Ashkenaz in Israel
An ideolo-blog.

Assaf Galay, the charismatic journalist and Yiddishist behind the "Hatenuah lezehut ashkenazit" (The Movement for Ashkenazic Identity), has a Hebrew blog that's well worth reading, though I can't say I agree with its post-Zionist slant.


(A)elul Aesthetics

"I'll ask one thing of God, one thing I'll request:
to dwell in God's house all my life;
to have a vision of God's pleasantness, to visit His palace."

A bit of Psalm 26, which we read during the month of Elul.

One could take the above verse to mean that we would like to be vouchsafed a vision of God through the merit of the commandments. The mitzvot would then be a ticket to the Palace, like an armband to a rock concert.

I think the point can be taken differently. God is pleasant. That is, God is beautiful, and during this time of year we would like to merit an appreciation of this beauty -- without unthinking anthropomorphisms or idolatrous projections, leaden fundamentalism or empty-headed laxities. The contemplation of the Divine should be a source of joy, not of confinement.


The health of China

Almost exactly a year ago, this blog mused about China's shifting burden of disease - the term epidemiologists use (hey, I guess I am one now) to denote what happens when a country becomes more developed (i.e. less poor), and different causes of death become more, or less, frequent. A fascinating issue of the New England Journal of Medicine includes an important study on that very topic. The abstract is below.

Background With China's rapid economic development, the disease burden may have changed in the country. We studied the major causes of death and modifiable risk factors in a nationally representative cohort of 169,871 men and women 40 years of age and older in China.
Methods Baseline data on the participants' demographic characteristics, medical history, lifestyle-related risk factors, blood pressure, and body weight were obtained in 1991 with the use of a standard protocol. The follow-up evaluation was conducted in 1999 and 2000, with a follow-up rate of 93.4 percent.

Results We documented 20,033 deaths in 1,239,191 person-years of follow-up. The mortality from all causes was 1480.1 per 100,000 person-years among men and 1190.2 per 100,000 person-years among women. The five leading causes of death were malignant neoplasms (mortality, 374.1 per 100,000 person-years), diseases of the heart (319.1), cerebrovascular disease (310.5), accidents (54.0), and infectious diseases (50.5) among men and diseases of the heart (268.5), cerebrovascular disease (242.3), malignant neoplasms (214.1), pneumonia and influenza (45.9), and infectious diseases (35.3) among women. The multivariate-adjusted relative risk of death and the population attributable risk for preventable risk factors were as follows: hypertension, 1.48 (95 percent confidence interval, 1.44 to 1.53) and 11.7 percent, respectively; cigarette smoking, 1.23 (95 percent confidence interval, 1.18 to 1.27) and 7.9 percent; physical inactivity, 1.20 (95 percent confidence interval, 1.16 to 1.24) and 6.8 percent; and underweight (body-mass index [the weight in kilograms divided by the square of the height in meters] below 18.5), 1.47 (95 percent confidence interval, 1.42 to 1.53) and 5.2 percent.

Conclusions Vascular disease and cancer have become the leading causes of death among Chinese adults. Our findings suggest that control of hypertension, smoking cessation, increased physical activity, and improved nutrition should be important strategies for reducing the burden of premature death among adults in China.


A Jew and a Cabbie

On the way to drop off some shipments of the new book (that would be George der Naygeriker, Curious George in Yiddish), I started chatting with the cabbie -- a Dominican, it turns out. I learned some stuff. First, my neighborhood (the Lower East Side) is not Dominican; the Latinos down here are from all over. (I had already known that the main Dominican concentration in the city is in Washington Heights, but a bakery, some soccer fans, and other manifestations had led me to the mistaken belief that the LES constituted a branch of the DR Diaspora.) Second is the interesting way he referred to my religious-ethnic affiliation:

Eres un americano judio, no?


You're a Jewish American, right?

Interesting, because no one would use this locution ("Jewish American") in English, at least not these days. (Not that it's inaccurate or suspect, just out of date.) So: is this the way Dominicans (habitually?) refer to American Jews? Was it an effort not to say something unintentionally offensive? Just this cabbie's idiolect? Inquiring bloggers seek Dominicanologists for explanations.


Medicine Monster
Time to find myself.

