A likhtikn ganeydn zol er hobn*
Itche Goldberg dead at 102.

Even non-leftists (or non-socialist liberals like me) should mourn Reb Itche, or read about him if they don't know who he is.

*May he rest in peace.

The Great Charedi Smoke-Out
Cheers to Toldos Aharon!

I read here (via Yiddish Wikipedia) that the present rebbe of the Toldos Aharon sect issued two new edicts (takones) on Chanukah of this year - the traditional season for such things among this group of Chasidim. (I think the present rebbe is Rabbi Duvid Kahn, but Chasidic schismatics make my head spin.)

One takone has to do with not eating salad on Shabbos (I won't go into the reasons here). But the other is wonderful: it requires that adherents give up smoking for one day a week other than Shabbos (when religious Jews can't smoke anyway owing to prohibitions against burning). Maybe a few years from now smoking can be edict-ed out of existence in this group altogether!

Mass solemnization
Or: liturgy on deadline.

It turned out that this Shabbos (when I wasn't working) happened to be the day when our shul's rabbi talked about gays, lesbians, and marrying 'em off to each other. Being a rabbi, and a sober, thoughtful one at that, he said (I'm paraphrasing): "I'll think about it and let you know." No surprise there.

The decision for our shul about whether to solemnize (celebrate, kiddush-ify, etc.) gay and lesbian partnerships is not really up in the air; I'd be surprised if the rabbi's decision does not make use of the CJLS teshuvot allowing them. But one main thing, now that the decision has more or less already been made, is that these ceremonies be not lame.

By "not lame" I actually mean a somewhat higher standard: liturgically powerful. With traditional oomph. Let the first GL couple come up to our bimah and get married in the context of psukim thoughtfully and poetically framed. I want liturgical creativity but in a formalist vein. Let us not have fifty different versions of self-written vows, nor de-heterosexualized versions of kiddushin -- since homosexual marriages are bound to be something else. Why not a legal formula that challenges and surprises, as does the harei at every time I hear it said? Why not re-write the ketubah from scratch? Who says a glass has to be broken?

Super Jewish Historical Prediction Game
Anybody can play. And everybody wins!

I. circa 1980

Cathy Conservative: Women should read from the Torah!
Joe Modern Orthodox: Pshaw!

c. 1995

Joe M.O.: Look, everybody! Women can read from the Torah!

II. 2006

Cathy Conservative: Monogamous gay and lesbian relationships are kosher!
Joe M.O.: Pshaw!

c. 2025

Joe M.O.: __________ (you fill in the blank)

Hospital performance
Does it make a difference?

Maybe you know that you can now compare hospitals with regard to a number of "performance measurements." This does not refer to how well Mass General can play the hammered dulcimer, but to a number of indices that are considered basic to acute hospital care. Does the hospital give aspirin to everyone having a heart attack? Are people with heart failure encouraged to quit smoking when they leave the hospital? Et cetera. These indices are considered important not just on the experts' say-so, but because they have been associated in the scientific literature with improved outcomes. People who take aspirin after a heart attack live longer (and have fewer repeat MIs) than those who don't; smoking hurts heart failure; etc. These studies are, in general, randomized trials of large populations.

What's missing is the link between populations, outcomes, and hospitals. Do hospitals that perform better according to these indices reap the benefits (in terms of reduced morality for their patients) that the literature of populations would indicate? If a hospital gives more of its heart-attack patients aspirin than another hospital, will the first hospital have a lower rate of death due to heart attacks than the second? It seems plausible.

Comes a study by Werner and Bradlow to answer this question. In brief, the answer seems to be "Yes, but not much." To continue the MI (heart attack) example: eight percent of all hospitals surveyed were in the 75th percentile of achieving all reported measures. (That is, all the things that are supposed to happen before or after an acute MI in a hospital happened seventy-five percent of the time or more in these hospitals.) When these hospitals were compared to those in the 25th percentile, the mortality due to heart attacks at one year after the event was about two percent less. For pneumonia (another disease represented among the performance standards), the difference is about one percent.

So that's it? A hospital does everything right, more often than the other guy, and the mortality rate is only reduced by a few percentage points? The indices must be less closely related to mortality than we thought. The authors, however, as responsible scientists, take a more nuanced take. First, if you amortize the few percentage points' worth of difference over thousands of patients -- perform the thought experiment of moving all the patients who get seen at the "worst" 25th percentile to the "best" 75th -- the number of lives saved would reach the thousands. Secondly, we need to remember that wholesale improvements in mortality take societal and medical revolutions, like large-scale reductions in smoking, introduction of the intensive care unit, or (perhaps!) government intervention to reduce consumption of trans fatty acids. If "mere" organizational optimization (boring paper-pushing, hospital by hospital) can make a few percentage points' difference, then something small can be huge indeed.

There are the typical limitations and qualifications to attach to any study, of interest mostly to specialists like me. For instance, this is a "cross-sectional" study, overlaying snapshots of performance measures with snapshots on mortality -- not a more time- and resource-consuming, but potentially more rigorous, follow-up of a population over years to see if implementation of such performance standards leads in cause-and-effect fashion to improvement in mortality. And, of course, it's always problematic to compare the mortality rates of Raucous Public Hospital to Fancy Private Hospital, which differ for reasons much deeper than performance standards. It's possible (even expected) that even after controlling for every possible variable that could confound the relationship between performance and mortality, there are some factors still left out.

