Floating at night

The hospital, with all its activity and mad transformation, is subdued at night. A cover is dropped over everything.

But it is not as if everything goes to sleep. The activity is dampened but not stilled, like music heard outside a soundproofed room.

Even those events that happen in a mad rush - the resuscitation, the emergency surgery - feel slower. It is night's recognition that daytime matters. Not every shift is like every other.

The renaissance cosmopolitan

A friend/colleague of mine made the following throwaway comment today which I found interesting:

Renaissance people were dabblers - you could have influence or excel in a number of different fields. Today the only way to be a Renaissance person is to feel comfortable anywhere in the world, whether in rural Arkansas or a megalopolis of twenty million.

Another loss for the co-inventor of the calculus

No one calls them Fig Leibnizes.

Re-volver
Como un récord, baby.

Yes, the "new Almodóvar" is a moving tale of love, murder, sin, and the supernatural. But I was every bit as excited as I was by the plot to learn that "to flip out" in today's Spain is flipárselo.

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.

Rejoice like a hero running the basepaths

In a previous post I wondered how you say "home run" in Hebrew. Now I know how to say that, along with backstop, pivot foot, and RBI. If I cared at all about baseball I'm sure this would come in handy.

Verbal gymnastics at the Forward

Maybe it's just me, but the title of this article reads like an attempt at an anagram or a palindrome. It fails as the latter. I was never good at the former, and the phrase is too long for the Internet's various anagram servers -- but I'm sure some of my readers are more combinatorically talented than I.

The only other option is to take the article seriously.

Listen!

Miryem-Khaye Seigel has such a voice, I can only think our generation must be doing something right. She writes great Yiddish songs too. Now she has a Web page -- go look.

Defining the WikiJew
The ethnoreligious identity that anyone can edit: an article of mine in this week's Forward.

Who is a Jew? Let’s see what Wikipedia says about it. Or, rather, what the Wikipedias say, since the online encyclopedia is available in more than 100 languages. The answer to our question in English neither offends nor omits anyone: “[A] follower of Judaism, or [a member] of the Jewish people, an ethno-religious group descended from the ancient Israelites and from converts who joined their religion. The term also includes those who have undergone an officially recognized formal process of conversion to Judaism.” The Hebrew version (“Jews are an ethnic group of Semitic origin, in which membership is based on the Jewish religion”) is clearer, with a refreshing Israeli directness, but one will look in vain for the word “convert” — it isn’t mentioned in the article. And in Yiddish: “A Jew is a person who belongs to the Jewish people.” QED.

The English Wikipedia includes more than a million articles, and the Hebrew version about 45,000. Yiddish Wikipedia includes a little more than 2,000 articles, which makes it bigger than its counterpart in Tajik but smaller than Limburgian. So comparisons between these versions are not entirely fair.

Even so, the differences are illuminating. The English Wikipedia is a collaboration of thousands. Entries on non-trivial topics generally converge to a quasi-official style, with any unconventional stand revised out of existence. For its part, Hebrew is a Jewish language — but as far as Wikipedia (and modern Israel) are concerned, it is a national language, unceremoniously banishing to the sidelines the cozy bits of culture that Diaspora Jews hold dear. “Kugel” has no entry of its own, but languishes in the general entry “Pastries,” rubbing elbows awkwardly with “lasagna” and “pie.” Click on “Period of the Exile” in the Hebrew article “Jewish People” and you will be urged to (in Wikipedia-speak) “Edit ‘Period of the Exile.’” In other words, there’s nothing there.

And the Yiddish version? It’s Wikipedia moonshine, brewed by a bunch of bloggers, mostly Hasidic, with too much time on their hands. (I’m among the contributors.) Its entertainment-to-reliability ratio is far and away the highest of the three.