Medicine Mensch 9, in which I specialize, specialize, specialize.

Job Hunt: Choosing the Right White Coat
By Zackary Sholem Berger
September 2, 2005

I am 32 years old, and it's time to decide what I want to be when I grow up.

I do have things narrowed down somewhat: I want to be a doctor. But what kind? I don't have the luxury of thinking it over much longer. The time has come to apply to residency programs (the four-or-so-year stints of hospital-based indentured servitude marking the start of a doctor's career), and I need to decide on a specialty.

There are many different kinds of physicians. A Web site run by the American Medical Association lists more than 50 specialties, ranging from aerospace medicine to colon and rectal surgery. Each has its partisans and its detractors, but finally the decision is my own.

Many medical students ask themselves whether they should apply to one of the "lifestyle residencies" — specialties chosen because of desirable salaries or fewer demanding hours. There is a whiff of snobbery in this label. Medicine is, after all, still an attractive profession for many, precisely because it offers a comfortable living. Even those specialties that are not the highest paying certainly are no road to self-denial. By most definitions, doctors are still rich. Isn't lifestyle a reasonable criterion for choosing a career?

I won't even say which specialties are considered "lifestyle residencies," because the definition changes every five years. Each specialty, no matter how unpopular or looked down on at one time, is redeemed eventually through market forces. Take, for example, circus medicine (not a real specialty, as far as I know). It used to be that no one wanted to be a circus doctor, dodging screaming children all day and putting casts on unlucky trapeze artists. But the wheel of fortune turned, and some students discovered the attractions of the specialty. The pay is not bad, and the hours are reasonable: The shows are at regular times, and in between you can hang out with the Siberian tigers or do whatever else you want. Plus the popcorn's free. Suddenly it's a buyer's market, and circus showmen have more applicants than they can handle. How did circus medicine get more popular? The specialty didn't change at all, but more medical students discovered that they'd rather do something else during their residency than work 18-hour days.

Ideally, our passions and our needs would coincide. What we want to do would be precisely what we're trained to do, and a good bit of money would be made doing it. Sometimes, though, it works the other way: Money (and livable hours) point out a career to us that we wouldn't have thought of before. To go even further, there's nothing wrong with moneymaking as the chief criterion for one's choice of medical specialty or any other profession. The rabbis of the Talmud tell us to teach our children a trade, not a career. If our child can make a good living in something legal, nine to five, and completely dull, there is no reason (according to this strain of Jewish thought) for her employment to have a larger redeeming social value. Her redeeming value should come from her spiritual life, not her professional one.

But of course, work is more than work. It shapes our life. The stereotypes that medical students attach to various specialties are only partially untrue. Certain specialties are known to be impatient with abstractions, abrupt and unfriendly, while others are known for indulgent book-learning and a tendency toward long-windedness. Even if a doctor doesn't conform to these stereotypes when he enters these specialties, he might be brought more into line with them, both by working with his colleagues and by the particular kind of medicine for which these personalities make sense.

So instead of choosing a specialty (or a job) that makes possible the rest of your life, you can choose one that becomes your life. The rabbis were experts in choosing a "clean and simple trade," a profession that provided both sustenance and space for what they held to be life's most important pursuit: the study of Torah. But they didn't have as much to say about choosing careers that provide professional satisfaction, possibly because this wasn't relevant either to their historical moment or to their economic class. (The same rabbis also said, "The best of doctors are bound for hell." But that's a discussion for another time.) Later Jewish thought does see a place for intellectual and professional absorption in things other than Torah — a career for career's sake — as a worthwhile way to spend one's time.

The answer to all this is the punch line of an old joke: You're right, you're right and you're right, too. Someone who chooses a career (or a medical specialty) for the sake of personal satisfaction might find out years later, when it's too late, that his personal satisfaction depends not only on intellectual and spiritual sustenance but also on having time to spend with one's family as well as money to buy what one needs. But one who chooses a job that leaves time for the rest of life might discover that the rest of life feels boring without the stimulation of a demanding profession.

I'm still not sure what I'll be. Maybe I'll run off and join the circus to cure the age-old medical syndrome of big red noses and oversized feet.

Zackary Sholem Berger, a fourth-year medical student, accepts all well-meaning job advice at doctor@forward.com.