These caveats aside, this study may be a small but encouraging sign.

Conservosexuality NextGen
Where halachah meets the road.

It will be interesting to see what the rabbi of our liberal-but-observant Conservative shul says this Shabbos about the new teshuvot. Will he take the opportunity to affirm and sanctify the relationships of the many openly gay and lesbian balebatim? Or will he take a conservative tack? I won't be there; I'll be working then. Maybe someone else will fill me in.

Gay gezunt
A brief note about Rabbi Roth.

The decision of the Conservative movement's Committee on Jewish Law and Standards to approve three separate teshuvot with regard to homosexuality will satisfy no one completely. This baffles the extremists, who believe that no one should be satisfied at all. (For isn't the point of halachah an iron-bound maximalism?)

I wish Rabbi Roth weren't resigning from the Committee; I'm guessing this means that he will choose to no longer be affiliated with the movement. He is a towering scholar of unparalleled erudition. Perhaps though this a fitting moment to remind ourselves of two recent statements of Rabbi Roth's (made here):

I urge halakhically committed gay Jews not to reject the possibility that the severity of the halakhic demand of celibacy might be somewhat or significantly mitigated by some modes of therapy and treatment. Since the halakhic prohibition stands irrespective of whether there is treatment possible or not, there is little to be lost in giving a chance to treatment for which claims of marked success are made and attested.

As I mentioned before, the fact that Rabbi Roth believes such "attested" claims of "marked success" in the mitigation of homosexual behavior speaks more to his biases and unintentional ignorance than to any intellectual failing. More important however is his following claim:

. . . an inability to legitimate homosexuality halakhically makes no negative claim whatsoever about the humanity, sanctity, worth, and dignity of homosexuals.

The fact that Rabbi Roth sees no difficulty with this claim (or, at least, no necessity to defend it properly) casts light on a sharp disconnect between halachic strict constructivism and halachic compassion. (Note that this sentence itself makes no distinction between homosexual behavior and homosexuals themselves, a difference which Rabbi Roth dwells upon at length elsewhere.)

Update: A JTS source writes us.

Rabbis Roth and Rabinowitz left for different reasons. in Rabinowitz's case he believes there is not much point to the CJLS. Any rabbi can write a teshuvah and publish it on the web and any other rabbi can either follow that p'sak or not. Rabbi Roth left to make a point that "decisions have consequences". He thought the Dorff Nevins Reiser teshuvah was clearly a case of poskim considering an issue with a predetermined answer in mind. He sees nothing wrong with being predisposed to a certain answer as in the case with deciding someone is not a mamzer or not an agunah, but he says even then if the case is clear there is nothing to do. In his mind this a case where the answer was clear the other way. In particular he said the decision rested on three pillars--all of which would have to hold--and all of which are "tenuous at best". In particular he thought they made way too much out of an apparent makhlokhet between Rambam and Ramban about whether "everything else" is d'rabbanan. He said almost every rabbi since has said that Ramban simply misunderstood Rambam and thought Rambam was saying innocent touching was prohibited d'oraita. [I wish I could find a copy of Roth's teshuvah to better understand these arguments]. Roth also thought the principle of k'vod habrit was with only a few excpetions used for person X to violate a prohibition for the sake of person Y, and even when that was not the case it was always a social situation whereas private bedroom behavior was not a social situation.

Roth was asked how this decision was any worse than the driving teshuvah--and he served on the committee after that. Roth responded that he was a kid when the driving teshuvah came out. That this decision was not worse, but rather on par with the driving teshuvah and that he served on the committee to try to prevent anything like that from happening again, which it did. He notes that both the authors of the homosexuality teshuvah and the driving teshuvah had pure intentions, but were irresponsible. Roth said he will continue to pasken if asked his opinion on an issue. He also noted that many people asked him to reconsider his decision so he is doing that--reconsidering. He has not made any decisions yet about returning to the CJLS. Once again though it sounds clear that the resignation was solely from the CJLS and Roth does not seem to have any intention of leaving either JTS or the movement.

Imperfection and medicine
Or: You don't look well.

Here's a suggestion about one thing that makes being a doctor different from other professions, like playing the flute, writing poetry, or studying rattlesnakes. Each of these is concerned with the attainment of a perfect expertise -- or, at least, it's commonly thought by the practitioners themselves that there is such a thing as the most expressive flute player, the greatest poet, the most knowledgeable and groundbreaking herpetologist. Certainly it's true that one doctor can be better than another, but the trick is to define the right criteria. I'm not sure that doctors think that Jones, say, is a better doctor than Smith because she cures more of her sick patients than Smith does -- outcomes research notwithstanding. Because even if Jones cures all of her patients in one heady day of clinic, there are those of them who will get sick again -- some of them incurably. Some others will die. Some, to be sure, will get better again, through Jones's talents or in spite of them. But -- and this is what might distinguish doctoring from philosophizing or flute-playing -- much of Jones's professional life will be spent not attaining or even working towards perfection. Health is a doctor's goal, but only in a first-order sense. Most of the doctor's time is spent helping his patients deal with sickness. It would be strange to call the pianist an expert in missed notes, or the poet a coiner of slightly inapposite phrases, though such is their lot. It is more fitting to call the doctor a navigator of illness. If there's an aesthetic in the doctor's art, it's a negative one.