Why People Become Cannibals

There's cameraderie.

There's shared values.

They practice what they preach.

And there's always someone to have for Shabbos lunch.

[thanks to House of Gil for laying out the principles]

Best medical quote ever

“It’s incumbent on the community to dispense with the need for evidence-based medicine,” [some cardiologist] said [in the New York Times, in support of expensive, unproven "CT angiograms"].

Couples Therapy

I never lend a hand
when I can take yours
to drag our couple
across unders and overs.

What brought us together
is chicken-or-egg.
You bring and I give.
We cry and we beg.

My hobby

(with apologies to xkcd)

Judging articles in the medical literature based on whether the authors have cool names.

Boring paper:

Project LIFE-Learning to Improve Fitness and Function in Elders: Methods, design, and baseline characteristics of randomized trial.

Morey MC, Peterson MJ, Pieper CF, Sloane R, Crowley GM, Cowper P, McConnell E, Bosworth H, Ekelund C, Pearson M, Howard T.

Good paper:

Enck P, Zimmermann K, Menke G, Müller-Lissner S, Martens U, Klosterhalfen S.

A mixture of Escherichia coli (DSM 17252) and Enterococcus faecalis (DSM 16440) for treatment of the irritable bowel syndrome - A randomized controlled trial with primary care physicians.

Excellent paper:

Adeoye AO, Omotoye OJ.

Eye disease in Wesley Guild Hospital, Ilesa, Nigeria.

Afr J Med Med Sci. 2007 Dec;36(4):377-80.

Note that the Dutch are usually at the top of the heap as well. How can anyone resist these authors?

Thyroid hormone transport and metabolism by OATP1C1 and consequences of genetic variation.
van der Deure WM, Hansen PS, Peeters RP, Kyvik KO, Friesema EC, Hegedus L, Visser TJ.

Passion with a purpose

I don't read a book
One moment after it stops exciting my
Curiosity or interest, and this passion
Has finally stopped my reading altogether [...]

-David Shapiro, Poems from Deal, 1969
(thanks to AS)

Today's Strand haul

This is a blogpost, so motivated by a blend of two complementary impulses: preening (look at the books I'm reading! aren't I erudite!) and the search for people to share the books with (talk to me about them! what do you think?).

I did get some nice stuff today, and I hope the upshot here will tend more towards the second motivation than the first:

גימטריקון (Gimatrikon), i.e. a gematria dictionary
Rats, Lice, and History
How We Die
The Poems of Gerard Manley Hopkins
The Courtier and the Heretic: Leibniz, Spinoza, and the Fate of God in the Modern World
The Examined Life: Philosophical Meditations

Growth Song

Children are drinking from lukewarm brass gargoyles.
The wheel gruntingly swivels.
I stand in the field directing sprouts
mediating growth from sand to sun.
Let me be a mother-man.

Simply not honored? The "hypersensitivities" of Jewish women

Often the most interesting part of a responsum, especially a traditional responsum redolent with the assumptions of strict construction (one merely has to read the law correctly out of the proper book, and all will be truth), is not so much what is termed the "halachic analysis" (quoting sources, lists of poskim) but the interstices of the argument, in which the strict-construction myth is exploded despite itself: opinions do matter in the interpretation and creation of halachah, and in many a halachic analysis the posek's personal notions are determinative.

Consider the newly posted review (at the Seforim blog) by Rabbi Aryeh Frimer of Rabbi Daniel Sperber's Darka shel Halakha. The majority of his explicit argument is (a) Sperber misunderstands the original Talmudic statement about women and aliyot; (b) Sperber misconstrues the scope of kavod-haberiyot - it can only temporarily nullify a rabbinic decree; and (c) Sperber misapplies kavod-haberiyot to the matter of women reading Torah.

Two side comments, however, throw as much light on Frimer's argument as do the more bibliographic portions:

[I]n the case of aliyyot, no act of shame has been performed to all
those not called to the Torah (both men and women); they are simply not honored.

This is incorrect. As R. Frimer surely knows, reading from the Torah at fixed times is one of the basic requirements which a Jewish community must fulfill (not, as far as I am aware, an individual requirement, as he seems to assume). In the case of a man, not being called for an aliyah at one occasion means "simply" that he must wait for another occasion. But the possibility remains that he may someday be called. For an Orthodox woman, she will never be honored. Thus "both men and women" is a misleading formulation, and "simply not honored" is rhetorical sleight-of-hand: if one can never be honored - never participate in a basic community ritual - I think shame is something to be careful of.

The second group of misstatements is more revealing.

This view [of many rabbis] explicitly rejects subjective standards - in which what is embarrassing results from the idiosyncrasies or hypersensitivities of an individual or small group. The vast majority of religiously committed women are not offended when they do not receive an aliyya. Indeed, they understand and accept the halakhic given, although some might clearly have preferred it to be otherwise.