But there’s more to this comparison than clichéd Israel-Diaspora differences. The readers of each language have the benefit of a view denied to the others, so one can triangulate a version that benefits from all. What is Israel, for example? Says the English version, with overtones of propaganda: “The Middle East’s only parliamentary democracy and the nation state of the indigenous people of Eretz Yisrael.” Hebrew: “[A] parliamentary democracy found in the Middle East… defined as a Jewish, democratic state.” Yiddish Wikipedia reminds you first — before you’re even told about the State of Israel — that Yisroel can refer to a Jew, someone not of priestly lineage or a member of the Ten Tribes of the Kingdom of Israel. There is also a separate Yiddish article on what it means for there to be a Jewish state (a subject, as far as this reader can tell, undiscussed in the other Wikipedias).

Or, to take another example of a topic that gets different treatment, what is secular Jewish culture? The indulgent English-language article on the topic is apparently meant to catalog every movie, symphony, novel and TV show that Jews have had a hand in, while “Judaism as Culture” (in Hebrew) is a bare-bones — but useful — comparison of three philosophies of Jewish cultural peoplehood.

Other subjects, though not intrinsically Jewish, might be considered Jewish by association. “Homosexuality in Judaism” (English) is by and large given over to the positions of the three major Jewish movements, with obligatory hat-tips to Orthodox struggles with science, Conservative back-and-forthing and Reform cutting of the Gordian knot. Let us thank Herzl that there is no such article in the Hebrew Wikipedia. Homosexuality in (Israeli) Judaism is, in great measure, what the Jewish state makes of homosexuality. The items on the agenda in the United States are also matters of discussion in Israel. (The Yiddish reader looking up “Homosexuality” in her Wikipedia must first click through a notice that the content is only suitable for adults, before being told flatly that homosexuality “is not a Jewish concept.”)

The reader who uses these Wikipedias for Jewish research realizes that each of them has its particular virtues. The English Wikipedia is broad and detailed. The Hebrew version is relatively solid as a source for basic information on Israeli culture, literary and otherwise. The Yiddish version could be called Charedipedia. If you want the latest information on the Satmar succession struggle, the life history of the rabbis Teitelbaum, or diagrams of Hasidic dynasties, look no further. (Its treatment of religious topics, though fundamentalist, is also informative.)

But, as with any encyclopedia, Wikipedia (for Jewish topics as for anything else) should be used with care: There are large parts of the Jewish world that are ignored, glossed over or misunderstood in its pages. Hebrew Wikipedia knows nothing about the Jews of North America; until very recently, English Wikipedia was ignorant about Yiddish literature (as the Hebrew version still is); and Yiddish Wikipedia says little about nonreligious Jewish creativity, or intellectual endeavor in general. In the final analysis, the response to the user coming upon these deficiencies should not be a list of complaints, but a paraphrase of Hillel’s famous words to the convert: “Go and edit.”

Zackary Sholem Berger is a frequent contributor to the Forward. Wikipedia can change fast; some content referred to here might have changed since the article was written.

Annals of theocracy: special Jerusalem riots edition
Condemnation please?

It is probably too much to ask that Stateside religious Zionists (and I mean the Orthodox variety) distance themselves from this sort of loutish talk:

Israel’s chief rabbinate issued a statement Monday [against a planned gay pride parade in Jerusalem] calling Israel’s homosexuals the “lowest of people."

But it would be nice.

"Finish my pants!" "It's the New Yorker on the phone."
Tragedy, poetry, and Brooks Brothers.

For anyone who would like to publish a book of poetry, but doesn't think it will ever happen, I recommend this interview with Spencer Reece: a moving narrative of personal tragedy and poetic success (if not redemption).

How many people aged 20 to 39 do you talk to in a week?
Random epidemiology table.

Some authors from the Netherlands tried to improve estimates of the transmission of respiratory infections, by asking their study population: How many people did you have face-to-face conversations with during the past week? They asked this question separately for each age group: that is, the 20-39 year olds (e.g.) got asked how many people in each of the separate age groups (1-5, 6-12, 13-19, 20-39, 40-59, 60 or over) they had spoken to. This was done in Utrecht; see if your estimate matches theirs.

Why diagnose?

Just Google.