot! The sad part is that you're not even embarrassed about it!

Clearly, in your depraved opinion, anyone that has at one time in his life attended a bible class at a pizza shop is now disqualified to author a scientific medical review about anything to do with religious practice.

I see that everyone's really right when they all say that you really are toasted!

Oh my.. did you hear that it's possible he may have uttered a prayer of thanks to the Lord above from a SIDDUR nonetheless!!!! Oy vay! How could he?!!!

You're a sick man and you keep getting sicker with hatred every day that you continue to live.

It's sad you couldn't make something out of yourself..

succesful and content –

He is Orthodox. I have pictures of his family that clearly prove that. I know the shul they attend and much more. But Id like to protect those kids from national attention if possible.

Of course, the more people like you act out, the less possible that will be.

"I'm only wondering whether depicting suction from a wound as "penis sucking" distracts from the true reasons why this is a reprehensible practice."

Posted by: Outcast Yid | April 13, 2013 at 10:46 PM

Yes it does. And the Penis is not inserted into the mohels mouth, head or otherwise that I know of. It is a quick suctioning of the wound for less than a second and there is nothing sexual about it, except in the minds of perverted people.

Even if there is only a minute risk of spreading a disease to a baby this practice should be banned. I think it's more than minute risk and should be banned. However calling it a penis sucking ritual, detracts from the issue and any mainstream orthodox person who reads that will give zero credibility to the rest of the article, in my opinion.

ca –


The head and shaft of the penis is fully inserted into the mohels mouth by the mohel, and it is then sucked by him.

Posted by: succesful and content | April 13, 2013 at 11:22 PM

I hope your success is more successful than your spelling of successful. That said, plain and simple you are an idiot. Go read again the above article, and if you don’t understand why I called an idiot, it’s not my problem, because you are indeed an idiot.

Posted by: Shmarya Rosenberg | April 13, 2013 at 11:54 PM

Thank you. It's a very weird practice to say the least. When I saw it done, it was so fast and didn't seem like the whole head went in, but I'll take your word for it. TY

succesful and content --Its even more sad that you are so full of hate,to me youre hate is consuming you,saying that i will say one thing about mbp its a no brainer that on an open wound something should put his dirty mouth on a helpless babies penis,when i first saw this being done i was about 9 years old i could not beleive what i see i thought i was hallucinating i know it was done on me since i live near satmer and the chassidim are the masters of all this insanity.

The question of if its the entire shaft, or just the tip, or if suction is applied or only licking seems to be a "Talmudic" distinction.

That the child could die is also a problem, but it gives the poskim much less trouble.

If a doctor was doing a circumcision in a hospital, and he did MBP, he would be arrested immediately and have his license taken away.

Leas has a degree in health policy. that is not comparable to a degree in biostatistics, epidemiology or health research. It is not clear from his credentials that he is competent to do this sort of research.

I also wonder how a health literature search of this sort could ignore the relationship between saliva of any sort on an open wound of an infant and herpes risks. The authors completely ignored that literature and the literature on Herpes Type 1 presence in the saliva of the adult population (50-80%). they narrowly confined themselves to the question the proof of Herpes transmission via MBP and focused on the limits to the research while ignoring the main factor of the limits, the non-cooperation of parents of likely MBP victims. They usually refuse to identify the Mohel. If Agudah was honest intstead of trying to rationalize MBP they would encourage cooperation with researchers so the question could be definitively answered. But they do not want the truth.

shmarya- GREAT WORK!!

it made no sense that they would choose this topic to begin with, and then disagree with the findings of all 4 such studies since 2000. the stench of rotting fish was overwhelming. to now have the answers is just great. not only does it not exonerate the position of those who defend this barbaric ritual, but it shows to what depths of dishonesty theyll sink in order to defend it.

WSC-

amazing comments here. highly informative and well laid out. thanks.

APC, thanks.
If you look at that Penn Center for Evidence-based Practice website, there's a list of the studies done. All are topics relevant to clinical practice in most hospitals. And then in the middle of the list is the Penis Sucking Study.
Is MBP a topic of concern at the Hospital of the University of Pennsylvania (HUP)? It was obviously made to order for the Agudah. The UPenn Center leadership needs to call those 2 authors on the carpet.

Wow! Betesh was on a Kollel dinner committee and Leas was invited to a Torah class. Lets paint a large scarlet H on their backs for "Haredi". Rosenberg - you are a fraud - an imposter, as you clearly have no meaningful connection to any Orthodox Jews, nor did you ever. You have NO CLUE as to the religious orientation of anyone on the committee, and if you had any meaningful experience in any Jewish community fundraising event you would know that serving on a Dinner Committee or going to a Torah class can't possibly accurately define anyone's Hashkafah. Moreover you've gotten your panties in a twist over this one and have come out on both sides of the argument. You are like the criminal who is arrested and says I couldn't commit the crime - I have an alibi, and even if I did commit the crime I didn't mean it. The conclusion of the Penn study suggests there is a connection established in previous studies between MBP and herpes, not as suggested by Agudah that there is none. The study also points out, as any reasonable epidemiological study should, that the quality of previous studies (and therefore any conclusion drawn from them) is leas than optimal. Now we understand that you are not a physician and therefore you cannot fathom the deeper medical and epidemiological concepts. However even a moron like you ought to be able to understand the foregoing.

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