"Idiosyncrasies" and "hypersensitivities" are strange terms to be applied to the spiritual strivings of half of all Jews - to which Frimer begins his essay with an avowal of respect.

And then - how does R. Frimer know that "the vast majority of religiously committed women are not offended when they do not receive an aliyya"? Has he talked to them? Or are "religiously committed women" defined as those who do not think about receiving aliyot? In any case, the formulation "...when they do not receive an aliyya" is again misleading, implying as it does that we are considering an individual aliyah, one of many, which Leah or Sarah happens not to be called for at a particular moment. Rather, as I pointed out, we are talking here about the wholesale exclusion of a very large group (half of all Jews!) from a basic community obligation.

Finally:

More importantly, does it make halakhic sense that if a group of women – nay, any group, says: “this Rabbinic halakha offends me” – be it mehitsa, tsni’ut, kashrut, stam yeynam, many aspects of taharat ha-mishpahah, who counts for a minyan, and who can serve as a hazzan - then we should have a carte blanche to go about abrogating it. Such a position is untenable, if not unthinkable.

More rhetorical sleight-of-hand! The premise in this paragraph is not being advocated by any party to this dispute (or indeed any observant Jewish feminist!). I very much doubt that R. Sperber is indicating that any group which thinks itself offended by a given Rabbinic edict "should have a carte blanche to go about abrogating it" (whatever that means). It is true that when a Rabbinic edict does lead to the wholesale exclusion of women, the circumstances of the legislation (whether or not they apply, and when) should be very carefully examined. No slippery slope here, merely R. Sperber's derekh-haTorah.

To reframe the question R. Frimer is asking (but without the stacked deck): does it make halachic sense that a community which values the spiritual striving of women should consider whether its own honor is sensitive to their wholesale exclusion? The question answers itself.

Should we specialize medical education?

It's common wisdom that surgeries are better done at high-volume centers. Specialists should do what they're best at - this reduces errors.

By analogy, medical schools should do what they're best at. Different medical schools are (I speculate) better at educating different types of doctors: NYU might be better at training primary care physicians, while Columbia (to pluck a name out of the air) might be better at training future cardiologists.

So why can't medical schools specialize? Why not telescope the long and tiresome haul of medical school-residency-fellowship into a single training program?

We know "physician" is a variegated profession. Why must all doctors be trained the same? Wouldn't it make sense for a medical school to be able to choose an area of specialty, rather than trying (fruitlessly) to be all things to all possible future doctors?

The Yiddish Leprechaun of Baltimore

Presenting the genial, silver-tongued, exaggeration-prone professor (and friend of mine), Marc Caplan. His life story is worth reading about.

(He was a guest on this very blog some time ago.)

Chasidim complain about Maimonides?

Last week's issue of Zeitshrift, a Yiddish magazine from Monsey, has this cover headline in red and black:

The Truth About Maimonides Medical Center
Community leaders and dozens of former patients complain to Zeitshrift about negative treatment in the Borough Park hospital - Some leaders say that other hospitals aren't any better - What can we do to improve the situation?

Inside is a 15 (!)-page article about the hospital, its detractors, and its defenders.

GG is for pluggable

Are you looking for kids' books which are witty but not saccharine? Look no further than AA is for Aardvark, the latest creation from the unjustly unfamous Mark Shulman (a friend of mine), brimming (both author and book) with wordplay, illustrations, and double letters.

Saving a life - according to the doctors. II

If a non-rabbi could decide what sofek pikuach nefesh means, could a doctor do it? I'm not sure, because I don't think the work of a doctor has much to do with calculating mortalities - that is more fittingly the work of an actuary or an epidemiologist. If you ask a doctor, given a certain presentation of symptoms, what is the chance that a certain patient sitting (or lying) in front of them will die, they will generally say, "It depends on the patient." Doctors are notoriously reluctant to give probabilities.

Even if doctors are reluctant to quote such possibilities, maybe they still practice according to them? The literature on medical decision-making gets broader every day, and I fear to tread where I am ignorant. I know enough though to say that it strongly depends on the specialty. Sometimes subspecialties of medicine differ so much from each other it's as if they are different professions altogether. The emergency-room doctor and the critical-care physician deal in life and death every day, while the outpatient practitioner has influence in the gradual development of healing or disease - these are broad generalizations, of course.

Not blinded in Belarus

When this study on breastfeeding and IQ was hyped in the press (MSNBC; see WebMD for a better take) why did no one mention that the pediatricians who rated the IQ of the children in question (more vs. less breastfeeding) were not blinded to which group the children were in?

I would understand if the findings of the study were a slam dunk, but they aren't: verbal IQ was the only category with a statistically significant difference (performance and total were not statistically significant), and the IQ difference is probably not behaviorally significant in any case (what's five or seven points?).

Given that the differences are small and possibly not statistically significant, it behooves those reporting the news to give a sense of potential sources of bias: factors which could skew the results in one way or another. And one way in which results can be skewed is for raters to "know" or "guess" while rating the children in one group that their IQ should be higher. We are all inherently biased creatures - blinding is the way, in modern epidemiology, to reduce bias. When small results are claimed (as they are here) a source of bias like this is quite worrisome.

The cognitive benefits of breastfeeding remain unproven.

(Of course my son is being breastfed - with formula too. But the reason he'll grow up smart, God willing, is because his mother is smart.)

Grass-roots beef

Not surprising: the organizational impetus and scholarship behind the growing concern with Rubashkin's - this comes from the Conservative movement's rabbis. But the grass-roots activism comes from the Orthodox (albeit the most liberal).

A bright-eyed fish (or: how do you write "ghoti" in Yiddish?)

I had the pleasure just now of holding in my hot little hand a sample copy of Eyn Fish Tsvey Fish Royter Fish Bloyer Fish, our new Yiddish translation of Dr. Seuss's ichthian classic. It looks yellow and lovely and typo free. (Jinx!) More details when the whole shipment wends its way to us from Singapore. Save up your pennies!

(The cat and the monkey you already have, yes?)

PTSD in the military

The findings suggest that psychiatric disorders in Marines are diagnosed most frequently during the initial months of recruit training rather than after combat deployment. The disproportionate loss of psychologically unfit personnel early in training creates a "healthy warrior effect," because only those persons who have proven their resilience during training remain eligible for combat.

Saving a life - according to the doctors

A conversation in the bikur cholim room:

"Doctor, if a man had chest pain, can he walk home for two hours [on Shabbos]?"

"It depends what kind of pain."

"The doctors said it wasn't heart pain. Can he walk home? I don't think it's safe to walk home. The rabbi said he could take a car home."

From this conversation (which went on for some time) I learned a number of things. One of them was that the guy in question (who got to ride back to Borough Park on late Friday night via car service - I wonder if he got dropped off a couple of blocks from home?) has 11 kids in his house. No wonder he's having chest pain.

The other was that the Satmar rebbe (the recently deceased one? one or more of his quarreling heirs?) apparently was of the opinion that presenting to the hospital with chest pain was enough of a sofek pikuach nefesh to make riding in a car on the Shabbat permissible.

This raises all sorts of questions, predominant among which (as usual) is whether this opinion as relayed to me by Some Random Satmar Guy is faithfully rendered at all. Maybe the Satmar rebbe (or various present-day quarreling rebbes) holds nothing of the sort. If that's the case, never mind.

However, let's assume that the above rendering is true. Then two questions: (a) is a doctor the right person to ask for the definition of sofek pikuach nefesh? (b) if a doctor is the right person to ask, how would she judge?

A doctor might not be the right person to ask because one might hold (I don't, but one might) that halachic categories are to be determined by halachic authorities. Just as pikuach nefesh has a halachic cutoff (several, actually, but "a dangerously ill person" being the most prominent among them), so does sofek pikuach nefesh. The problem is that while there are intricate discussions about the precise definition and interpretation of safek sfeika, the issue of sofek itself is something I'm not aware of any conclusive opinions about. Is doubt probabilistic, intuitive, psychological?Thus even the strict constructionists - which I am not - who believe in immutable and exactly specified halachic categories would have great difficulty specifying a sofek pikuach nefesh, let alone a pikuach nefesh, without the help of health workers.  

The question is, how are we to translate halachic categories into medical ones? There are sick people who look terribly ill to the layperson but a doctor knows (or is said to know!) that these people will get better. The converse is true. 

Then it is not rabbis alone to whom we need to have recourse in the definition of sofek pikuach nefesh (as I write this I more and more realize that pikuach nefesh itself has the same definitional complexities), but health care professionals (most often doctors) together with rabbis. 

I don't think doctors can make the definitions; that's for halachah to work out with their help. But doctors do need to figure out some way to translate their thoughts into lay-cum-halachic language. And that is difficult, for epistemologic, not just lexical reasons.

In the next post I consider how a doctor might answer the question, "Will I die with this chest pain, doctor?" In the interim, though, consider the possibility that the doctor is not the right person after all, but the community. 

An example of this position is found in an interesting article by a Rabbi M. M. Farbshtein (I don't know if I'm transliterating his name correctly) in the journal Assia (my translation):

[T]he question up to what level of possibility [doubt, sofek] something is considered sofek pikuach nefesh does not have an objective answer, but rather [is according to] the assessment of the community that the activity was done for the sake of saving a life [pikuach nefesh]. The situation in which such an activity is required is considered to be "sofek pikuach nefesh."

The question then becomes: what community are we talking about, and how does it decide?

That's too big for now. We'll return to the doctors in the next post. What does "risk of death" mean for a doctor contemplating a patient with chest pain?

Phrases I could say all day

Seronegative spondylarthropathies!

A letter to Sholom Rubashkin

Read the letter here. ("Effective June 15, 2008 we will stop patronizing any restaurant which serves your meat.")